The risky gene: epidemiology and the evolution of race

ABSTRACT

Alcabes examines how modern epidemiology views race, including a historical review and a critique of methods. Race occupies a central place in health discourse partly because of two misapprehensions. First, contemporary epidemiologic research focuses on individual behaviour as a determinant of disease risk, despite the fact that risk as predicted from epidemiologic data is solely interpretable for large populations, not for individuals. Historically and today, connections between behaviour and disease have been used to fortify racial discrimination, with reprobate behaviours imputed to unwanted races. Second, the advent of evolutionary theory and the recognition that genetics provides a mechanism by which evolution proceeds together have allowed for the social concept of ‘race’ to be imbued fallaciously with biological determinants. With an epidemiology based on behaviour, a behavioural indexing of race and a racial interpretation of evolutionary theory and genomics, the circle closes: society can ascribe differences in disease occurrence to the genetic make-up of the sufferers or to their behaviour, or both—that is, to race—and avoid having to address social problems that typically underlie disease risk.

Keywords:

• behavioural medicine
• epidemiology
• ethics
• genetics
• history
• race

Notes

¹Vicente Navarro, ‘Race or class versus race and class: mortality differentials in the United States’, in Dan E. Beauchamp and Bonnie Steinbock (eds), New Ethics for the Public's Health (New York and Oxford: Oxford University Press 1999), 39–44.

²The argument was articulated by Mindy Fullilove in ‘Comment: abandoning “race” as a variable in public health research—an idea whose time has come’, American Journal of Public Health, vol. 88, 1998, 1297–8. Others have offered rationales for related approaches, for instance, James Y. Nazroo, ‘The structuring of ethnic inequalities in health: economic position, racial discrimination, and racism’, American Journal of Public Health, vol. 93, 2003, 277–84.

³Nancy Krieger sets forth the argument in ‘Does racism harm health? Did child abuse exist before 1962? On explicit questions, critical science, and current controversies: an ecosocial perspective’, American Journal of Public Health, vol. 93, 2003, 94–9. Camara Phyllis Jones offers a prescription for how to address racism in ‘Invited commentary: “race,” racism, and the practice of epidemiology’, American Journal of Epidemiology, vol. 154, no. 4, 2001, 299–304. See also Nancy Krieger,’ Discrimination and health’, in Lisa F. Berkman and Ichiro Kawachi (eds), Social Epidemiology (New York and Oxford: Oxford University Press 2000), 36–75.

⁴‘121 Cities Mortality Reporting System’, available on the CDC website at www.cdc.gov/epo/dphsi/121hist.htm (viewed 18 July 2006).

⁵Nancy Krieger recounts some of this history in ‘Epidemiology and the social sciences: towards a critical reengagement in the 21st century’, Epidemiologic Reviews, vol. 22, 2000, 155–63.

⁶The remaining 62 of the 104 research articles published in that period concerned either methodological problems or analysed the relation between individually measured non-behavioural covariates, such as genetic type or serologic markers, with individually measured outcomes.

⁷Sheldon Watts, Epidemics and History: Disease, Power and Imperialism (New Haven, CT and London: Yale University Press 1999), 198.

⁸John Duffy, A History of Public Health in New York City 1625–1866 (New York: Russell Sage 1968).

⁹This argument is put forth, with a slightly different assessment of its place in the development of a moral agenda in public health, by Charles Rosenberg in The Cholera Years, rev. edn (Chicago: University of Chicago Press 1987), see esp. chs 7 and 8.

¹⁰Georgina Feldberg, Disease and Class. Tuberculosis and the Shaping of Modern North American Society (New Brunswick, NJ: Rutgers University Press 1995), 19–35.

¹¹Georgina Feldberg, Disease and Class. Tuberculosis and the Shaping of Modern North American Society (New Brunswick, NJ: Rutgers University Press 1995), 29.

¹²Andrew Spielman and Michael D'Antonio, Mosquito. A Natural History of Our Most Persistent and Deadly Foe (New York: Hyperion 2001), 64.

¹³Watts, Epidemics and History, 215.

¹⁴I have drawn the terminology of ‘implicated’ from Richard Goldstein's 1987 article about AIDS in the Village Voice, and his 1988 article in Milbank Quarterly, titled ‘The implicated and the immune’.

¹⁵The full text of Snow's book, as well as maps and statistics on cholera in nineteenth-century London, can be found at Ralph R. Frerichs's encyclopaedic website on Snow, at www.ph.ucla.edu/epi/snow.html (viewed 18 July 2006).

¹⁶Feldberg, Disease and Class, 42–8.

¹⁷Watts, Epidemics and History, 241.

¹⁸Watts, Epidemics and History, 256, quoted from Gordon Harrison, Mosquitoes, Malaria and Man: A History of Hostilities since 1880 (New York: Dutton 1978), 94. Watts says that Ross was not the discoverer of Anopheles mosquitoes as the vector of malaria; Ross took credit for the work of his assistant Muhammed Bux.

¹⁹Götz Aly, Peter Chroust and Christian Pross, Cleansing the Fatherland. Nazi Medicine and Racial Hygiene, trans. from the German by Belinda Cooper (Baltimore: Johns Hopkins University Press 1994), 39, 23 and 44ff.

²⁰See, for example, the homepage of the Office of Minority Health at the CDC, available at www.cdc.gov/omh/AboutUs/disparities.htm (viewed 18 July 2006).

²¹US National Center for Health Statistics (NCHS), Health, United States, 2005, Tables 36 and 37, available at www.cdc.gov/nchs/data/hus/hus05.pdf (viewed 19 July 2006).

²²US National Center for Health Statistics (NCHS), Health, United States, 2005, Table 69.

²³US National Center for Health Statistics (NCHS), Health, United States, 2005, Table 53.

²⁴NCHS, ‘Asthma prevalence, health care use and mortality, 2002’, available at www.cdc.gov/nchs/products/pubs/pubd/hestats/asthma/asthma.htm (viewed 19 July 2006).

²⁵Charles Marwick and Mike Mitka, ‘Debate revived on hepatitis B vaccine value’, Journal of the American Medical Association, vol. 282, no. 1, 1999, 15–17.

²⁶NCHS, Health, United States, 2005, Tables 42 and 52.

²⁷G. K. Singh and S. M. Yu, ‘Infant mortality in the United States: trends, differentials, and projections, 1950 through 2010’, American Journal of Public Health, vol. 85, 1995, 957–64. See also NCHS Health, United States, 2005, Table 20.

²⁸NCHS, Health, Unites States, 2005, Tables 13 and 14.

²⁹Laufey T. Amundadottir, Patrick Sulem, Julius Gudmundsson, Agnes Helgason, Adam Baker et al., ‘A common variant associated with prostate cancer in European and African populations’ (letter), Nature Genetics (online), 7 May 2006 (print publication in vol. 38, no. 6, June 2006).

³⁰See, for instance, Nicholas Wade, ‘Scientists discover gene linked to higher rates of prostate cancer’, New York Times, 8 May 2006.

³¹Troy Duster, ‘Buried alive: the concept of race in science’, Chronicle of Higher Education, 14 September 2001, B11–12.