It is no secret that a longer life is a white privilege in the U.S. In 2011, the Centers for Disease Control and Prevention (CDC) reported that white men lived more than four years longer than black men, and white women lived more than three years longer than black women. The main reason for the racial mortality gap is heart disease. “There’s a huge number of years of life lost because some people have the black life expectancy and not the white life expectancy,” Kaufman said. “It’s killing people prematurely on the basis of race.”
To understand if there is any genetic reason for these deaths, Kaufman’s team reviewed six years of genome-wide studies of cardiovascular disease. Having crawled across the genome for every possible variant that could trigger deadlier disease, they only found three that fit the bill—and two of them suggested that whites, not blacks, should be on the suffering side of the disparity. “We’re spending a huge amount of money on these studies,” he said, “but if you are interested in understanding disparities, all this money that’s been spent has come up with basically nothing.”
Maybe this finding isn’t entirely earth-shattering. After all, it is almost universally agreed that race is a social construct. In 2005, only two years after the sequencing of the human genome, the editors of Nature Biotechnology put it like this: “Pooling people in race silos is akin to zoologists grouping raccoons, tigers, and okapis on the basis that they are all stripey.” Perhaps, then, the better question is: Why do we continue to search for a connection between race and genetics to explain health disparities?
One reason has less to do with biology and more to do with finances. Take BiDil, the first race-specific medication, which made a cameo on House, M.D. BiDil is a combination of two generic drugs for heart failure that have been on the scene for decades. In 2005, the Food and Drug Administration approved the old drugs for a new purpose: the treatment of heart failure in a single race, African Americans. Jonathan Kahn, author of Race in a Bottle, has written extensively on the history of this medication. There is no doubt that BiDil works for African Americans. The sleight of hand, Kahn points out, is that the clinical trial for the drug’s approval—the African American Heart-Failure Trial—had no comparison group. Researchers only studied BiDil in African Americans. The drug likely worked not because they are black, but because they are human. But the juicier claim is that NitroMed, the company behind BiDil, was able to extend its patent to 2020, which otherwise would have expired in 2007. The magic touch was the race-specific label, which made the old method new again.
Another reason for the persistence of race and genetics in biomedical research is much more subtle. Certain diseases cluster in populations, such as Tay-Sachs, which is most common in people with an Ashkenazi Jewish background. In such cases, some researchers say we should turn our attention away from race and toward ancestry. If it is true that there are differences in disease risk between human groups, then what we need is a more clever way to dice up humanity. “It has nothing to do with race, it has more to do with ancestry,” explained Rick Kittles, the director of the Center for Population Genetics at the University of Arizona and co-founder of African Ancestry, Inc. “We talk about ancestry, we talk about shared genetic backgrounds. That is a better proxy for biology than race. If someone says they’re of Ashkenazi Jewish ancestry, and they have a family history of Tay-Sachs, that’s not because of a race. That’s because of shared ancestry. If a person of West African descent has a family history of prostate cancer, that’s a shared genetic background.”