Biopolitical governance positions the black body outside of the category of “human” which imposes specific forms of biomedical targeting while simultaneously forcing the black subject to keep their blackness in check in the face of mass forms of surveillance. These technologies such as BiDil and medical hot spotting designed for blacks use only posit the black body as an independent category or as a site of experimentation to fit the white template of a good citizen which blurs racial disparities into a source of marketization.

Contemporary biomedical technologies that target race seem to ameliorate the ‘‘cut’’ of systemic racism—by targeting supposedly race-specific health factors or directing health care toward particular spaces to alleviate health disparities. In what follows, we consider two examples of biomedical targeting technologies and their biopolitical operations. First, we focus on BiDil, a pharmaceutical approved by the U.S. Food and Drug Administration (FDA) in 2005, and subsequently marketed as a race-specific drug for self-identified African Americans suffering from heart failure. Second, we turn to what is known as ‘‘medical hot spotting,’’ a practice that began in Camden, New Jersey in 2007, and that uses GIS technologies and spatial profiling to identify populations that are medically vulnerable (‘‘health care’s costliest 1%’’) in order to provide preemptive care at home and lower hospital admissions and health care costs. These targeting operations are deployed ostensibly to affirm life: They are said to redress past forms of biomedical neglect and enable the tailoring of biomedical intervention into vulnerable communities, and they are advocated as the means through which to foster the health of those populations—through attention, through targeting. Such forms of redress and attention might be understood, then, as the attempt to practice—and actualize—a different racial future, precisely through attending to inequities in the present. However, targeted health interventions may in effect signal inequitable and endangering forms of biomedical administration.3 We advance this more cautionary view through three foundational claims. First, regardless of the motivations for biomedical targeting—that is, the will to attend to black health—the operation of race-specific biomedical targeting of black subjects is structured through an epistemology of anti-blackness. More than racist actions against blacks, the architecture of racial discrimination, or a paradigm that binds blackness and death together, anti-blackness is a form of knowledge that positions the black subject outside of the category Human.4 This positioning stems from liberal humanist thought and is constitutive of Western modernity (Barrett, 2014). Not only has the epistemology of anti-blackness shaped the racial past in the U.S., but it also curtails the present and future of black life. Such expulsion of black lives from the normative position Human is undeniable, ‘‘[g]iven the histories of slavery, colonialism, segregation, lynching’’ and the ongoing daily imperiling of black lives through police brutality and mass incarceration (Weheliye, 2014: 19). That biomedical targeting is structured through antiblackness is evident in the way it reinstitutes racial difference and separation and, as we will show, stages an additional form of violence by actually expelling blacks from the possibility of optimal health. Black lives have been consistently imperiled in and through the biomedical encounter, in the form of lack of access to care and health insurance, inequities in caregiving, and the medical abuse of black bodies, from grave robbing for medical experimentation, to the Tuskegee Syphilis Experiments, and the appropriation of the Henrietta Lacks cell line (Duster, 2003a; Institute of Medicine Report, 2002; Nelson, 2011; Roberts, 2012; Van Ryn and Fu, 2003; Washington, 2008). Anti-blackness continues to thwart black life and futurity through biomedical targeting operations that subject African Americans to what Du Bois (1899) named as a ‘‘social atmosphere . . . which differs from that surrounding whites.’’5 Race-based targeting efforts that are aimed at redressing health inequities recursively secure anti-blackness by refusing to acknowledge its structuring logic, thus equating blackness with inevitable vulnerability, risk, threat, and premature death.6 Second, and related to our first point, these biomedical targeting operations extract the conditions of black health and illness from the broader contexts of structural racism. Biomedical targeting generally fails to recognize the social conditions in which poor health emerges and, in the case of black subjects, how poor health, institutional racism, and the epistemology of anti-blackness are ontologically enmeshed. The targeting of black populations—specifically the two cases we explore here—does not simply direct resources to black subjects. Instead, in such operations, race is objectified as that to be targeted, meaning that race itself is not undone: That is, race as a stratifying mechanism that orders the social—a social order characterized by anti-blackness—is not called into question. Both BiDil and medical hot spotting demarcate populations, with supposedly distinct bodies, and name them as a political problem in need of specific health governance; black bodies and racialized spaces are targeted in order to manage the life of the population. Accordingly, BiDil might be seen to ontologize blackness as a corporeal truth for market accumulation, while medical hot spotting can be said to spatially ontologize structural racism in order to secure cost efficiencies of the health care system. BiDil is predicated on financial extraction; medical hot spotting is predicated on threat containment. These biomedical targeting technologies reveal how health interventions do not necessarily support or achieve a better future for African Americans. Instead, they advance the epistemological violence of anti-blackness by concentrating the ‘‘problem’’ of black life in the U.S. at the scales of: (1) the racialized body (BiDil) and (2) space (hot spots), which both become objects of ever more heightened administration, financial exploitation, and securitization. BiDil positions African Americans as ‘‘problem bodies’’ that must take on responsibility for their own racialized embodied risk through the act of buying and consuming race-based medicine; here, anti-blackness operates through the black responsibilization of risk. Medical hot spotting tracks, maps, and fixes high-cost health care users in ‘‘problem spaces’’ that are positioned outside the populace; hot spotting locates and reifies the structural position of anti-blackness in space for the purposes of surveillance, anticipation of risk, and containment. Third, contemporary biomedical targeting technologies are an endangering form of health administration exacerbated by the logics of neoliberalism. Under neoliberal conditions, populations previously excluded from the vital politics of the nation are now ostensibly being addressed. However, the two biomedical targeting technologies that we explore reveal a predatory power to demarcate race for purposes spanning financial extraction to threat containment—even as such ‘‘targeting’’ is advocated as the means for addressing the embodied and spatial effects of racial inequality. In neoliberal times, the color line no longer operates as a clear and obvious modality of exclusion, as Du Bois would have it (Goldberg, 2008). The neoliberal biopolitics of health increasingly emphasizes customizing health, the body, and life itself through biomedical practices (Clarke et al., 2003: 181–182). Our two case studies reveal how customizing health seems to be an operation of inclusion (directly or indirectly by race) within biomedicine: BiDil is a customized drug that attends to black health; it targets racial minorities supposedly to extend life. Medical hot spotting is also a form of customization through care delivery: It delineates ‘‘problem spaces’’—where high utilizers of health care are located—in order to direct resources and generate efficiencies in health provisions. ‘‘Customizing’’ works in the first case through ‘‘color awareness’’ and marketing within biomedicine (i.e. the racialized spectacle of the body), and paradoxically in the second, through invisibilizing race at the level of ‘‘location’’/space according to the socalled colorblind agency of the free market and cost–benefit analysis (O’Boyle, 2007). While both targeting technologies may attempt to alleviate racial health disparities, they simultaneously augment racial difference and exacerbate racial inequalities—but they do so in very different ways: thus emphasizing the importance of tracing out the empirically distinct means through which each technology resecures the epistemology of anti-blackness. BiDil highlights the neoliberal refusal to acknowledge the social production of risk, by casting health as an individual—not social—enterprise. Medical hot spotting disavows the historical and spatial processes of racial formation that structure the present and simultaneously shows that certain (racialized) subjects are positioned—in advance—as risk failures within the paradoxically ‘‘race-neutral future’’ of the nation. To begin exploring these ideas, we turn to the case of BiDil, the oft-disputed first pharmaceutical with a race-specific indication.