Social Consequences of Genetic Explanations for Racial Differences in Health: A Backdoor to Eugenics?

Jo Phelan 10th Annual Health Disparities Research Symposium Birmingham, Alabama March 18, 2015

Human Genome Project (1990-2003)

n  MAGNITUDE q  "single most important project in biology and the biomedical

sciences" - Collins et al. q  “largest biological project in history” – Kevles and Hood

n  INTENDED CONSEQUENCES q  “revolutionize the practice of medicine in the 21st century by

providing the tools to determine the hereditary component of virtually all diseases”

q  “promises longer, healthier lives for everyone” - Collins et al.

n  UNINTENDED CONSEQUENCES q  Privacy, insurance discrimination, gene patents

My questions:

n  Impact of “geneticization” (Lippman) on

q  Stigmatization of deviant behavior and characteristics, especially mental illness

q  Racism: In particular, belief in essential differences between blacks and whites

Stigma (for example racism) occurs when a human characteristic . . . n  is identified as socially significant; n  is labeled; label . . . n  sets a person apart from others (us and them), n  links the person to undesirable attributes, n  leads to status loss, rejection and discrimination, n  occurs in a power context that allows one group to

stigmatize another. (Link and Phelan, Annual Review of Sociology, 2001)

Central role in racism of belief in racial difference

q  “Racism is the belief that race is a primary determinant of human traits and capacities and that racial differences produce an inherent superiority of a particular race” (Merriam-Webster’s Dictionary ).

q  “A racial project can be defined as racist if and only if it creates or reproduces structures of domination based on essentialist categories of race.” Omi and Winant, Racial Formation in the United States: From the 1960s to the 1990s

q  “the perpetuation of systemic racism requires an intertemporal reproducing not only of racist institutions and structures but also of the ideological apparatus that buttresses them.” Feagin, Racist America: Roots, Current Realities, and Future Reparations.

When racism has been extreme, belief in racial

differences have been extreme: ¡  “humanity is at its greatest perfection in the race

of the whites. The yellow Indians do have a meagre talent. The Negroes are far below them, and at the lowest point are a part of the American people" (Kant).

¡  “there is nothing remotely humanized in the Negro’s character” (Hegel).

¡  “there is physical difference between the white and black races which I believe will forever forbid the two races living together on terms of social and political equality” (Abraham Lincoln).

Stigma (for example racism) occurs when a human characteristic . . . n  is identified as socially significant; n  is labeled; label . . . n  sets a person apart from others (us and them), n  links the person to undesirable attributes, n  leads to status loss, rejection and discrimination, n  occurs in a power context that allows one group to

stigmatize another. (Link and Phelan, Annual Review of Sociology, 2001)

What is the historical trajectory of beliefs in racial differences? n  Strong trend away from beliefs in stark racial

differences since 19th century. n  Modern genomic revolution has the potential

to stall or reverse this trajectory.

Why?

n  Genomic revolution has probably increased “genetic essentialism” (Lippman; Nelkin and Lindee)

q  Genes are essence of our human and individual identity

q  We are our genes. Our genes make us who and what we are.

q  “DNA is what makes us human” (Watson) q  Genes are “a vital part of who you are” (Morely

Safer, 60 Minutes, April 4, 2010. q  “It’s in my/your/their DNA” (everyone, all the

time)

Bearing of genetic essentialism on belief in racial differences:

q  To the extent that the genes of blacks and whites are the same, blacks and whites are essentially the same.

q  To the extent that the genes of blacks and whites are different, blacks and whites are essentially different.

What messages have emerged from modern genomics research about racial differences?

¨  “I believe one of the great truths to emerge from this triumphant expedition inside the human genome is that in genetic terms, all human beings, regardless of race, are more than 99.9 percent the same. What that means is that modern science has confirmed what we first learned from ancient fates. The most important fact of life on this Earth is our common humanity” (Bill Clinton).

¨  “the concept of race has no genetic or scientific basis” (Craig Venter).

Transcript: White House Briefing on Genome Map June 26, 2000.

