Sunday, July 09, 2006

 

Navigating Continents of Origin


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Denise Grady, in an article this past week in the New York Times entitled "Imperfect, Imprecise but Useful: Your Race," reports on what is becoming a difficult issue for the medical profession: how should doctors approach any study that indicates a disparity in the incidence, outcome or efficacy of treatment of a disease is based on the patient's racial or ethnic group?

An editorial in The New England Journal of Medicine in 2001 said race was a "social construct, not a scientific classification," and denounced "race-based medicine," including "medical research arbitrarily based on race." The editorial concluded that "in medicine, there is only one race — the human race."

Such high-minded sentiments sound pretty good. But the same issue of the journal also included an article and another editorial suggesting there were some important racial differences in the way people reacted to various medicines, including drugs used to treat high blood pressure, heart failure, depression and pain. The differences could affect the dose a person needed, or whether a particular drug should be used at all.

For example, Dr. James P. Evans, director of adult genetics at the University of North Carolina says:

It's a very explosive issue. And for a good reason. The whole concept of race has been abused blatantly in the past and egregiously misused in order to accomplish very distasteful ends socially and politically. ...

The question remains, does any of the differential distribution of gene forms have potential medical significance? I think the answer is, sure. There may be differentially distributed genotypes that put a group, in aggregate, at increased or decreased risk for certain diseases or affect their responses to certain medications.

Complicating the whole issue is the fact that there is no direct correlation between what people think of as "race" and the genetic inheritance of the individual patient. Mixed ancestry may, in fact, be the norm and, if it isn't, it soon will be with the expansion of the global economy and travel. Add to that the fact that economic and social differences that effect "education, stress, diet, exercise and access to health care" can also play a significant role in the onset, severity and outcome of the treatment of disease, and it becomes questionable if knowing the race of the patient provides any useful information. Ideally, according to Dr. Evans, we would want to know the exact genes in each individual that effect susceptibility to disease, rather than rely on some statistical correlation. But that information is not available for most diseases at this time.

To avoid the charged word "race," "continent of origin" is being used more and more and may reflect the useful information better anyway. Dr. Lisa A. Carey, the medical director of the University of North Carolina at Lineberger says:

I agree with people who say race is an artificial construct. It has limited usefulness now, as a proxy for ancestral geographic region.

But she adds:

It's what we have. If it gives us some information it's better than no information.

It's a difficult situation that we face because of our own past and present failures, both as a society and as individuals. But it would be ironic indeed if the victims of racism were harmed again because people of good will, in their desire not to repeat past wrongs, were afraid to consider all the evidence that might be put to use in helping them.

Link - Posted by John Pieret @ 5:33 PM
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