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Lynn TM, D’urzo KA, Vaughan-Ogunlusi O, Wiesendanger K, Colbert-Kaip S, Capcara A, Chen S, Sreenan S, Brennan MP. The impact of a student-led anti-racism programme on medical students' perceptions and awareness of racial bias in medicine and confidence to advocate against racism. MEDICAL EDUCATION ONLINE 2023; 28:2176802. [PMID: 36787247 PMCID: PMC9930825 DOI: 10.1080/10872981.2023.2176802] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 10/30/2022] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Systemic racism impacts personal and community health; however, education regarding its role in perpetuating healthcare inequity remains limited in medical curricula. This study implemented and evaluated the impact of a student-led anti-racism programme on medical students' perceptions of racial bias in medicine, awareness of, and confidence to advocate against racism in medicine. METHOD A total of 543 early stage medical students were invited to participate in the programme. Participants were assigned readings and videos exploring racial injustice in medicine and attended a virtual small-group discussion facilitated by faculty and students. Online surveys were used to collect pre- and post-programme data using Likert scales for response items. Open-ended questions were independently reviewed by three authors using reflexive thematic analysis. RESULTS Sixty-three early-stage medical students enrolled in the programme, of which 42 completed the pre-programme survey. There was a 76% (n = 32) response rate for the post-programme survey. The majority of students (60%, n = 25) had no previous education about racism in medicine. From pre- to post-programme, there was a significant change in students' perceived definition of race from genetic, biological, geographical, and cultural factors to socio-political factors (P < 0.0001). Significant increases in almost all factors assessing student awareness of racism and confidence to advocate against racism were observed. Student-identified barriers to discussing racism included lack of education and lived experience, fear of starting conflict and offending others. All survey respondents would recommend this programme to peers and 69% (n = 32) engaged in further topical self-directed education. CONCLUSION This simple and reproducible programme improved awareness and confidence to advocate against racism in medicine and resulted in a change in opinion regarding race-based medical practice. These findings are in line with best practice towards addressing racial bias in medicine, decolonizing medical curricula and strengthening anti-racism teaching of future physicians.
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Affiliation(s)
- Thérése M. Lynn
- Graduate Entry Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Katrina A. D’urzo
- Graduate Entry Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Kathryn Wiesendanger
- Graduate Entry Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Sarah Colbert-Kaip
- Graduate Entry Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Austin Capcara
- Graduate Entry Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Sarah Chen
- Graduate Entry Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Seamus Sreenan
- Graduate Entry Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Department of Endocrinology, Connolly Hospital, Dublin, Ireland
| | - Marian P. Brennan
- Graduate Entry Medicine, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- School of Pharmacy and Biomedical Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Sharma S, Mariño-Ramírez L, Jordan IK. Race, Ethnicity, and Pharmacogenomic Variation in the United States and the United Kingdom. Pharmaceutics 2023; 15:1923. [PMID: 37514109 PMCID: PMC10383154 DOI: 10.3390/pharmaceutics15071923] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 06/30/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023] Open
Abstract
The relevance of race and ethnicity to genetics and medicine has long been a matter of debate. An emerging consensus holds that race and ethnicity are social constructs and thus poor proxies for genetic diversity. The goal of this study was to evaluate the relationship between race, ethnicity, and clinically relevant pharmacogenomic variation in cosmopolitan populations. We studied racially and ethnically diverse cohorts of 65,120 participants from the United States All of Us Research Program (All of Us) and 31,396 participants from the United Kingdom Biobank (UKB). Genome-wide patterns of pharmacogenomic variation-6311 drug response-associated variants for All of Us and 5966 variants for UKB-were analyzed with machine learning classifiers to predict participants' self-identified race and ethnicity. Pharmacogenomic variation predicts race/ethnicity with averages of 92.1% accuracy for All of Us and 94.3% accuracy for UKB. Group-specific prediction accuracies range from 99.0% for the White group in UKB to 92.9% for the Hispanic group in All of Us. Prediction accuracies are substantially lower for individuals who identified with more than one group in All of Us (16.7%) or as Mixed in UKB (70.7%). There are numerous individual pharmacogenomic variants with large allele frequency differences between race/ethnicity groups in both cohorts. Frequency differences for toxicity-associated variants predict hundreds of adverse drug reactions per 1000 treated participants for minority groups in All of Us. Our results indicate that race and ethnicity can be used to stratify pharmacogenomic risk in the US and UK populations and should not be discounted when making treatment decisions. We resolve the contradiction between the results reported here and the orthodoxy of race and ethnicity as non-genetic, social constructs by emphasizing the distinction between global and local patterns of human genetic diversity, and we stress the current and future limitations of race and ethnicity as proxies for pharmacogenomic variation.