However,

¨  Attention has increasingly turned to the .1% of the genome that varies between humans

¨  Research has increasingly looked to racial (or Asian, European and African “population” or “continental”) differences as the basis for variation in that small portion of the genome

¨  A major direction of this research is the search for genomic bases of differences in disease outcomes between racial groups

¨  (e.g., lung cancer, breast cancer, prostate cancer, hypertension, heart attack, congestive heart failure, stroke)

Genes May Cause Racial Difference in Heart Attacks

Doctors have long known that African Americans are prone to heart attacks. In fact, not only are African Americans more likely to suffer from heart attacks, their heart attacks are more likely to be fatal, compared to Caucasians.

A recent study suggests that genetics may help explain this racial difference. Dr. Bruce Firman and other geneticists at Columbia University detected a version of a gene that raises the risk of heart attack in African-Americans by more than 250 percent. That means the gene more than doubles the risk of heart attack in African-Americans. Results of the study were published yesterday in the journal Nature Genetics

The gene identified by the researchers is called

leukotriene A4 hydrolase. The gene is involved in inflammation. Inflammation, which we commonly see as swelling,

redness and pain, is the process by which the body responds to injury or infection. Inflammation is usually beneficial to health. But new evidence shows that inflammation plays a key role in causing heart attacks. Too much inflammation seems to damage the lining of artery walls and contribute to the buildup of fatty deposits (called plaque) inside the artery.

Plaques block the flow of blood through the arteries, leading to heart attacks. Inflammation can also cause plaques to burst, which scientists think is a cause of heart attacks.

Dr. Firman said that the gene they identified is much more strongly associated with heart attack in African-Americans than in Caucasians.

“These findings,” said Dr. Firman, “offer strong evidence that genetic factors are important in explaining the higher rates of heart attack in African Americans.”

Backdoor to eugenics n  Such reports may seem far removed from genetic

essentialism, racism, etc. – but are they? n  (1) They communicate, with the authority of science and

medicine, that race is a valid and useful way of categorizing humans.

n  (2) Unlikely that public will restrict their conclusions to genetic disorders: They will ask: q  “If genetic disorders are differentially distributed by

race and ethnicity, why aren’t other human traits and characteristics?” (Duster 2003: 5).

n  (3) Acceptance and generalization of messages facilitated by the manner in which they are communicated: objective, apolitical, non-ideological.

n  In this way, eugenics comes in the back door.

Basic research question

n  Will increased reports of differences between racial groups in genetic aspects of disease (associated with the genomic revolution) lead to increased beliefs in essential racial differences?

Backdoor-to-eugenics hypothesis only supported if

n  Genomic revolution increases the public’s exposure to statements indicating that racial groups differ in terms of genetic disorders.

n  n  The public responds to these statements with

an increased belief that racial groups differ more fundamentally, in ways that go beyond health.

Genes and Stigma: The Role of Mass Media

n  Research team: Jo Phelan, PhD, Bruce Link, PhD, Naumi Feldman, MPH, Claire Espey, BA, Sarah Johnson, MPH , Sara Kaplan-Levenson, MPH, Rebecca Levine, MPH, Nora Sturm, BA, Nicholas Valentino, PhD, Asmara Knighton, MPH, Parisa Tehranifar, DrPH, Sara Kuppin, DrPH, Laura Gabby, MPH, Kelli Soto, BA, and Edna Bonhomme, BA.

n  Funded by the National Human Genome Research Institute (Ethical, Legal and Social Implications Program)

Research strategy: Multi-method

n  Has the public been increasingly exposed to news stories about race, genomics and health as the genomics revolution has progressed?

n  Are such stories presented in a socially and ideologically neutral manner? q  Content analysis of newspaper articles about race and

genomics from 1985 to 2008 n  If members of the public are exposed to such

stories, do they respond with a heightened belief in fundamental racial differences? q  Survey experiment assessing impact of different

versions of mock newspaper articles about race and genomics on beliefs in fundamental racial differences in population-based sample of Americans

Content analysis: Hypotheses

n  # of articles that discussed race, genomics and health increased significantly between 1985 and 2008

n  # of articles that resemble the Backdoor Vignette (shown previously) increased significantly between 1985 and 2008.

n  Articles that discuss health-related differences are less likely to discuss racism or other ethical concerns than articles that do not discuss health-related differences, and articles that discuss health-related differences are more likely to endorse (rather than refute or give contrasting views) genetic causes than articles that do not discuss health-related differences.

