Race/Ethnicity in biomedical research and clinical practice
L FellerI; R BallyramII; R MeyerovIII; J LemmerIV; OA Ayo-YusufV
IDMD, MDent (OMP). Department of Periodontology and Oral Medicine, University of Limpopo, Medunsa Campus, South Africa
IIBDS, MDS. Department of Periodontology and Oral Medicine, University of Limpopo, Medunsa Campus, South Africa
IIIBSc, BDS, MDent (OMP). Department of Periodontology and Oral Medicine, University of Limpopo, Medunsa Campus, South Africa
IVBDS, HDipDent, FCD(SA)OMP, FCMSAae, Hon. FCMSA. Department of Periodontology and Oral Medicine, University of Limpopo, Medunsa Campus, South Africa ]]>
VBDS, MSc(Odont), MPH, PhD. Director, School of Oral Health Sciences, University of Limpopo, Medunsa Campus, South Africa
ABSTRACT
There is ongoing debate as to whether persons of different racial/ethnic groups are biologically significantly different, and, if such differences exist, whether they are relevant in relation to disease susceptibility and to treatment outcomes. There is also debate about the benefits of using race/ethnicity as a factor in clinical decision making, and as a variable in biomedical or public health research, because of the emotional sensitivities attached to race/ethnic categorisation. Such categorisation may also divert attention from underlying issues such as socioeconomic status and lack of access to modern health care. In this short article we will discuss these controversies, and will emphasize the importance of responsible and sensitive use of race/ethnicity as a variable in biomedical research and in clinical practice.
Key words: race, ethnicity, biomedical research, BRCA, Tay-Sachs.
INTRODUCTION
]]> The term race refers to a group of genetically related persons who share certain physical characteristics such as skin colour and facial features, and who have for a long time been isolated geographically, or have in common cultural or religious practices.1, 2 On the other hand, the term ethnicity, which has been found to be more socially acceptable, applies to a group of people of the same nationality, language or culture, and who may or may not have genetic markers in common.1, 2There are two ways of considering race. The first is in terms of anthropological classifications of negroid, caucasoid etc; and the second is based either on overt physical characteristics or, as in the United States, on self racial-identification.3 Almost universally throughout the world, this second system of classification is applied.
As there is no clear distinction between race and ethnicity, many researchers no longer distinguish between these, but rather use the single term race/ethnicity.1, 2 Analysis of genetic markers show that many people possess a high degree of genetic admixture, with the majority of self-reported blacks (African Americans) in the United States being in fact of mixed racial origin.4 Thus, from a genetic point of view, categorizing persons by physical features into racial/ethnic groups is imprecise, arbitrary and subjective, and only genotyping tests can assign persons to genetic subgroups.2, 5
The biological concept of race/ethnicity is emotionally charged because throughout history it has been used by political and social forces to discriminate between humans on the basis of skin colour, customs or religion. Therefore it is claimed that using race/ethnicity in biomedical research and in clinical practice is unwarranted because it may lead to stereotyping and to preconceived judgements, and to inequalities in medical care.2, 4, 6, 7
However, others consider race/ethnicity to be informative in relation to the genetic make-up since individuals assigned to different racial/ethnic groups largely differ in allele frequencies at a variety of loci. This can provide valuable information about racial/ethnic risk factors for disease susceptibility and for adverse treatment outcomes.3 This information may aid in developing preventive treatment strategies.8
Racial/ethnic groups not infrequently differ from one another in relation to socioeconomic status, education and access to good quality health care, which are well known factors influencing the incidence and outcomes of treatment of disease. Nevertheless, racial/ethnic differences in incidence of disease and response to treatment may sometimes remain after socioeconomic status and access to health care have been removed from the equation. This strongly suggests that race/ethnic-specific genetic factors, environmental factors, or a combination of both, do indeed play a role in susceptibility to disease and in response to medication.
Some points illustrating the limitations of using self-reported race/ethnic categorisation in biomedical research and clinical practice.
Some points illustrating the importance of using race/ethnicity as a variable in biomedical research and as a factor in clinical practice
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CONCLUSION
Declaration: No conflict of interest declared.
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Correspondence:
L Feller
Head: Dept. Periodontology and Oral Medicine
Box D26 School of Oral Health Sciences
MEDUNSA 0204.
South Africa
Tel: (012) 521 4834
E-mail: liviu.feller@ul.ac.za