Mixed Race Studies

There Is No Scientific Rationale for Race-Based Research

Journal of the National Medical Association
Volume 99, Number 6 (June 2007)
pages 690-692

Eddie L. Hoover, Professor of Surgery
State University of New York, Buffalo

For centuries, the colonial governments used a combination of race and ethnic characteristics to subjugate and control people of color, and scientists of the day provided evidence of the “natural order of things” to support national policies of domination, segregation and control. There have been many examples of events in the past 70 years to suggest that achievements by ethnic peoples are not genetically determined and that race and ethnicity are merely terms to describe external features, language, culture, social mores and folklore. BiDil was the first drug in this country approved by the FDA for use in a single “race” after a clinical trial that enrolled only members of that race. Thus arose the question of the efficacy of doing race-based research in humans. In order for this kind of research to have any scientific basis, each individually defined or self-declared race would have to have a 100% pure gene pool, and the data show that the gene pool among whites, blacks and Hispanics in America is very heterogeneous. This makes for far greater similarities among U.S. citizens than any perceived differences, and genomic science has failed to support the concept of racial categories in medicine.Scientists involved with the first mapping of the human genome have noted that there is no basis in the genetic code for race. That being the case, there appears to be no justification for race-based research among human beings.

Although the United States has experienced enormous improvements in its healthcare system over the past half-century, there are still widening disparities in most disease processes between whites and blacks/Hispanics.’ There has been much debate as to how these disparities can be eliminated, but simple, logical programs that could be tailored to specific minority communities in different geographical locations have not proven to be practical for a variety of reasons. To be sure, disparities in healthcare, like anything else, are a function of a variety of factors, including education, environment, income and culture, among others. Race and ethnicity are important determinants of some of these functions, thus raising the question as to whether these parameters may, in fact, be determinants of outcome in some of these disease processes based upon genetics as well as the aforementioned risk factors.

Modern-day science has amassed enough evidence to suggest that there is very little biological difference between the various races. In order for race-based research to have any scientific basis, each individually defined or self-declared race would have to have a 100% pure and homogeneous gene pool. Some racial and ethnic groups have a very heterogeneous gene pool, such as whites and Hispanics. The same scientific data show that approximately 80% of American blacks have some degree of white ancestry, and although not so nearly well publicized is the fact that many whites also have black and Hispanic ancestry. This would make for far greater similarities in the U.S. black/white gene pool than any perceived differences, and genomic science has failed to support the concept of racial categories in medicine and further purports that there is more genetic diversity within a “racial cohort” than any differences between two such cohorts.” Craig Venter, who helped produce the first map of the human genome, noted that there is no basis in the genetic code for race.’ That being the case, race then becomes rather meaningless in scientific research. This would obviously include race-based pharmaceutical research that resulted in the drug BiDil. This is not to be confused with the fact that race indeed affects both access and outcomes in our healthcare system, as it most certainly does. Even black medical professionals do not enjoy the same access to highly specialized services as their white counterparts, such as coronary artery bypass grafting, but the basis is not biological and by extension, not genetically determined…

Read the entire article here.

Black and White Medicine

PsycCRITIQUES
Volume 58, Number 32 (August 2013)
5 pages

Alejandra Suarez, Professor of Psychology
Antioch University, Seattle

A review of Race in a Bottle: The Story of BiDil and Racialized Medicine in a Post-Genomic Age by Jonathan Kahn New York, NY: Columbia University Press, 2013. 311 pp. ISBN 978-0-231-16298-2 (hardcover); ISBN 978-0-231-53127-6 (e-book), hardcover.

What is your race? (a) Mestizo, (b) Greek, (c) Creole, (d) Peninsular, (e) Mulatto, (f) Quadroon, (g) Octoroon, (h) Indian, (i) Chinese, (j) Japanese, (k) Moor, (l) Syrian, or (m) Nubian? In another time and place, these may have been the available choices. Obviously these categories are not anthropologically or scientifically based.

Currently the United States uses the definition of racial categories as published by the Office of Management and Budget (1997) in its Revised Directive 15. Directive 15 stems from the civil rights movement; it aims to provide consistent data and a uniform language in order to increase fairness in society. All federally funded research with human participants is required to address issues of race, although the OMB explicitly states that its categories are not anthropologically or scientifically based.

