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Nature versus nurture

Examining racial disparities in medicine

Throughout history, the topic of race has encroached into many aspects of our lives, and medical research is definitely no exception. In the past, some people falsely believed that certain races were genetically more prone to disease than others, and used this as an excuse to justify the higher rates of health problems in certain races such as Black and Latinx people compared to white people. However, advances in medicine and recent research suggest that discrepancies are unrelated to genetics but rather is a direct result of societal inequality. In order to explain this problem, we must first look at the historical role of race in medical research, and how this has applied to advancements in healthcare.

A history of racism in medical research

Medicine in the West has an extremely troubling history where people of colour (POC) are concerned. The past is riddled with medical malpractice on minority groups. Indeed, this was because society saw POC as less valuable than their white counterparts. POC have been subjugated to serving as test subjects in harmful experiments, which were justified by the fact that this would be beneficial to the majority, white, population at that time.

A typical and sickening example of unethical research performed on POC was the Tuskegee syphilis experiment, conducted in 1932 on 600 Black men, 399 of whom had syphilis. The purpose of the experiment, which was to study the progression of untreated syphilis in Black males in order to identify the best treatment option, was never disclosed to the participants. In fact, the subjects were told that they were receiving treatment for their illness, though in reality they were receiving no treatment, and their blood was being taken purely for the purpose of performing tests. Even 13 years later, when penicillin was finally declared the treatment of choice for syphilis, the subjects were left untreated. The experiments continued for forty years, finally ending in 1972. Today, racism within the medical field is much more subtle due to stringent regulations in research methodology by independent review organizations.

Racism in scientific reasoning: nature versus nurture

There have also been claims in the past, such as in arguments related to eugenics, that certain groups are genetically superior to others, and that POC might be more susceptible to illnesses than their white counterparts. For example, a study published in the New England Journal of Medicine in 2009 reported that before the age of fifty, African Americans were twenty times more likely to have heart failure than their white counterparts. The study touches on an issue that has been studied throughout history: the question of whether or not a person’s race can play a significant role in their health.
This question is related to the concept of ‘nature versus nurture,’ the idea that certain traits are inherently coded into our genes – nature – while others are learned through experiments and adaptations to the environment – nurture. Recently, research has indicated that social conditions are a better indicator of predisposition to certain health conditions, as opposed to race.

Overall, the presumption that race has an effect on a person’s medical condition is a superficial, outdated analysis of a situation that is significantly more complex.

Even today, some researchers are still exploring the idea that people of different races are more prone to diseases, the claim that racial differences play an important role in determining one’s health, and whether any one group is more susceptible than another to certain illnesses.

Jay Kaufman, a professor of Epidemiology and Biostatistics at McGill, believes that the environment plays a more central role when accounting for medical disparities across different social group than races. Kaufman suggests inequality in socioeconomic factors, such as access to healthcare, and healthy food, are the root cause of the higher instances of disease in certain populations as compared to others.

“I do think that most of the differences that we observe between social groups in our society in North America and Europe – and we see big disparities between groups, between, say, people of African origin and people of European origin – that it’s much more plausible that those arise from different social conditions than some kind of differing physiological or genetic difference,” Kaufman told The Daily.

“The biomedical presumption is to find some kind of physiological or genetic difference, and that too often excludes much more reasonable social phenomena, like social discrimination, like differences in socioeconomic status and education and living conditions, nutrition, things like that.”

Kaufman also referenced BiDil, a drug for treating congestive heart failure that was approved by the Food and Drug Administration (FDA) in the U.S. in 2005 and was described as being solely for Black people. Further research concluded, however, that the drug worked for everyone regardless of their race, and that when the drug was tested, the test subjects consisted solely of self-identified African Americans.

“It was really […] an attempt to protect the patent of the drug by rebranding it as a drug for Black people,” Kaufman told The Daily. “So it’s a story of profits, it’s not really a story about any rational scientific evidence.” It’s also an example of the more subtle and modern form of racism present within medicine.

While he acknowledged that genetic differences could account for a small percentage of disparities, Kaufman believes that “by and large, the vast majority of differences we observe, I think, come from these different social environments, and not from any kinds of physiological process.”
Kaufman also spoke to addressing the underlying problem of racism in society in order to focus research efforts.

“We know that there are profound social differences. We can observe in the census, we can observe in the surveys, that there are big differences in education and nutrition and occupation and housing and all kinds of other life exposures, lifestyle, and social exposures,” Kaufman said. “I don’t think that the answer to that is to have different drugs for different groups, or different processes for different groups. I think that the real solution to that is to try to reduce the magnitude of the social disparities between racial, ethnic, or socioeconomic groups in the society.”

Overall, the presumption that race has an effect on a person’s medical condition is a superficial, outdated analysis of a situation that is significantly more complex. When discussing health discrepancies between races, factors of historical oppression and current socioeconomic barriers must be considered beyond a simple analysis of ‘x-race has this instance of disease’ and ‘y-race has a lower one.’ Recent research is beginning to dispel these racist perspectives on the situation, and may provide more information on what accommodations are necessary to combat the socioeconomic factors that lead to certain groups encountering more medical problems than others.