Friday, June 8, 2012

Race, Biology and Research

An interesting note in a Boston Review story about race (h/t nc links):
In Chicago in 1980, black and white women died of breast cancer at the same rate. Today, despite being slightly more likely to get breast cancer, white female Chicagoans are half as likely to die from it. Could the difference in death rates be due to genetic differences between black and white women? A wealth of evidence suggests otherwise.
First, the disparity is recent, so it is unlikely to be due to the slow evolution of genetic variations between populations. Second, the disparity is local. In New York City, where the disparity still favors white women, the difference is only 15 percent. Roberts interviews Dr. Steven Whitman, an epidemiologist at the aging Mt. Sinai Hospital—located in the overwhelmingly black community of North Lawndale on Chicago’s West Side—who seems to understand how such a huge divergence came about. As he explains, in the 1950s the residents of North Lawndale were white. But in that decade, 110,000 of the whites moved out and an equal number of blacks moved in. Then half the neighborhood burned down during the riots that followed Martin Luther King’s murder, and now only 40,000 residents remain. Their median income is about $28,000, whereas Chicago’s median is $46,700. Mount Sinai Hospital has suffered, so that comparing its bankroll and daily operating cash to that of Northwestern University’s Memorial Hospital is a bit like comparing an automobile assembly line worker’s income to Mitt Romney’s.
This disparity has consequences: the breast cancer death rate for Chicago’s black women has not changed since 1980. Women of color living in segregated neighborhoods have limited access to mammograms, sometimes having to travel on public transportation up to ten miles away, only to be told that their health insurance won’t cover the screening. Adding injury to insult, the quality of available mammograms is poor compared to what’s offered at the state-of-the-art facilities more commonly accessible to white women. Whitman cites a North Lawndale facility that catches only two cancers per thousand people screened, rather than the expected six. Getting advanced care is next to impossible for women living in black neighborhoods. In Whitman’s words, all “the fancy institutions . . . are in white neighborhoods.”
What ought to be done about the disparities in breast cancer deaths between blacks and whites in Chicago seems clear: build state-of-the-art hospitals in the black neighborhoods and treat women where they live. Or organize a transportation system that would bring women in need of high-quality screening and treatment to existing high-quality centers. But scientists instead seek funding for basic research focused on possible genetic explanations for race-based health disparities.
I would think the differences in outcome are obviously based on economic and health care access issues, but I guess other people disagree.  Doesn't make sense to me.

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