Content analysis: Selection of articles n  Search Nexis

q  Articles with subject terms (race or racial or ethnic or cauasian or African) and (genetic or genes or genomic)

q  1985 (5 years prior to HGP) to 2008 q  New York Times and Associated Press q  Any type of article except paid death notices

n  Articles reviewed by research assistants using specific inclusion criteria -- the article discussed genetic causes of some type of racial difference or discussed “race per se” (e.g., race as social construction) q  Inter-rater reliability (kappa) for selection of article =.90

n  N articles = 189

Content analysis: Coding of articles

n  Quantitative ratings

n  Each article rated by two research assistants

n  Acceptable to excellent inter-rater reliability

n  Consensus reached on disagreements

Content analysis: Measures q  Article discussed genetic causes of health-related

racial differences (e.g. diseases, biological risk factor for disease and response to medication) Kappa = .92

q  Resemblance of article to Backdoor Vignette n  Rated 1 (very dissimilar) to 7 (very similar); Kappa for

dichotomized measure = .74. q  Endorsement of genetic cause

n  Rated 1 (only refutes genetic cause) to 5 (only endorses); ICC = .66.

q  Mention of racism, prejudice or similar concepts n  Rated 0 (definitely no); 1 (possibly yes); 2 (definitely yes); ICC

= .88. q  Discussing ethical concerns, such as discrimination,

prejudice, stereotyping, eugenics n  Rated 0 (definitely no); 1 (possibly yes); 2 (definitely yes); ICC

= .78.

Number of articles in NYT and AP 1985-2008

Start HGP End HGP

Significant increases (P < .001 for total and health; P<.01 for resembles vig)

Mentions of racism (mean: 0=no racism; 1=possible racism; 2=definite racism)

p<.01 Health Non-Health

Raises ethical concerns (mean: 0=no concerns; 1=possible concerns; 2=definite concerns)

p<.001 Health Non-Health

Endorsement of genetic cause (mean on 1 to 5 scale; 1=only refutes; 5=only endorses)

p<.001 Health Non-Health

Conclusions so far

n  First necessary component for backdoor-to-eugenics is present q  Increase in number of relevant articles q  Messages presented in positive and objective

manner without mention of controversy or social issues

Vignette experiment: Methodology

n  From content analysis, identified three types of articles: one representing type of message central to backdoor-to-eugenics hypothesis (“Backdoor Vignette”) and two strategically selected points of comparison

n  Created mock articles modeled closely after actual articles; modified to standardize length, prestige of sources cited in articles, and to lower reading level.

n  Randomly assign one mock article or no article to each research participant.

n  Assess impact of article on belief in essential racial differences.

No-vignette control condition

n  But, possible that any discussion of race and genetics, or simply race, may affect endorsement of essential racial differences

Is race real? Genes say ‘No’

Most people would agree it is easy to tell at a glance if a person is Caucasian, African or Asian.

But a recent study suggests that it is not so easy to make these distinctions when one probes beneath surface characteristics and looks for DNA markers of “race.”

Results of the study were published yesterday in the journal Nature Genetics. The study was conducted by Dr. Bruce Firman and other geneticists at Columbia University.

Analyzing the genes of people from around the world, the researchers found that the people in the sample were about 99.9 percent the same at the DNA level. “That means that the percentage of genes that vary among humans is around .01 percent, or one in ten thousand. This is a tiny fraction of our genetic make-up as humans,” noted Dr. Firman.

The researchers also found that there is more genetic variation within each racial or ethnic group than there is between the average genomes of different racial or ethnic groups.

Why the discrepancy between the ease of distinguishing “racial” groups visually and the difficulty of distinguishing them at a genetic level?

