Mixed Race Studies

How Do Integrated Health Care Systems Address Racial and Ethnic Disparities in Colon Cancer?

Journal of Clinical Oncology
Published online: 2015-01-26
DOI: 10.1200/JCO.2014.56.8642

Kim F. Rhoads, Colon and rectal surgeon, Colorectal surgeon, Surgical oncologist; Assistant Professor of Surgery at the Stanford University Medical Center
Stanford Cancer Institute
Stanford University School of Medicine

Manali I. Patel, MD
Stanford Cancer Institute
Stanford University School of Medicine

Yifei Ma, Statistician
Stanford University School of Medicine

Laura A. Schmidt, Professor of Health Policy
Philip R. Lee Institute for Health Policy Studies
University of California, San Francisco

Presented as a poster at the American Society of Clinical Oncology Quality Care Symposium, San Diego, CA, November 30-December 1, 2012.

Purpose: Colorectal cancer (CRC) disparities have persisted over the last two decades. CRC is a complex disease requiring multidisciplinary care from specialists who may be geographically separated. Few studies have assessed the association between integrated health care system (IHS) CRC care quality, survival, and disparities. The purpose of this study was to determine if exposure to an IHS positively affects quality of care, risk of mortality, and disparities.

Patients and Methods: This retrospective secondary-data analysis study, using the California Cancer Registry linked to state discharge abstracts of patients treated for colon cancer (2001 to 2006), compared the rates of National Comprehensive Cancer Network (NCCN) guideline–based care, the hazard of mortality, and racial/ethnic disparities in an IHS versus other settings.

Results: More than 30,000 patient records were evaluated. The IHS had overall higher rates of adherence to NCCN guidelines. Propensity score–matched Cox models showed an independent and protective association between care in the IHS and survival (hazard ratio [HR], 0.87; 95% CI, 0.85 to 0.90). This advantage persisted across stage groups. Black race was associated with increased hazard of mortality in all other settings (HR, 1.15; 95% CI, 1.04 to 1.27); however, there was no disparity within the IHS for any minority group (P > .11 for all groups) when compared with white race.

Conclusion: The IHS delivered higher rates of evidence-based care and was associated with lower 5-year mortality. Racial/ethnic disparities in survival were absent in the IHS. Integrated systems may serve as the cornerstone for developing accountable care organizations poised to improve cancer outcomes and eliminate disparities under health care reform.

Read or purchase the article here.

Penn PIK Professor Dorothy Roberts to Receive APA’s 2015 Fuller Award

Penn News
University of Pennsylvania
2015-01-23

Jacquie Posey, Media Contact
Telephone: 215-898-6460

The American Psychiatric Association has named University of Pennsylvania professor Dorothy Roberts recipient of the 2015 Solomon Carter Fuller Award in recognition of her demonstrated leadership and exceptional achievements.

The award honors “a Black citizen who has pioneered in an area which has significantly benefitted the quality of life for Black people.”

Roberts is an acclaimed scholar of race, gender and the law who joined the University in 2012 as its 14th Penn Integrates Knowledge Professor. She is the George A. Weiss University Professor of Law and Sociology. Her appointment is shared between the School of Law and the departments of sociology and Africana studies in Penn Arts & Sciences. She is also the founding director of Penn’s Program on Race, Science and Society.

Roberts’ path-breaking work explains the mechanisms and consequences of racial inequities for women, children, families and communities and counters scientific misunderstandings about racial identity. Her research focuses on family, criminal and civil-rights law; bioethics; child welfare; feminist theory; reproductive justice; critical race theory;  and science and society.

Her major books include Fatal Intervention: How Science, Politics and Big Business Re-Create Race in the Twenty-first Century; Sex, Power and Taboo: Gender and HIV in the Caribbean and Beyond; Shattered Bonds: The Color of Child Welfare; and Killing The Black Body: Race, Reproduction and the Meaning of Liberty…

Read the entire news release here.

U.S. to Collect Genetic Data to Hone Care

The New York Times
2015-01-30

Robert Pear, Washington Correspondent

WASHINGTON — Saying that “the possibilities are boundless,” President Obama on Friday announced a major biomedical research initiative, including plans to collect genetic data on one million Americans so scientists could develop drugs and treatments tailored to the characteristics of individual patients.

