Mixed Race Studies

The Racial Discrimination Embedded in Modern Medicine

Newsweek
2015-10-20

Lindsey Konkel

Minutes separated Are’Yana Hill from death as she struggled to breathe in the hallway of her San Francisco high school. The 18-year-old had lived with asthma attacks since before she could talk, and on that day, in April 2014, she could not speak. She thrust the rescue inhaler she carried in her backpack between her lips and inhaled. No relief. It felt, she thought, as if a charley horse had formed in her chest, knotting her lungs—each gasp trammeled by tightening airways. Her pursed lips turned gray, and all she could think about was her unborn baby. Hill, eight months pregnant, clutched her inhaler and prayed for paramedics to arrive.

“I take my medicine every day. I do everything the doctors tell me. I’ve tried every single thing, and I still have attacks,” Hill said a little more than a year later, as a nurse at San Francisco General Hospital’s Asthma Clinic placed a stethoscope on her back, between her shoulders. Her wheezing was barely audible. Each expiration sounded like the whistle of a distant tea kettle.

The attack in 2014 put Hill in the hospital. Asthma attack patients in the emergency room are often given oxygen and albuterol or other medications to relax the airways through a nebulizer mask. These treatments typically last a couple of hours, but Hill’s airways weren’t opening. She breathed through a nebulizer continuously for a week while the doctors closely monitored her pregnancy. Hill has brittle asthma—severe and unpredictable attacks that are poorly controlled, even with medication. Two weeks after she left the hospital, her son was born, healthy. Others are not as lucky…

…In the U.S. medical community, studying racial differences in disease susceptibility and response to treatments remains controversial. Race and ethnicity are social constructs that have been used to marginalize and exploit. Scientifically, race serves only as a crude proxy for what experts call genetic ancestry—the diverse signatures that arose in the genetic code as our ancestors traversed the globe.

Some experts worry that a focus on finding genetic differences obscures the need to address the socioeconomic disparities that lead to uneven access to health care in the U.S. “Focusing on inclusion in clinical trials is a great way to ignore the fact that large numbers of poor and minority people are getting less than optimal health care,” says Dr. Otis Brawley, chief medical officer for the American Cancer Society.

Yet because of its social baggage, race remains a powerful tool for studying patterns of disease and health, according to Sam Oh, an epidemiologist in Burchard’s laboratory at UCSF. A person’s self-identified race or ethnicity can offer important clues beyond genetic ancestry about important cultural, socioeconomic and environmental factors that may influence disease risk…

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