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Debating the Cause of Health Disparities: Implications for Bioethics and Racial Equality

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1. Smedley BD, Stith AY, Nelson AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: National Academy Press; 2003 , at 5.

2. Epstein RA. Disparities and discrimination in health care coverage: A critique of the Institute of Medicine study. Perspectives in Biology and Medicine 2005;48:S26S41, at S40.

3. Klick J, Satel S. The Health Disparities Myth: Diagnosing the Treatment Gap. Washington, DC: American Enterprise Institute Press; 2006, at 3.

4. See note 3, Klick, Satel 2006, at 31–2.

5. Barr DA. Health Disparities in the United States: Social Class, Race, Ethnicity, and Health. Baltimore, MD: Johns Hopkins University Press; 2008; Bach PB, Pham HH, Schrag D, Tate RC, Hargraves JL. Primary care physicians who treat blacks and whites. New England Journal of Medicine 2004;351:575584;Sack K. Research finds wide disparities in health care by race and region. New York Times 2008 Jun 5:A18.

6. Whitehead M, Dahlgren G. Concepts and Principles for Tackling Social Inequities in Health: Levelling Up Part 1. Copenhagen: World Health Organization Regional Office for Europe; 2006, at 2.

7. See note 5, Barr 2008; Kitagawa EM, Hauser PM. Differential Mortality in the United States: A Study in Socioeconomic Epidemiology. Cambridge, MA: Harvard University Press; 1973; Adler NE, Rehkopf DH. U.S. disparities in health: Descriptions, causes, and mechanisms. Annual Review of Public Health 2008;29:235252;Marmot MG, Kogevinas M, Elston MA. Social/economic status and disease. Annual Review of Public Health 1987;8:111135.

8. Marmot MG, Shipley MJ, Hamilton PJ. Employment grade and coronary heart disease in British civil servants. Journal of Epidemiology and Community Health 1978;32:244249; Marmot MG, Shipley MJ, Rose G. Inequalities in death: Specific explanations of a general pattern? Lancet 1984;323:10031006.

9. Gravlee CC. How race becomes biology: Embodiment of social inequality. American Journal of Physical Anthropology 2009;139:4757, at 52; Drexler M. How racism hurts—literally. Boston Globe 2007 Jul 15:E1.

10. See note 5, Barr 2008:157; Krieger N. The science and epidemiology of racism and health: Racial/ethnic categories, biological expressions of racism, and the embodiment of inequality—and ecosocial perspective. In: Whitmarsh I, Jones DS, eds. What’s the Use of Race? Modern Governance and the Biology of Difference. Cambridge, MA: MIT Press; 2010, at 225–255, at 235; Williams DR, Collins C. Racial residential segregation: A fundamental cause of racial disparities in health. Public Health Reports 2001;116:404416;Kuzawa CW, Sweet E. Epigenetics and the embodiment of race: Developmental origins of US racial disparities in cardiovascular health. American Journal of Human Biology 2008; 21:215.

11. LaViest T, Pollack K, Thorpe R Jr, Fesahazion R, Gaskin D. Place, not race: Disparities dissipate in southwest Baltimore when blacks and whites live under similar conditions. Health Affairs 2011;30:18801887.

12. Cooper RS, Kaufman JS. Race and hypertension. Hypertension 1998;32:813816;Cooper RS, Kaufman JS, Ward R. Race and genomics. New England Journal of Medicine 2003;348:11661170; Shanawani H, Dame L, Schwartz DA, Cook-Deegan R. Non-reporting and inconsistent reporting of race and ethnicity in articles that claim association among genotype, outcome and race or ethnicity. Journal of Medical Ethics 2006;32:724728.

13. Kistka ZA-F, Palomar L, Lee KA, Boslaugh SE, Wangler MF, Cole FS, et al. . Racial disparity in the frequency of recurrence of preterm births. American Journal of Obstetrics & Gynecology 2007;196:131. e1e6.

14. Stamilio DM, Gross GA, Shanks A, DeFranco E, Chang JJ. Discussion: “Racial Disparity in Preterm Birth” by Kistka et al. . American Journal of Obstetrics & Gynecology 2007;196:e1e5.

15. Bakalar N. Study points to genetics in disparities in preterm births. New York Times 2007 Feb 27:F5.

16. Kaufman JS, Cooper RS. In search of the hypothesis. Public Health Reports 1995;110:662666.

17. See note 12, Cooper, Kaufman 1998, at 813.

18. Brewster LM, Clark JF, van Montfrans GA. Is greater tissue activity of creatine kinase the genetic factor increasing hypertension risk in black people of sub-Saharan African descent? Journal of Hypertension 2000;18:15371544.

19. Cooper R, Wolf-Maier K, Luke A, Adeyemo A, Banegas JR, Forrester T, et al. . An international comparative study of blood pressure in populations of European vs. African descent. BMC Medicine 2000;3:2; available at http://www.biomedcentral.com/content/pdf/1741-7015-3-2.pdf (last accessed 15 Apr 2012).

20. See note 12, Shanawani et al. 2006, at 724.

21. Kaufman JS, Cooper RS, McGee DL. Socioeconomic status and health in blacks and whites: The problem of residual confounding and the resiliency of race. Epidemiology 1997;8:621628; Kaufman JS. Epidemiologic analysis of racial/ethnic disparities: Some fundamental issues and a cautionary example. Social Science & Medicine 2008;66:16591669.

