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Patel RA, Ungar RA, Pyke AL, Adimoelja A, Chakraborty M, Cotter DJ, Freund M, Goddard P, Gomez-Stafford J, Greenwald E, Higgs E, Hunter N, MacKenzie TMG, Narain A, Gjorgjieva T, Martschenko DO. Increasing equity in science requires better ethics training: A course by trainees, for trainees. CELL GENOMICS 2024; 4:100554. [PMID: 38697124 PMCID: PMC11099339 DOI: 10.1016/j.xgen.2024.100554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/23/2024] [Accepted: 04/06/2024] [Indexed: 05/04/2024]
Abstract
Despite the profound impacts of scientific research, few scientists have received the necessary training to productively discuss the ethical and societal implications of their work. To address this critical gap, we-a group of predominantly human genetics trainees-developed a course on genetics, ethics, and society. We intend for this course to serve as a template for other institutions and scientific disciplines. Our curriculum positions human genetics within its historical and societal context and encourages students to evaluate how societal norms and structures impact the conduct of scientific research. We demonstrate the utility of this course via surveys of enrolled students and provide resources and strategies for others hoping to teach a similar course. We conclude by arguing that if we are to work toward rectifying the inequities and injustices produced by our field, we must first learn to view our own research as impacting and being impacted by society.
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Affiliation(s)
- Roshni A Patel
- Department of Genetics, Stanford University, Stanford, CA 94305, USA.
| | - Rachel A Ungar
- Department of Genetics, Stanford University, Stanford, CA 94305, USA.
| | - Alanna L Pyke
- Department of Genetics, Stanford University, Stanford, CA 94305, USA
| | - Alvina Adimoelja
- Department of Genetics, Stanford University, Stanford, CA 94305, USA
| | | | - Daniel J Cotter
- Department of Genetics, Stanford University, Stanford, CA 94305, USA
| | - Malika Freund
- Department of Genetics, Stanford University, Stanford, CA 94305, USA
| | - Pagé Goddard
- Department of Genetics, Stanford University, Stanford, CA 94305, USA
| | - Justin Gomez-Stafford
- Department of Hematology and Oncology, Boston Children's Hospital, Boston, MA 02115, USA
| | - Emily Greenwald
- Department of Genetics, Stanford University, Stanford, CA 94305, USA
| | - Emily Higgs
- Department of Cardiovascular Genetics, University of California San Francisco, San Francisco, CA 94158, USA
| | - Naiomi Hunter
- Department of Genetics, Stanford University, Stanford, CA 94305, USA
| | - Tim M G MacKenzie
- Department of Genetics, Stanford University, Stanford, CA 94305, USA
| | - Anjali Narain
- Department of Genetics, Stanford University, Stanford, CA 94305, USA
| | - Tamara Gjorgjieva
- Department of Genetics, Stanford University, Stanford, CA 94305, USA
| | - Daphne O Martschenko
- Center for Biomedical Ethics, Stanford University, Stanford, CA 94305, USA; Department of Pediatrics, Stanford University, Stanford, CA 94305, USA
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Bentz M, Saperstein A, Fullerton SM, Shim JK, Lee SSJ. Conflating race and ancestry: Tracing decision points about population descriptors over the precision medicine research life course. HGG ADVANCES 2024; 5:100243. [PMID: 37771152 PMCID: PMC10585473 DOI: 10.1016/j.xhgg.2023.100243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/20/2023] [Accepted: 09/20/2023] [Indexed: 09/30/2023] Open
Abstract
Responding to calls for human genomics to shift away from the use of race, genomic investigators are coalescing around the possibility of using genetic ancestry. This shift has renewed questions about the use of social and genetic concepts of difference in precision medicine research (PMR). Drawing from qualitative data on five PMR projects, we illustrate negotiations within and between research teams as genomic investigators deliberate on the relevance of race and genetic ancestry for different analyses and contexts. We highlight how concepts of both social and genetic difference are embedded within and travel through research practices, and identify multiple points across the research life course at which conceptual slippage and conflation between race and genetic ancestry occur. We argue that moving beyond race will require PMR investigators to confront the entrenched ways in which race is built into research practices and biomedical infrastructures.
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Affiliation(s)
- Michael Bentz
- Division of Ethics, Department of Medical Humanities and Ethics, Vagelos College of Physicians & Surgeons, Columbia University, 630 West 168th Street, PH 1525, New York, NY 10032, USA.
| | - Aliya Saperstein
- Department of Sociology, Stanford University, 450 Jane Stanford Way, Building 120, Room 160, Stanford, CA 94305-2047, USA
| | - Stephanie M Fullerton
- Department of Bioethics & Humanities, University of Washington School of Medicine, Box 357120, Seattle, WA 98195-7120, USA
| | - Janet K Shim
- Department of Social & Behavioral Sciences, University of California, San Francisco, 490 Illinois Street, Floor 12, Box 0612, San Francisco, CA 94143-0612, USA
| | - Sandra Soo-Jin Lee
- Division of Ethics, Department of Medical Humanities and Ethics, Vagelos College of Physicians & Surgeons, Columbia University, 630 West 168th Street, PH 1525, New York, NY 10032, USA.