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Affiliation(s)
- Shivam Sharma
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA 30332, USA;
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD 20892, USA;
| | - Leonardo Mariño-Ramírez
- National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD 20892, USA;
| | - I. King Jordan
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA 30332, USA;
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Braveman P. Preventing Maternal Mortality. Med Care 2023; 61:255-257. [PMID: 36929776 DOI: 10.1097/mlr.0000000000001847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Affiliation(s)
- Paula Braveman
- Family and Community Medicine, University of California, San Francisco, CA
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Payne-Sturges DC, Gee GC, Cory-Slechta DA. Confronting Racism in Environmental Health Sciences: Moving the Science Forward for Eliminating Racial Inequities. ENVIRONMENTAL HEALTH PERSPECTIVES 2021; 129:55002. [PMID: 33945300 PMCID: PMC8096378 DOI: 10.1289/ehp8186] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND The twin pandemics of COVID-19 and systemic racism during 2020 have forced a conversation across many segments of our society, including the environmental health sciences (EHS) research community. We have seen the proliferation of statements of solidarity with the Black Lives Matter movement and commitments to fight racism and health inequities from academia, nonprofit organizations, governmental agencies, and private corporations. Actions must now arise from these promises. As public health and EHS scientists, we must examine the systems that produce and perpetuate inequities in exposure to environmental pollutants and associated health effects. OBJECTIVES We outline five recommendations the EHS research community can implement to confront racism and move our science forward for eliminating racial inequities in environmental health. DISCUSSION Race is best considered a political label that promotes inequality. Thus, we should be wary of equating race with biology. Further, EHS researchers should seriously consider racism as a plausible explanation of racial disparities in health and consider structural racism as a factor in environmental health risk/impact assessments, as well as multiple explanations for racial differences in environmental exposures and health outcomes. Last, the EHS research community should develop metrics to measure racism and a set of guidelines on the use and interpretation of race and ethnicity within the environmental sciences. Numerous guidelines exist in other disciplines that can serve as models. By taking action on each of these recommendations, we can make significant progress toward eliminating racial disparities. https://doi.org/10.1289/EHP8186.
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Affiliation(s)
- Devon C. Payne-Sturges
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Gilbert C. Gee
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
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Nagar SD, Conley AB, Jordan IK. Population structure and pharmacogenomic risk stratification in the United States. BMC Biol 2020; 18:140. [PMID: 33050895 PMCID: PMC7557099 DOI: 10.1186/s12915-020-00875-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 09/22/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Pharmacogenomic (PGx) variants mediate how individuals respond to medication, and response differences among racial/ethnic groups have been attributed to patterns of PGx diversity. We hypothesized that genetic ancestry (GA) would provide higher resolution for stratifying PGx risk, since it serves as a more reliable surrogate for genetic diversity than self-identified race/ethnicity (SIRE), which includes a substantial social component. We analyzed a cohort of 8628 individuals from the United States (US), for whom we had both SIRE information and whole genome genotypes, with a focus on the three largest SIRE groups in the US: White, Black (African-American), and Hispanic (Latino). Our approach to the question of PGx risk stratification entailed the integration of two distinct methodologies: population genetics and evidence-based medicine. This integrated approach allowed us to consider the clinical implications for the observed patterns of PGx variation found within and between population groups. RESULTS Whole genome genotypes were used to characterize individuals' continental ancestry fractions-European, African, and Native American-and individuals were grouped according to their GA profiles. SIRE and GA groups were found to be highly concordant. Continental ancestry predicts individuals' SIRE with > 96% accuracy, and accordingly, GA provides only a marginal increase in resolution for PGx risk stratification. In light of the concordance between SIRE and GA, taken together with the fact that information on SIRE is readily available to clinicians, we evaluated PGx variation between SIRE groups to explore the potential clinical utility of race and ethnicity. PGx variants are highly diverged compared to the genomic background; 82 variants show significant frequency differences among SIRE groups, and genome-wide patterns of PGx variation are almost entirely concordant with SIRE. The vast majority of PGx variation is found within rather than between groups, a well-established fact for almost all genetic variants, which is often taken to argue against the clinical utility of population stratification. Nevertheless, analysis of highly differentiated PGx variants illustrates how SIRE partitions PGx variation based on groups' characteristic ancestry patterns. These cases underscore the extent to which SIRE carries clinically valuable information for stratifying PGx risk among populations, albeit with less utility for predicting individual-level PGx alleles (genotypes), supporting the concept of population pharmacogenomics. CONCLUSIONS Perhaps most interestingly, we show that individuals who identify as Black or Hispanic stand to gain far more from the consideration of race/ethnicity in treatment decisions than individuals from the majority White population.