22. LaViest TA. On the study of race, racism, and health: A shift from description to explanation. International Journal of Human Services 2000;30:217219, at 218.

23. See note 9, Gravlee 2009, at 47.

24. Duster T. Buried alive: The concept of race in science. Chronicle of Higher Education 2001;48:B11; see also Ossorio P, Duster T. Controversies in biomedical, behavioral, and forensic sciences. American Psychologist 2005;60:115128.

25. U.S. Food and Drug Administration. Press Release: FDA Approves BiDil Heart Failure Drug for Black Patients; 2005 June 23; available at http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2005/ucm108445.htm. See also Saul S. U.S. to review drug intended for one race. New York Times 2005 June 13:A1(last accessed 15 Apr 2012).

26. Taylor AL, Ziesche S, Yancy C, Carson P, D’Agostino R, Ferdinand K, et al. . Combination of isosorbide dinitrate and hydralazine in blacks with heart failure. New England Journal of Medicine 2004;351:20492057, at 2049.

27. See note 26, Taylor et al. 2004, at 2049.

28. See note 26, Taylor et al. 2004, at 2049; BiDil. Common Questions: BiDil and the African American Heart Failure Trial (A-HeFT); available athttp://www.bidil.com/pnt/questions.php#1 (last accessed 15 Apr 2012).

29. Temple R, Stockbridge NL. BiDil for heart failure in black patients: The U.S. Food and Drug Administration perspective. Annals of Internal Medicine 2007;146:5762.

30. Kahn J. How a drug becomes ethnic: Law, commerce, and the production of racial categories in medicine. Yale Journal of Health Law, Policy & Ethics 2004;4:146;Sankar P, Kahn J. BiDil: Race medicine or race marketing? Health Affairs 2005;24:455463; Kahn J. Race in a bottle. Scientific American 2007;297:40–45.

31. Roberts DE. Is race-based medicine good for us? African-American approaches to race, biotechnology, and equality. Journal of Law, Medicine & Ethics 2008;36:537545.

32. Washington H. Medical Apartheid. New York: Random House; 2006.

33. See note 31, Roberts 2008, at 537.

34. Puckrein G. BiDil: From another vantage point. Health Affairs 2006;25:w368w374, at w372

35. Ferdinand KC. Fixed-dose isosorbide dinitrate-hydralazine: Race-based cardiovascular medicine benefit or mirage? Journal of Law, Medicine & Ethics 2008;36:458463, at 458.

36. See note 35, Ferdinand 2008, at 458.

37. See note 35, Ferdinand 2008, at 459.

38. Wilkinson R, Pickett K. The Spirit Level: Why Greater Equality Makes Societies Stronger. New York: Bloomsbury Press; 2009; Kawachi I, Kennedy BP. The Health of Nations: Why Inequality Is Harmful to Your Health. New York: New Press; 2002.

39. See note 38, Wilkinson, Pickett 2009, at 19–20.

40. See note 38, Wilkinson, Pickett 2009, at 20.

41. See note 38, Wilkinson, Pickett 2009.

42. de Vries J, Bull SJ, Doumbo O, Ibrahim M, Mercereau-Puijalon O, Kwiatkowski D, et al. . Ethical issues in human genomics research in developing countries. BMC Medical Ethics 2011;12:5; available at http://www.biomedcentral.com/content/pdf/1472-6939-12-5.pdf (last accessed 15 Apr 2012).

43. Washington HA. Deadly Monopolies: The Shocking Corporate Takeover of Life Itself—And the Consequences for Your Health and Our Medical Future. New York: Doubleday; 2011.

44. Hammonds EM. Straw men and their followers: The return of biological race. Is Race Real?; 2006 June 7; available at http://raceandgenomics.ssrc.org/Hammonds (last accessed 15 Apr 2012).

45. Pear R. Gap in life expectancy widens for the nation. New York Times 2008 Mar 23:A19.

46. Bonilla-Silva E. Racism without Racists: Color-Blind Racism and the Persistence of Racial Inequality in the United States. Lanham, MD: Rowman & Littlefield; 2003; Brown MK, Carnoy M, Currie E, Duster T, Oppenheimer DB, Shultz M, et al. . White-Washing Race: The Myth of a Color-Blind Society. Berkeley: University of California Press; 2003. See also, for example, Thernstrom S, Thernstrom A. America in Black and White: One Nation, Indivisible. New York: Simon & Schuster; 1999.

This article is based on material in Dorothy Roberts, Fatal Invention: How Science, Politics, and Big Business Re-Create Race in the Twenty-First Century (New York: New Press, 2011) and was supported by the National Science Foundation under Grant No. 0551869, an RWJF Investigator Award in Health Policy Research from the Robert Wood Johnson Foundation in Princeton, New Jersey, and the Kirkland & Ellis Fund. I thank S.J. Chapman for assistance in preparing this article and Lundy Braun, Annette Dula, and John R. Stone for comments on an earlier draft.

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Cambridge Quarterly of Healthcare Ethics
  • ISSN: 0963-1801
  • EISSN: 1469-2147
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