The current racial choices in the United States are (a) American Indian or Alaska Native, (b) Asian, (c) Black or African American, (d) Native Hawaiian or other PacificIslander, and (e) White. There are two categories for data on ethnicity: (a) Hispanic or Latino and (b) not Hispanic or Latino (Office of Management and Budget, 1997). Many people objected that it is difficult to fit into these categories, so in the 2000 census, one could also self-select multiple categories of race/ethnicity. Selecting one’s race is complicated: It is about identities; it is not about genetic differences.

The human genome project, completed in June 2000, concluded that all human beings, regardless of race, have pretty much the same genes. In fact, the American Anthropological Association has asserted that race is “a worldview, a body of prejudgments that distorts our ideas about human differences and group behavior” and that “racial beliefs constitute myths about the diversity in the human species and about the abilities and behavior of people homogenized into ‘racial’ categories” (American Anthropological Association, 1998, para. 8, and cited in book under review, p. 40).

Race is an ideology that changes according to time and place. However, at the same time that the human genome project has unequivocally demonstrated that race is a construct with no biological validity, the idea of race as a genetically based population variant is becoming more and more entrenched in biomedical research and practice. How is it possible?…

Read the entire review here.

Disparity in Breast Cancer Between Black and White Women Can Be Eliminated by Regular Mammography Screening

Rush University Medical Center
News Release
2012-09-25

(CHICAGO) — Regular mammography screening can help narrow the breast cancer gap between black and white women, according to a retrospective study published in Breast Cancer Research and Treatment in August.

Earlier studies have shown that black women in Chicago are more than twice as likely to die of breast cancer compared to white women. Black women with breast cancer reach the disease’s late stages more often than white women, and their tumors are more likely to be larger and more biologically aggressive.

But according to the study, when women of both races received regular breast cancer screening — a mammogram within two years of breast cancer diagnosis — there was no difference in the rate of how many of them presented in the disease’s later stages…

Read the entire news release here.

Our Zip Code May Be More Important Than Our Genetic Code: Social Determinants of Health, Law and Policy

Social Determinants of Health
Rhode Island Medical Journal
Volume 96, Number 7 (July 2013)

Dannie Ritchie, MD, MPH, Clinical Assistant Professor of Family Medicine
Lead, Transcultural Community Health Initiative
Brown University Center for Primary Care and Prevention

Public health is defined as “what we, as a society, do collectively to assure the condition for people to be healthy.” (Institute of Medicine (IOM), 1988, 2003). This evokes the social determinants of health – where we live, learn, work and play has a greater impact on individual and population health than does access to health care. However, when we discuss health and health disparities, clinical care problems are often framed as the problems with the health-care system. Recently, the Institute of Medicine has moved to make the distinction that in public health, the clinical care system is but one part of the overall health system, which should help to avoid the conflation of health as only a product of medical care (IOM 2010)…

…This special issue contains a series of papers expanding key themes addressed in the seminars. Making real improvements in the health of our communities, especially the economically, socially and environmentally impoverished communities, requires much more than “fixing” our wasteful, fragmented and misdirected medical-care systems. If we are to achieve health equity, it is time for us to evaluate how to truly shift the dialogue, and not inadvertently replicate the same disparities we are trying to eliminate. We must examine how disparities impact us all across demographics and not only the most vulnerable, though they bear the greater burden. It is our intent with this edition to provide tools to better equip us to evaluate the social determinants of health and ways to take action through law and policy…

Read the entire article here.

Status and Stress

The New York Times
2013-07-27

Moises Velasquez-Manoff

Although professionals may bemoan their long work hours and high-pressure careers, really, there’s stress, and then there’s Stress with a capital “S.” The former can be considered a manageable if unpleasant part of life; in the right amount, it may even strengthen one’s mettle. The latter kills.

What’s the difference? Scientists have settled on an oddly subjective explanation: the more helpless one feels when facing a given stressor, they argue, the more toxic that stressor’s effects.