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Martinez S, Jones JD. A pilot study examining the relationship between chronic heroin use and telomere length among individuals of African ancestry. Pharmacol Biochem Behav 2023; 231:173631. [PMID: 37689117 PMCID: PMC10545475 DOI: 10.1016/j.pbb.2023.173631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/29/2023] [Accepted: 09/06/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Prior research has suggested a possible link between heroin use and shortened telomere length (TL), a marker of cellular aging and genomic stability. We sought to replicate these findings by examining the relationship between TL and heroin use among individuals of African ancestry. METHODS This cross-sectional study examined TL among 57 participants [17.5 % female; mean age 48.0 (±6.80) years] of African ancestry with Opioid Use Disorder (OUD) and a mean heroin use duration of 18.2 (±10.7) years. Quantitative polymerase chain reaction (qPCR) was used to calculate TL as the ratio between telomere repeat copy number (T) and a single-copy gene, copy number (S). The primary dependent variable was TL (T/S Ratio) measured in kilobase pairs. Covariates included heroin use years and personality traits. Using a hybrid approach, multiple linear regression and Bayesian linear regression examined the association of chronological age, heroin use years and personality traits with TL. RESULTS The multiple linear regression model fit the data well, R2 = 0.265, F(7,49) = 2.53, p < .026. Chronological age (β = -0.36, p = .017), neuroticism (β = 0.46, p = .044), and conscientiousness (β = 0.52, p = .040) were significant predictors of TL. Bayesian linear regression provided moderate support for the alternate hypothesis that chronological age and TL are associated, BF10 = 5.77, R2 = 0.120. The posterior summary of the coefficient was M = 0.719 (SD = 0.278, 95 % credible interval [-1.28, -0.163]). CONCLUSIONS Contrary to prior studies, these findings suggest that heroin use duration may not be significantly associated with TL among individuals of African ancestry, highlighting the need for more rigorous research to elucidate the complexity of this relationship.
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Affiliation(s)
- Suky Martinez
- Division on Substance Use Disorders, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Jermaine D Jones
- Division on Substance Use Disorders, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA
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Iwai Y, Toumbou K, Zuze T, Morgan JS, Simwinga L, Wright ST, Fedoriw Y, Oladeru OT, Balogun OD, Roberson ML, Olopade OI, Tomoka T, Elmore SN. Breast Cancer Germline Genetic Counseling and Testing for Populations of African Heritage Globally: A Scoping Review on Research, Practice, and Bioethical Considerations. JCO Glob Oncol 2023; 9:e2300154. [PMID: 37944088 PMCID: PMC10645409 DOI: 10.1200/go.23.00154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/05/2023] [Accepted: 09/05/2023] [Indexed: 11/12/2023] Open
Abstract
PURPOSE Despite the disproportionately high risk of breast cancer among women of African heritage, little is known about the facilitators and barriers to implementing germline genetic testing and counseling (GT/C). METHODS This scoping review followed guidelines recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. Published manuscripts from database inception through 2021 were sourced from PubMed, Cumulative Index to Nursing and Allied Health Literature via EBSCO, Embase, Cochrane Library, and Scopus. Search terms were used to retrieve articles addressing (1) African heritage, (2) breast cancer, and (3) GT or GC. The screening involved abstract and title review and full-text review. Data were extracted for all articles meeting the inclusion criteria. RESULTS A total of 154 studies were included. Most studies that took place were conducted in the United States (71.4%), and most first authors (76.9%) were from the United States. GT was conducted in 73 (49.7%) studies. BRCA1/BRCA2 were the most commonly studied genes for germline mutations. GC was conducted in 49 studies (33.3%), and perspectives on GC were evaluated in 43 (29.3%). The use of racial/ethnic categories varied broadly, although African American was most common (40.1%). Racism was mentioned in three studies (2.0%). CONCLUSION There is a growing body of literature on GT/C for breast cancer in women of African heritage. Future studies on GT/C of African populations should consider increased clarity around racial/ethnic categorizations, continued community engagement, and intentional processes for informed consent.
