Race and Biomedicine

Re: Heart attack drug less effective for Maori and Pacific Islanders

The non-response rate for Maori and Pacific Island patients was very high with 57% not demonstrating an adequate response.

“This is an important finding as Maori and Pacific Island patients have a high rate of cardiovascular disease and poor outcomes following heart attacks. This finding could partially explain these poor outcomes,” says Dr Harding, who is also an adjunct professor at Victoria University. Additional aspects of the study also found that the drug dose and the presence of diabetes affected the patients’ response to the drug.

The study conducted by Dr. Harding and Victoria PhD student Lisa Johnston is the first New Zealand-based study to examine what proportion of patients suffering a heart attack is not being effectively treated with the standard drug approach.

“You can’t always extrapolate data from international studies and apply it to New Zealand. We have a unique population that means results overseas aren’t necessarily the same for us,” says Miss Johnston.

I was just conjecturing about this possibility over at Intersecting Processes:

In case you missed it, Nature Genetics had an issue on this (Nature Genetics v. 36, 2004). Many of the concerns that you noted were mentioned but it was generally thought that knowledge of ancestry had value and that, to the extent ‘race’ was a proxy for ancestry, knowledge of that also had value — at least, given the current state of knowledge. You might find the argument made by Tate and Goldstein in “Will tomorrow’s medicines work for everyone?” interesting. In that article, the authors argued that, for the sake of “social justice,” more consideration of ancestry in medical research is needed. The article brings to mind some problematic ethical issues that run reverse to your concerns. In that regards, it’s worth considering that pharmaceutical and other companies market their products internationally and yet their experimental populations are not always globally representative. Usually opposition to the idea of “race based medicine” hangs on images of handing out different pills to “X people” than “Y people,” but you can look at the issue in reverse. Globally, medicine is used yet the efficacy, it could be argued, is judged by unrepresentative samples. I guess, though, that would only be a concern if you think that there could be medical relevant genetic differences between historic regional.

To continue with what I was saying, one problem that I have with critiques of “race based medicine” is that often overly provincial views are taken. Take your following point:

“You might ask, “Does your ancestry trace back to region X?” There is a good chance that African-Americans won’t know this, or won’t know their places of ancestry with enough precision to be helpful, or will have multiple places of origin in Africa. Moreover, if he is a descendant of slaves, you know he has probably has a lot of European ancestry. “OK, we need to do a genetic test to see if he has the genetic variant in question.”

Your implicit reasoning about race based medicine seems to be, basically: is it good for Africans Americans? The question “Do calcium channel blockers treat hypertension worse than beta blockers?” has relevance, though, not just for African-Americans but for the billions of non-Europeans who were likely underrepresented in the study samples. (Or were the samples globally representative? — I don’t know; it’s something to look into,) Perhaps considerations of ‘race’ has questionable relevance for African-Americans and other hybrid groups, but what about West Africans, Oceanians, and East Asians? Presumably, much of the West African medical knowledge is based on research conducted on non-African populations. (I don’t know, but again it might be worth looking into). Does this have relevance? Should medical practitioners outside the US be alerted that there could be medicine x population genotype interactions? Those, to my mind, are the important questions. The exclusive focus on ‘race’ in context to the US or West is somewhat myopic especially given the global demographics and projected growth.

Personally, I’m fine with Eurocentered medicine.

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4 Responses to Race and Biomedicine

  1. Steve Sailer says:

    The simplest way for doctors to think productively about race is as an extension of “family medical history.”

    • Chuck says:

      You’re really pounding away at this “race” = family idea. Generally, I prefer “race” = lineage (or ancestry), from which “race” as family can be derived. I tend to call Hispanics, for example, multiracial because they represent a mix of continental lineages — where you would called them monoracial because they are “a partially inbred extended family.” It’s a difference in focus. (I also find that it’s easier to debate anti-racers when race is equated with ancestry.)

      Interestingly, Pete Taylor,whose site I was commenting on, goes on and on, criticizing what he sees as the conflation of race and family in medicine. From what I glean, he’s not the only one.

  2. Steve Sailer says:

    Why would I call Hispanics monoracial? I certainly wouldn’t for medical purposes.

    Doctors are trained to think about family medical history. For example, here’s a Mayo Clinic project to get people to compile their “medical family tree:”

    http://www.mayoclinic.com/health/medical-history/HQ01707

    Thus, it’s easier for doctors to think about race as representing the family tree beyond the written-down family tree. In an easily fatigued child, sickle cell anemia should be higher up the list of what to test for if the baby is black than white because sickle cell anemia is more likely to run in black families than white families.

    • Chuck says:

      So Steve, no one answered my previous question. Was Sarich right about FST values in relation to between individual diversity? The low Fst value keeps getting trotted out to dismiss the possibility of significant genetic mediated differences. For example, Barbujani and Colonn — both foes of the race concept — note:

      “Moving to the second question, differences between populations are often summarized by another popular figure, FST = 0.15 (Box 2), and this means that they account for roughly 15% of the species’ genetic variance [17–19]. The remaining 85% represents the average difference between members of the same population. One way to envisage these figures is to say that the expected genetic difference between unrelated individuals from distant continents exceeds by 15% the expected difference between members of the same community [20]” (Barbujani and Colonn, 2010. Human genome diversity: frequently asked questions)

      Sarich, citing Harpending, contends the above statement is incorrect since a large portion of the diversity is locked up within individuals. As such “the remaining 85% represents” the average difference between and within members of the same population. Which would lead to the conclusion that: “the expected genetic difference between unrelated individuals from distant continents exceeds by ~35% the expected difference between members of the same community.”

      Would you mind asking Harpending whether he concurs with Sarich or whether he concurs with Barbujani? If the former, I’ll be sure to email the latter and all those that have cited him. These small points are important.

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