Should people's ethnicity matter in their medical treatment?

Oct. 24, 2012, 10:35 a.m.

Research has found that certain ethnic groups are prone to certain conditions and diseases. But how should health providers and medical researchers use that information? (Mae Ryan/KPCC)

Chances are, medical research has found that your ethnicity makes you more likely to have certain conditions or diseases.

For Latinos, it's diabetes. For black folks, it's high blood pressure. For white people, it's cystic fibrosis. For Asian women, it's osteoporosis.

But one scholar says race-based medical recommendations to patients potentially mislead them about their health risks – and reinforce harmful notions about race at the same time.

That scholar is Sean Valles, an assistant professor of philosophy at Michigan State University in a new paper appearing in Preventive Medicine.

In his paper, Valles agrees that some racial groups are, on average, more prone to certain diseases and conditions than other ethnic groups. But, he says, within each ethnic group are what he calls "islands" of lower risk that shouldn't go unacknowledged.

He gave a couple of examples. The government recommends that black people eat less salt than other ethnic groups, due to their predisposition for high blood pressure. But Valles notes that foreign-born black people tend to have different lifestyles, and as such have substantially lower rates of heart disease, for which high blood pressure is a risk factor.

Same with white folks and cystic fibrosis: One in 25,000 people of Finnish descent get the disease, which makes their prevalence rate 10 times lower than the broader white community.

All that is to say, according to Valles, that when medical recommendations forget the pockets of low-risk within ethnic communities, those recommendations are basically promoting prejudice, stereotyping and potentially discrimination.

"There's something a little bit dishonest about not recognizing low-risk groups when we know they're there," he said in a statement. "I'm not trying to say that we should change the course of science to be politically correct. I'm saying we know this stuff. Let's take it seriously."

It can be tempting, though, for medical professionals to use any information they have to get an edge on their patients' ailments. But still, said Dr. Felix Aguilar, the chief medical officer at South Central Family Health Center, "we have to be careful when we use race."

Aguilar said oftentimes, when people point to ethnicity as a factor in medicine, they're often conflating it with socioeconomic status.

"Yes, there definitely are genetics involved in a lot of these procedures, but that's not the whole story," he said, adding that health providers should ask themselves: "Are we using [ethnicity] for the genetic aspects or are we using it for the socioeconomic aspects?"

If the answer is the latter, said Aguilar, then ethnicity probably doesn't need to be part of the discussion.

"Our position in society many times tells us how long we're going to live, how healthy we're going to be and whether we have access to clean water, clean air and good food," he said.

"Why do Latina women have the highest rate of cervical cancer in the U.S.?" Aguilar continued. "You can say, 'Alright, it's genetic.' And maybe there's a genetic element. But most likely it's access to care."

Same goes for Latinos and diabetes. "OK, there's probably a large genetic element, so we recognize that," he said. "But we also know that Latinos who have access to green space, exercise and more fruits and vegetables have lower rates of diabetes."

In other words, ethnicity can be helpful, Aguilar explained – but it can't be the answer.

"In our society and our current paradigm, we like to divide everything into little boxes: black, Latino, white," he said. "The medical reality is that things are a lot more nuanced and we cannot just say, 'Well, this is true for everybody'."

As far as the solution, Valles says it's both simple and not. Regarding salt intake among black people, he says all the government needs to do is further specify that its recommendations only apply to those who are "U.S.-born." For recommendations about cystic fibrosis, adding "non-Finnish" to the term Caucasian would solve the problem.

But it points to a larger problem with using broad ethnic labels.

"It's not even clear whether the term 'African-American' includes black immigrants," Valles said. "The census form kind of implies yes. Some members of African-American or immigrant communities might say no. It's a mess."

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