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Race in medicine

Biopolitical Times, an online publication of the Center for Genetics and Society, rekindled the debate over race with a recent commentary by Jessica Cussins on the value of the concept in medicine. Although not as biased in its coverage of genetics as anti-biotech campaigners and such groups as the ill-named Council for Responsible Genetics, it is known for its selective analysis of hot button genetics issues, the validity of the race concept among them.

Cussins stumbled out of the gate, writing that the “legitimacy of race as a biological concept has been largely discredited,” but offering no links to support that contention. The best Cussins can muster is an unlinked quote from a college student. Yet, as she notes in the very same sentence, racial categories (often as crude proxies for genetic differences between populations) are currently ubiquitous in medicine and medical research.”

Are research scientists just not as smart as Cussins? Are they just stubborn, hanging onto outdated and dangerous ideas?

Obviously not. No one seriously questions the deciding role of “race”—defined as population—in circumscribing the possibility of elite success in many sports, including running, soccer, football and field events. For example, no scientist was surprised that yet again, all of the finalists in the sprint races were of West African ancestry, the distance races were dominated by East Africans, and the strength and field events were won mostly by Eurasians.

Of more consequence, population differences are central to the emerging era of personalized medicine, which is grounded in the sometimes uncomfortable reality that human sub-groups evolved differently as the result of cultural and physical isolation. The simplistic white/black/Asian construct is dated, but geneticists, now more than ever, points to the reality of patterned differences in everything from drug reactions to thinking patterns to body type and athletic ability.

The thorny reality is that if there were no “racial” differences, the entire Human Genome Project would be meaningless. Frequencies of many polymorphic genes vary with population clusters and can have powerful health consequences. The great paradox of human biodiversity research, which is focused on finding the genetic basis to many diseases, is that the only way to understand how similar humans are is to learn how we differ.

“The classification of human ethnic or racial groups remains a viable, important feature in understanding the nature and mechanism of human evolution,” writes Ranajit Chakraborty, a population geneticist at the University of Texas Health Science Center at Houston. Chakraborty distinguishes between the popular concept of race (which includes cultural dimensions, such as self-definition) and the term now used by geneticists and evolutionary biologists to mean a common biological inheritance. The precise number and grouping of races will always be somewhat arbitrary–race is in part a social construct. Typology, the typing of humans into categories, is akin to wrestling an octopus into a shoe box: no matter how hard you fight with it, you still have something dangling out somewhere. Modern typologists cannot even agree whether it is more meaningful to lump races into large fuzzy groups or to split them into smaller units of dozens or even hundreds of populations.

There are no doubts in the broader medical community that “race” can play a critical role in treating disease or chronic health problems. Genetic factors help explain the prevalence of Tay-Sachs, a neurological disease, among European Jews and their Diaspora descendants and the proclivity to skin cancer and cystic fibrosis among Northern Europeans. The presence of the gene apolipoprotein E allele, E-4 allele is a potent risk factor of Alzheimer’s in Caucasians but not for blacks of West African ancestry. The Pima Indians have one of the highest rates of diabetes in the world. A condition called primaquine sensitivity is responsible for the intensity of the reaction to certain drugs among African, Mediterranean, and Asian men. Another mutated gene accounts for the sensitivity of the Japanese to alcohol. Other genetic polymorphisms found in specific population groups are associated with sensitivity to certain foods, type one diabetes, QT syndrome (a heart disease), asthma, thrombophilia (bleeding disorder), and an inability to metabolize common drugs like codeine, beta-blockers and antidepressants. These are all “racial” differences of a kind; potentially thousands more remain to be identified.

For example, if you need a blood transfusion or a bone marrow transplant, knowing that you have African roots and taking that into account in finding appropriate matches could be the difference between life and death. People of sub-Saharan African descent have distinct and relatively rare genetic make-ups. In the United States, while 40 percent of Caucasians who didn’t have a bone marrow match in their own family were able to receive a transplant through the national marrow donor program, the rate for African-Americans was 15 percent.

How do we sort out sometimes-slippery facts about “race” from folkloric nonsense? After all simplistic notions of race have been misused to justify discrimination against blacks, Aboriginals, Jews and other groups. The five common arguments are:

1. Humans are 99.9 percent the same. Therefore, race is “biologically meaningless.”

2. The genetic variation among European, African and Asian populations is minuscule compared to differences between individuals within those populations.

3. Human differences are superficial because populations have not had enough evolutionary time to differentiate.

4. “There are many different, equally valid procedures for defining races, and those different procedures yield very different classifications.”

5. Documenting human group differences is outside the domain of modern scientific inquiry.

Here’s an analysis of these issues and a template for a far more textured discussion than you’ll find at CGS and similar ideologically-based NGOs. It might be nice if there were no innate differences of any kind among population groups, at least besides the obvious cosmetic ones. But genes do not confer equality, for without differences, evolution would be impossible. Humans are different, the consequence of thousands of years of evolution in varying terrains. Society, and science in particular, pay a huge price for not discussing this openly, if carefully.

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