Donna Murch shows that we continue to live in a world made by Reagan, one where corporate empowerment both benefits from and reinforces racialized regimes of punishment. In this smoke-and-mirrors theater of national distraction, nonwhite populations are stereotyped, locked up, and otherwise sacrificed so that corporate exploitation and dispossession can proceed apace, behind closed doors and beyond the reach of public accountability. Trump thus represents only the most recent—and chaotic—outbreak of a much longer epidemic of racial capitalism. His public speeches often sound like a hallucinatory rehash of sound bites from the history of U.S. conservatism, parroting the racist drug policy and rhetoric of earlier administrations. The age of Trump is thus an age of unveiling: his language blatantly exposes the usually unstated logic of state violence and its predation on vulnerable populations in the name of corporate theft, capitalist accumulation, and widening social immiseration and dispossession.

The suffering and deaths of nonwhite users are virtually invisible, obscured by a discourse focused on saving innocent white users from harm.

Murch gives the example of Purdue Pharma’s OxyContin market strategy, which sought to avoid the PR and regulatory stigmas of being associated with “urban” (black) drug users. The result was a white market that took shape through aggressive marketing campaigns and targeting of states with majority white populations that were also known for their hostility to federal regulation. Thus the “white drug” was born. There is also the racialization of the crisis itself, which Murch does not discuss: the suffering and deaths of nonwhite users are virtually invisible, obscured by a discourse focused on saving innocent white users from harm. Purdue’s consumer strategy thus produced two dynamics: a market of control, in which white patients in pain became addicted to opioids, and a market of abandonment, in which black pain is ignored.

In addition to being a site of profound injustice and a political wedge issue, race thus became a strategy for market expansion. But the racialization of pharmaceuticals runs deeper than appeals to whiteness; blackness, too, has become a source of Big Pharma profit extraction. In 2005 a company named NitroMed used a strategy similar to Purdue’s when it gained approval for a heart-failure medication that was specially targeted to African American patients. After the drug, BiDil, was initially rejected by the FDA in 1997, researchers sought to resuscitate it as a racial medicine by seizing on data from the original clinical trials to argue that black patients responded better to the drug than white patients. The first FDA-approved drug with a race-specific indication, BiDil was approved and marketed as a “black drug,” despite limited and unconvincing evidence that race played any role in the drug’s effectiveness.

The story of BiDil adds one more twist to the story Murch exposes of a segregated pharmaceutical market. NitroMed’s marketing campaign targeted black consumers through grassroots networks and African American community spaces, including schools, community centers, radio, and churches. Murch notes that desegregation did not extend to medical care or the racial structuring of drug markets, but BiDil reminds us that drug makers have occasionally deployed the language and social capital of civil rights to sell racial drugs.

BiDil also points to a time when drug makers tried and failed to target black patients. An expensive and unncessary repackaging of two generics already on the market, BiDil failed and NitroMed folded in 2009. But in a capitalist system, failed drugs often denote merely failed business models: they stand ready to be pulled back into cycles of market acquisition and rebranding. BiDil itself is a case in point; it was bought by the Atlanta-based company, Arbor Pharmaceuticals, which the very day I write this announced the launch of the “Shaquille Gets Real About Heart Failure” campaign, teaming up with basketball superstar Shaquille O’Neal to resuscitate what has been called a “controversial and spectacularly unsuccessful cardiology drug.” The strategy is ubiquitous. In her study of how Big Pharma’s flight from Nigeria has profoundly shaped both legal and illegal drug economies there (as well as stoked cultural anxieties about unsafe and “fake” drugs), anthropologist Kristin Peterson writes about the significant ontological confusion that surrounds drugs today—about the actual composition of drugs as well as the legality of their circulation—which pharmaceutical companies exploit for profit. The ongoing War on Drugs also depends on this categorical fuzziness to bend drug policy to the needs and desires of the racial state.

The pattern of profiting from racialized sickness endures, and it shows no sign of stopping.

Perhaps most chilling about the NitroMed story is the company’s cynical manipulation of the history of racism, which portrayed BiDil as the cure to generations of health disparities. In this, it also pulls back the curtain on an insidious technique of racial capitalism: appropriate injustice in order to sell products and capture profits. In NitroMed’s case, the long and brutal legacy of medical neglect and exploitation—with roots going back to the Atlantic slave trade—was remade into a marketing ploy. (One thinks as well of Ram Trucks’ commercial during the 2018 Super Bowl, which featured a speech of Martin Luther King, Jr.) NitroMed’s marketing was exploitative not only because of the high cost of the drug but also because selling it would only empower the social structures—including rampant corporate power, a broken insurance system, and a privatized, neoliberal health care regime—that helped to cause the racial health disparities in the first place. In this sense, no drug, no matter how miraculous, can ever hope to remedy the root causes of racial injustice. Indeed, in the case of OxyContin, a drug only further exacerbated them. Murch shows that racial capitalism can have damaging effects that radiate far beyond those specifically targeted as patients and consumers.

The pattern of profiting from racialized sickness endures, and it shows no sign of stopping. In the wake of the opioid crisis, whiteness is becoming more and more visible as a site of medical intervention; it can now be deployed as a category for drug marketing in a way that would have been impossible in the past. One reason is the negative health outcomes increasingly associated with whiteness itself, including higher suicide rates, reduced life expectancy, and the deleterious health effects of racial resentment chronicled by Jonathan Metzl in his book Dying of Whiteness (2019). Another is the resurgence of cultural anxieties—facilitated by Trump and undergirded by a eugenic logic of whiteness—about demographic change, what philosopher Achille Mbembe has called the “becoming black of the world.”

Murch shows clearly how our society is calibrated toward the health of markets rather than the health of people. As the story of BiDil teaches us, we cannot expect a market solution to solve this problem. Correcting the imbalance will require challenging entrenched corporate power and the Reagan-era logic of markets—both of abandonment and of control—head on. It may also require more utopian strategies, including imagining a world in which medications are not commodities at all.