Professional Documents
Culture Documents
Bio-Race Caste-Race
Asian, African, Caucasian, Pacific Japanese or Japanese-American,
Islander etc
Throughout history scientists have used social and politically determined racial
categories to make scientific comparisons between races—with little or no discussion
about the meaning or rationale. . . .
Race might be a proxy for discriminatory experiences, diet or other environmental
factors. . . .
There is no justification, however, to use race as a substitute for other parameters
that can be measured . . ..
Nature Genetics 2000:24:97-8.
Multivariate “caste-race” Analysis
Environment
Disease
(Physical and
incidence,
psychological
outcome
toxins) “Race”
Behaviors
(compliance, diet,
sex, exercise,
practitioner bias,
etc)
Race as a Medical Variable
Useful Variable Distracting Relic
• Whether African Americans, Hispanics, • Scientific Grounding:
Native Americans, Pacific Islanders or Asians – Race was constructed by a false biology, misused
respond equally to a drug is an empirical for repression and neglect and remains un-
validated.
question that can only be addressed by
studying these groups individually. • Given that cultural factors:
– Are poorly controlled for by most studies using
• We strongly support the search for race as a variable (partly as a legacy of the social
candidate genes that contribute to disease construction of race categories)
susceptibility and treatment response, – Are a more plausible explanation for the huge
within and across racial/ethnic groups. diversity of race disparities (longevity,
birthweight, cancers, heart disease, disabilities
• A lot of the problem is terminology. I'm not etc)
even sure what race means, people use it in – Are more susceptible to cost effective intervention
many different ways. . . . but that doesn't than gene targeted therapy,
preclude you from using it or the fact that it • Therefore, unless new research finds otherwise,
has utility. bio-race should not be used as an explanatory
– Risch N variable for profiling or explaining health care
states, except for allele based diseases that
highly sort to narrowly inbred populations.
Race Medicine
“Facts”
• Blacks have 2X the risk of first strokes as whites.
• Blacks have ↑ stroke death rates than whites.
CDC 2009
Images from American Stroke Assn Home Page.
Most Powerful Voices Choir Power Gospel Tour Dates Power Finance Healthy Soul Food Recipes
Competition Revised! Having a stroke can be a life- Consumer Publications has
PTES and the Gospel Music The Power Gospel Tour is a changing event. In addition to created an oversized hardcover
Channel are looking for the celebration of faith and health, impacting your health, the cookbook to honor Ms. Yolanda
Most Powerful Voices in an punctuated by key messages effects can be equally King, the first national
online choir competition. about stroke prevention. devastating to your finances. Ambassador for Power To End
Stroke.
PR Week Awards
Power To End Stroke
received honorable
mention in the category
of Multicultural
Marketing Campaign of
the Year...
Black / White Stroke incidence
after SocioEconomic Status (SES) adjustment.
• Disadvantage in early childhood
may confer increased risk in
adulthood, perhaps mediated by
infectious diseases, nutritional
conditions, or poverty-related
stresses.
• Cardiovascular risk factors are
established early in life and begin
to diverge in black and white
subjects during childhood.
– Ann Epi 2008;18:904 -12. 24000
Whites and 24000 Blacks
Epidem 1995;6;181-3.
Am J Pub Health;2009;99;690-97.
Class, 5 yr Cancer Survival: Access matters.
Low Income
AJPH 2000;
90:1866-72
Previous slide does not take account of
High Wealth relatively wider gap between rich and
Inequality
USA, Norway,
poor in the US relative to Canada.
Australia.
Medium
Wealth
Inequality
Italy, Finland Lower Inequality
France, Austria,
Netherlands, associated with:
Switzerland.
Education,
Obesity,
Low Wealth Heart disease,
Inequality Stroke,
Spain, UK,
Australia,
Unhealthy behaviors
Sweden,
Denmark,
Germany Soc Sci & Med 2008;66:1719-32.
A Problem
Ethnicity-targeted health
campaigns risk ethnic
Ethnic community targeted
branding that reinforces
health campaigns can be an
fatalism about the health
important to reducing
consequences of cultural
disparities.
difference and
socioeconomic stratification.
Minneapolis, Minn. - January 21, 2010 - HealthPartners Medical Group today
announced that it has launched an initiative aimed at saving lives by
providing more timely colorectal cancer screening for African American
patients. Organizations, such as the American College of Gastroenterology
recommend that regular colorectal cancer screening for African Americans
should begin at age 45, compared to age 50 for other races.
"Nationally, colorectal cancer deaths are 48 percent higher among African
Americans than among Caucasians," said Brian Rank, M.D. an oncologist and
medical director of the HealthPartners Medical Group. "Our goal is to save
lives by ensuring that more African American patients in our clinics receive
recommended colorectal cancer screening in a timely manner.“ . . . "We
have made reducing health disparities a top priority," said Rank. . . .
• Participants exposed to “disparity” (e.g. Blacks are doing worse than Whites) articles:
– reported more negative emotional reactions to the information and
– were less likely to want to be screened for CRC than those in other groups (both P < 0.001).
• Progress articles (e.g., Blacks are improving, but less than Whites, Blacks are
improving over time) elicited more positive emotional reactions and participants were
more likely to want to be screened.
– Cancer Epidemiology, Biomarkers & Prevention 2008; 17:2946-53, 2008. Double-blind RCT
compared emotional and behavioral reactions to 4 versions of the same colon cancer (CRC)
information in mock news articles to a community sample of 300 African-American adults. All
articles said colon cancer important problem for African-Americans.
Pain Treatment
JAMA 1993;269:1537–9. Single ED in TN. Adjusted Ann Emerg Med 2000;35:11–6. Retrospective cohort study of patients
for gender, language, insurance, severity, single ED in GA.
intoxication.
These findings also apply to post-op pain tx after hip fx and to nursing home residents.
This disparity is not due to decreased pain perception by clinicians.
It is due to a failure to act on the perception of pain in minority patients.
Pain Med 2003;4:277-94.
Possible Solutions
Culturally competent health care providers.
Given that there are more epigenetic control marks than genes, is it fair to
assert that nature, not nurture, is the primary determinant of who we are?
Slides Available
Steven Miles, MD
University of Minnesota
miles001@umn.edu