Transcript The new biopolitics of race, health, and justice

Mistreating Health
Inequities:
The New Biopolitics of Race,
Health & Justice
Dorothy Roberts
D.Roberts, UPenn
• 111 “excess” deaths of black women in
Chicago in 2005
• Almost one-half of annual black breast
cancer deaths
D.Roberts, UPenn
Black and White Breast Cancer Mortality Rates,
Chicago, 1980-2005
White
Black
50
45
Rate Per 100,000 Females
40
41.4
38.1
35
37.4
30
25
20
15
19.2
10
5
0
1980
1982
1984
1986
1988
1990
1992
1994
1996
1998
2000
Year
D.Roberts,
UPenn Per 100,000 Population
Age-Adjusted Female Breast Cancer Mortality
for Chicago,
2002
2004
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% the same.
June 26, 2000
D.Roberts, UPenn
The Scientific Invention of Race
D.Roberts, UPenn
The Tuskegee Experiment, 19321972
D.Roberts, UPenn
North Carolina Eugenics Board,
1933-1973
D.Roberts, UPenn
Nicholas Wade, NY Times, July 20, 2001
“
Scientists planning the next phase of the
human genome project are being
forced to confront a treacherous issue:
the genetic differences between human
races.
D.Roberts, UPenn
“An explosive new
account of the
genetic basis of
race and its role in
the human story.”
D.Roberts, UPenn
D.Roberts, UPenn
A New Biopolitics of Race
• New racial science defines race as genetic
grouping.
• Biotechnology and pharmaceutical industries
develop race-specific products.
• Racial inequality & state violence persist in
supposedly “post racial” society.
D.Roberts, UPenn
“Genome Study Points to Adaptation in Early AfricanAmericans,” Nicholas Wade, Jan. 2, 2012
HARSH NEW WORLD
Slaves in Georgia, circa
1850. A new
environment
apparently brought
genetic change.
D.Roberts, UPenn
“[C]ertain disease-causing variant genes
became more common in AfricanAmericans after their ancestors reached
American shores—perhaps because they
conferred greater, offsetting benefits.”
D.Roberts, UPenn
Infant mortality rate for
blacks increased from 1.6
times to 2.3 times rate for
whites since 1950s.
D.Roberts, UPenn
Test the hypothesis that “black race
independent of other factors increases the
risk of extreme preterm birth and its
frequency of recurrence.”
Zachary A.-F. Kistka, et al., “Racial Disparity in the Frequency of
Recurrence of Preterm Births,” American Journal of Obstetrics &
Gynecology 196 (2007): 131.e1.
D.Roberts, UPenn
Findings “suggest a probable genetic
component that may underlie the
public health problem presented by
the racial disparity in preterm birth.”
D.Roberts, UPenn
Nicholas Bakalar, “Study Points
to Genetics in Disparities in
Preterm Births,” New York Times,
February 27, 2007, F5.
D.Roberts, UPenn
• Overall birthweight distribution for infants
of US-born white women and African-born
women almost identical.
• Black women born in US experienced
higher rates of very low birthweight.
Richard David & James Collins Jr., Disparities in Infant Mortality:
What’s Genetics Got to Do With It? A JPH 97 (2007): 1191-1197.
D.Roberts, UPenn
“Our findings were not readily explained by
any genetic mechanism but rather suggested
that negative effects of minority status are
cumulative through the life course from fetus
to childbearing women.”
D.Roberts, UPenn
Race-specific Medicine
D.Roberts, UPenn
“Observed racial disparities in mortality and
therapeutic response rates in black patients may
be due in part to ethnic differences in the
underlying pathophysiology of heart failure"
Nitromed March 2001 press release
D.Roberts, UPenn
“We’re using self-identified
race as a surrogate for genetic
markers.”
Dr. Steve Nissen, chair FDA advisory committee
D.Roberts, UPenn
A pharmacogenomic drug?
• “Representing a step toward the promise of
personalized medicine.” FDA News Release, 6/23/05
• “On the leading edge of the emerging field of race-
based pharmacogenomics.” NYT Mag, 10/10/04
D.Roberts, UPenn
BiDil as remedy for
medical wrongs against
African Americans “for
whom treatment has
been denied and
deferred for 400 years.”
D.Roberts, UPenn
“the
strategic use of race as a
genetic category to obtain patent
protection and drug approval”
Jonathan Kahn, Hamline University
D.Roberts, UPenn
False Equation
0.1 % genetic difference = race
unequal health outcomes
D.Roberts, UPenn
Embodying Racism
D.Roberts, UPenn
Colorblind Social Policy
“The way to stop
discrimination on the
basis of race is to stop
discriminating on the
basis of race.”
Chief Justice John Roberts, Parents
Involved in Community Schools v.
Seattle School District No. 1 (2007)
D.Roberts, UPenn
Social race is the
phenomenon
constructionists have in
mind…. Biological race,
however, is what BiDil’s
developers are
concerned with – that is,
race as ancestry.
Sally Satel (2004)
D.Roberts, UPenn
We talk a lot about diversity
in the United States, as long
as we wink and smile that
this diversity is not real ….
But in some aspects of our
humanity, it is very real, and
such differences can have
huge consequences in
everything from sports
performance to success in
the classroom.
Jon Entine (2007)
D.Roberts, UPenn
Twisted Logic
Racial differences are real at the
molecular level, but merely
constructed in society
D.Roberts, UPenn
“A DATE WITH DNA”
NYTimes, Sept. 2008
D.Roberts, UPenn
Apple & Facebook pay
for egg freezing
Apple & Facebook offer to
pay female employees
D.Roberts, UPenn
Gang-Banging May Be Genetic
By Associated Press, June 17, 2009
Wrong Direction
Social hierarchies are facts of
nature that require private
technological fixes & punitive
controls.
D.Roberts, UPenn
A more just society
would be a
healthier one
D.Roberts, UPenn