That sense of control tends to decline as one descends the socioeconomic ladder, with potentially grave consequences. Those on the bottom are more than three times as likely to die prematurely as those at the top. They’re also more likely to suffer from depression, heart disease and diabetes. Perhaps most devastating, the stress of poverty early in life can have consequences that last into adulthood.

Even those who later ascend economically may show persistent effects of early-life hardship. Scientists find them more prone to illness than those who were never poor. Becoming more affluent may lower the risk of disease by lessening the sense of helplessness and allowing greater access to healthful resources like exercise, more nutritious foods and greater social support; people are not absolutely condemned by their upbringing. But the effects of early-life stress also seem to linger, unfavorably molding our nervous systems and possibly even accelerating the rate at which we age…

…“Early-life stress and the scar tissue that it leaves, with every passing bit of aging, gets harder and harder to reverse,” says Robert Sapolsky, a neurobiologist at Stanford. “You’re never out of luck in terms of interventions, but the longer you wait, the more work you’ve got on your hands.”

This research has cast new light on racial differences in longevity. In the United States, whites live longer on average by about five years than African-Americans. But a 2012 study by a Princeton researcher calculated that socioeconomic and demographic factors, not genetics, accounted for 70 to 80 percent of that difference. The single greatest contributor was income, which explained more than half the disparity. Other studies, meanwhile, suggest that the subjective experience of racism by African-Americans — a major stressor — appears to have effects on health. Reports of discrimination correlate with visceral fat accumulation in women, which increases the risk of metabolic syndrome (and thus the risk of heart disease and diabetes). In men, they correlate with high blood pressure and cardiovascular disease.

Race aside, Bruce McEwen, a neuroscientist at Rockefeller University in New York, describes these relationships as one way that “poverty gets under the skin.” He and others talk about the “biological embedding” of social status. Your parents’ social standing and your stress level during early life change how your brain and body work, affecting your vulnerability to degenerative disease decades later. They may even alter your vulnerability to infection. In one study, scientists at Carnegie Mellon exposed volunteers to a common cold virus. Those who’d grown up poorer (measured by parental homeownership) not only resisted the virus less effectively, but also suffered more severe cold symptoms…

Read the entire article here.

Study explores race differences of lung cancer risk

Vanderbilt University Medical Center Reporter
2013-08-01

Mimi Eckhard

Vanderbilt research scientist Melinda Aldrich, Ph.D., MPH, has been awarded a National Institutes of Health Academic Career Award to investigate some of the genetic secrets behind a greater risk of lung cancer among African-Americans compared with other racial and ethnic groups.

Aldrich, assistant professor of Thoracic Surgery and Epidemiology, will study the genetic ancestry of African-Americans to identify the genetic and environmental risk factors associated with a higher incidence of lung cancer in this population.

To date, this represents the largest study of African-Americans with lung cancer.

Though smoking is certainly a well-documented risk factor for lung cancer, it does not explain the racial disparity in lung cancer risk. Therefore, Aldrich believes a genetic difference may lie at the root of the problem…

…This five-year research study will be the largest to examine the genetics of lung cancer in a population whose ancestry is mixed and separated by thousands of years. African-Americans have ancestry in both Africa and Europe, and genetic mapping could identify common key regions that contribute to racial differences in lung cancer incidence…

Read the entire article here.

Medical Experimentation and Race in the Eighteenth-century Atlantic World

Social History of Medicine
Volume 26, Issue 3 (August 2013)
pages 364-382
DOI: 10.1093/shm/hkt011

Londa Schiebinger, The John L. Hinds Professor of History of Science
Stanford University

This article examines medical experimentation with humans in the Atlantic world. Physicians in this period tended to use bodies interchangeably in medical trials; subjects were scarce and, for the most part, used with extreme care. Experimentalists in this period, however, faced a paradox. In the second half of the eighteenth century naturalists across Europe began focusing attention on what they perceived to be racial differences. At the same time medical experimentalists required that human bodies be fully interchangeable if results were to hold universally. The dilemma, then, was this: on the one hand, physicians tended to emphasize racial difference with respect to the science of race; on the other hand, they assumed uniformity across humans with respect to developing drug therapies. It was in this context that important questions arose about whether experiments done among Caribbean slave populations were valid for Europeans.

Read or purchase the article here.

