Race and Ethnicity
Vital constructs for diabetes research
- Andrew John Karter, PHD
- From the Division of Research, Northern California Region, Kaiser Permanente, Oakland, California
- Address correspondence and reprint requests to Andrew John Karter, PhD, 2000 Broadway, Research Division, Kaiser Permanente, Oakland, CA 94611. E-mail: andy.j.karter{at}kp.org.
Medical researchers are now paying increasing attention to findings of racial or ethnic (“racial/ethnic” hereafter) differences in quality and access to care, health outcomes, risk factors, genetic markers, and therapeutic response. However, this attention has been met with growing controversy and debate. Society’s history of discrimination, racism and eugenics, and continued disparities in access and quality of care make this a particularly sensitive issue. In the past year, the New England Journal of Medicine (1–4) and the International Journal of Epidemiology (5,6) have published several commentaries and editorials, some criticizing and others arguing in favor of the use of race/ethnicity in medical research. The editorial board of the Archives of Pediatric and Adolescent Medicine recently instructed submitting authors not to detail race/ethnic variation in disease or risk factors unless there is proof of the biologic, scientific, or sociologic bases for these differences (7). While social epidemiologists have justifiably criticized some molecular scientists’ espousing “genetic-determinism,” many social epidemiologists have promoted the equally unsubstantiated perspective that dismisses the influence of genetics on racial disparities in disease (5). At the heart of this controversy is a dispute about whether studying the construct of race/ethnicity has any justification in medical research at all. Concerns of the sociologic risks associated with doing racial/ethnicity research [e.g., stigmatization and emphasis on differences rather than similarities and racial profiling in choice of therapy (2)] have also been raised. Epidemiological research on race/ethnicity, however, has a long history of apparent utility, facilitating the identification of subgroups with higher rates of disease (8) and differing levels of risk factors (9) and the detection of disparities in the quality of and access to care (10,11) and differing response to pharmacotherapy (12), and providing potentially important leads about etiology and the roles of genes and environment …