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Affiliation(s)
- Shashwat Deepali Nagar
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA USA
- PanAmerican Bioinformatics Institute, Cali, Colombia
| | - Andrew B. Conley
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA USA
- PanAmerican Bioinformatics Institute, Cali, Colombia
- IHRC-Georgia Tech Applied Bioinformatics Laboratory, 950 Atlantic Drive, Atlanta, GA 30332 USA
| | - I. King Jordan
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA USA
- PanAmerican Bioinformatics Institute, Cali, Colombia
- IHRC-Georgia Tech Applied Bioinformatics Laboratory, 950 Atlantic Drive, Atlanta, GA 30332 USA
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Caspari R. Race, then and now: 1918 revisited. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2019; 165:924-938. [PMID: 29574831 DOI: 10.1002/ajpa.23417] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 01/07/2018] [Accepted: 01/08/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Rachel Caspari
- Department of Sociology, Anthropology and Social Work, Central Michigan University, Mt. Pleasant, Michigan 48859
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Gutin I. Essential(ist) medicine: promoting social explanations for racial variation in biomedical research. MEDICAL HUMANITIES 2019; 45:224-234. [PMID: 29941665 DOI: 10.1136/medhum-2017-011432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/30/2018] [Indexed: 06/08/2023]
Abstract
Biomedical research has a long and complicated history as a tool of oppression, exemplary of the racial science used to legitimise and maintain racial hierarchies in the USA and abroad. While the explicit racism and racial inferiority supported by this research has dissipated and modern methods of inquiry have increased in sophistication and rigor, contemporary biomedical research continues to essentialise race by distilling racial differences and disparities in health to an underlying, biogenetic source. Focusing on the persistence of essentialism in an era of genomic medicine, this paper examines the deep social origins and social implications of the essentialist viewpoint in biomedicine and how it relates to the broader construction of social and scientific knowledge. Invoking Hacking's 'looping effects' as a useful conceptual tool, I then demonstrate how sociohistorical forces influence scientific and medical research in producing evidence that favours and legitimises a biological construction of race. I extend the looping framework to consider a parallel 'louping' process whereby applying a socially rooted meaning to race in biomedical research results becomes magnified to influence social norms and ideas about race. As many biomedical researchers are motivated by a desire to eliminate racial disparities in outcomes, I argue that greater social acuity allows scientists to avoid individualising and racialising health, challenge preconceived assumptions about the meaning of racial variation in health and medicine and thus promote and strengthen a socioenvironmental focus on how to best improve individuals' and population health. Concluding with a call for structural competency in biomedical research, I suggest that empowering scientists to more freely discuss sociostructural factors in their work allows for the continued use of race in biological and medical research, while social scientists and medical humanities scholars stand to benefit from seeing their work imbued with the cultural authority currently granted to biomedicine.
