The present health disparities in the US are the result of complex interactions among genetic variants, environmental and social factors, and health-related behaviors," said Rick Kittles, "The effects of biology cannot be separated from the environment and behavioral effects."

Kittles, co-director of Molecular Genetics at the National Genome Center at Howard University and an assistant professor in Howard's microbiology department, is also an adjunct professor at Johns Hopkins. His comment came during a Gene Media Forum panel on race and health.

Other panelists were: Harold Freeman, a surgeon and the former head of Harlem's North General Hospital who is now with the National Institutes of Health; Joseph L. Graves Jr., a professor of evolutionary biology at Arizona State University; and Joel Clairborne Stephens, vice president of genetics for Genaissance Pharmaceuticals. Alan McGowan, the Gene Media Forum's director and a member of the New School University's faculty, moderated. Forum discussions, held several times a year, enable journalists to meet and question experts on issues in genetics.

A recent race and health discussion ranged from the meaning of race, to the fact that popular perceptions of race are based on outward appearances which reflect 0.01 percent of a person's 35,000 genes, to remarks about a study which indicated that Ashkenazi Jewish women were more susceptible to breast cancer than other women.

"Race does not exist, and yet it does exist," said Freeman. "It doesn't exist from a scientific and biological point of view, but it does exist from a social, political point of view. And in our society we see, value and behave toward each other through this powerful lens of race."

Freeman said, "Class is a powerful determinant of what happens to people. Poverty causes negative human events--groups of people who are disproportionately poor will have more negative events. Culture is another determinant of health. And by culture," he said, "I mean people who have a similar communication system, similar social environment, traditions, lifestyle, attitude and behavior, world view. Culture is not equal to race. You'll find many cultures within a so-called race, and culture may go across race." What causes the "unequal burden of disease," Freeman said were socioeconomic status, culture, and social injustice­historical and current. For example, many studies reported in the "New England Journal of Medicine," he said, "indicate that race is a determinant of how people get treated." A national study done in veterans's hospitals, he said, indicated that when black males presented symptoms of chest pains that may indicate coronary disease or risk for death from heart disease they were less likely than white males to be fully evaluated, to have complete work-ups. There is, he said, "a huge difference" between blacks and whites getting referred for kidney transplants "even when the economics are the same." And, similarly, studies have shown that in Los Angeles and Atlanta emergency rooms, Hispanic and black men with long bone fractures are less likely to be treated with pain medicine, regardless of insurance.

"We need to look at what I call the meaning of the lens of race," Freeman, the surgeon, said. "How people see each other. Care givers seeing patients and patients seeing care givers. Race is a powerful factor in determining how we see each other, value each other, and behave toward each other even when people do not intend harm."

Stephens, the only panelist representing a commercial outfit, said "the level of genetic variation that does exist in human populations is not close to being high enough to allow the definition of subspecies of races." Stephens's company, Genaissance Pharmaceuticals, is a biotechnology firm based in New Haven, Connecticut. Company literature says its goal is to discover genomic variation patterns "that exist in the human population and connect this information to the way people respond to medication."

Instead of using "race as a proxy for disease," scientists and health care professionals should be asking for, panelists said, a person's family history. It is necessary to get beyond "population identifiers," Stephens said. "It is appropriate to ask, ŒDoes this run in your family'," Stephens said. "We want to pin down what the genetic basis of a disease is, what the genetic basis of a drug response is."

Graves, the molecular biologist, said to talk about a link between genetics and health, "requires the ability to control environments." Things like permissive mutations, environmental effects, and maternal effects make it difficult for a "simplistic hypotheses," he said. The fact that 93 to 97 percent of genetic variation occurs within groups, means, he said, "97 percent of the genes sampled at random in this room between any two people here who are not close relatives are likely to be the same." Graves held up his newly published book, "The Emperor's New Clothes: Biological Theories of Race at the Millennium," and said he wrote it, in part, to "raise the problem about how our information concerning health disparity and other issues related to biological questions in race have been constructed in America.."

On the issue of "racialized disease," Kittles cited breast cancer mutations and the Ashkenazi Jewish population. Studies in 1990 seemed to indicate that Ashkenazi women had a greater risk of developing breast cancer than non-carriers of certain genetic mutations. However, nine years later, more studies among "larger outbred" populations of English women demonstrated that the certain mutations are not associated with early breast cancer onset. Kittles said the association of certain mutations within the Ashkenazi Jewish population "obviously was an unintended consequence of the research design and the translation of the results to the general population." He added, "These disease chromosomes are segregating in families and not necessarily within the entire population. Breast cancer susceptibility alleles are not specific to the Ashkenazi Jewish population, and thus, despite the good intentions of the research, there were some negative outcomes." Simply put, alleles are genes conveying characteristics inherited according to Mendelian law.

Kittles also emphasized the efficacy of self-reported ethnicity. "The scientific community can benefit from a more complete description of study participants in published research. A persons's self-reported ethnicity is due to biological and psychological factors. We believe that the self-reported ethnicity is better than categorizing somebody on some a priori assumption of race." Self-reported ethnicity, he said, "takes into account possible genetic lineages that may be running in certain families, and social/culture factors that are shared within the group. Disease chromosomes are segregated in families, and not in the entire population of a race."

Asked about health differences and "the mind-body" connection, Graves cited a study produced by researchers at Meharry Medical College that related hypertension to socioeconomic status. "When you remove the higher socioeconomic groups from African Americans and Euro-Americans," he said, "the hypertension differential disappears."

Contrary to common belief, he said, getting rid of the higher socioeconomic group gets rid of the differential. "I think that is due to the stress of being an African American in a racist world, which expects different standards of you compared to your Euro-American colleagues," Graves said. The discussion wound up with Freeman saying "the definition of who is black in America still today is the Œone drop rule'." The one-drop notion was espoused in the US in the 18th and 19th centuries to promote the idea of white racial "purity." The so-called rule addressed the existence of black ancestors by declaring that any person (no matter how white looking) with "one drop of black blood" was black. Such a rule, Freeman said, is not a scientific standard for anything. And he related an anecdote involving the former Haitian president who died in 1971, Papa Doc Duvalier. During an interview by a predominantly white group of journalists, Freeman said, Duvalier was asked, "ŒWhat percentage of the people in Haiti are white?' He answered, ŒI think about 98 percent of the people in Haiti are white?' The journalists looked incredulous and asked how could that be. Papa Doc said, ŒWe use the one drop rule, too'."