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    Race medicine Race medicine Document Transcript

    • Valdez 1Anthony ValdezDr. Mary ScogginAnth. 410March 8, 2013 “Race” MedicineIntroduction Recently, the medical field have been making great strides in personalizing medicine.However, in doing so, they took a giant leap backwards in the equality of healthcare. The hottopic in medical research is the genetic studies of population differences in order to identifydiseases among specific ethnic groups in order to develop new targeted drugs. The heatedopinions center on whether this type of research is useful, or even ethical. Is this just one moremisstep in medicine‟s long history of race-related disasters? Throughout our anthropologicalcareer we are taught that race has minimal relevance in our inner workings. In addition, researchhas shown that there is more variation within populations than between populations. This paperwill review the literature for genetic studies of population differences, and against the geneticstudies of population differences.Race as a Category in Epidemiology Most statistics in the United States are stratified by race (Root, 2002). Because of this, itis easier to document morbidity and mortality rates among a population. Epidemiologistsroutinely use race as a control variable in their search for risk factors and typically find that raceis a good indicator of risk of death and disease in the United States (Jones et al, 1991). It is
    • Valdez 2because of these classifications that we get statistics such as: blacks in the U.S. are seven timesmore likely to die of tuberculosis than whites and three times more likely to die of HIV/AIDS(Root, 2002). So, race, in the view of most epidemiologists, is an important category. Many believed that race, for many years, was biological. They believed that blacks andwhites were divided by genes (Root, 2002). Today most biologist oppose the idea that race isbiologically determined. According to Root, “most epidemiologists believe that race can bebiologically salient category even though there are no biological races, and race can mark therisk of a biological condition like diabetes or hear disease even though race is not itself abiological condition but a social status.”Use of race in a medical setting Doctors sometimes use race as an individual variable, as a way to classify an individualpatient (Root, 2002). In addition, physicians use race an individual variable, for example, whenthey use race as a proxy for an individual patient‟s response to a medical treatment or as a proxyfor a gene. Constance Holden, a writer for Science Magazine, reported that “researchers in thelast 35 years has uncovered significant differences among racial and ethnic groups in their rate ofdrug metabolism, in clinical responses to drugs, and in drug side effects” (2003). According toRoot, “there is good evidence that race correlates with a disease, and that racial profiling inmedicine is reasonable and fair” (2002). “The reason that if it is legitimate for anepidemiologists to stratify a population by race when explaining differences in disease rates withthe population, then it should be legitimate for doctors to divide their patients by race as wellwhen deciding how best to treat them” (2002).Genetic studies of population differences
    • Valdez 3 Very few people dispute that some diseases affect disproportionately in some racial orethnic groups-thalassemia in people whose ancestors came from the Mediterranean area, sicklecell anemia in people of African origins, for example (Holden, 2003). However, what scientistsare more concerned with the more subtle gene variants that occur in various populations and thatseem to influence a multitude of conditions (Holden, 2003). As of now, one of the main drugtrials that have been launched is directed at compensating for what is believed to be a nitric oxide(NO) deficiency in many African Americans (Holden, 2003). In addition, other work that isbeing done has to do with different levels of certain drug-metabolizing enzymes found in whites,blacks, and Asians (Holden, 2003). Rosenberg et al explain that “most studies of humanvariation begin by sampling from predefined “populations”- these populations are usuallydefined on the basis of culture or geography and might not reflect underlying geneticrelationships” (2002).“Population Profiling” As stated before, as aspiring biological anthropologists, we are taught that race does notexist-it is merely a myth. And that there are more variation within a population than betweenpopulations. Although I do accept that certain diseases show up in certain populations, I believethe science community is walking on thin ice when researching genetic differences amonggroups. One must be wary of racial profiling and ignorance. I agree with George Ellison when he explains that generating any data disaggregated byrace/ethnicity can fuel the use of biological reductionism or cultural essentialism to explaininequalities in health (2005). In addition, by doing this, they are drawing on popularmisconceptions that groups categorized using race are homogeneous with innate genetic