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Affiliation(s)
- Iliya Gutin
- Department of Sociology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Cook AD, Ward JG, Chapple KM, Akinbiyi H, Garrett M, Moore FO. Race and rehabilitation following spinal cord injury: equality of access for American Indians/Alaska Natives compared to other racial groups. Inj Epidemiol 2016; 2:17. [PMID: 27747749 PMCID: PMC5005801 DOI: 10.1186/s40621-015-0049-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 06/10/2015] [Indexed: 11/27/2022] Open
Abstract
Background Representing 2 % of the general population, American Indians/Alaska Natives (AIs/ANs) were associated with 0.5 % (63) of the estimated 12,500 new cases of spinal cord injury (SCI) reported to the National Spinal Cord Injury Statistic Center in 2013. To date, the trend in health care disparities among AIs/ANs in the SCI community has not been examined. We sought to compare the rate of discharge to rehabilitation facilities (DRF) following traumatic SCI among adult AIs/ANs to other racial/ethnic groups for patients 15 to 64 years old. Methods Utilizing data from the National Trauma Data Bank (NTDB), we performed a retrospective analysis of SCI cases occurring between January 1, 2008 and December 31, 2012. SCI injuries were identified by International Classification of Diseases 9th Revision-Clinical Modification (ICD-9) codes or Abbreviated Injury Scale (AIS) scores. Injury severity was determined using the Trauma Mortality Prediction Model (TMPM) which empirically estimates each patient’s probability of death given their individual complement of injuries. A series of seven logistic regression models were used to predict DRF between racial groups. Results Among the 29,443 patients in our cohort, 52.4 % were discharged to rehabilitation facilities. AIs/ANs comprised 1.1 % of the population, with 63.8 % dismissed to rehabilitation. AIs/ANs were significantly younger, had a higher probability of death, had longer hospital length of stay (HLOS), and were proportionately more likely to be discharged to rehabilitation compared to non-AIs. Regression models demonstrated increased odds of DRF for AIs/ANs compared to Hispanic and Asian racial/ethnic groups. Conclusions American Indians/Alaska Natives who sustain SCI access rehabilitative care at a rate equitable to or greater than other races when multiple factors are taken into account. Further research is needed to assess the effect of those patient, physician, and health care system determinants as they relate to a patient’s ability to access post-trauma rehabilitative care. Recommendations include advancing the level of racial, insurance, and geographic data necessary to adequately explore disparities related to such ubiquitously life-altering conditions as SCI.
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Affiliation(s)
- Alan D Cook
- Chandler Regional Medical Center, Chandler, AZ, USA.
| | | | | | | | - Mark Garrett
- Chandler Regional Medical Center, Chandler, AZ, USA
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Physicians' knowledge, beliefs, and use of race and human genetic variation: new measures and insights. BMC Health Serv Res 2014; 14:456. [PMID: 25277068 PMCID: PMC4283084 DOI: 10.1186/1472-6963-14-456] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 09/18/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding physician perspectives on the intersection of race and genomics in clinical decision making is critical as personalized medicine and genomics become more integrated in health care services. There is a paucity of literature in the United States of America (USA) and globally regarding how health care providers understand and use information about race, ethnicity and genetic variation in their clinical decision making. This paper describes the development of three scales related to addressing this gap in the literature: the Bonham and Sellers Genetic Variation Knowledge Assessment Index--GKAI, Health Professionals Beliefs about Race-HPBR, and Racial Attributes in Clinical Evaluation-RACE scales. METHODS A cross-sectional, web survey of a national random sample of general internists in the USA (N = 787) was conducted. Confirmatory factor analysis was used to assess the construct validity of the scales. Scale items were developed through focus groups, cognitive interviews, expert advisory panels, and exploratory factor analysis of pilot data. RESULTS GKAI was measured as a count of correct answers (Mean = 3.28 SD = 1.17). HPBR yielded two domains: beliefs about race as a biological phenomenon (HPBR-BD, alpha = .69, 4 items) and beliefs about the clinical value of race and genetic variation for understanding risk for disease (HPBR-CD alpha = .61, 3 items). RACE yielded one factor (alpha = .86, 7 items). CONCLUSIONS GKAI is a timely knowledge scale that can be used to assess health professional knowledge of race and human genetic variation. HPBR is a promising new tool for assessing health professionals' beliefs about the role of race and its relationship with human genetic variation in clinical practice. RACE offers a valid and reliable tool for assessing explicit use of racial attributes in clinical decision making.
