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Race and medicine in light of the new mechanistic philosophy of science

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Abstract

Racial disparities in health outcomes have recently become a flashpoint in the debate about the value of race as a biological concept. What role, if any, race has in the etiology of disease is a philosophically and scientifically contested topic. In this article, I expand on the insights of the new mechanistic philosophy of science to defend a mechanism discovery approach to investigating epidemiological racial disparities. The mechanism discovery approach has explanatory virtues lacking in the populational approach typically employed in the study of race and biomedicine. The explanatory constraints that form an integral part of the new mechanistic approach enable mechanism discovery to avoid the epistemic and normative shortcomings of the populational approach. The methodology of mechanism discovery can fruitfully be extended to the treatment and reversal of epidemiological racial disparities.

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Notes

  1. By epidemiological racial disparities I mean statistically significant differences in the incidence of disease between racialized groups. Except when discussing the views of others, I use “race” and “racialized group” interchangeably. However, see Hochman (2019) for the argument that since racialization theory is not committed to a racial ontology, “racialized groups” are conceptually distinct from “races.” Since I am not committed to a racial ontology in my use of “race” (unless I am referring to another author’s conception), I do not take this distinction to be a problem for my usage. Thanks to an anonymous reviewer for drawing my attention to this issue.

  2. Sesardic (2010) defends genetic race realism and race as a genetic concept. See Taylor (2011) for a response.

  3. African Americans are fairly admixed with only modest variation in ancestry and are primarily drawn from populations originating in West and West-Central Africa, including the Yoruba in Nigeria (Zakharia et al. 2009).

  4. Thanks to an anonymous reviewer for suggesting this term.

  5. See discussion of evidence for details.

References

  • Alexander D, Currie J (2017) Is it who you are or where you live? Residential segregation and racial gaps in childhood asthma. J Health Econ 55:186–200

    Google Scholar 

  • Alzheimer’s Association (2019) Alzheimer’s disease facts and figures. Alzheimer’s Dement J Alzheimer’s Assoc 15(3):321–387

    Google Scholar 

  • Andreasen RO (2004) The cladistic race concept: a defense. Biol Philos 19(3):425–442

    Google Scholar 

  • Bagby SP, Martin D, Chung ST, Rajapakse N (2019) From the outside in: biological mechanisms linking social and environmental exposures to chronic disease and to health disparities. Am J Public Health 109(S1):S56–S63

    Google Scholar 

  • Barnes LL, Bennett DA (2015) Dementia: cognitive resilience in APOE* ε4 carriers—is race important? Nat Rev Neurol 11(4):190–191

    Google Scholar 

  • Bogen J (2008) Causally productive activities. Stud Hist Philos Sci Part A 39(1):112–123

    Google Scholar 

  • Centers for Disease Control and Prevention (CDC) (2005) Racial/ethnic disparities in infant mortality–United States, 1995–2002. MMWR Morb Mortal Wkly Rep 54(22):553

    Google Scholar 

  • Collins JW, Wu SY, David RJ (2002) Differing intergenerational birth weights among the descendants of US-born and foreign-born whites and African Americans in Illinois. Am J Epidemiol 155(3):210–216

    Google Scholar 

  • Craver CF, Darden L (2013) In search of mechanisms: discoveries across the life sciences. University of Chicago Press, Chicago

    Google Scholar 

  • Darden L, Pal LR, Kundu K, Moult J (2018a) The product guides the process: discovering disease mechanisms. In: Danks D, Ippoliti E (eds) Building theories: heuristics and hypotheses in the sciences. Springer, Cham, pp 101–117

    Google Scholar 

  • Darden L, Kundu K, Pal LR, Moult J (2018b) Harnessing formal concepts of biological mechanism to analyze human disease. PLoS Comput Biol 14(12):e1006540

    Google Scholar 

  • Drake AJ, Walker BR (2004) The intergenerational effects of fetal programming: non-genomic mechanisms for the inheritance of low birth weight and cardiovascular risk. J Endocrinol 180(1):1–16

    Google Scholar 

  • Efstathiou S (2012) How ordinary race concepts get to be usable in biomedical science: an account of founded race concepts. Philos Sci 79(5):701–713

