Race and Medicine

We seem to be pursuing a theme here today, albeit an unintentional one, with race and medicine. In the medical field, there’s something that’s referred to as “personalized medicine.” This is the idea that doctors will (some day) be able to individually tailor medical care to the patient’s needs based on an individual-level analysis of the individual’s genome. Now, some are suggesting that this “personalized medicine” should replace racial classification. Sharon Begley writing in “LabNotes” for Newsweek, says:

…a new paper published online this week by the journal Clinical Pharmacology & Therapeutics, .. concludes that classifying people by the crude category of race—as in, of African, Asian or European ancestry—for medical purposes, as some people want to do, is really, really stupid.

The article Begley refers to, “Individual Genomes Instead of Race for Personalized Medicine,” reports on the results of the sequencing of the genes of two white guys – Craig Venter and James Watson (yes, the same Watson) – to see how they metabolize six different drugs. The results were revealing.

What they found is that these two men, ostensibly of the “same race,” in fact have very different genetic make-ups when it comes to how their bodies process certain drugs. What these geneticists conclude is consistent with what social scientists have been saying for some time: “race” is social category, not a meaningful biological category. In the words of the authors of the study:

…race/ethnicity should be considered only a makeshift solution for personalized genomics because it is too approximate; known differences may occur within a defined category. …The label “African” or “African-American” is therefore insufficient to determine whether an individual comes from a population with a high frequency of the *17 allele. Even if an individual is known to be, for example, Ethiopian rather than Zimbabwean, the ancestry is less relevant than the true genotype, which could be easily resolved with today’s technology. Even the term “Caucasian” can be deceptive. If a self-identified Caucasian originates from a founder population in which certain disease-specific alleles occur at higher frequencies (e.g., Quebec French Canadians or Ashkenazi Jews), his or her doctor may miss an important aspect of the patient’s medical history. One’s ethnicity/race is, at best, a probabilistic guess at one’s true genetic makeup.

I have to say, I feel quite vindicated, given the little dust-up back in November 2007 (see the comments) with guys who wanted to argue that the “reality of race is genetic.” Still, it’s deeply ironic that this news should come from Venter and Watson, not known for their forward thinking on race (see my earlier posts about both of them here and here). But hey, I’ll take it.

AMA Apologizes for Institutionalized Racism: Another Look

In mid-July Jessie did a post on the AMA apology, but I would like to add a bit more on this issue, especially about how racism works in US medicine. One good result from anti-racism efforts in the last decade may be that we are getting more serious apologies from white organizations about slavery or Jim Crow segregation. Harriet Washington reports in a late July 2008 New York Times article on one of the most institutionally racist sectors of our society, U.S. medical care institutions. Highly (photo of AMA building: Steve and Sara) and blatantly segregated until the late 1960s, she notes, the American Medical Association has recently apologized the National Medical Association, the country’s leading black medical association:

An apology to the nation’s black physicians, citing a century of ”past wrongs.”

From the beginning, U.S. medicine’s institutions have been racially and gender segregated, but Jim Crow and gender segregation increased in the early 1900s with the implementation of private and government “reforms” designed to get rid medical practitioners who were not officially licensed—which usually meant they were not from the more elite (almost all white) medical schools and often practiced various kinds of folk medicine (including midwives). These reforms did raise U.S. medical standards, at least for allopathic mainstream medicine, yet also effectively excluded many white women and practitioners of color from their traditional medical practices. And Jim Crow segregation became very central to this newly reformed medical system:

. . . black patients and doctors were often relegated to subterranean ”colored” or charity wards or banned from hospitals altogether; they had responded with their own hospitals and medical schools, at least seven of which existed in 1909. By 1938, the situation had grown so dire that Dr. Louis T. Wright of Harlem Hospital declared, ”The A.M.A. has demonstrated as much interest in the health of the Negro as Hitler has in the health of the Jew.”

Washington notes that the American Medical Association continued to be a problem until the end of the civil rights movement era:

The Civil Rights Act of 1964 passed without active support from the A.M.A. Title VI of the act closed the Hill-Burton loophole: segregation within hospitals became illegal….But for African-American and other antisegregationist physicians, there remained a final bastion of racial exclusion to conquer: the A.M.A.

Demands by African American physicians and some white allies that the association desegregate were ignored by its leadership until the late 1960s. From 1963 to 1968 the association had to endure public protests against its racist practices. In 1968 the association finally took action to end legal segregation in its constituent state societies.

Still, today, the percentage of U.S. physicians who are African American (2.2 percent) is still smaller than it was in 1910 (2.5 percent). And our medical care system is riddled with numerous kinds of institutional racism, as recent research reports (see various chapters here and chapter 7 here) frequently make clear. There are some very good scholarly bloggers like U. Dayton’s Prof. Vernellia Randall (see her great website here) who have given even more details on how such institutionalized racism works and how it is a violation of international human rights and anti-discrimination laws.

Note: I have given more than 100 invited lectures over the years on my research on racism at many schools and colleges within our top universities and liberal arts colleges across the country, and I have only had one invited lecture cancelled–ever. This was after two faculty members saw at the xerox machine the handout (it had quotes from whites making various racist comments, from my research interviews) that I was going to talk about. This was a Florida medical school, which had invited me and other researchers to talk about racial matters because they had had racist graffitti in their medical school classrooms. They reportedly still have problems today.