Should Doctors Focus on "Racial Genetics" as a Means of Reducing Black-White Health Disparities?
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| 19th Century Concept of Racial Types |
Several years ago, I set out to explore what some scientists refer
to as the “genetics of race.” The reason medical researchers give for this
far from new preoccupation on skin color is that it might aid in reducing
health disparities between blacks and whites. However, the conclusions I
reached after exhaustive study and research was that there is no such thing as
“racial genetics”. It is true that I am not a scientist. Rather, I
am a historian. But an incident happened years ago, that caused me
to suspect that identifying treatment protocols by race can turn
lethal.
The Bell Curve
In 1994, Richard Herrnstein and Charles Murray published The Bell Curve. In this 850 page book replete with page upon page of empirical data, statistical analyses, and graphs, the two authors asserted that intelligence was a genetic factor defined by one’s race, and that social inequities in American life resulted from the fact that whites exhibited higher cognitive levels than blacks.
Shortly after its publication, a spate of articles and books by prominent scholars began appearing to refute the book’s argument.[i] Critics, including an impressive array of scientists and academics in other fields as well, convincingly demonstrated that The Bell Curve sat on highly fallacious ground. While Herrnstein and Murray had argued that intelligence was heritable and thus blacks were genetically doomed to a lower intelligence level than whites, their critics counter-argued that even heritable traits could be changed by a healthier social environment. Critics also pounced on The Bell Curve’s use of a now outmoded, linear conception of intelligence. That is, Herrnstein and Murray’s work insisted on using IQ exams as the sole measure of human intelligence, even though such tests had been shown to be not merely culturally biased, but also prejudiced in favor of mathematical-logical intelligence at the expense of other dimensions to human cognition, such as linguistic, musical, kinetic, and interpersonal intelligence. While Herrnstein and Murray asserted that the 15 point IQ score between whites and blacks was essentially immutable, they simply ignored what scholars now referred to as “the Flynn effect.” Professor James R. Flynn, a political scientist from New Zealand discovered that IQ scores have steadily risen in technologically advanced countries over the course of this century at a rate of three points per decade. With such being the case, it was simply not possible for human genetics to have changed at such a rapid pace, thus invalidating the assertion that IQ scores were a true measure of immutable, genetically-defined human intelligence.[ii]
After carefully digesting both The Bell Curve and the writings of its critics, the comments of the Senegalese doctor whom I had met years before began to reverberate through my thoughts like a struck brass gong. “Perhaps race is not what it seems.” And indeed, an entire generation of contemporary biologists and geneticists now insist that there are no biological races within anatomically-modern humans.[iii]
Non-Existence of Race Gene
Most geneticists working at the cutting edge of this dynamic field have now refute old notions of racial classifications based on the antiquated belief that differences in skin color corresponded to a package of genetic differences, and thus formed a basis for human categorization. Geneticists and physical anthropologists came to recognize that the human races were socially-constructed. That is, the racial delineations we used within society to delineate groups did not exist in science. They were not genetic. One of the most insightful comments regarding the true nature of race came from Columbia University anthropologist, Alexander Alland, who asserted in Race in Mind:
Finding a pure race is like looking for the heart of an onion.
You peel away layer after layer until you are left in tears with nothing in your hand.[iv]
Admittedly, the layperson might not at first glance understand why “race” was not genetic. The non-existence of a “race gene” was counter-intuitive in the same way that our knowledge that the earth revolved around the sun flew in the face of the evidence of our very eyes.[v] The socially-contrived nature of race categories was in some ways even more difficult to appreciate than the fact of the earth’s revolution since, even a pre-schooler could be taught to distinguish, visually, black people from white people from yellow people. “So, surely the races must be genetic,” our visual senses might scream out to us. But alas, this was just not so. Human geographic variation was of course familiar to all of us, that is, the fact that we could distinguish a Nigerian from a Norwegian at a glance. The problem though was in assuming that because two people shared the same skin color, nose-shape and hair texture, that they were more genetically similar to one another than to someone of another “race.” Of course, geography does play a role, but not as definitive a one as many might believe. Even if one did try to correlate geographic proximity to race, less than half the world’s population could be correctly categorized. The majority would fall somewhere in-between, negating the scientific basis of the exercise. Besides, what sane human being in today’s world would ever accept a blood transfusion from someone based on the fact that the potential donor was categorized as being in the same race?
