In this program, Joseph L. Graves, Jr., PhD, Pilar Ossorio, PhD, JD, and Morris W. Foster, PhD, address key issues in the controversial topic of race-specific medicine.

Joseph L.Graves, Jr., PhD, explores three main points:

1. Human populations do not have strong genetic differentiation, i.e., there are not biological races as present in other species.
2. Recent claims that analyses of DNA polymorphisms unambiguously partition individuals into groups that correspond to lay conceptions of race do not allow identification of specific loci that can explain contemporary health disparities between the "supposed" human races.
3. Human populations are not genetically disjoint. The case for genetic influences on health disparity is not nearly as well supported as the case for the impact of social dominance on health disparity. Thus, medicine should take both social environment and population genetics into account, instead of seeking explanations in terms of spurious "races" that inappropriately conflate the two.

Pilar Ossario, PhD, JD, analyzes two central themes:

1. Many race-based claims in science and medicine extrapolate beyond the data. For instance, many announcements about the approval of BiDil discussed a racial difference in treatment response, and suggested that the purported difference was due to a genetic difference between races. However, the clinical trial data does not show a racial difference in treatment response, nor have there been any reports of genes associated with or causally connected to the BiDil response. Other examples include the many instances in which commentators/researchers proposed a genetically-caused racial difference based on the absence of data for alternative explanations. Often, after statistically controlling for income and educational level does not explain the total between-race variability, commentators assume that all possible non-genetic differences have been ruled out, and that any residual between-race difference must have a genetic cause.
2. Race-based medicine is not individualized medicine. When there is data that people of different races respond differently to a drug or intervention, the data consists of differences in the mean of population response curves. Such findings do not imply categorical claims, such as "black people do not respond to ACE inhibitors" or "Asians are slow responders to X." In any population, individuals will vary in their responses to any treatment. Individualizing medicine means determining a particular individual's health risks, treatment responses, and treatment goals. Attributing a group average to all individuals in the group is bad science and is not individualized medicine.

Morris W. Foster, PhD, discusses drug development in the context of health disparities. Dr. Foster suggests that instead of customized therapies for individuals, pharmacogenomics may just re-arrange the way in which the economics of drug development are calculated. He uses American Indian/Alaska Native (AI/AN) populations as a framework for a model for the groups that may be affected. Like many other populations that experience health disparities, AI/AN populations have a lesser economic capacity to attract investments in targeted drug discovery and pay for access to cutting-edge diagnostics and drugs. If pharmacogenomic drugs are provided or developed for AI/AN people through that identity-specific lens, the potential for confounding the social and the biological is considerable. But the economic, cultural, and other challenges that AI/AN people face in having access to pharmacogenomic benefits may most effectively be addressed through the identity portal, so the engagement between pharmacogenomics and historical, social groups and identities may be unavoidable.

This two-hour program is from the University of North Carolina-Chapel Hill, Minority Health Project's 12th Annual Summer Public Health Research Institute and Videoconference.

UNC-Chapel Hill's annual Summer Public Health Research Institute and Videoconference is a unique forum that enables experts in the area of health disparities to reach an audience of several hundred researchers, educators, administrators, practitioners, and students throughout the U.S. Initiated in 1995, its aims include the identification and reduction of barriers to conducting health research in minority communities. Read more on the UNC website.