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Affiliation(s)
- Yoshiko Iwai
- University of North Carolina School of Medicine, Chapel Hill, NC
| | | | | | - Jenny S. Morgan
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
- Department of Clinical Medicine, Indiana University School of Medicine, Indianapolis, IN
- Department of Global Health, Indiana University School of Medicine, Indianapolis, IN
| | | | - Sarah T. Wright
- UNC Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Yuri Fedoriw
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Oluwadamilola T. Oladeru
- Department of Radiation Oncology, University of Florida, Gainesville, FL
- Department of Radiation Oncology, Mayo Clinic in Florida, Jacksonville, FL
| | | | - Mya L. Roberson
- Department of Health Policy, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC
| | | | | | - Shekinah N.C. Elmore
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, NC
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Gombault C, Grenet G, Segurel L, Duret L, Gueyffier F, Cathébras P, Pontier D, Mainbourg S, Sanchez-Mazas A, Lega JC. Population designations in biomedical research: Limitations and perspectives. HLA 2023; 101:3-15. [PMID: 36258305 PMCID: PMC10099491 DOI: 10.1111/tan.14852] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 10/03/2022] [Accepted: 10/14/2022] [Indexed: 12/13/2022]
Abstract
In biomedical research, population differences are of central interest. Variations in the frequency and severity of diseases and in treatment effects among human subpopulation groups are common in many medical conditions. Unfortunately, the practices in terms of subpopulation labeling do not exhibit the level of rigor one would expect in biomedical research, especially when studying multifactorial diseases such as cancer or atherosclerosis. The reporting of population differences in clinical research is characterized by large disparities in practices, and fraught with methodological issues and inconsistencies. The actual designations such as "Black" or "Asian" refer to broad and heterogeneous groups, with a great discrepancy among countries. Moreover, the use of obsolete concepts such as "Caucasian" is unfortunate and imprecise. The use of adequate labeling to reflect the scientific hypothesis needs to be promoted. Furthermore, the use of "race/ethnicity" as a unique cause of human heterogeneity may distract from investigating other factors related to a medical condition, particularly if this label is employed as a proxy for cultural habits, diet, or environmental exposure. In addition, the wide range of opinions among researchers does not facilitate the attempts made for resolving this heterogeneity in labeling. "Race," "ethnicity," "ancestry," "geographical origin," and other similar concepts are saturated with meanings. Even if the feasibility of a global consensus on labeling seems difficult, geneticists, sociologists, anthropologists, and ethicists should help develop policies and practices for the biomedical field.
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Affiliation(s)
- Caroline Gombault
- Laboratoire de Biométrie et Biologie Evolutive, Université Lyon 1, UMR CNRS 5558, Lyon, France
| | - Guillaume Grenet
- Laboratoire de Biométrie et Biologie Evolutive, Université Lyon 1, UMR CNRS 5558, Lyon, France.,Pole de Santé Publique, Hospices Civils de Lyon, Service Hospitalo-Universitaire de PharmacoToxicologie, Lyon, France
| | - Laure Segurel
- Laboratoire de Biométrie et Biologie Evolutive, Université Lyon 1, UMR CNRS 5558, Lyon, France
| | - Laurent Duret
- Laboratoire de Biométrie et Biologie Evolutive, Université Lyon 1, UMR CNRS 5558, Lyon, France
| | - François Gueyffier
- Laboratoire de Biométrie et Biologie Evolutive, Université Lyon 1, UMR CNRS 5558, Lyon, France.,Pôle de Santé Publique, Hospices Civils De Lyon, Lyon, France
| | - Pascal Cathébras
- Service de Médecine Interne, Hôpital Nord, CHU de Saint-Etienne, Saint-Etienne, France
| | - Dominique Pontier
- Laboratoire de Biométrie et Biologie Evolutive, Université Lyon 1, UMR CNRS 5558, Lyon, France
| | - Sabine Mainbourg
- Laboratoire de Biométrie et Biologie Evolutive, Université Lyon 1, UMR CNRS 5558, Lyon, France.,Service de Médecine Interne et Pathologie Vasculaire, Hôpital Lyon Sud, Hospices Civils De Lyon, Lyon, France
| | - Alicia Sanchez-Mazas
- Laboratory of Anthropology, Genetics and Peopling history, Department of Genetics and Evolution, University of Geneva, Geneva, Switzerland
| | - Jean-Christophe Lega
- Laboratoire de Biométrie et Biologie Evolutive, Université Lyon 1, UMR CNRS 5558, Lyon, France.,Service de Médecine Interne et Pathologie Vasculaire, Hôpital Lyon Sud, Hospices Civils De Lyon, Lyon, France
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Caliebe A, Tekola‐Ayele F, Darst BF, Wang X, Song YE, Gui J, Sebro RA, Balding DJ, Saad M, Dubé M. Including diverse and admixed populations in genetic epidemiology research. Genet Epidemiol 2022; 46:347-371. [PMID: 35842778 PMCID: PMC9452464 DOI: 10.1002/gepi.22492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/31/2022] [Accepted: 06/06/2022] [Indexed: 11/25/2022]
Abstract
The inclusion of ancestrally diverse participants in genetic studies can lead to new discoveries and is important to ensure equitable health care benefit from research advances. Here, members of the Ethical, Legal, Social, Implications (ELSI) committee of the International Genetic Epidemiology Society (IGES) offer perspectives on methods and analysis tools for the conduct of inclusive genetic epidemiology research, with a focus on admixed and ancestrally diverse populations in support of reproducible research practices. We emphasize the importance of distinguishing socially defined population categorizations from genetic ancestry in the design, analysis, reporting, and interpretation of genetic epidemiology research findings. Finally, we discuss the current state of genomic resources used in genetic association studies, functional interpretation, and clinical and public health translation of genomic findings with respect to diverse populations.
