Facts of Life:
Issue Briefings for Health Reporters
Vol. 11, No. 2
February 2006
Different Risk: Race-based Health Care and Medicine
The Issue
The Facts
Targeted Prevention
Expert Sources
References
Scientists have long noted racial differences in the way patients respond to medicine or suffer from disease, says Dr. Esteban González Burchard, who studies genetic and biologic risk factors at the University of California, San Francisco. The charged nature of race enters discussions about racial differences, such as why white women have higher rates of osteoporosis.
Nature or Nurture?
Pediatrician Matthew M. Davis says, “To say that racial and ethnic identity has nothing to do with clinical care is to have our heads in the sand.”
Davis offers the example of an infant with chronic infections and signs of delayed growth and development.“ If that infant is Asian-American with no history of European heritage, it’s very unlikely that cystic fibrosis is the problem,” Davis said.
“ But if that child is European-American, I’ll do tests for cystic fibrosis much more quickly. Is that considered race-based medicine?”
“ Two groups living in different social contexts can have different responses. That may have nothing to do with underlying genetics,” says David R. Williams, a professor at the University of Michigan. “The gap in health for poor blacks and middle-class blacks is bigger than the black-white health gap.”
Harvard University health policy expert Brian Gibbs believes doctors must appreciate a patient’s background. “The thing to understand is their poor access to care, the influence of poverty, the influence of racism and its toll on how the body responds to those stressors.” Gibbs said.
- A 2003 study of asthma patients of Mexican and Puerto Rican heritage found that the Puerto Rican patients had poorer response to the asthma control drug Albuterol, a bronchodilator medicine used to improve breathing capacity.1
- After a November 2004 New England Journal of Medicine study found that BiDil dramatically reduced black patients’ death rate, the combination drug received approval as a heart failure therapy for people who identify themselves as black.2
- A 2006 New England Journal of Medicine study found that blacks are more vulnerable to lung cancer from smoking cigarettes than whites, Japanese-Americans and Latinos.3
- A 2005 study that found that black and white girls process salt differently provides clues to racial differences in hypertension and osteoporosis rates. When the adolescents consumed high-salt diets, black girls retained both more calcium and more sodium than their white counterparts.4
- In March 2005, the
cholesterol-lowering drug Crestor was relabeled to urge doctors to lower
the starting dose of the medicine for Asian patients to decrease their
risk of muscle damage, an uncommon side effect of drugs in the class called
statins.
- Several studies, including a 2001 New England Journal of Medicine
