5/21/20151 Thinking Systematically about Nature and Nurture: Part II – Race and Bones Anne Fausto-Sterling, Brown University

5/21/20152 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

5/21/20153 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)

5/21/20154 Typological Thinking: history 18 th and 19 th Century Hierarchies 18 th and 19 th Century Hierarchies  Brain size  Skull shapes  Pain thresholds  Developmental and evolutionary sequence

5/21/20155 Race in Contemporary Medicine: Bodies out of Context Lung function correction Lung function correction “race specific” pharmaceuticals “race specific” pharmaceuticals Body mass index and obesity Body mass index and obesity Age at menarche Age at menarche Diabetes Diabetes

5/21/20156 What is Race? 1999: Institute of Medicine agrees with American Anthropologists that race is a social but not a biological concept 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 Post 2000 Editorials in Nature Genetics, JAMA, NEJM insist researchers should define race and explain why it is a relevant variable

Competing contemporary views of Race 5/21/20157

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

5/21/20159 The common race categories are unscientific Breadth: each has important historical, cultural and genetic substructure Breadth: each has important historical, cultural and genetic substructure Populations are on the move—skin color is a poor marker of current populations 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

5/21/ “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.) 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 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 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

5/21/ “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.” 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 Composition: depends on diet, physiology developmental history of use and disuse

5/21/ What do Genes Have to do With It? Genes are mediators, not causal agents Genes are mediators, not causal agents Genes translate experience into molecular and cellular change Genes translate experience into molecular and cellular change In mice over 30 genes affect bone development either positively or negatively In mice over 30 genes affect bone development either positively or negatively Probably at least that many in humans 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 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

5/21/ Source: West-Eberhard, Mary Jane. Developmental Plasticity and Evolution, Oxford University Press: Chewing bones makes crested hyena skulls

5/21/ 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”. “genetic, anthropological, medical and epidemiological definitions and uses are not analytically congruent in theory or practice”. Assessment of race is unreliable Assessment of race is unreliable Race is an invalid concept for genetic studies Race is an invalid concept for genetic studies Does not facilitate development of useful mechanistic hypotheses Does not facilitate development of useful mechanistic hypotheses Typological view overemphasizes and inappropriately divides biological factors from social and environmental components Typological view overemphasizes and inappropriately divides biological factors from social and environmental components --Shields et al, 2005

5/21/ 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

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5/21/ Racial Science is Bad Science Biological race is not a useful variable although skin color (vitamin D) or genotype might be 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 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 Stop using macro-ethnic categories

5/21/ Nature Culture M.C. Escher