Racialized Medicine: Prophecies for Profit

A few days ago, on a website I recently joined, I was faced with an interesting comment regarding my position on race. The comment read as follows:

"Basically the definition [of race] here you've given me is from the New Left. Unsurprisingly, its adherents do not address the differences in populations relating to genetics, responses to medications, vulnerabilities to disease, or incompatibilities with cross-group transplantation. To say that there are no differences between human population groups is either a flagrant lie or indicates you have been raised in a cave by wild hogs."

Of course, the commenter was unaware of the fact that I have addressed many arguments concerning race before, so to say that these "differences in populations" have not been addressed is pretty funny. In actuality, the entirety of this comment was a goldmine, but considering that I've addressed much of it before, and that there's really too much to consider in a single post (without boring everyone to death), I decided to narrow down my focus to "responses to medications;" or in other words, race-targeted medicine. The answer to this question, actually, can be applied to a lot of between-group differences regarding race, so this is an important case to look at. The idea, as the moniker implies, is that certain racial/ethnic groups respond differently to medications, and thus pharmaceutical/medical treatment should take race/ethnicity into consideration when treating patients.

If we were to take a look at the data, we might be convinced that this is the case. For example, Burroughs et al. (2002) writes:

"The recent report of the Institute of Medicine (IOM), "Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare;" illustrates in eloquent scientific detail that racial and ethnic disparities in health care do exist and are prevalent in both the treatment of medical illness and in the delivery of care services to minorities in the United States." (Burroughs et al. 2002:1)

There are two problems with such a conclusions: (1) the parameters; and, (2) the use of race as a proxy.

By parameters, I mean how "race" is defined in these studies which show racial/ethnic disparities in responses to medical treatment. Much of my knowledge on race is informed by the special 2009 edition of the American Journal of Physical Anthropology entitled "Race Reconciled: How Biological Anthropologists View Human Variation." It's incredibly informative, and for anyone who is willing to sit through some of the jargon (much like I may end up doing), I would highly recommend it. In any case, it's thus only appropriate that I refer to Gravlee (2009), "How race becomes biology: Embodiment of social inequality." Gravlee writes:

"Racial-genetic determinism persists in part because of the uncritical use of race in biomedical sciences and public health. Systematic reviews in health-related disciplines show that race is widely used--appearing in ~80% of recent articles--but that it is seldom defined (Anderson and Moscou, 1998; Drevdahl et al., 2001; Comstock et al., 2004; Gravlee and Sweet, 2008). For example, in three independent reviews of literature in genetics (Sankar et al. 2007), infant mortality research (Anderson and Moscou, 1998), and health services research (Williams, 1994), not a single article defined race." (Gravlee 2009:49)

In the absence of definition, we can only assume that we are looking at the traditional racial/ethnic categories that are used in the United States. This is problematic for reason 2 as stated above: that in these studies, race is used as a substitute for individual genotypes based on tested averages. Of course, this is a terrible proxy due to the complexity and nested pattern of human diversity. As Long et al. (2009) writes:

"[...] a classification that takes into account evolutionary relationships and the nested pattern of diversity would require that Sub-Saharan Africans are not a race because the most exclusive group that includes all Sub-Saharan African populations also includes every non-Sub-Saharan African population." (Long et al. 2009:32)

Hunley et al. (2009) comes to the same general conclusions, but tackles the idea of racialized medicine with their findings:

"Our findings confirm that broad ethnic categories employed in medical genetic research might not adequately take into account the complex geographic pattern of genetic structure in the species, but for the same reason, neither may continental ancestry. This is because our results also indicate that substantial, potentially medically important genetic differences may exist between populations within regions." (Hunley et al. 2009:45)

Practitioners who use race as a substitute for the true genetic explanations behind their results are making a grave mistake, and so are drug companies, because they are severely underestimating the true degree of diversity in different populations, especially sub-Saharan Africa. That being said, race is a horrible substitution for known alleles and genotypes. Thankfully, individual DNA analysis has become quite cheap over the years, and offers much more insight for individualized treatment.

Unfortunately, failures such as BiDil are ultimately going to be swatted at back and forth by the left and right, because scandals such as these are profitable, inspire research for the pharmaceutical field, and fans the flames of debates over race and "political correctness."

So, in summation:
(1) In biomedical research, race is hardly defined, if at all;
(2) To answer the question: "why do races respond differently to medical treatment," the answer is, we don't know if they really do;
(3) Using race as a mean for individual genotypes and alleles ignores the pattern of human diversity and the staunch differences within populations; and,
(4) Race-targeted medicines are honestly just prophecies for profits despite the much cheaper, more accurate use of individual DNA testing.

To conclude, I think it's interesting that individuals such as the commenter I am replying to, who are so skeptical of mainstream science, do not suspect the foul play going on here, simply for the fact that it seemingly validates the biological concept of race. This doesn't mean, however, that variation doesn't exist, and this is a point I've repeated many times in the past. As Relethford 2009:20 writes, race is "a culturally constructed label that crudely and imprecisely describes real variation." The possibility that our DNA is affecting our responses to medical treatment is definitely there; but race, as it stands, is a bad representation of this genetic variation.

Thank you for reading.



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References:

Burroughs VJ, Maxey RW, & Levy RA (2002). Racial and ethnic differences in response to medicines: towards individualized pharmaceutical treatment. Journal of the National Medical Association, 94 (10 Suppl), 1-26 PMID: 12401060

Gravlee, C. (2009). How race becomes biology: Embodiment of social inequality. American Journal of Physical Anthropology, 139 (1), 47-57 DOI: 10.1002/ajpa.20983

Hunley, K., Healy, M., & Long, J. (2009). The global pattern of gene identity variation reveals a history of long-range migrations, bottlenecks, and local mate exchange: Implications for biological race. American Journal of Physical Anthropology, 139 (1), 35-46 DOI: 10.1002/ajpa.20932

Long, J., Li, J., & Healy, M. (2009). Human DNA sequences: More variation and less race. American Journal of Physical Anthropology, 139 (1), 23-34 DOI: 10.1002/ajpa.21011

Relethford, J. (2009). Race and global patterns of phenotypic variation American Journal of Physical Anthropology, 139 (1), 16-22 DOI: 10.1002/ajpa.20900