Dr. Francis S. Collins, the director of the National Institutes of Health, said the studies would help doctors decide which treatments would work best for which patients.

White House officials said the “precision medicine initiative” would begin with a down payment of $215 million in the president’s budget request for the fiscal year that starts Oct. 1.

Precision medicine, also known as personalized or individualized medicine, “gives us one of the greatest opportunities for new medical breakthroughs that we have ever seen,” Mr. Obama said at a White House event attended by patients’ advocates, researchers, and drug and biotechnology company executives.

Among those in the audience was Senator Lamar Alexander, Republican of Tennessee and chairman of the Senate health committee, who said he intended to work with the president on the issue.

Mr. Obama said the new initiative could save lives, create jobs, foster new industries and help people overcome “the accidents and circumstances of our birth.”

“If we’re born with a particular disease, or a particular genetic makeup that makes us more vulnerable to something, that’s not our destiny, that’s not our fate,” Mr. Obama said. “We can remake it. That’s who we are as Americans, and that’s the power of scientific discovery.”…

Read the entire article here.

Aboriginal Identity: Who is ‘Aboriginal’?

Creative Spirits
2014-12-23

Jens Korff

• People who identify themselves as ‘Aboriginal’ range from dark-skinned, broad-nosed to blonde-haired, blue-eyed people.
• Aboriginal people define Aboriginality not by skin colour but by relationships.
• Light-skinned Aboriginal people often face challenges on their Aboriginal identity because of stereotyping.

Ever since white people mixed with Aboriginal people they have struggled to define who is ‘Aboriginal’.

Racist definitions of Aboriginal identity

• ‘full-blood’ as a person who had no white blood,
• ‘half-caste’ as someone with one white parent,
• ‘quadroon’ or ‘quarter-caste’ as someone with an Aboriginal grandfather or grandmother,
• ‘octoroon’ as someone whose great-grandfather or great-grandmother was Aboriginal.

Caste categories in an identity card used in the 1940s [4].

These “one-dimensional models of Aboriginality” [41] pervaded literature of that time. Today these words are considered offensive and racist. In fact, racism lies just beneath the surface and it “bubbles out” when Aboriginal identity is discussed [40]…

…Is there genetic proof of Aboriginality?

Proposals of genetic testing as a means of proving one’s Aboriginality have been dismissed on the grounds that ‘race’ and ‘ethnicity’ are social, cultural and political constructs [2] which cannot be tested objectively.

Cheri Yavu-Kama-Harathunian has a story to tell about genetic proof [48]: “I have a brother (by association, and my own recognition), who has sought ‘recognition’ of his Torres Strait/Aboriginal heritage for the last five years. “This dear man comes and sits with me to tell me of the joys of his discoveries and the sorrows of hearing, ‘This is not enough.’

“His last attempt [was] back to an Aboriginal organisation in the town of his birth was met with, ‘You might have to get DNA proof’ DNA proof! I rang the Chairperson, and asked what this DNA stuff was about. I heard the phone being placed back and the line go dead.

“This man lived in this town all of his life, is known by the Chairperson, and the organisation… and only moved later in life. He is in his fifties now, and he, his wife and I have been trawling through historical documents, court documents, government documents for this ‘proof’.”…

…Most people still believe that Aboriginal people are poor, uneducated and live in the desert. But only 25% of Aboriginal people live in remote areas.

While the vibrant life of urban Aboriginal communities goes mostly unnoticed, the national eyes turn willingly to reports of violence, criminal activities or antisocial behaviour (such as drinking) which then shape the perception of urban Aboriginal identity.

Aboriginal writer Anita Heiss, author of “Am I Black Enough For You?”, describes herself as “a concrete Koori with Westfield dreaming” [43]. She is urban, educated, glamorous and cheeky, hates camping and cannot tell the time by the sun [44]…

Read the entire article here.

The Dubious, Dangerous Science of Race Lives On, Says Scholar

Colorlines: News for Action
2011-09-23

Julianne Hing, Reporter/Blogger
Oakland, California

Back in the 19th century, scientists thought it was possible to determine a person’s race, and their corresponding levels of intelligence, based on the size of their skull. In the 20th century, mainstream scientists were convinced that intelligence was genetically determined, and therefore an inheritable trait; they helped spur the now disgraced eugenics movement.