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Affiliation(s)
- Amke Caliebe
- Institute of Medical Informatics and StatisticsKiel University and University Hospital Schleswig‐HolsteinKielGermany
| | - Fasil Tekola‐Ayele
- Epidemiology Branch, Division of Population Health Research, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentNational Institutes of HealthBethesdaMarylandUSA
| | - Burcu F. Darst
- Center for Genetic EpidemiologyUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
- Public Health Sciences DivisionFred Hutchinson Cancer Research CenterSeattleWashingtonUSA
| | - Xuexia Wang
- Department of MathematicsUniversity of North TexasDentonTexasUSA
| | - Yeunjoo E. Song
- Department of Population and Quantitative Health SciencesCase Western Reserve UniversityClevelandOhioUSA
| | - Jiang Gui
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth CollegeOne Medical Center Dr.LebanonNew HampshireUSA
| | | | - David J. Balding
- Melbourne Integrative Genomics, Schools of BioSciences and of Mathematics & StatisticsUniversity of MelbourneMelbourneAustralia
| | - Mohamad Saad
- Qatar Computing Research InstituteHamad Bin Khalifa UniversityDohaQatar
- Neuroscience Research Center, Faculty of Medical SciencesLebanese UniversityBeirutLebanon
| | - Marie‐Pierre Dubé
- Department of Medicine, and Social and Preventive MedicineUniversité de MontréalMontréalQuébecCanada
- Beaulieu‐Saucier Pharmacogenomcis CentreMontreal Heart InstituteMontrealCanada
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Rubin L, Ingram LA, Resciniti NV, Ashford-Carroll B, Leith KH, Rose A, Ureña S, McCollum Q, Friedman DB. Genetic Risk Factors for Alzheimer's Disease in Racial/Ethnic Minority Populations in the U.S.: A Scoping Review. Front Public Health 2021; 9:784958. [PMID: 35004586 PMCID: PMC8739784 DOI: 10.3389/fpubh.2021.784958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/23/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: As the United States (U.S.) population rapidly ages, the incidence of Alzheimer's Disease and Related Dementias (ADRDs) is rising, with racial/ethnic minorities affected at disproportionate rates. Much research has been undertaken to test, sequence, and analyze genetic risk factors for ADRDs in Caucasian populations, but comparatively little has been done with racial/ethnic minority populations. We conducted a scoping review to examine the nature and extent of the research that has been published about the genetic factors of ADRDs among racial/ethnic minorities in the U.S. Design: Using an established scoping review methodological framework, we searched electronic databases for articles describing peer-reviewed empirical studies or Genome-Wide Association Studies that had been published 2005-2018 and focused on ADRD-related genes or genetic factors among underrepresented racial/ethnic minority population in the U.S. Results: Sixty-six articles met the inclusion criteria for full text review. Well-established ADRD genetic risk factors for Caucasian populations including APOE, APP, PSEN1, and PSEN2 have not been studied to the same degree in minority U.S. populations. Compared to the amount of research that has been conducted with Caucasian populations in the U.S., racial/ethnic minority communities are underrepresented. Conclusion: Given the projected growth of the aging population and incidence of ADRDs, particularly among racial/ethnic minorities, increased focus on this important segment of the population is warranted. Our review can aid researchers in developing fundamental research questions to determine the role that ADRD risk genes play in the heavier burden of ADRDs in racial/ethnic minority populations.