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Friedman A, Lee C. Producing knowledge about racial differences: tracing scientists' use of "race" and "ethnicity" from grants to articles. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2013; 41:720-732. [PMID: 24088163 DOI: 10.1111/jlme.12082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The research and publication practices by which scientists produce biomedical knowledge about race and ethnicity remain largely unexamined, and most of the existing research looks at the knowledge production process at a single point in time. In light of this, we specifically focus on the questions of whether and in what ways researchers' discussions of race and ethnicity change over the course of the research process by comparing grant proposals to published articles. Using content analysis, we investigated the use of race and ethnicity in 72 grants funded by the National Cancer Institute of the National Institutes of Health between 1990 and 1999 and 144 matched articles published between 1996 and 2010, tracing the production of biomedical knowledge from study design to published findings. This is also the first study to look at whether the NIH Inclusion Mandate, which went into effect in June of 1994, changed the way investigators research and write about racial and ethnic differences. In following this knowledge production process, we explore how scientists "deliver" on their research proposal goals. In addition, we provide insight into whether and how state policies directed at guiding research practices can shape output.
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Affiliation(s)
- Asia Friedman
- Assistant Professor in the Department of Sociology and Criminal Justice at the University of Delaware. Associate Professor of sociology and a faculty associate at the Institute for Health, Health Care Policy, and Aging Research at Rutgers University
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Fujimura JH, Rajagopalan R. Different differences: the use of 'genetic ancestry' versus race in biomedical human genetic research. SOCIAL STUDIES OF SCIENCE 2011; 41:5-30. [PMID: 21553638 PMCID: PMC3124377 DOI: 10.1177/0306312710379170] [Citation(s) in RCA: 131] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
This article presents findings from our ethnographic research on biomedical scientists' studies of human genetic variation and common complex disease. We examine the socio-material work involved in genome-wide association studies (GWAS) and discuss whether, how, and when notions of race and ethnicity are or are not used. We analyze how researchers produce simultaneously different kinds of populations and population differences. Although many geneticists use race in their analyses, we find some who have invented a statistical genetics method and associated software that they use specifically to avoid using categories of race in their genetic analysis. Their method allows them to operationalize their concept of 'genetic ancestry' without resorting to notions of race and ethnicity. We focus on the construction and implementation of the software's algorithms, and discuss the consequences and implications of the software technology for debates and policies around the use of race in genetics research. We also demonstrate that the production and use of their method involves a dynamic and fluid assemblage of actors in various disciplines responding to disciplinary and sociopolitical contexts and concerns. This assemblage also includes particular discourses on human history and geography as they become entangled with research on genetic markers and disease.We introduce the concept of'genome geography' to analyze how some researchers studying human genetic variation'locate' stretches of DNA in different places and times. The concept of genetic ancestry and the practice of genome geography rely on old discourses, but they also incorporate new technologies, infrastructures, and political and scientific commitments. Some of these new technologies provide opportunities to change some of our institutional and cultural forms and frames around notions of difference and similarity. Nevertheless, we also highlight the slipperiness of genome geography and the tenacity of race and race concepts.
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Affiliation(s)
- Joan H Fujimura
- Department of Sociology, University of Wisconsin-Madison, 8128 Social Science Building, 1180 Observatory Drive, Madison, WI 53706, USA.
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Royal CD, Novembre J, Fullerton SM, Goldstein DB, Long JC, Bamshad MJ, Clark AG. Inferring genetic ancestry: opportunities, challenges, and implications. Am J Hum Genet 2010; 86:661-73. [PMID: 20466090 PMCID: PMC2869013 DOI: 10.1016/j.ajhg.2010.03.011] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Revised: 02/22/2010] [Accepted: 03/10/2010] [Indexed: 10/19/2022] Open
Abstract
Increasing public interest in direct-to-consumer (DTC) genetic ancestry testing has been accompanied by growing concern about issues ranging from the personal and societal implications of the testing to the scientific validity of ancestry inference. The very concept of "ancestry" is subject to misunderstanding in both the general and scientific communities. What do we mean by ancestry? How exactly is ancestry measured? How far back can such ancestry be defined and by which genetic tools? How do we validate inferences about ancestry in genetic research? What are the data that demonstrate our ability to do this correctly? What can we say and what can we not say from our research findings and the test results that we generate? This white paper from the American Society of Human Genetics (ASHG) Ancestry and Ancestry Testing Task Force builds upon the 2008 ASHG Ancestry Testing Summary Statement in providing a more in-depth analysis of key scientific and non-scientific aspects of genetic ancestry inference in academia and industry. It culminates with recommendations for advancing the current debate and facilitating the development of scientifically based, ethically sound, and socially attentive guidelines concerning the use of these continually evolving technologies.