In the 21st century, with racial science’s embarrassing history—and its disgraceful, deadly effects on people of color—seemingly long behind us, it’s easy to dismiss the science of yore as silly and antiquated. But Northwestern University law professor Dorothy Roberts argues this line of scientific inquiry is as alive as ever.

In her new book “Fatal Invention: How Science, Politics, and Big Business Re-create Race in the 21st Century,” Roberts says that scientists are still preoccupied with the problematic questions of whether racial stratification in society is the result of genetic differences. Is race something that’s written into our genetic code? Is there, say, a gene within black folks that makes them more predisposed to cancer and hypertension? Why not use DNA as a forensic tool to predict the race of an unknown suspect?

This obsession, she argues, has led us astray from focusing on the more pressing and legitimate causes of racial stratification: racial inequality that’s deeply embedded in the structures of society. We caught up with Roberts to talk about her new book, and some of the ridiculous, troubling ways this racial science is impacting everyday people’s lives.

You write in the intro that you took on this question looking into the biological reality of race as a personal challenge to yourself, to test your convictions that race is a political category. Can you say more about that?

What motivated me to write the book was that I noticed this revival of the idea that human beings are divided into biological races in genomic science and biotechnologies. I read the headlines, first, of studies that purported to prove that there was a deep structure based on race in the human genome, [of] the approval of race-specific medicine. And I went to a lecture at Northwestern’s medical school where a conservative commentator was invited to talk about race even though he was well-known for his views that biological race determines intelligence. So I was really alarmed that this idea was being resuscitated in new technologies and on the cutting edge of science, and even some liberals were embracing it as a way to address health inequities, without having any sense that there was a danger in this way of thinking about human beings.

So when I say it was a personal challenge it was because I was at first surprised that genomic science was going in that direction and also surprised in the number of people who I talked to who believe that race really is a natural division of human beings and who embrace genetic technologies for a test of identity. To me that really contradicted the political convictions I had, not only about the meaning of race but also the way to fight against racism in America…

Read the entire interview here.

The myth of race, debunked in 3 minutes

Vox
2015-01-13

Jenée Desmond Harris

You may know exactly what race you are, but how would you prove it if somebody disagreed with you? Jenée Desmond Harris explains. And for more on how race is a social construct, click here.

Tracking the First Americans

National Geographic
January 2015

Glenn Hodges, Staff Writer

New finds, theories, and genetic discoveries are revolutionizing our understanding of the first Americans.

The first face of the first Americans belongs to an unlucky teenage girl who fell to her death in a Yucatán cave some 12,000 to 13,000 years ago. Her bad luck is science’s good fortune. The story of her discovery begins in 2007, when a team of Mexican divers led by Alberto Nava made a startling find: an immense submerged cavern they named Hoyo Negro, the “black hole.” At the bottom of the abyss their lights revealed a bed of prehistoric bones, including at least one nearly complete human skeleton.

Photograph by Paul Nicklen.  Set upside down to keep its teeth in place, the skull of a young woman found in an underwater cave in Mexico has put a face on the New World’s first inhabitants.

Nava reported the discovery to Mexico’s National Institute of Anthropology and History, which brought together an international team of archaeologists and other researchers to investigate the cave and its contents. The skeleton—affectionately dubbed Naia, after the water nymphs of Greek mythology—turned out to be one of the oldest ever found in the Americas, and the earliest one intact enough to provide a foundation for a facial reconstruction. Geneticists were even able to extract a sample of DNA.

Photograph by Timothy Archibald. Re-Creation: James Chatters, Applied Paleoscience; Tom McClelland.  Divers who discovered her bones named her Naia. A facial reconstruction reveals that the first Americans didn’t look much like later Native Americans, though genetic evidence confirms their common ancestry.

Together these remnants may help explain an enduring mystery about the peopling of the Americas: If Native Americans are descendants of Asian trailblazers who migrated into the Americas toward the end of the last ice age, why don’t they look like their ancient ancestors?…

Read the entire article here.

Naia Reborn: See the Surprising Face of a First American

NBC News
2015-01-05

Alan Boyle, Digital’s Science Editor

Timothy Archibald / National Geographic

Researchers and artists have reconstructed the face of a teenage girl who lived 12,000 years ago in Mexico, and it’s not the kind of face a person might typically associate with Native Americans.