    Google Scholar 

  • Epel ES, Blackburn EH, Lin J, Dhabhar FS, Adler NE, Morrow JD, Cawthon RM (2004) Accelerated telomere shortening in response to life stress. Proc Natl Acad Sci USA 101(49):17312–17315

    Google Scholar 

  • Forna F, Jamieson DJ, Sanders D, Lindsay MK (2003) Pregnancy outcomes in foreign-born and US-born women. Int J Gynecol Obstet 83(3):257–265

    Google Scholar 

  • Franklin-Hall LR (2016) New mechanistic explanation and the need for explanatory constraints. In: Aizawa K, Gillett C (eds) Scientific composition and metaphysical ground. Palgrave Macmillan, London, pp 41–74

    Google Scholar 

  • Frohlich KL, Potvin L (2008) Transcending the known in public health practice: the inequality paradox: the population approach and vulnerable populations. Am J Public Health 98(2):216–221

    Google Scholar 

  • Goosby BJ, Heidbrink C (2013) The transgenerational consequences of discrimination on African-American health outcomes. Sociol Compass 7(8):630–643

    Google Scholar 

  • Goosby BJ, Cheadle JE, Mitchell C (2018) Stress-related biosocial mechanisms of discrimination and African American health inequities. Annu Rev Sociol 44:319–340

    Google Scholar 

  • Gravlee CC (2009) How race becomes biology: embodiment of social inequality. Am J Phys Anthropol 139(1):47–57

    Google Scholar 

  • Green CR, Cupples LA, Go R, Benke KS, Edeki T, Griffith PA, Williams M (2002) Risk of dementia among white and African American relatives of patients with Alzheimer disease. JAMA 287(2):329–336

    Google Scholar 

  • Hardimon MO (2013) Race concepts in medicine. J Med Philos 38(1):6–31

    Google Scholar 

  • Hendrie HC, Ogunniyi A, Hall KS, Baiyewu O, Unverzagt FW, Gureje OW, Gao S (2001) Incidence of dementia and Alzheimer disease in 2 communities: Yoruba residing in Ibadan, Nigeria, and African Americans residing in Indianapolis, Indiana. JAMA 285(2):739–747

    Google Scholar 

  • Hochman A (2013) Against the new racial naturalism. J Philos 110(6):331–351

    Google Scholar 

  • Hochman A (2019) Racialization: a defense of the concept. Ethnic Racial Stud 42(8):1245–1262

    Google Scholar 

  • Kaplan JM (2014) When socially determined categories make biological realities: understanding Black/White health disparities in the US. Monist 93(2):281–297

    Google Scholar 

  • Kaplan JM, Winther RG (2014) Realism, antirealism, and conventionalism about race. Philos Sci 81(5):1039–1052

    Google Scholar 

  • Kaup AR, Nettiksimmons J, Harris TB, Sink KM, Satterfield S, Metti AL, Ayonayon HN, Yaffe K (2015) Cognitive resilience to apolipoprotein E ε4: contributing factors in black and white older adults. JAMA Neurol 72(3):340–348

    Google Scholar 

  • Kennedy A, Malanowski S (2019) Mechanistic reasoning and informed consent. Bioethics 33(1):162–168

    Google Scholar 

  • Kitcher P (2007) Does ‘race’ have a future? Philos Public Affairs, pp 293–317

  • Kramer MS, Ananth CV, Platt RW, Joseph KS (2006) US black vs. white disparities in fetal growth: physiological or pathological? Int J Epidemiol 35(5):1187–1195

    Google Scholar 

  • Kuzawa CW, Sweet E (2009) Epigenetics and the embodiment of race: developmental origins of US racial disparities in cardiovascular health. Am J Hum Biol 21(1):2–15

    Google Scholar 

  • Kuzawa CW, Thayer Z (2011) The timescales of human adaptation: the role of epigenetic processes. Epigenomics 3(2):221–234