Geneticists now know that if they took a random group of people and separated them into three rooms using the popular social designation of skin color, so that the black-skinned people were placed in room “A”, yellows or Orientals in room “B”, and whites in room “C”, the range of genetic similarities and differences would simply not correspond by room, i.e. by skin color. The visually definable differences between the individuals allotted to each room would not correspond to a prescribed genetic package for each grouping. In short, human variability did not track with racial groupings. It was firstly because humans shared 99.9% identical DNA. But the second reason was that a greater proportion of the remaining 0.1% DNA, which accounted for human variation in height, skin color, blood type and so forth, was parceled among the people in each room (or so-called race) than the amount of variation between rooms (or races). If blood or genetic markers were used as criteria for room (racial) selection, then for each new genetic attribute chosen, a completely new grouping would be formed. That is, new groupings of individuals sharing those particular genetic commonalities would emerge, shuffling the skin-color admix of the original groupings ad infinitum. It is not that people could not be separated out and grouped. It is simply that the initial sectioning of people based on skin-color would quickly dissolve into an array of other groupings just as arbitrary as the first.
In the face of this larger genetic reality, one could certainly have insisted that visual inspection by skin-color be maintained. But that insistence would emanate either from social and political impulses or otherwise from geographic prejudices rather than scientific-genetic evidence. It was in this regard that Michigan State University Professor Alain Corcos pointed out:
“Scientists have finally realized that they were no more successful using blood groups, or other genetic markers, than they had been in the past when they were using skulls or skin color. They have finally realized that categorizing human beings into ‘races’ requires such a distortion of the facts that its usefulness as a tool disappears.”[vi]
And yet, how could it be that the people with black skin didn’t share more genetic material in common with each other than the people with white skin? There were several misconceptions that needed to be addressed. Mainstream scientists now knew something most of them might only have suspected years ago, when genetics was still in its infancy. That is, there were two ways that people might come to resemble one another in terms of the characteristics of skin color, hair texture, shape of nose and other external characteristics we popularly use to define “race.” The first was of course familial. We all knew it because we saw it occurring before our very eyes. Two people met, married, had offspring, who then shared some “familial” resemblance to the parents, grandparents, possessing as well an indisputable genetic closeness. It was for this reason that when we observed people who shared similar characteristics of skin color, or hair texture or physique, it was understandable that many of us might have jumped to the conclusion that this race of people was actually a loosely-knit family, the result of intermarrying ancestors and the concomitant inter-sharing of genes.
But alas, modern geneticists have now confirmed a second way that a group of people could come to share similar physical or racial attributes through a process having little to do with the familial transmission of genes. It was of course, environmental. Thus two populations could live in different parts of the world, share the same characteristic of having dark skin, but still be more genetically distant than one of those groups would be to Europeans.
While geneticists have found a host of human variations – the perhaps shocking discovery of modern genetics was that they did not coincide with our social designation of races. For instance, Stanford population geneticist Luca Cavalli-Sforza found the largest genetic difference between African and Australian aboriginals. But such evidence created a fundamental problem for “race science” because these two groups would both be classified as ‘black,” within the popular Negroid, Caucasoid, Mongoloid racial classification scheme. It was, in fact, for this reason that 19th century anthropologists coined the term “Negritoes,” to describe the not-quite-equatorial-African but nevertheless “Negro-like” physical traits of Australian aboriginal populations.
Dr. Spencer Wells, a population geneticist at Oxford University explained why legitimate population geneticists recognized race as a cultural construct and did not subscribe to the concept of a biology of race in a Times of London article (November 20, 2000): He stated: “You can find more genetic differences between two Africans than between an African and someone from the Outer Hebrides [off the west coast of Scotland].” Professor Wells also explained that as early humans migrated from Africa they evolved variations in skin color and other traits that helped them adapt to their new European and Asian environments. The emergence of a paler skin color, a trait which may be only a few thousand years old, allowed for a more efficient production of vitamin D among these northern populations, who had appreciably less exposure to the sun than their tropical ancestors. The later group had evolved darker complexions to protect them from overexposure to the sun’s damaging rays. Interestingly, the idea that pale skins reflected a more evolved race, a tenet of white supremacy was bogus, population genetics revealed. It was most likely that when man appeared in Africa around 100,000 years ago, his skin was mid-brown. Paler and darker skins would have surfaced in tandem, according to where people settled.
Forensics
The general public was sometimes confused by media accounts of forensic specialists identifying the “race” of a crime suspect based on DNA evidence. The assumption was that there were actual genetic markers enabling the expert to distinguish the white, black, and Asian races. In truth, what criminologists were employing were statistical procedures, examining a wide range of genetic markers in order to offer a probability of certain geographic ancestry. If, for example, 40 percent of West Africans and 15 percent of Polynesians shared a particular allele, that is, different expressions of the same gene, the fact that a forensics specialist designated a DNA fragment found in Harlem, New York as belonging to an “African-American,” did not mean that the specialist actually identified a “race” gene. That individual was making an educated guess based on the cultural configuration of New York neighborhoods. But in announcing the race of the perpetrator, the specialist might inadvertently mislead the general public into believing that race was something that could be clearly discerned under the microscope.