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Affiliation(s)
- Lindsey Rubin
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States
| | - Lucy A. Ingram
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States
| | - Nicholas V. Resciniti
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, United States
| | - Brianna Ashford-Carroll
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States
| | - Katherine Henrietta Leith
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States
| | - Aubrey Rose
- School of Medicine, University of South Carolina, Columbia, SC, United States
| | - Stephanie Ureña
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States
| | - Quentin McCollum
- College of Social Work, University of South Carolina, Columbia, SC, United States
| | - Daniela B. Friedman
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, United States
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8
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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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Zhang F, Finkelstein J. Inconsistency in race and ethnic classification in pharmacogenetics studies and its potential clinical implications. PHARMACOGENOMICS & PERSONALIZED MEDICINE 2019; 12:107-123. [PMID: 31308725 PMCID: PMC6612983 DOI: 10.2147/pgpm.s207449] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 05/30/2019] [Indexed: 12/11/2022]
Abstract
Introduction Racial and ethnic categories are frequently used in pharmacogenetics literature to stratify patients; however, these categories can be inconsistent across different studies. To address the ongoing debate on the applicability of traditional concepts of race and ethnicity in the context of precision medicine, we aimed to review the application of current racial and ethnic categories in pharmacogenetics and its potential impact on clinical care. Methods One hundred and three total pharmacogenetics papers involving the CYP2C9, CYP2C19, and CYP2D6 genes were analyzed for their country of origin, racial, and ethnic categories used, and allele frequency data. Correspondence between the major continental racial categories promulgated by National Institutes of Health (NIH) and those reported by the pharmacogenetics papers was evaluated. Results The racial and ethnic categories used in the papers we analyzed were highly heterogeneous. In total, we found 66 different racial and ethnic categories used which fall under the NIH race category “White”, 47 different racial and ethnic categories for “Asian”, and 62 different categories for “Black”. The number of categories used varied widely based on country of origin: Japan used the highest number of different categories for “White” with 17, Malaysia used the highest number for “Asian” with 24, and the US used the highest number for “Black” with 28. Significant variation in allele frequency between different ethnic subgroups was identified within 3 major continental racial categories. Conclusion Our analysis showed that racial and ethnic classification is highly inconsistent across different papers as well as between different countries. Evidence-based consensus is necessary for optimal use of self-identified race as well as geographical ancestry in pharmacogenetics. Common taxonomy of geographical ancestry which reflects specifics of particular countries and is accepted by the entire scientific community can facilitate reproducible pharmacogenetic research and clinical implementation of its results.
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Affiliation(s)
- Frederick Zhang
- Center for Bioinformatics and Data Analytics, Columbia University Irving Medical Center, New York, NY, USA
| | - Joseph Finkelstein
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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10
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Mitochondrial mothers of a fat nation: Race, gender and epigenetics in obesity research on Mexican mestizos. BIOSOCIETIES 2017. [DOI: 10.1057/s41292-017-0078-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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11
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Wagner TH, Taylor T, Cowgill E, Asch SM, Su P, Bokhour B, Durfee J, Martinello RA, Maguire E, Elwy AR. Intended and unintended effects of large-scale adverse event disclosure: a controlled before-after analysis of five large-scale notifications. BMJ Qual Saf 2016; 24:295-302. [PMID: 25882785 PMCID: PMC4413746 DOI: 10.1136/bmjqs-2014-003800] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND AND OBJECTIVE How patients respond to being notified of a large-scale adverse event (LSAE), such as improper sterilisation of medical equipment that exposes them to bloodborne pathogens, is not well known. The objective of this study was to determine, using administrative data, the intended and unintended consequences of patient notification following a LSAE. METHODS We examined five LSAEs where patients may have been inadvertently exposed to hepatitis C virus (HCV), HIV, and hepatitis B virus (HBV). A total of 9638 cases were identified at five Department of Veteran Affairs (VA) medical facilities between 2009 and 2012. We identified controls at the same facility prior to the exposure period and at neighbouring facilities (n=45,274). Difference-in-differences models were used with Veterans Health Administration (VHA) and Medicare data to examine infectious disease testing rates and subsequent utilisation patterns. RESULTS Receipt of a LSAE notification was associated with a 73.2, 76.8 and 77.1 adjusted percentage point increase for HCV, HIV and HBV testing, respectively (all p<0.001). Compared with white patients, African-American patients were significantly less likely to return to VHA for follow-up testing. Patients exposed to a dental LSAE reduced their use of preventive and restorative dental care over the subsequent year, but they eventually came back to VHA for dental services 18-months post exposure. CONCLUSIONS The majority of patients notified of a LSAE responded by getting tested for HCV, HIV and HBV, although there remains room for improvement. Potential exposure to a LSAE was associated with increased odds of subsequently using non-VA facilities, but the size and timing of the shift depended on the type of care.
