Race, Health & Society, Feb 22 notes
Howard Kushner opened the discussion with a recap of the previous week.
Two different issues were discussed:
1. A new Alzheimer study that showed black males in the US had a higher incidence of Alzheimer than an age-adjusted population of West African males, even when the West Africans had the APO4 gene, which is believed to be causally linked with the disease. The researchers did not address the fact that American population is not the same as the African population.
2. How is science conducted? Medical research versus medical practice: different paradigms are competing for the way research is to be done and outcomes depend upon the way the study is designed. Is science racist? Science is not monolithic--projects within may be racially biased, which is different than all of science being inherently racist.
Was research influenced in any way by societal notions of pathological people (certain selective traits in populations could mix with other populations and cause disease)?
In the instance of sickle cell, were scientists figuring out the mechanism of the disease in a racist social climate were cultural assumptions affecting:
- Data gathering;
- Scientific method;
-Interpretation of data?
Maladaptive versus adaptive: genes are context-dependent as to what genes are superior or inferior.
Where methods biased?
What was going on here?
Why was the study scientifically plausible at the time?
-Doubt regarding the effectiveness of treatments (questions were raised as to whether the treatment was helpful or harmful);
-The idea that you can't answer the above question until you know what no treatment looks like.
Assumption of difference without testing the assumption: latent syphilis was believed to be different in whites than blacks.
USPHS--was the government using the promise of gaining respect as a lever to influence the involvement of the Tuskegee doctors?
The PCPs were primarily black--were financial issues involved?
Where is the locus of informed consent--at the community of individual?
Issues raised by Tuskegee:
The current debate whether informed consent has gone too far;
Long-term studies: At what point are researchers responsible for adapting to advances in technology (new treatments) and/or ethical/moral advancements?