Genetics – Marilyn R. Gardner

“Pooling people in race silos is akin to zoologists grouping raccoons, tigers, and okapis on the basis that they are all stripey.” from Genes Don’t Cause Racical Disparities, Society Does

An article from The Atlantic, as quoted above, says this “Researchers are looking in the wrong place: White people live longer not because of their DNA but because of inequality.”

It’s NOT about race people!

Basically, billions of dollars have gone into funding studies that look at race as a basis for health disparities when, in fact, it is far more about living conditions. For years conventional wisdom has argued that there is really nothing we can do about these health disparities, because it’s really about biology. But a review of the literature showed none of that. Jay Kaufman, lead author of the study “The Contribution of Genomic Research to Explaining Racial Disparities in Cardiovascular Disease: A Systematic Review” says this:

“If you show that this is a predisposition that is genetically determined—black people just have this gene, there’s nothing we can do about it, this is just nature—then society is completely absolved. We don’t have any responsibility to solve this problem….If you show that it is because of racism and injustice and people’s living conditions, well, then, there is some responsibility and we have to do something about this.”

One of the things that we pay a lot of attention to in public health is something called the “social determinants of health.” The social determinants of health are defined as “the conditions in which people are born, grow, live, work and age, including the health system.” This takes into account not only your genetic code, but also your zip code.

Here is an example: Four years ago I did some consulting work in Washington state for community health workers. One of the classes that I held was in a public housing space in Tacoma, Washington. The space was beautiful. It was a ‘mixed use housing’ area which means that some people owned their homes while others rented. There was a beautiful playground, a clinic, an assisted living space, and a school down the road. But when I asked someone who lived there where residents purchased food, she looked at me and said “It takes three different bus rides to get to a grocery store.” This is what we call a “food desert.” Right across the street you could buy 1500 calories of junk for a dollar and yet it took a major part of the day to buy good food.

A researcher who goes into that community, a community largely made up of “people of color,” may find high rates of heart disease. But it has little to do with the color of their skin, and perhaps a lot to do with the fact that healthy food is so far away.

All of us, regardless of our station in life, interact with the world around us. And it is in this world that our health is created. So if we live in a neighborhood that has clean air, wide sidewalks, well-lit streets and play grounds, along with affordable farmers markets for fruit and vegetables, we have a far better chance at health than the person who has none of these things. Turns out that person is far more likely to struggle with asthma, lack of physical activity, obesity and poor nutrition. It also turns out that most of “those people” end up being people of color.

Where we live matters!

In the PBS series “Is Inequality Making us Sick?” questions about the social determinants of health are asked. Like the article in The Atlantic, the answers are troubling, because it’s a lot more to do with our neighborhoods and zip codes than our genetic codes. And that means we can do something about it.

All of this is best summed up in this statement:

“When it comes to why many black people die earlier than white people in the U.S., Kaufman and his colleagues show we’ve been looking for answers in the wrong places: We shouldn’t be looking in the twists of the double helix, but the grinding inequality of the environment.”

But, like almost everything, it is far easier to write about it, then to take concrete action and actually do something about it.

The waiting room has just two couples in it. They are slightly nervous, self-conscious, avoiding eye contact with each other. The room is dimly lit and resembles a sterile, designer living room. Magazines are in carved racks on one wall as well as stacked perfectly, fan style in threes, on a glass-topped side table. A stand in the corner holds a carafe, the card written in black calligraphy tells the couples it’s “lemon and strawberry infused water”.

Nothing in the room suggests that this is where couples go to pick out their babies. Their very own designer babies. The first decision will be on sex– male or female? But then it moves on: Will it be black hair or blonde? Blue eyed or Brown? Tall or short? Art or sports?

Smart or ….no that one’s easy! The couple smiles at each other, their eyes communicating the message — We don’t want any dumb kids!

This is not a brave new world. This is today. Couples are increasingly able to pick what they want, when they want it. Consider this advertisement from the leading fertility group around sex selection:

Recognized by ABC, NBC, CNN, Fox, Reuters, and United Press International News Services as among “THE” worldwide leaders in gender selection technology.

By examining the genetic makeup of embryos, we can virtually guarantee* your next child will be the sex of your choice.

Leaders in Pre-implantation Genetic Diagnosis (PGD)
Among the most successful gender-selection programs anywhere
Screening for over 400 hereditary diseases
Critical procedures performed by MD and PhD specialists
Available to nearly all patients (not just those with genetic disorders)
Now combinable with Microsort sperm sorting at patient request
Featured on 60 Minutes, CNN, ABC, NBC, Newsweek, Time and more

In 2009 an article titled “Designer Babies: Ethical? Inevitable?” told of a woman who had applied embryo screening on eleven 3-day old embryos to determine which one would be the most likely to be disease free. She then had that one implanted in her uterus.

At surface this can, perhaps, seem empowering. What parent would ever choose for their children to have a disease? We weep over our children’s minor difficulties, like not being invited to a birthday party, let alone those big things like diabetes and leukemia. One professor claims this is just “Responsible Parenting*”.

But there is a dark side to this. As humans we are prone to extremes – and while many may choose to use this technology just to avoid disease, others would abuse.

Because that’s how we are.

In that same article Richard Hayes, executive director of the Center for Genetics and Society, says this:

“If misapplied, [these technologies] would exacerbate existing inequalities and reinforce existing modes of discrimination … the development and commercial marketing of human genetic modification would likely spark a techno-eugenic rat-race,….”Even parents opposed to manipulating their children’s genes would feel compelled to participate in this race, lest their offspring be left behind.”

While I’d like to assume the best of this race called ‘Human’, I see too much evidence that we would modify to our own detriment, and face the unforeseen consequences of our choices.

Equally troubling is that the developing world continues to face enormous problems with infant mortality and morbidity as well as child malnutrition, even as this side of the ocean dabbles in extreme technologies to produce a “Super Race”.

My post from yesterday received a variety of comments, and I appreciated all the perspectives brought into the discussion – one of the things that didn’t come into the discussion was our increasing ability to control all of life – from conception to sex selection to gender reveal to when we die.

This discussion goes far beyond designer babies – but designer babies are one more spoke in this wheel of control.

What do you think? And are all these even related or am I off base? Continue the discussion with me through the comments!