Sickle Cell Anemia
Another issue that often arose to confound the public was the issue of disease, the fact that African-Americans suffered, for example, from sickle cell anemia, which whites did not. But alas, appearances could indeed be deceptive. As I learned in the 1970s from my experience in Africa, those East and Southern African groups, who emanated from non-malarial areas, did not possess the Hemoglobin S responsible for sickle cell anemia, while coastal Greeks and East Indians (both of which have been categorized as white), did.
But what if I had been socialized into drawing boundaries around human groupings according to skin color and I was not consciously aware of the ways in which my beliefs skewed my perceptions? Then, it was almost certain that I would presume that science would have been able to find greater genetic distinctions between people possessing more or less melanin in their skin than it would using other human characteristics that were not as outwardly visible – such as blood groupings or alleles. In such a case, the fault did not actually lie with my capacity to analyze data. It was simply that the lens through which I was conducting my measurements was distorted from the beginning. It was for this reason that modern geneticists came to realize that such attempts at racial classifications were in the end a fool’s errand. This was not because of political correctness or social sensibilities. It was rather because of the genetic configuration of the human species itself. The belief that visible human variation connoted fundamental deep differences within the species was not borne out by modern science.
Health Disparities
A new generation of health practitioners are becoming preoccupied with racial genetics at the moment when many scholars are dismissing the term. The reasons relate specifically to BiDil, the first drug in Amnerica that is being niche-marketed to blacks. It was approved by the Food and Drug Adminstration in 2003. Robin Marantz Henig writing in the October 10, 2004 New York Times had the following to say about it: BiDil is also a feat of creative repackaging. Five years ago, the F.D.A. rejected it for use in the general population because it was found to be ineffective in the treatment of heart failure, a common complication of cardiovascular disease that affects some five million Americans and leads to 300,000 deaths a year. But in 2001, the manufacturer, NitroMed, asked permission to test BiDil exclusively in blacks, whose heart failure tends to be more severe and harder to treat. The company reasoned that the drug's effect on nitric-oxide deficiency, more common in black heart-failure patients than in nonblacks, might make it especially suited to them. With the collaboration of the Association of Black Cardiologists, NitroMed embarked on a large clinical trial involving more than 400 black women and 600 black men, all of whom had heart failure.”
So what’s wrong with this approach? It’s dangerous. Many African-Americans emanated from the same region of West Africa and thus share greater genetic similarities. But, America is a society with immigrants from many different regions. Just because a person in America is labeled black, it does not necessarily mean that the individual in question shares the same genetic characteristics with everybody else found with a dark skin. BiDil might turn out to work even better among some farmers in southeast Sweden. But will the pharmaceutical company marketing this drug, that is Nitromed, even research the possibility? The answer is no, because their scientists, are also Americans, sharing many of the same social attitudes and prejudices as their non-scientific colleagues. The assumption under which they operate is that “black” means something truly distinctive and unique that goes beyond skin color and hair texture and other so-called racial characteristics or phenotypes.
Another common example sometimes given to refute the racial genetics argument relates to the Hutu and Tutsi of Rwanda. We’re all familiar with the grisly story of genocide committed by the Hutu against the Tutsi in 1994? In which an estimated one million people were killed. Well, if you set a Hutu or Tutsi down in Greensboro, North Carolina, they would be perceived as “black” and treated accordingly. But in their own country of Rwanda, they are considered to be two distinct races. Who then decides who belongs to what race? It turns out to be whomever has the power to make their labels stick. That is not science. That is politics pure and simple.
Correcting health disparities as a reason for focusing on racial genetics seems humanitarian and good. But if history is any indication at all: the human impulse to mis-use science as a means of legitimizing its most shameful tendencies leads me to say -- that we humans, or at least those of us in America, have not yet shown that we have the maturity to group populations without using such groupings sooner or later, to stigmatize or in other ways victimize those in vulnerable positions.
Or let’s look at it another way, if we readily accepted a return to the old racial genetics, which led us to so-called scientific treatises like The Bell Curve, and its claim that blacks were cognitively inferior to whites. would health-disparities between blacks and whites disappear. Of course not. These disparities are a function of socio-economic status and historic discrimination patterns against blacks.
Timbuktu, Salt & High Blood Pressure
As a historian of West African intellectual traditions, I’ve from time to time translated manuscripts from regions such as Timbuktu. Their enormous wealth was based on gold. That gold was traded for salt. Many areas of inland west Africa were salt deficient.