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Affiliation(s)
- Todd H Wagner
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California, USA Department of Health Research and Policy, Stanford University, Stanford, California, USA
| | - Thomas Taylor
- Department of Health Research and Policy, Stanford University, Stanford, California, USA
| | - Elizabeth Cowgill
- Department of Health Research and Policy, Stanford University, Stanford, California, USA
| | - Steven M Asch
- Department of Health Research and Policy, Stanford University, Stanford, California, USA Division of General Internal Medicine, Stanford University, Stanford California, USA
| | - Pon Su
- Department of Health Research and Policy, Stanford University, Stanford, California, USA
| | - Barbara Bokhour
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Janet Durfee
- Veterans Health Administration, Office of Public Health, Washington DC, USA
| | - Richard A Martinello
- Veterans Health Administration, Office of Public Health, Washington DC, USA Yale School of Medicine, Departments of Internal Medicine and Pediatrics, New Haven, Conneticut, USA
| | - Elizabeth Maguire
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA
| | - A Rani Elwy
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
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Yudell M, Roberts D, DeSalle R, Tishkoff S. SCIENCE AND SOCIETY. Taking race out of human genetics. Science 2016; 351:564-5. [PMID: 26912690 DOI: 10.1126/science.aac4951] [Citation(s) in RCA: 295] [Impact Index Per Article: 36.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
| | | | - Rob DeSalle
- American Museum of Natural History, New York, NY 10024, USA
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Byrd WC, Best LE. Between (Racial) Groups and a Hard Place: An Exploration of Social Science Approaches to Race and Genetics, 2000-2014. BIODEMOGRAPHY AND SOCIAL BIOLOGY 2016; 62:281-299. [PMID: 27809658 DOI: 10.1080/19485565.2016.1238299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
As the social sciences expand their involvement in genetic and genomic research, more information is needed to understand how theoretical concepts are applied to genetic data found in social surveys. Given the layers of complexity of studying race in relation to genetics and genomics, it is important to identify the varying approaches used to discuss and operationalize race and identity by social scientists. The present study explores how social scientists have used race, ethnicity, and ancestry in studies published in four social science journals from 2000 to 2014. We identify not only how race, ethnicity, and ancestry are classified and conceptualized in this growing area of research, but also how these concepts are incorporated into the methodology and presentation of results, all of which structure the discussion of race, identity, and inequality. This research indicates the slippage between concepts, classifications, and their use by social scientists in their genetics-related research. The current study can assist social scientists with clarifying their use and interpretations of race and ethnicity with the incorporation of genetic data, while limiting possible misinterpretations of the complexities of the connection between genetics and the social world.
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Affiliation(s)
- W Carson Byrd
- a Department of Pan-African Studies , University of Louisville , Louisville , Kentucky , USA
| | - Latrica E Best
- a Department of Pan-African Studies , University of Louisville , Louisville , Kentucky , USA
- b Department of Sociology , University of Louisville , Louisville , Kentucky , USA
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Hunt LM, Kreiner MJ. Pharmacogenetics in primary care: the promise of personalized medicine and the reality of racial profiling. Cult Med Psychiatry 2013; 37:226-35. [PMID: 23264029 PMCID: PMC3593998 DOI: 10.1007/s11013-012-9303-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Many anticipate that expanding knowledge of genetic variations associated with disease risk and medication response will revolutionize clinical medicine, making possible genetically based Personalized Medicine where health care can be tailored to individuals, based on their genome scans. Pharmacogenetics has received especially strong interest, with many pharmaceutical developers avidly working to identify genetic variations associated with individual differences in drug response. While clinical applications of emerging genetic knowledge are becoming increasingly available, genetic tests for drug selection are not as yet widely accessible, and many primary care clinicians are unprepared to interpret genetic information. We conducted interviews with 58 primary care clinicians, exploring how they integrate emerging pharmacogenetic concepts into their practices. We found that in their current practices, pharmacogenetic innovations have not led to individually tailored treatment, but instead have encouraged use of essentialized racial/ethnic identity as a proxy for genetic heritage. Current manifestations of Personalized Medicine appear to be reinforcing entrenched notions of inherent biological differences between racial groups, and promoting the belief that racial profiling in health care is supported by cutting-edge scientific authority. Our findings raise concern for how pharmacogenetic innovations will actually affect diverse populations, and how unbiased treatment can be assured.
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Affiliation(s)
- Linda M Hunt
- Department of Anthropology, Michigan State University, 338 Baker Hall, East Lansing, MI 48824, USA.