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Affiliation(s)
- Charmaine D Royal
- Institute for Genome Sciences & Policy, Duke University, Durham, NC 27708, USA.
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Haiman CA, Stram DO. Exploring genetic susceptibility to cancer in diverse populations. Curr Opin Genet Dev 2010; 20:330-5. [PMID: 20359883 DOI: 10.1016/j.gde.2010.02.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 02/09/2010] [Accepted: 02/20/2010] [Indexed: 01/15/2023]
Abstract
Incidence rates for many cancers differ markedly by race/ethnicity and furthering our understanding of the genetic and environmental causes of such disparities is a scientific and public health need. Genome-wide association studies (GWAS) are widely acknowledged to provide important information about the etiology of common cancers. To date, these studies have been primarily conducted in European-derived populations. There are important reasons for extending the reach of GWAS studies to other groups and for conducting multiethnic genetic studies involving multiple populations and admixed populations. These include a (1) need to discover the full scope of variants that affect risk of disease in all populations, (2) furthering the understanding of disease pathways, and (3) to assist in fine-mapping of genetic associations by exploiting the differences in linkage disequilibrium between populations to narrow the range of marker alleles demarking regions that contain a true biologically relevant variant. Challenges to multiethnic studies relating to study power, control for hidden population structure, imputation, and use of shared controls for multiple cancer endpoints are discussed.
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Affiliation(s)
- Christopher A Haiman
- Department of Preventive Medicine, Keck School of Medicine and the Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
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Gravlee CC, Non AL, Mulligan CJ. Genetic ancestry, social classification, and racial inequalities in blood pressure in Southeastern Puerto Rico. PLoS One 2009; 4:e6821. [PMID: 19742303 PMCID: PMC2731885 DOI: 10.1371/journal.pone.0006821] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Accepted: 08/03/2009] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The role of race in human genetics and biomedical research is among the most contested issues in science. Much debate centers on the relative importance of genetic versus sociocultural factors in explaining racial inequalities in health. However, few studies integrate genetic and sociocultural data to test competing explanations directly. METHODOLOGY/PRINCIPAL FINDINGS We draw on ethnographic, epidemiologic, and genetic data collected in Southeastern Puerto Rico to isolate two distinct variables for which race is often used as a proxy: genetic ancestry versus social classification. We show that color, an aspect of social classification based on the culturally defined meaning of race in Puerto Rico, better predicts blood pressure than does a genetic-based estimate of continental ancestry. We also find that incorporating sociocultural variables reveals a new and significant association between a candidate gene polymorphism for hypertension (alpha(2C) adrenergic receptor deletion) and blood pressure. CONCLUSIONS/SIGNIFICANCE This study addresses the recognized need to measure both genetic and sociocultural factors in research on racial inequalities in health. Our preliminary results provide the most direct evidence to date that previously reported associations between genetic ancestry and health may be attributable to sociocultural factors related to race and racism, rather than to functional genetic differences between racially defined groups. Our results also imply that including sociocultural variables in future research may improve our ability to detect significant allele-phenotype associations. Thus, measuring sociocultural factors related to race may both empower future genetic association studies and help to clarify the biological consequences of social inequalities.
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Affiliation(s)
- Clarence C Gravlee
- Department of Anthropology, University of Florida, Gainesville, Florida, United States of America.