Even though there is still a considerable amount of controversy surrounding this issue, I believe that the increased rates of high blood pressure of the sodium-sensitive type among African-Americans has a direct relationship to this history. The people taken as slaves, like my ancestors, were from the decentralized societies inland of the coast. Coastal West Africans had access to sea salt. But my ancestors had to adapt to exceedingly hot climates over thousands of years which were very salt deficient. Thus they developed very efficient kidneys. But what happens when those highly efficient kidneys, able to function in extremely hot climates with very little sodium, are brought to the Americas, where salt is exceedingly abundant. What might be normal for many Americans of European descent, would in all probability be nearly toxic for the descendants of West Africans from these regions. But are we talking about race here? Of course not. Coastal West Africans would be lumped together in the same “black race” as their inland neighbors. But the environmental circumstances to which their bodies were exposed as it relates to sodium would have been profoundly different. Or might we then choose to associate salt-sensitivity with race? Well, then if that is the case then coastal West Africans would end up in the same racial category as many Europeans. But that particular categorization of race offers no financial benefit to pharmaceutical companies or scholars for that matter. So, now it will not stick.
Population Groups
Racial genetics has too dangerous a history for us to allow or even encourage its resurrection by pharmaceutical companies promising health care benefits for African-Americans as some alternative market for drugs that don't work for the mainstream. The true costs, of using science to legitimate racial categories -- lurk in the deepest recesses of the human psyche. And knowing what I know of human history, I for one do not believe we ready to let that tiger out of its cage.
But let me be clear on one thing. There may indeed be instances where a drug might work better for African-Americans, not as amorphous members of the "Negroid" race. But in another, genetically-defined sense. Black Americans can be seen as a somewhat unique population group. Their general constitution is that of having 80% West African ancestry and 19% Northern European ancestry, and 1% Native American ancestry. Population groups are fluid and created by the whims of history and human migration. White Americans are also a population group, which emerged around the same time as that of Black Americans. This was simultaneous with the institutionalization of slavery. Before that time, European population groups were defined by the English marrying other English people, the Irish marrying within their own ethnic group and so forth. But once slavery defined people from Africa as forming the category of sub-humans, being those who fell into the pit of bondage, then society needed to define the category of those who did not. The national boundaries began to fall among the various European nationalities, who had come to America. Over time they have formed a population group, with more genetic similarities within this new group than to any particular European nationality. But alas, the world is made up of thousands of population groups, which cannot be made to fit the manipulative paradigm of race.
But let me be clear on one thing. There may indeed be instances where a drug might work better for African-Americans, not as amorphous members of the "Negroid" race. But in another, genetically-defined sense. Black Americans can be seen as a somewhat unique population group. Their general constitution is that of having 80% West African ancestry and 19% Northern European ancestry, and 1% Native American ancestry. Population groups are fluid and created by the whims of history and human migration. White Americans are also a population group, which emerged around the same time as that of Black Americans. This was simultaneous with the institutionalization of slavery. Before that time, European population groups were defined by the English marrying other English people, the Irish marrying within their own ethnic group and so forth. But once slavery defined people from Africa as forming the category of sub-humans, being those who fell into the pit of bondage, then society needed to define the category of those who did not. The national boundaries began to fall among the various European nationalities, who had come to America. Over time they have formed a population group, with more genetic similarities within this new group than to any particular European nationality. But alas, the world is made up of thousands of population groups, which cannot be made to fit the manipulative paradigm of race.
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[i] Several of the most well-known refutations of The Bell Curve: Intelligence and Class Structure in American Life by Richard J. Hernstein and Charles A. Murray include, The Bell Curve Wars: Race, Intelligence and the Future of America, by Steve Fraser (BasicBooks, 1995); Measured Lies: The Bell Curve Examined, by Joe Kincheloe and Shirley R. Steinberg (St. Martin’s press, NY, 1996); Inequality by Design; Cracking the Bell Curve Myth by Claude S. Fischer (Princeton University Press, 1996); The Bell Curve Debate: History, Documents, Opinions by Naomi Glauberman and Russell Jacoby (Times Books, 1995); and Intelligence, Genes, and Success: Scientists respond to the Bell Curve by Berne Devlin (Springer, 1997).
[ii] For indepth arguments refuting both The Bell Curve and its various premises, see the books identified in footnote 1.
[iii] See Joseph Graves, The Race Myth: Why We Pretend Race Exists in America, Dutton, New York, 2004.
[iv] Alexander Alland, jr.,Race in Mind: Race, IQ and other Racisms, Palgrave Macmillan, New York, 2002, p.42.
[v] See Jared Diamond, Discover Magazine.
[vi] Alain F. Corcos, The Myth of Human Races, Michigan State University Press, East Lansing, 1984, p.109.
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