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Medical Folklore: Relative Risk for Bone Disease

Thinking Systematically about Nature and Nurture: Part II – Race and Bones Anne Fausto-Sterling, Brown University. Medical Folklore: Relative Risk for Bone Disease. White and Asian women >Hispanic women >White and Asian men = African American women >African American men

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Medical Folklore: Relative Risk for Bone Disease

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  1. Thinking Systematically about Nature and Nurture:Part II – Race and BonesAnne Fausto-Sterling, Brown University

  2. Medical Folklore: Relative Risk for Bone Disease White and Asian women >Hispanic women >White and Asian men = African American women >African American men Source: National Osteoporosis Foundation and the National Institutes of Health

  3. Science-Health Policy: a confusing message “the fact that osteoporosis and fragility fractures are often mistakenly viewed by both the public and health care practitioners as only being a problem for older White women…may delay and even prevent treatment in men and minority women…” US Surgeon General’s report : Bone Health and Osteoporosis (2004)

  4. Typological Thinking: history • 18th and 19th Century Hierarchies • Brain size • Skull shapes • Pain thresholds • Developmental and evolutionary sequence

  5. Race in Contemporary Medicine: Bodies out of Context • Lung function correction • “race specific” pharmaceuticals • Body mass index and obesity • Age at menarche • Diabetes

  6. What is Race? • 1999: Institute of Medicine agrees with American Anthropologists that race is a social but not a biological concept • Post 2000 Editorials in Nature Genetics, JAMA, NEJM insist researchers should define race and explain why it is a relevant variable

  7. Competing contemporary views of Race

  8. Current Debates in the Medical Literature • Race neutral • Geographical ancestry • Self identification using census categories But… • Census categories are a socio-political construction

  9. The common race categories are unscientific • Breadth: each has important historical, cultural and genetic substructure • Populations are on the move—skin color is a poor marker of current populations • E.g. more recent African immigrants now in the US than descendants of those from the middle passage

  10. “Real” differences are contextual-1 (e.g. Taaffe et al, 2003): (sex/race diffs in bmd and X-sect. geometry of femur mid-shaft in older adults) • Males 4.3% higher vol. b.d. than females (no racial diff.) • Even when factored in diffs in smoking, medication, physical activity, height and weight • Males had greater cortical, medullary, areas of femur shaft and no race difference between men • Black women had 4.3% greater total, and 5.7% greater cortical areas than white women • These differences disappeared if they corrected for total bone length

  11. “Real” differences are contextual-II • Taafe et al: “Thus racial differences in volumetric density and geometry are likely dependent on the composition of the bone, whether an apparent or true density measurement is obtained as well as the skeletal site assessed and age of the population.” • Composition: depends on diet, physiology developmental history of use and disuse

  12. What do Genes Have to do With It? • Genes are mediators, not causal agents • Genes translate experience into molecular and cellular change • In mice over 30 genes affect bone development either positively or negatively • Probably at least that many in humans • Conclusion: individual genetic make-up relevant to bone structure and density but effects can only be calculated in context of mechanical experience, environment and cultural habits

  13. Chewing bones makes crested hyena skulls Source: West-Eberhard, Mary Jane. Developmental Plasticity and Evolution, Oxford University Press: 2003.

  14. Race is a poor category for analysis of complex health issues* • “genetic, anthropological, medical and epidemiological definitions and uses are not analytically congruent in theory or practice”. • Assessment of race is unreliable • Race is an invalid concept for genetic studies • Does not facilitate development of useful mechanistic hypotheses • Typological view overemphasizes and inappropriately divides biological factors from social and environmental components --Shields et al, 2005

  15. Analytical and treatment goals Combine knowledge of personal history (past and current nutrition, physical activity, geographical location, geographic history, etc.) with an analysis of key components of individual biology to devise a particularized bone health plan

  16. Racial Science is Bad Science • Biological race is not a useful variable although skin color (vitamin D) or genotype might be • Sociological race might correlate with particular cultural practices, economic status, types of physical activity, etc., but why not study these instead of an imperfect stand-in • Stop using macro-ethnic categories

  17. Culture Nature M.C. Escher

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