Traits like skin and eye color, or nose width are controlled by a small number of genes. Thus, these traits have been able to change quickly in response to extreme environmental pressures during the short course of human history.

But the genes that control our external

appearance are only a small fraction of all the genes that make up the human genome.

Traits like intelligence, artistic talent and social skills are likely to be shaped by thousands, if not tens of thousands of genes, all working together in complex ways. For this reason, these traits cannot respond quickly to different environmental pressures in different parts of the world.

This is why the differences that we see in skin color do not translate into widespread biological differences that are unique to groups and why Dr. Firman says “the standard labels used to distinguish people by ‘race’ have little or no biological meaning.”

Is Race real? Genes Say ‘Yes’

Most people would agree it is easy to tell at a glance if a person is Caucasian, African or Asian.

A recent study suggests that the same racial groups we can identify do in fact correspond with broad genetic differences between groups.

Results of the study were published yesterday in the journal Nature Genetics. The study was conducted by Dr. Bruce Firman and other geneticists at Columbia University.

Dr. Firman says that racial differences exist because early humans in Africa spread throughout the world 40,000 years ago, resulting in geographical barriers that prevented interbreeding. On each continent, natural selection and the random change between generations known as genetic drift, caused peoples to diverge away from their ancestors, creating the major races.

The effects of this natural selection and genetic drift

that have followed different pathways on each continent can be seen by looking at people from different racial groups as traditionally defined. Certain skin colors tend to go with certain kinds of eyes, noses, skulls and bodies.

When we glance at a stranger’s face we use those associations to guess what continent, or even what country, he or his ancestors come from – and we usually get it right. What Dr. Firman and his colleagues showed was that genetic variations that aren’t written on our faces – that can be seen only in our genes – show similar patterns. The researchers sorted by computer a sample of people from around the world into five groups on the basis of genetic similarity. The groups that emerged were native to Europe, East Asia, Africa, America and Australasia – the major races of traditional anthropology.

Hence, Dr. Firman says, “race matches the branches on the human family tree as described by geneticists.”

In contrast to Backdoor Vignette, comparison vignettes . . .

n  emphasize broad rather than specific racial differences

n  thus should be more likely than the backdoor vignette to affect endorsement of essential racial differences Except for the possibility of backdoor-to-eugenics effects: q Specific effects generalize q Comparison vignettes are more recognizable as “conservative” or “liberal”

Debriefing

n  Thank you for answering our questions about the news article. That article was constructed from a variety of different news articles and reflects only one viewpoint among many views on this issue.

Dependent measure: Belief in essential racial differences (Cronbach’s alpha = .78)

q  Although black and white people may be alike in many ways, there is something about black people that is fundamentally different from white people.

q  Different racial groups are all basically alike “under the skin” (reverse scored)

q  There are very few genetic differences among racial groups (reverse scored)

q  When you compare black and white people, you think they are very similar (1); somewhat similar (2); not very similar (3); not similar at all (4).

Belief in essential racial differences, cont’d

q  To what extent do you agree with the following statement? Racial and ethnic minority groups in the U.S. are very distinct and very different from one another;

q  To what extent do you agree with the following statement? Whites as a group are very distinct and different from racial and ethnic minority groups.

n  (4) strongly agree; (3) somewhat agree; (2) somewhat disagree; (1) strongly disagree.

Vignette experiment: Sample n  Internet survey (2009) n  Part of American National Election Studies (ANES) panel

– panel participates in series of surveys n  Nationally representative sample of Americans age 18+

in households with telephones n  Complex sample design; data are weighted and

analyzed to account for sample design. n  Completion rate = 66%. n  N for present analysis = 445

q  Internet equipment supplied to those who do not own it q  Experiment embedded in nationally representative survey

combines good internal and external validity

Vignette experiment: Hypothesis

n  Backdoor Vignette produces q  Significantly greater belief in essential racial

differences than Race-as-social-construction vignette and no-vignette control

q  No significant difference in belief in essential racial differences from Race-as-genetic-reality Vignette.

