The Impact of Race and Genetic Ancestry on Medicine // Which Box Do I Check?


It’s very difficult to separate the idea of race from its biologic component, or genetic ancestry, because they’re interrelated. And in medicine there’re very clear examples where we know that race is very important. And it’s applied in medicine every day. Race is a social construct, but it includes biologic aspects like genetic ancestry. And I view race as a shopping cart that contains lots of information that’s relevant for clinical and biomedical research. So, for example, minority populations tend to live in impoverished areas, which tend to be exposed to higher levels of air pollution. They tend to face higher levels of discrimination. That has nothing to do with their biology, but it does have health consequences. So the idea of race will never go away in medicine. It’s a good epidemiologic proxy
for a lot of information. Well, here’s the problem. Any time you get a clinical measure, we need to compare you to a reference population. In the United States the Office of
Management and Budgets, OMB, has designated five racial groups: African American, White, Asian, Pacific Islanders, and Native American. And they classify two ethnic groups. You’re either Hispanic, or non-Hispanic. That’s an archaic terminology that really doesn’t fit. So, for example, I am Latino, identifying as Mexican. But my genetic ancestry actually
has three racial groups: Native American, African, and European. So I have three racial groups within me. I identify as being Hispanic, and I don’t neatly fit into any one of those boxes. That’s a conundrum. How do we diagnose President Obama? Is he black or is he white? When I was in training at
UCSF as a pulmonary physician, I saw a patient who was
African American, light skin, looked like Obama, and he
had an occupational injury where he inhaled toxic fumes. At the end of the test,
it came down to comparing him to a reference standard. Depending upon the pull down, I could change the outcome of his results. If I called him Black, he would not have qualified, if I called him white, he would have qualified for benefits. The technician said, well, he looks black. And I said, well, clinically
he’s 50-50, so we’d get it wrong either way. And so I erred on the side of making him qualify for disability benefits. I labeled him as White. When I first encountered that experience in the Pulmonary Function Lab at UCSF, it really opened my eyes to the fact
that race is in the background, and we are making clinical decisions based on standards that were developed
for different racial groups. And it has real life clinical implications. The consequences of the one size fits all approach in medicine is that there are gonna be groups of populations that will be harmed in that they’ll either be misdiagnosed, over-diagnosed, or not benefit from modern
therapeutic interventions. There are many systematic
issues on a scientific level, cultural level, institutional level, that have led to the fact that we have very few minority physicians and scientists,
as well as very few studies in minority populations. But they go hand in hand.

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