Race-based medicine, or the practice of treating people differently based on their racial and ethnic background, has long been a subject of interest to healthcare providers, public health practitioners, communicators and others. Now, with the introduction of Bi-Dil, the first medication approved for the treatment of a condition in a specific race (African Americans), the topic is once again gaining increased attention.
Given the intense interest in this subject, I have decided to conduct a series of periodic interviews with physicians, executives from medical societies, communications experts and others. Each interview subject provides his or her unique perspective on race-based medicine, which I then publish on this blog.
I invite all of you to comment on this issue. If you wish to be interviewed on this subject, please contact me. I can be reached at news at envisionsolutionsnow dot com.
Interview Subject: Sally Guttmacher, PhD
About Dr. Guttmacher: Sally Guttmacher is Professor and Director of the Masters Program in Public Health at New York University. Public health concerns, particularly as they pertain to world health, are at the center of Guttmacher’s research. She has published extensively on the topics of health policy, the prevention of chronic and infectious diseases and the intersection between policy and public health. She has also spent extensive time in South Africa focusing on the HIV epidemic there.
Interview
Q: There has been a lot of discussion recently about race-based
medicine. What are the benefits and/or drawbacks to using race as a means of treating and grouping patients?
A: All humans are identical for about 75% of genetic factors and about 95% of the variation is within racial groups rather than between them. This does not preclude any biological difference between races, but it tells us that the differences are not so great. Therefore, to focus on race as a basis for medical intervention seems inappropriate at best. Much more of the health and disease differences that we see between groups of people are related to socioeconomic status, age, life style, culture, and gender. It would seem to me to be much more productive to base medicine on these factors rather than race.
Q: In your mind, is there a link between race and disease or is
there something else going on?
A: As I just mentioned, there are many other things going on that by far outweigh the difference in health and disease related to race. Almost all disease is class related. Racism in the United States has played a major part in keeping non-whites, especially African Americans or Latinos from moving up the social class ladder. Non-whites are more likely to remain in the lower class and thus are more likely to die at an earlier age than whites from class related disease such as asthma, diabetes, heart disease, cancer, stroke etc..
Q: Pharmaceutical companies, advocacy organizations and others
spend a lot of time and effort attempting to communicate to different groups about diseases that impact them. From what you’ve seen, are these efforts effective?
A: This depends upon how you want to measure effective. I do not believe that secondary prevention is the way to go to decrease the health status difference between whites and blacks in the USA. I think that it is far better to prevent people from getting disease than getting people to use drugs to manage chronic disease once they are afflicted.
Increased education leading to life style changes is the way to prevent disease. Decreasing poverty is a far more efficient way to decrease the burden of disease because living in poverty is frequently associated with poor eating habits, increased use of illicit substances and decreased opportunity for healthy activities.
On the whole, pharmaceutical companies are in the business of selling drugs and making a profit for shareholders. Certainly, they have through advertising managed to reach every group that has access to mass media. Viagra is a good example of this. Sometimes this has been too effective in the sense that many sexually active young men have become careless in their sexual encounters because they now see HIV/AIDS as a chronic disease which can be effectively managed through the use of drugs. I do not think that the problem is that the pharmaceutical companies have been unable to reach people, the problem is that many people in the US lack health insurance and are unable to afford the drugs that they need to have to treat their disease.
Q: What would you do to improve them?
A: I don’t think that the problem is communication. You can not watch TV without seeing drug related advertisements. There are some things that pharmaceutical companies can do to help folks once they have developed treatable chronic diseases. They can work to keep costs down, possibly by spending less money on advertising. They can stop raising prices by bringing “new†drugs on the market that are simply reformulated versions of old drugs in new packaging. They can refrain from creating new markets that don’t necessarily lead to better health. Sleeping pills are a good recent example of this problem. They are currently being aggressively promoted so that their use has skyrocketed.
I believe that pharmaceutical companies have an ethical obligation to see that the drugs that are needed by folks in underdeveloped parts of the world such as sub-Saharan Africa have access to the drugs for major infectious diseases such as HIV/AIDS, TB and Malaria. This means allowing countries to produce these drugs themselves if the companies are not willing to produce them at low cost.
Q: Are there any ethnic/racial groups that are currently being neglected or overlooked in health promotion efforts?
A: I am not aware of any ethnic groups that are being overlooked. Those groups that are being overlooked by the pharmaceutical companies are the ones that do not have the money to pay for drugs.
Q: Have you been following the Jackson Heart Study? If so, what are your thoughts on this effort?
A: I am aware of the study and it certainly looks interesting and I would support such work. But as I have said above, there are many other factors such as class that are more clearly related to disease than race.
Q: Is there anything going on over seas around race-based medicine that disturbs or inspires you?
A: I am not really aware of any work in this area. I work in South Africa for part of each year and I do not know of anyone in South Africa who is focusing on race based medicine. As far as I know such a focus was abandoned when South Africa made the transition from Apartheid to Democracy.
Q: Can you provide any general commentary on this issue?
A: Definitions of race have changed over time and have often been developed uncritically (i.e. skin color). At the turn of the century national origin was thought of as race, i.e. Italians or Irish. The definition of African American has changed from African to Black to African American. Currently ‘ethnicity has been “racialized†to Latinos, Whites, blacks/African American. Certainly the biological meaning of race continues to be refuted by work in population genetics, anthropology and sociology. Do these current concepts of race add anything to our understanding of health and disease? Perhaps a more important question for us in the US is to develop an understanding of how racism contributes to ill health.
I will end my response to your questions with the following quote by Thomas LaVeist:
“Only when we move beyond race as a proxy and directly measure those concepts believed to be measured by race, will we make truly important advances in describing the true nature of racial variation in health. And, only then can we begin what is really the important work: eliminating disparities in health status.â€
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