Results: Mean endorsement of essential racial differences (1 to 4 scale) (ANOVA P<.001)

P<.01 P<.05 N.S.

Generality of results

n  This pattern of results holds true across race and gender groups and across different levels of age, education, and family income

n  Exception: Blacks and whites differ in their response to the no-vignette control condition

Do results vary depending on participants’ degree of racial bias?

n  Backdoor effect relies on messages slipping “under the radar screen” of pre-existing attitudes q  Saw that health-related articles were presented as

objective with little mention of social issues q  Is there evidence from the vignette experiment

that backdoor messages are not filtered through pre-existing attitudes?

Mean acceptance of vignette (accurate and unbiased) 1 to 4 scale (alpha = .64)

P<.001 N.S.

n  Implicit racial bias (measured on an earlier occasion) was significantly positively related to belief in racial difference for Social Construction and Genetic Reality Vignettes but not for the Backdoor Vignette

n  Backdoor vignette elevates belief in racial difference regardless of pre-existing racial bias.

Conclusions so far

n  Both necessary ingredients for backdoor to eugenics are present q  Increase in number of relevant articles q  Articles have hypothesized effect on belief in

fundamental racial differences q  Not confined to highly biased whites

But do beliefs in essential racial differences really matter? n  Argued that belief in racial differences are

key to racism and that increased belief in such differences could exacerbate racism

n  If not, backdoor to eugenics may be real but not that consequential

n  Are beliefs in essential racial differences related to other measures of racism in our data?

Correlations with belief in essential racial differences among non-Hispanic whites (controlling vignette type)

n  Explicit racism -.06 n  Implicit racism .16*** n  Social distance .31***

Conclusion: Backdoor to eugenics is something to worry about n  Articles such as those Duster describes have

increased significantly over period of genomic revolution.

n  Such articles increase belief in essential racial differences.

n  Beliefs in essential racial differences are not isolated but significantly related to other indicators of racism.

n  This is an “invisible” phenomenon.

n  Not saying belief in racial differences is ultimate cause of American racism

n  More likely it was need for slavery to maintain wealth of white landowners (Feagin 2001)

n  But . . .

Stigma (for example racism) occurs when a human characteristic . . . n  is identified as socially significant; n  is labeled; label . . . n  sets a person apart from others (us and them), n  links the person to undesirable attributes, n  elicits negative emotions, n  leads to status loss, rejection and discrimination, n  occurs in a power context that allows one group to

stigmatize another. (Link and Phelan, Annual Review of Sociology, 2001)

“Backdoor” messages

Belief in racial

differences

Social distance from blacks

Genomic revolution

Mean belief in essential racial differences

Implicit racism

n  Affect Misattribution Procedure (AMP). After seeing a photograph of a black or white face (75 milliseconds), participants see a Chinese character (100 milliseconds), then a grey screen and indicate whether they find the Chinese character pleasant or unpleasant. There are 48 trials. The AMP score is the percent of characters associated with black faces judged to be unpleasant minus the percent of characters associated with white faces judged to be unpleasant.

Social distance from blacks (Cronbach’s alpha among non-Hispanic whites = .72)

n  How would you feel about having a close relative or family member marry a black person? q  (1) strongly favor; (2) favor; (3) neither favor nor oppose;

(4) oppose; (5) strongly oppose.

n  If you could find the housing that you would want and like, would you rather live in a neighborhood where (1) most of your neighbors do not belong to your own racial group; (2) about half of your neighbors belong to your own racial group; (3) most of your neighbors belong to your own racial group; (4) all your neighbors belong to your own racial group.

n 

Social distance from blacks (cont’d)

n  Suppose you were thinking of adopting a child out of foster care. Would the race of the child be a concern for you in thinking about whether to adopt the child? q  (1) no concern; (2) minor concern; (3) major concern.

n  How would it make you feel to receive a blood transfusion from someone who is of a different race than you?

n  How would it make you feel to receive an organ transplant from someone who is of a different race than you? q  (1) not uneasy at all; (2) somewhat uneasy: (3) very

uneasy