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Racial/ethnic health disparities and ethics -- the need for a multilevel approach. Camb Q Healthc Ethics 2012; 21:309-19. [PMID: 22624534 DOI: 10.1017/s0963180112000035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Baer RD, Arteaga E, Dyer K, Eden A, Gross R, Helmy H, Karnyski M, Papadopoulos A, Reeser D. Concepts of race and ethnicity among health researchers: patterns and implications. ETHNICITY & HEALTH 2012; 18:211-225. [PMID: 22900633 DOI: 10.1080/13557858.2012.713091] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES This study adds to the discussion of appropriate categories of analysis in health research. We contribute data based on actual interviews about the concepts of race and ethnicity, conducted among a broad range of US health researchers. DESIGN In-person qualitative interviews were conducted with 73 scientists at two health research institutions, one that focused on public health research, and one that focused on research about a specific disease. This represents a larger and more interdisciplinary sample of health researchers than has been previously interviewed about these topics. RESULTS We identify a core model of how race and ethnicity are understood. The respondents were confused about the concepts of race and ethnicity and their link to genetic differences between populations; many treated these concepts as interchangeable and genetically based. Although ethnicity was considered somewhat more socially constructed, it was often felt to cause unhealthy behavior. In addition, the situation is not improving; the younger health researchers tended to put a stronger emphasis on the genetic aspects of race than did the older health researchers. CONCLUSION Unlike reviews of how these concepts are used in scientific publications in which race and ethnicity are often undefined, our face-to-face interviews with these researchers allowed an understanding of their concepts of race and ethnicity. Building on their actual perspectives, these data suggest alternative approaches to formal and continuing educational training for health researchers. We recommend beginning with discussions of human diversity, and then moving on to what race and ethnicity are - and are not.
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Affiliation(s)
- Roberta D Baer
- Department of Anthropology, University of South Florida, Tampa, FL, USA.
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Ishii S, Cauley JA, Greendale GA, Danielson ME, Safaei Nili N, Karlamangla A. Ethnic differences in composite indices of femoral neck strength. Osteoporos Int 2012; 23:1381-90. [PMID: 21927926 PMCID: PMC3584159 DOI: 10.1007/s00198-011-1723-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Accepted: 05/16/2011] [Indexed: 10/17/2022]
Abstract
UNLABELLED Bone mineral density does not explain race/ethnicity differences in hip fracture risk. In this study, we demonstrated that race/ethnicity differences in composite hip strength indices were consistent with documented race/ethnicity differences in hip fracture risk, suggesting that unlike bone density, the composite indices may represent ethnicity-independent measures of bone strength. INTRODUCTION African-American and Asian women have lower risks of hip fracture than Caucasian women, but such racial/ethnic variation in hip fracture risk cannot be explained by bone mineral density (BMD). The composite indices of femoral neck strength integrate femoral neck and body size with BMD and predict hip fracture risk in Caucasian women. We hypothesize that unlike race/ethnic differences in BMD, race/ethnic differences in the composite strength indices would be consistent with race/ethnic differences in hip fracture risk. METHODS We studied a community-based sample of Caucasian (n = 968), African-American (n = 512), Chinese (n = 221), and Japanese (n = 239) women, premenopausal or in early perimenopause, from the Study of Women's Health Across the Nation. RESULTS Unadjusted indices were similar in Caucasian and African-American women but higher in Asian women. After adjusting for age, body mass index, and menopause status, all three minority groups had higher composite strength indices than Caucasian women. Foreign-born Japanese women had higher unadjusted and adjusted composite strength indices than US-born Japanese women, but such differences by nativity were not observed in Chinese women. CONCLUSION We concluded that composite strength indices have the potential to explain racial/ethnic differences in hip fracture risk, suggesting that composite strength indices may represent ethnicity-independent measures of bone strength. This contention needs to be verified by further research on the fracture predictive ability of composite strength indices in multi-ethnic longitudinal cohorts.
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Affiliation(s)
- S Ishii
- Geriatric Research, Education and Clinical Center (GRECC), VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Building 220, Room 302, Los Angeles, CA 90073, USA.
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Ninnemann KM. Variability in the efficacy of psychopharmaceuticals: contributions from pharmacogenomics, ethnopsychopharmacology, and psychological and psychiatric anthropologies. Cult Med Psychiatry 2012; 36:10-25. [PMID: 22286864 DOI: 10.1007/s11013-011-9242-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Psychological and psychiatric anthropology have long questioned the universality of psychiatric diagnoses, bringing to light the fluidity of mental disorder, and recognizing that the experience and expression of psychopathology is influenced by complex and interacting genetic, environmental, and cultural factors. The majority of our discussions, however, have remained centered around the role of culture in shaping mental illness: drawing attention to subjective experiences of mental illness and culturally patterned modes of symptom presentation, and interrogating the cogency of universal diagnostic rubrics. Psychological and psychiatric anthropology have yet to robustly engage the broadly assumed universal validity of psychiatric medications and the ways in which they are prescribed and experienced. This article provides an introduction into the fields of pharmacogenomics and ethnopsychopharmacology, areas of inquiry seeking to understand the ways in which genetic variability occurring between, and within, large population groups influences individual ability to metabolize psychotropic medications. This piece further addresses the complex issue of psychopharmaceutical efficacy, stressing the ways in which, just as with psychopathology, medications and their outcomes are likewise influenced by the complex interactions of genes, environment, and culture. Lastly, ways in which anthropology can and should engage with the growing fields of pharmacogenomics and ethnopsychopharmacology are suggested.