    • Valdez 4differences and/or distinct cultures (Ellison, 2005). It is believe that this practice will rationalizedifferences and enact stereotyping and justify discrimination. It has been proven that race does not exists biologically. However, it does not mean thatrace doesn‟t exists at all. I accept the fact that race exists in cultural constructs, with that said, Ibelieve that there are many variables that come with establishing oneself a certain “race.” Someof these variables include social class, cultural practices, and even genetic traits (Ellison, 2005).Supports of the genetic studies of population differences say that racial data can be reliable, Iwould have to disagree. Race/ethnicity appears inherently unreliable, there is little consensus onwhat race/ethnicity means, or on how it should be defined and measured (Ellison, 2005). Withthat said, racial data would be more reliable if there were a single official way of assigning race.It will be more consistent if race is assigned in a single way. Therefore, although the evidencethat race matters in medicine is overwhelming, it not entirely reliable, for the data are not basedon a single understanding of race but many (Root, 2002). Using race/ethnicity as a tool reflects too many assumptions about a group or groups.Some might think that groups are relatively homogeneous, and the biological differences areessential of group identity (Ellison, 2005). I accept that these assumptions might hold true forsome characteristics in a group, but they do not hold up for most characteristics (Ellison, 2005).And using the data can create biases and not represent an entire population and some culturesmay be unrepresented.The alternative of race medicine There is no doubt that the body‟s ability to metabolize certain drugs can be influenced bya genetic component. However, there are other ways of determining genetic variations in an
    • Valdez 5individual without using race medicine. Personal genomics is a growing popular field inmedicine and offers the same personalized medicine as studies on genetic populations. Drug-metabolizing genes have been characterized sufficiently to enable practitioners to go beyondsimplistic ethnic characterization and into the precisely targeted world of personal genomics (Nget al, 2008). There is a lot of variability in a group, and an example of this is CYP2D6, which isinvolved in metabolizing codeine, antipsychotics, and antidepressants in African populations (Nget al, 2008). However, different population within Africa have different frequencies for variants(Ng et al, 2008). Lumping together entire populations can obscure differences betweenpopulations. The recent advent of whole-genome genotyping and whole-genome sequencing ofhumans has opened up the possibility of personalized medicine-medicine based on manyindividual characteristics in addition to ethnicity/race.Conclusions Although I agree with personalizing medicine by exploring differences among ancestralgroups as a way to learn more about complex diseases, I am concerned that this will play into“racial” concepts. I agree that race is not biological, however, it is real enough in culture aspectsto be used in medicine, with a grain of salt. Unfortunately, or fortunately, race is such anambiguous concept and can vary from place to place. Ultimately, using race medicine helpssustain a harmful racial ideology.
    • Valdez 6 Works CitedEllison, George T. H. "„Population Profiling‟ and Public Health Risk: When and How Should We Use Race/ethnicity?." Critical Public Health, 15.1 (2005): 65-74.Holden, Constance. "Race and Medicine." Science, 302.5645 (2003): 594-596.Jones, C P, T A LaVeist, and M Lillie-Blanton. "Race in the Epidemiologic Literature: An Examination of the American Journal of Epidemiology, 1921-1990." American Journal of Epidemiology, 134.10 (1991): 1079.Ng, PC, Q Zhao, S Levy, RL Strausberg, and JC Venter. "Individual Genomes Instead of Race for Personalized Medicine." Clinical Pharmacology & Therapeutics, 84.3 (2008): 306-309.Root, Michael. "The Problem of Race in Medicine." Philosophy of the Social Sciences, 31.1 (2001): 20- 39.Root, Michael. "The Use of Race in Medicine as a Proxy for Genetic Differences." Philosophy of Science, 70.5 (2003): 1173-1183.Rosenberg, Noah A, Jonathan K Pritchard, James L Weber, Howard M Cann, Kenneth K Kidd, Lev A Zhivotovsky, and Marcus W Feldman. "Genetic Structure of Human Populations." Science, 298.5602 (2002): 2381-2385.Tishkoff, Sarah A, and Kenneth K Kidd. "Implications of Biogeography of Human Populations for Race and Medicine." Nature Genetics, 36.11 Suppl (2004): S21-S27..