Taking race out of the equation in measuring women’s risk of osteoporosis and fractures

UCLA Newsroom
University of California, Los Angeles
2012-10-18

Enrique Rivero

For women of mixed racial or ethnic backgrounds, a new method for measuring bone health may improve the odds of correctly diagnosing their risk of osteoporosis and bone fractures, according to a UCLA-led study.

Currently, assessing osteoporosis and the risk of fractures from small accidents like falls requires a bone density scan. But because these scans don’t provide other relevant fracture-related information, such as bone size and the amount of force a bone is subjected to during a fall, each patient’s bone density is examined against a national database of people with the same age and race or ethnicity.

This approach, however, doesn’t work for people of mixed race or ethnicity because comparison databases can’t account for mixed heritage. A similar problem exists for those from smaller racial or ethnic groups for which there are not comparison databases.

“All the current ways of determining your risk for fractures require knowing your race and ethnicity correctly, and they ignore the fact that racial and ethnic groups are not homogenous,” said study co-author Dr. Arun Karlamangla, a professor of medicine in the geriatrics division at the David Geffen School of Medicine at UCLA. “It also flies in the face of the current reality in Southern California, where so many people are of mixed ethnicity.”

Given that osteoporosis and hip fractures are leading causes of injury in older people, alternative means of measuring risk are needed. Now, a UCLA-led team of researchers has found a way of assessing risk without knowledge of a person’s race or ethnicity. The method involves combining bone mineral density measures with body size and bone size to create composite bone strength indices.

The findings are published in the October issue of the Journal of Clinical Endocrinology and Metabolism…

…”The importance of bone size to fracture risk has been recognized by engineers and radiologists for some years now,” said the study’s lead investigator, Dr. Shinya Ishii, who started the research while a fellow in the UCLA Division of Geriatrics and is now at the University of Tokyo. “But no one, until now, has combined bone density, which is the traditional measure of osteoporosis, with bone size and body size to get at a more uniform way of assessing osteoporosis that applies across racial lines and does away with the need to know the person’s race or racial mixture.“…

Read the entire article here.

Fracture Risk Assessment without Race/Ethnicity Information

The Journal of Clinical Endocrinology & Metabolism
Volume 97, Number 10 (2012-10-01)
pages 3593-3602
DOI: 10.1210/jc.2012-1997

Shinya Ishii
Department of Geriatric Medicine (S.I.)
Graduate School of Medicine
University of Tokyo

Gail A. Greendale
David Geffen School of Medicine
University of California, Los Angeles

Jane A. Caule
Graduate School of Public Health
University of Pittsburgh

Carolyn J. Crandall
David Geffen School of Medicine
University of California, Los Angeles

Mei-Hua Huang
David Geffen School of Medicine
University of California, Los Angeles

Michelle E. Danielson
Graduate School of Public Health
University of Pittsburgh

Arun S. Karlamangla
David Geffen School of Medicine
University of California, Los Angeles

Context: Dual-energy x-ray absorptiometry-derived bone mineral density (BMD) does not explain interracial differences in fracture risk; thus, BMD-based fracture risk assessment requires patient race/ethnicity information and ethnicity-specific BMD reference databases.

Objective: The objective of the study was to investigate whether composite femoral neck strength indices, which integrate dual-energy x-ray absorptiometry-derived femoral neck size, femoral neck BMD, and body size, will allow fracture risk assessment without requiring race/ethnicity information.

Design: This was a prospective cohort study.

Setting and Participants: A total of 1940 community-dwelling women aged 42–53 yr from four race/ethnicity groups (968 Caucasian, 512 African-American, 239 Japanese, and 221 Chinese) were followed up for 9 yr.

Outcome Measurements: Self-reported, nondigital, noncraniofacial fractures were measured.

Results: Two hundred and two women (10.4%) sustained fractures and 82 (4.3%) had minimum-trauma fractures. Each sd increment in any of the strength indices was associated with a 34–41% reduction in fracture hazard over 9 yr (each P < 0.001). Race/ethnicity predicted fracture hazard independent of BMD (P = 0.02) but did not predict fracture hazard independent of any of the composite indices (P = 0.11–0.22). Addition of race/ethnicity did not improve risk discrimination ability of the strength indices, but did significantly improve the discrimination ability of BMD. The discrimination ability of BMD with race/ethnicity was not statistically different from that of any of the strength indices without race/ethnicity.