The remains of the girl, nicknamed Naia (after the Greek term for a water nymph), were recovered from an underwater cave on Mexico’s Yucatan Peninsula. Naia is regarded as one of the earliest known residents of the Americas — but her skull has a shape associated with African or South Pacific populations rather than the typical Siberian look.

Despite that different look, researchers say Naia is genetically related to Native Americans who came to America later, from Siberia via the Beringia land bridge…

Read the entire article here.

Pharmacogenomics and the Biology of Race

Myles Jackson, Albert Gallatin Research Excellence Professor of the History of Science
New York University

The Huffington Post
2015-01-05

The numerous and impassioned responses to Nicholas Wade’s recently published Troublesome Inheritance: Genes, Race and Human History have once again reminded us of the complexity, ambiguity and perils of writing about the biology of race. In the US one is reminded of the collective sins of our past, including the eugenics movement of the early twentieth century, whereby a disproportionate percentage of people of color and those from lower socio-economic classes were sterilized, and the Tuskegee Study conducted between 1932 and 1972 in which 600 African-American sharecroppers in rural Alabama were purposely not treated for syphilis in order to ascertain information on the long-term effects of the disease. More recently, debates about the biology of race have raged among certain academic circles. While biologists will tell you that humans (other than identical twins, triplets, etc.) do differ from one another genetically — i.e. at the level of the DNA, they will also admit that the difference is rather small. And many (but certainly not all) are loath to label populations, which share the same genetic alleles (or different versions of a gene) as “races.” It turns out there are numerous ways in which one can understand human diversity, including geographic ancestry or responses to environmental selection factors. Sickle cell anemia is a case in point. Identified over a century ago, it was originally thought to be limited to “the Negro race.” As time went on, people from parts of Italy, Greece, Iran, India, and in other diverse locations were identified with the disease…

So why then is race the privileged category used by biomedical researchers in understanding human diversity? There are four sets of institutions that have used race as the primary signify of difference, albeit for very different reasons, the National Institutes of Health (NIH), the Food and Drug Administration (FDA), Big Pharma, and personal genomics companies…

…Big Pharma, while initially protesting what it saw as the unwarranted meddling of the government in the affairs of private companies, eventually embraced the move. They quickly realized that race creates markets, as Dorothy Roberts has argued in Fatal Invention (New Press, 2011). In 1996 the US became the second nation (after New Zealand) to permit direct-to-consumer advertising; Big Pharma began to market some of their drugs as race-based, including BiDil, used to treat African Americans with a history of heart attacks and Amaryl, which is used to treat type 2 diabetes in Mexican Americans. Many biomedical researchers have challenged the claims that these medications are more efficacious in one race than in the others…

Read the entire article here.

Sense About Genetic Ancestry Testing

Sense About Science: Science and Evidence in the Hands of the Public
London, United Kingdom
2013-03-07
3 pages

Tabitha Innocent

Many companies now offer to tell you about your ancestors from a DNA test. Adverts for these tests can give the impression that your results are unique and that the tests will tell you about your specific personal history, but the very same history that you receive could equally be given to thousands of other people. Conversely, the results from your DNA tests could be matched with all sorts of different stories to the one you are given: you cannot look at DNA and read it like a book or a map of a journey. This guide will help explain why, and what it is exactly that genetic ancestry companies are offering.

There are now many companies which offer to tell you about your ancestors from a DNA test. You send off a sample of your DNA and £100–£200 ($150–300), and in return you receive a report. The results of these tests may find a connection with a well-known historical figure. They might tell you whether you are descended from groups such as Vikings or Zulus, where your ancient relatives came from or when they migrated.

Adverts for these tests give the impression that your results are unique and that the tests will tell you about your specific personal history. But the very same history that you receive could equally be given to thousands of other people. Conversely, the results from your DNA tests could be matched with all sorts of different stories to the one you are given.

It is well known that horoscopes use vague statements which recipients think are more tailored than they really are (referred to as the ‘Forer effect’). Genetic ancestry tests do a similar thing, and many exaggerate far beyond the available evidence about human origins. You cannot look at DNA and read it like a book or a map of a journey. For the most part these tests cannot tell you the things they claim to – they are little more than genetic astrology…

Read the entire paper here.