The beginning of the second millennium coincided with the highly celebrated completion of the draft of the human genome. In conclusion of the race to identify the entire genetic sequence of a representative human genome in 2000, President Clinton, flanked by then director of the National Human Genome Research Institute, Francis Collins, and Craig Venter, then president of Celera Genomics, took the opportunity to reject any assertion of a genetic basis for race. In the epigraph, President Clinton recites a position that becomes the 99.9 per cent mantra among leading researchers in genomics and the general media on lessons learned from the completion of the Human Genome Project (HGP): race does not exist in our genes – we are all the same. Given this unequivocal chorus on race and genetics, it is surprising that more than a decade of developments in human genetics and biomedicine have resulted in a dogged focus on the search for population differences at the molecular level. Although the scientific community has repeatedly affirmed that the vast majority of the human genome is synonymous among human beings, scientists continue to emphasize that the key to understanding the genetic basis for common, complex diseases and variability in drug response lies in the minutiae of genetic differences among groups. Inspecting the incongruity of the mantra of sameness and the increasing salience of racial and ethnic identification of research populations is useful in identifying how concepts of race are operationalized and, in particular, how ‘technologies of racialization’ that highlight, demarcate and exact difference from the human body – phenotypical characteristics such as skin tone, eye shape and blood type – are increasingly supplanted by molecular signatures.

Discovering how individual genetic variation influences why some people respond to therapeutics but others show little improvement or have serious side effects lies at the heart of the promise of pharmacogenomics to improve health care. Realizing this goal, however, will depend on building a robust infrastructure that supports genomic medicine. These changes include developing affordable and ubiquitous genomic sequencing capability, creating expansive DNA sample sets annotated with detailed phenotypic information, educating health care providers on developments in genomic medicine, integrating diagnostic tools into clinical decision making, and attending to a complex array of social, economic, and ethical concerns that accompany each of these shifts in biomedicine. Achieving these major endeavors will depend on ensuring that the public not only understands the goals of pharmacogenomics, but also that the public actively supports and participates in basic and clinical research.

Public approval of pharmacogenomics research will depend on assurances that the risks will be minimal and that the benefits of its integration into clinical care will result in improved health care. A major issue of concern over the collection, storage, and distribution of human DNA is the risk associated with potential breaches of confidentiality and privacy and the threat of stigmatization and/or discrimination against individuals by insurance companies, employers, and others. The principle of protecting an individual's genetic information in the course of research and/or clinical care is a deeply held principle in the United States. Personal medical history has remained a sensitive and legally protected category of information. The special status of privacy of medical information has led to confidentiality protections as in physician-patient privilege. To attend to these requirements, researchers and health providers must develop strategies that secure individual genetic information and personal medical history that also enable basic and translation research.