Conclusions: Composite strength indices of the femoral neck can predict fracture risk without race/ethnicity information as accurately as bone mineral density does in combination with race/ethnicity information and therefore would allow risk prediction in people of mixed race/ethnicity and in groups without a BMD reference database.

Read or purchase the article here.

Racial profiling in medicine

Nature Medicine
Volume 19, Number 7 (July 2013)
page 808
DOI: 10.1038/nm.3254

Aravinda Chakravarti, Professor of Medicine
McKusick-Nathans Institute of Genetic Medicine
Johns Hopkins University

Jonathan Kahn, Race in a Bottle: The Story of BiDil and Racialized Medicine in a Post-Genomic Age, Columbia University Press, 2012. 28 pp., ISBN: 0231162987

The field of human genetics is moving beyond using genomics as a tool for deeper understanding of human disease pathophysiology to the possibility of translating this knowledge for efficient treatment. A particular emphasis is being placed on Individualized medicine’, promising to tailor treatment based on each of our genomes. This ideal vision, however, can cause unease when our notions of genetic individuality intersect with those of ancestry and race. Jonathan Kahn’s book, Race in a Bottle, is a contemporary medical story born of this nexus. In it, he skillfully uses the story of the drug BiDil, a therapeutic for heart failure marketed specifically for African Americans (but whose use has declined markedly because it provides no unique benefit in comparison to similar drugs), as the backdrop for examining the expanding role of race in medical genomics, even when the same science has called the existence of race into serious doubt.

As Kahn highlights in the book, the innocuous birth of BiDil in 1992 was no predictor of its contorted history. BiDil is a combination of two vasodilators, hydralazine and isosorbide dinitrate (H-I), which are presumed to act through the nitric oxide pathway to provide benefit to patients with congestive heart failure. They were combined into one pill for easier administration, although each was already available in generic form. Between 1980 and 1991, two major clinical trials in the United States, involving patients of both European and African ancestries, clearly established that angiotensin-converting-enzyme inhibitors should be the preferred drug for patients with heart failure and that the H-1 combination should be used in individuals who did not benefit from this frontline therapy. Sensing a market opportunity, Medco Research obtained the intellectual property rights to BiDil, demonstrated its bioequivalence to the H-1 formulation and approached the US Food and Drug Administration(FDA) in 1996 for approval to market this ‘new’ drug. The FDA refused, arguing that clinical trials showing the utility of H-1 for heart failure did not meet the stiff criteria for such approval.

There was a suspicion that the nitric oxide response, and heart failure, was somehow different in blacks than in whites. So Jay Cohn, a respected cardiologist and owner of the original BiDil patent, reanalyzed the original clinical trial data to demonstrate that H-1 did work better in blacks than whites, a contention described and contested in the book. This finding not only led to a new patent but prompted its new owner, NitroMed, to conduct a fresh clinical trial in 2001, involving only African-American patients with heart failure, to demonstrate BiDils utility in this group. None of these facts are in doubt. What is doubted, however, is the implicit assumption that BiDil is not useful for white patients, the chronology of key events and the motivations of various actors in medicine, industry and government—factors that morphed an otherwise convenient drug formulation into a race-specific drug. Kahn makes the charge that “BiDil was not about personalizing medicine; it was about exploiting race to obtain cheaper, quicker FDA approval for a drug.”…

…Genetic analysis strongly suggests that early humans first arose in Africa and emerged out of Africa only ~100,000 years ago, a fairly recent development, evolutionarily speaking, which explains why we are all closely related. Any classification of biological races within our species is arbitrary because there are no major discontinuities in our diversity across the globe. Importantly, genetic data show that currently populous groups are not necessarily reflected by their past abundance, and human history is one of repeated admixture, not maintenance of purity. It is this genetic admixture that has left an imprint on every human disease with a genetic component, including common chronic ones. Thus, it is quite unlikely that the genetic variations underlying our diseases, which represent only a small fraction of our genetic diversity, will vary markedly across humanity…

Read or purchase the article here.