    Google Scholar 

  • Lewontin RC (1972) The apportionment of human diversity. Evol Biol 6:381–398

    Google Scholar 

  • Logue MW, Schu M, Vardarajan BN, Farrell J, Bennett DA, Buxbaum JD, Byrd G (2014) Two rare AKAP9 variants are associated with Alzheimer’s disease in African Americans. Alzheimer’s Dement J Alzheimer’s Assoc 10(6):609–618

    Google Scholar 

  • Lorusso L, Bacchini F (2015) A reconsideration of the role of self-identified races in epidemiology and biomedical research. Stud Hist Philos Sci Part C: Stud Hist Philos Biol Biomed Sci 52:56–64

    Google Scholar 

  • Machamer P (2004) Activities and causation: the metaphysics and epistemology of mechanisms. Int Stud Philos Sci 18(1):27–39

    Google Scholar 

  • Machamer P, Darden L, Craver CF (2000) Thinking about mechanisms. Philos Sci 67(1):1–25

    Google Scholar 

  • Matthews LJ (2017) On mechanistic reasoning in unexpected places: the case of population genetics. Biol Philos 32(6):999–1018

    Google Scholar 

  • McDade TW, Ryan CP, Jones MJ, Hoke MK, Borja J, Miller GE, Kuzawa CW, Kobor MS (2019) Genome-wide analysis of DNA methylation in relation to socioeconomic status during development and early adulthood. Am J Phys Anthropol 169(1):3–11

    Google Scholar 

  • McEwen BS, Gianaros PJ (2010) Central role of the brain in stress and adaptation: links to socioeconomic status, health, and disease. Ann N Y Acad Sci 1186(1):190–222

    Google Scholar 

  • O’Donnell KJ, Meaney MJ (2017) Fetal origins of mental health: the developmental origins of health and disease hypothesis. Am J Psychiatry 174(4):319–328

    Google Scholar 

  • Phillips DIW, Barker DJP, Fall CHD, Seckl JR, Whorwood CB, Wood PJ, Walker BR (1998) Elevated plasma cortisol concentrations: a link between low birth weight and the insulin resistance syndrome? J Clin Endocrinol Metab 83(3):757–760

    Google Scholar 

  • Prince M, Bryce R, Wimo AE, Ribeiro W, Ferri CP (2013) The global prevalence of dementia: a systematic review and metaanalysis. Alzheimer’s Dement J Alzheimer’s Assoc 9(1):63–75

    Google Scholar 

  • Reitz C, Jun G, Naj A, Rajbhandary R, Vardarajan BN, Wang LS, Valladares O et al (2013) Variants in the ATP-binding cassette transporter (ABCA7), apolipoprotein E ϵ4, and the risk of late-onset Alzheimer disease in African Americans. JAMA 309(14):1483–1492

    Google Scholar 

  • Root M (2003) The use of race in medicine as a proxy for genetic differences. Philos Sci 70(5):1173–1183

    Google Scholar 

  • Russo F, Williamson J (2007) Interpreting causality in the health sciences. Int Stud Philos Sci 21(2):157–170

    Google Scholar 

  • Safieh M, Korczyn AD, Michaelson DM (2019) ApoE4: an emerging therapeutic target for Alzheimer’s disease. BMC Med 17(1):64

    Google Scholar 

  • Scholaske L, Buss C, Wadhwa PD, Entringer S (2018) Acculturation and interleukin (IL)-6 concentrations across pregnancy among Mexican-American women. Brain Behav Immun 73:731–735

    Google Scholar 

  • Sesardic N (2010) Race: a social destruction of a biological concept. Biol Philos 25(2):143–162

    Google Scholar 

  • Spencer QNJ (2015) Philosophy of race meets population genetics. Stud Hist Philos Biol Biomed Sci 52:46–55

    Google Scholar 

  • Spencer QNJ (2018) A racial classification for medical genetics. Philos Stud 175(5):1013–1037

    Google Scholar 

  • Stepler KE, Robinson RA (2019) The potential of ‘omics to link lipid metabolism and genetic and comorbidity risk factors of Alzheimer’s Disease in African Americans. In: Reviews on biomarker studies in psychiatric and neurodegenerative disorders. Springer, Cham, pp 1–28

  • Sternthal MJ, Slope N, Williams DR (2011) Racial disparities in health. Du Bois Rev: Soc Sci Res Race 8(01):95–113