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Bonham VL, Sellers SL, Gallagher TH, Frank D, Odunlami AO, Price EG, Cooper LA. Physicians' attitudes toward race, genetics, and clinical medicine. Genet Med 2009; 11:279-86. [PMID: 19265721 PMCID: PMC3065019 DOI: 10.1097/gim.0b013e318195aaf4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE This qualitative study explored black and white general internists' attitudes about the relevance of race in clinical care; views of the relationships among race, genetics, and disease; and expectations about the future of genetics and health. METHODS We conducted 10 racially concordant focus groups of primary care physicians in five metropolitan areas in the United States. Ninety board certified or eligible general internists (50 self-identified whites and 40 self-identified blacks) participated in the study. Analysis included a two-stage independent review and adjudication process. RESULTS Both black and white physicians concluded that the race of the patient is medically relevant but did not agree upon why race is important in clinical decisions. They were reticent to make connections among race, genetics, and disease and asserted that genetics has a limited role in explaining racial differences in health. However, they were enthusiastic about the future of genomic medicine, believing that the main benefit will be the potential to improve the efficacy of commonly used drugs. CONCLUSIONS Understanding the similarities and differences between black and white physicians' attitudes and beliefs about race, health and genetics is important for the translation of genomics to clinical care.
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Affiliation(s)
- Vence L Bonham
- Social and Behavioral Research Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland 20892, USA.
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Gravlee CC. How race becomes biology: Embodiment of social inequality. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2009; 139:47-57. [DOI: 10.1002/ajpa.20983] [Citation(s) in RCA: 448] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Caulfield T, Fullerton SM, Ali-Khan SE, Arbour L, Burchard EG, Cooper RS, Hardy BJ, Harry S, Hyde-Lay R, Kahn J, Kittles R, Koenig BA, Lee SSJ, Malinowski M, Ravitsky V, Sankar P, Scherer SW, Séguin B, Shickle D, Suarez-Kurtz G, Daar AS. Race and ancestry in biomedical research: exploring the challenges. Genome Med 2009; 1:8. [PMID: 19348695 PMCID: PMC2651580 DOI: 10.1186/gm8] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The use of race in biomedical research has, for decades, been a source of social controversy. However, recent events, such as the adoption of racially targeted pharmaceuticals, have raised the profile of the race issue. In addition, we are entering an era in which genomic research is increasingly focused on the nature and extent of human genetic variation, often examined by population, which leads to heightened potential for misunderstandings or misuse of terms concerning genetic variation and race. Here, we draw together the perspectives of participants in a recent interdisciplinary workshop on ancestry and health in medicine in order to explore the use of race in research issue from the vantage point of a variety of disciplines. We review the nature of the race controversy in the context of biomedical research and highlight several challenges to policy action, including restrictions resulting from commercial or regulatory considerations, the difficulty in presenting precise terminology in the media, and drifting or ambiguous definitions of key terms.
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Affiliation(s)
- Timothy Caulfield
- Faculty of Law and School of Public Health Research, Health Law Institute, University of Alberta, 89 Ave and 111 St., T6G 2H5, Canada
| | - Stephanie M Fullerton
- Department of Medical History and Ethics and Department of Genome Sciences, University of Washington School of Medicine, Seattle, WA 98195, USA
| | - Sarah E Ali-Khan
- Program on Life Sciences Ethics and Policy, McLaughlin-Rotman Centre for Global Health, University Health Network, University of Toronto, MaRS Centre, 101 College St, Toronto, Ontario, M5G 1L7, Canada
| | - Laura Arbour
- Faculty of Medicine, Island Medical Program, University of British Columbia, 3800 Finnerty Rd, Victoria, British Columbia, V8P 5C2, Canada
| | - Esteban G Burchard
- Department of Biopharmaceutical Sciences and Department of Medicine, Divisions of Pharmaceutical Sciences and Pharmacogenetics, Pulmonary & Critical Care Medicine, and Clinical Pharmacology, University of California, San Francisco, CA 94143-2911, USA
| | - Richard S Cooper
- Department of Epidemiology & Preventive Medicine, Stritch School of Medicine, Loyola University, 2160 South First Avenue, Maywood, IL 60153, USA