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Megyesi MS, Hunt LM, Brody H. A critical review of racial/ethnic variables in osteoporosis and bone density research. Osteoporos Int 2011; 22:1669-79. [PMID: 21207012 DOI: 10.1007/s00198-010-1503-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Accepted: 11/11/2010] [Indexed: 12/16/2022]
Abstract
UNLABELLED Racial and ethnic variables are common in research on variation in bone density. This literature review describes some of the common flaws associated with the use of these variables and provides some suggestions for how bone density research may be able to better document and address skeletal health disparities. INTRODUCTION Racial/ethnic differences in bone density have been commonly documented in the research literature. While effective identification of the specific factors underlying these trends might go a long way in informing treatment and screening for osteoporosis, this would require careful consideration of exactly what these variables are capturing. However, the basis and implications of what racial/ethnic variables represent have not carefully been examined in bone density research. METHODS For this paper, we systematically reviewed 55 articles that included bone density and race/ethnicity as key variables. Our analysis reveals that racial/ethnic terminology in these articles is highly variable, and discussion of how race/ethnicity is determined is often vague and idiosyncratic. Racial/ethnic variables are being used for a wide range of analytical purposes in statistical tests, which may not be appropriate for such a complex and poorly defined variable. RESULTS Many articles attribute racial/ethnic differences in bone mass/bone density to genetic causes, although few studies actually examine genetic data. CONCLUSION This analysis indicates that more rigorous examination of what race/ethnicity actually captures, more careful definitions of group labels and the procedures for assigning them, and attention to the limitations of how such variables can reliably be used in data analyses is needed to help address the problems and issues outlined in this review.
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Affiliation(s)
- M S Megyesi
- Joint POW/MIA Accounting Command, Central Identification Laboratory, 310 Worchester Ave Bldg 45, Hickam AFB, HI 96853-5530, USA.
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Knerr S, Wayman D, Bonham VL. Inclusion of racial and ethnic minorities in genetic research: advance the spirit by changing the rules? THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2011; 39:502-12. [PMID: 21871045 PMCID: PMC4082969 DOI: 10.1111/j.1748-720x.2011.00617.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Genetic research aimed at understanding human health and disease is grounded in the study of genetic variation. The inclusion of research subjects with diverse ancestral backgrounds is essential for genetic and genomic research that fully explores human diversity. Large-scale cohort studies and biobanks in Europe and the United States often do not include the breadth of ethnic and racial diversity observed in their countries' citizens. This article explores the findings of a qualitative study of U.S. scientists' understanding and views of the NIH Policy and Guidelines on the Inclusion of Minorities as Subjects in Clinical Research. The findings suggest that the policy restricts how scientists use racial and ethnic categories to define and report their study populations and does little to motivate their efforts to increase the inclusion of non-European ancestral populations in genetic and genomic research.
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Affiliation(s)
- Sarah Knerr
- Department of Health Services, University of Washington School of Public Health, WA, USA
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21
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Population description and its role in the interpretation of genetic association. Hum Genet 2010; 127:563-72. [PMID: 20157827 DOI: 10.1007/s00439-010-0800-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2009] [Accepted: 02/04/2010] [Indexed: 01/12/2023]
Abstract
Despite calls for greater clarity and precision of population description, studies have documented persistent ambiguity in the use of race/ethnicity terms in genetic research. It is unclear why investigators tolerate such ambiguity, or what effect these practices have on the evaluation of reported associations. To explore the way that population description is used to replicate and/or extend previously reported genetic observations, we examined articles describing the association of the peroxisome proliferator-activated receptor-gamma-gamma Pro12Ala polymorphism with type 2 diabetes mellitus and related phenotypes, published between 1997 and 2005. The 80 articles identified were subjected to a detailed content analysis to determine (1) how sampled populations were described, (2) whether and how the choice of sample was explained, and (3) how the allele frequency and genetic association findings identified were contextualized and interpreted. In common with previous reports, we observed a variety of sample descriptions and little explanation for the choice of population investigated. Samples of European origin were typically described with greater specificity than samples of other origin. However, findings from European samples were nearly always compared to samples described as "Caucasian" and sometimes generalized to all Caucasians or to all humans. These findings suggest that care with population description, while important, may not fully address analytical concerns regarding the interpretation of variable study outcomes or ethical concerns regarding the attribution of genetic observations to broad social groups. Instead, criteria which help investigators better distinguish justified and unjustified forms of population generalization may be required.
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Foster MW. Looking for race in all the wrong places: analyzing the lack of productivity in the ongoing debate about race and genetics. Hum Genet 2009; 126:355-62. [DOI: 10.1007/s00439-009-0674-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Accepted: 04/17/2009] [Indexed: 12/25/2022]
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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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