    Google Scholar 

  • Stewart CP, Oaks BM, Laugero KD, Ashorn U, Harjunmaa U, Kumwenda C, Dewey KG (2015) Maternal cortisol and stress are associated with birth outcomes, but are not affected by lipid-based nutrient supplements during pregnancy: an analysis of data from a randomized controlled trial in rural Malawi. BMC Pregnancy Childbirth 15(1):346

    Google Scholar 

  • St-Pierre J, Hivert MF, Perron P, Poirier P, Guay SP, Brisson D, Bouchard L (2012) IGF2 DNA methylation is a modulator of newborn’s fetal growth and development. Epigenetics 7(10):1125–1132

    Google Scholar 

  • Strevens M (2008) Depth: an account of scientific explanation. Harvard University Press, Cambridge

    Google Scholar 

  • Sullivan S (2013) Inheriting racist disparities in health: epigenetics and the transgenerational effects of white racism. Critical Philos Race 1(2):190–218

    Google Scholar 

  • Tabery J (2014) Beyond versus: the struggle to understand the interaction of nature and nurture. MIT Press, Boston

    Google Scholar 

  • Tarver-Carr ME, Powe NR, Eberhardt MS, LaVeist TA, Kington RS, Coresh J, Brancati FL (2002) Excess risk of chronic kidney disease among African-American versus white subjects in the United States: a population-based study of potential explanatory factors. J Am Soc Nephrol 13(9):2363–2370

    Google Scholar 

  • Taylor P (2011) Rehabilitating a biological notion of race? A response to sesardic. Biol Philos 26(3):469–473

    Google Scholar 

  • Temple R, Stockbridge NL (2007) BiDil for heart failure in black patients: the US Food and Drug Administration perspective. Ann Intern Med 146(1):57–62

    Google Scholar 

  • Valles SA (2012) Heterogeneity of risk within racial groups, a challenge for public health programs. Prev Med 55(5):405–408

    Google Scholar 

  • Vlietinck R, Derom R, Neale MC, Maes H, Van Loon H, Derom C, Thiery M (1989) Genetic and environmental variation in the birth weight of twins. Behav Genet 19(1):151–161

    Google Scholar 

  • Waters CK (2007) Causes that make a difference. J Philos 104(11):551–579

    Google Scholar 

  • Weslake B (2010) Explanatory depth. Philos Sci 77(2):273–294

    Google Scholar 

  • Whitfield JB, Treloar SA, Zhu G, Martin NG (2001) Genetic and non-genetic factors affecting birth-weight and adult body mass index. Twin Res 4(05):365–370

    Google Scholar 

  • Wilson V, Rogers III WM (2016) Black white wage gaps expand with rising wage inequality. Economic Policy Institute. Web. http://www.epi.org/publication/black-white-wage-gaps-expand-with-rising-wage-inequality/#epi-toc-7

  • Woodward J (1997) Explanation, invariance, and intervention. Philos Sci 64:S26–S41

    Google Scholar 

  • Woodward J (2003) Making things happen: a causal theory of explanation. Oxford University Press, New York

    Google Scholar 

  • Woodward J (2010) Causation in biology: stability, specificity, and the choice of levels of explanation. Biol Philos 25:287–318

    Google Scholar 

  • Zakharia F, Basu A, Absher D, Assimes TL, Go AS, Hlatky MA, Sidney S (2009) Characterizing the admixed African ancestry of African Americans. Genome Biol 10(12):R141

    Google Scholar 

  • Zijlmans MA, Riksen-Walraven JM, de Weerth C (2015) Associations between maternal prenatal cortisol concentrations and child outcomes: a systematic review. Neurosci Biobehav Rev 53:1–24

    Google Scholar 

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  1. Department of Philosophy, University of Maryland, College Park, 1125 Skinner, 4300 Chapel Lane, College Park, MD, 20742, USA

    Kalewold Hailu Kalewold

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Kalewold, K.H. Race and medicine in light of the new mechanistic philosophy of science. Biol Philos 35, 41 (2020). https://doi.org/10.1007/s10539-020-09759-x

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