| | - Billie-Jo Hardy
- Program on Life Sciences Ethics and Policy, McLaughlin-Rotman Centre for Global Health, University Health Network, University of Toronto, MaRS Centre, 101 College St, Toronto, Ontario, M5G 1L7, Canada
| | - Simrat Harry
- Faculty of Law and School of Public Health Research, Health Law Institute, University of Alberta, 89 Ave and 111 St., T6G 2H5, Canada
| | - Robyn Hyde-Lay
- Genome Alberta, 3553-31 St NW, Calgary, Alberta, T2L 2K7, Canada
| | - Jonathan Kahn
- Hamline University School of Law, 1536 Hewitt Avenue, St. Paul, MN 55104, USA
| | - Rick Kittles
- Department of Medicine, Section of Genetic Medicine, Department of Human Genetics, University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, USA
| | - Barbara A Koenig
- Program in Professionalism & Bioethics, Mayo College of Medicine, 200 First St SW, Rochester, MN 55905, USA
| | - Sandra SJ Lee
- Stanford Center for Biomedical Ethics, Stanford University Medical School, 701 Welch Rd, Palo Alto, CA 94304, USA
| | - Michael Malinowski
- Paul M Hebert Law Center, Louisiana State University, 1 East Campus Drive, Baton Rouge, LA 70803, USA
| | - Vardit Ravitsky
- Department of Medical Ethics and Center for Bioethics, University of Pennsylvania, 3401 Market St, Philadelphia, PA 19104, USA
| | - Pamela Sankar
- Department of Medical Ethics and Center for Bioethics, University of Pennsylvania, 3401 Market St, Philadelphia, PA 19104, USA
| | - Stephen W Scherer
- The Centre for Applied Genomics, The Hospital for Sick Children, and Department of Molecular Genetics, University of Toronto, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada
| | - Béatrice Séguin
- Program on Life Sciences Ethics and Policy, McLaughlin-Rotman Centre for Global Health, University Health Network, University of Toronto, MaRS Centre, 101 College St, Toronto, Ontario, M5G 1L7, Canada
- Leslie Dan School of Pharmacy, University of Toronto, 144 College St, Toronto, Ontario, M5S 3M2, Canada
| | - Darren Shickle
- Leeds Institute of Health Sciences, University of Leeds, 101 Clarendon Rd, Leeds, LS2 9LJ, UK
| | - Guilherme Suarez-Kurtz
- Pharmacology Division, Instituto Nacional de Câncer, Rua André Cavalcanti 37, Rio de Janeiro 20231-050, Brazil
| | - Abdallah S Daar
- Program on Life Sciences Ethics and Policy, McLaughlin-Rotman Centre for Global Health, University Health Network, University of Toronto, MaRS Centre, 101 College St, Toronto, Ontario, M5G 1L7, Canada
- Department of Public Health Sciences and of Surgery, University of Toronto, 155 College St, Toronto, Ontario, M5T 3M7, Canada
- McLaughlin Centre for Molecular Medicine, University of Toronto, MaRS Centre, 101 College St, Toronto, Ontario, M5G 1L7, Canada
- Department of Medicine, University of Toronto and University Health Network, 190 Elizabeth St, Toronto, Ontario, M5G 2C4, Canada
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Abstract
In this paper I examine claims of racial difference in bone density and find that the use and definitions of race in medicine lack a theoretical foundation. My central argument is that the social produces the biological in a system of constant feedback between body and social experience. By providing a different angle of vision on claimed racial differences I hope to move the conversation away from an ultimately futile discussion of nature versus nurture, where time is held constant and place seen as irrelevant, and begin to build a new paradigm for examining the contributions of geographic ancestry, individual lifecycle experience, race, and gender to varied patterns of health and disease.
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Affiliation(s)
- Anne Fausto-Sterling
- Department of Molecular Biology, Cell Biology and Biochemistry, Brown University, Providence, RI 02912, USA.
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Kelaher M, Paul S, Lambert H, Ahmad W, Smith GD. The Impact of Different Measures of Socioeconomic Position on the Relationship Between Ethnicity and Health. Ann Epidemiol 2008; 18:351-6. [DOI: 10.1016/j.annepidem.2007.12.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Revised: 12/11/2007] [Accepted: 12/28/2007] [Indexed: 11/25/2022]
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Braun L, Fausto-Sterling A, Fullwiley D, Hammonds EM, Nelson A, Quivers W, Reverby SM, Shields AE. Racial categories in medical practice: how useful are they? PLoS Med 2007; 4:e271. [PMID: 17896853 PMCID: PMC1989738 DOI: 10.1371/journal.pmed.0040271] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Is it good medical practice for physicians to "eyeball" a patient's race when assessing their medical status or even to ask them to identify their race?
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