Complicated Medicine: Philosophy Colloquium to Explore Genomics and the Issue of Race

It is one of the most vexing questions that has emerged in the brave, new world of cutting-edge medicine: When does the world of personalized medicine become too personal?

Specifically, the question of race has the potential to be one of the most sensitive issues, a subject that will be addressed at UC’s 43rd annual Philosophy Colliquium, "Race in the Age of Genomic Medicine: The Science and its Applications."

The three-day program on April 12-14 at UC’s Vontz Center for Molecular Studies will look at developing issues in medicine from many viewpoints, with a panel of the nation’s leading experts in the field exploring in depth the potential – and the pitfalls – that are immediately ahead in medical science.

Genomic medicine has its basis in genetics, but looks at the functions and interactions of all genes in the body. Diagnosing problems and establishing therapies can have many variations based on the individual makeup of the patient, but what happens when the grouping of race is brought into the discussion?

"This is a huge issue today," says Koffi Maglo, an assistant professor of philosophy at UC who researches the subject of population stratification in biology and health sciences. While that may sound daunting, the subject matter actually has very practical, real-life implications.

"The fear is that what may happen is people may be stigmatized, that insurance companies may raise premiums based on race, that instead of treating a sick person with individual needs medical doctors will treat ‘race.’ Race could become a marketing niche for drug companies, even if it wasn’t a valid scientific and genuine medical concept, and it may actually delay the progress of personalized medicine," says Maglo.

He adds that there has been a history of cases of abuse based on race in medicine.

But equally urgent are arguments from the other side of the issue. "The concern here is that if we don’t use this concept, we won’t deal properly with the subject of health disparities among groups. Samples and findings in scientific research and clinical trials will be biased in favor of the group that is numerically in the majority. There are epidemiological differences among groups and, simply put, one dose does not fit all," says Maglo.

Add that up and it equals a full-fledged debate, with most medical professionals standing in the middle, trying to sort out best practices for the future.

A prime example of the potential for group-based medicine is the heart failure drug BiDil. When the drug was tested with a general population of heart-failure patients, it produced no benefit. But researchers noted that black patients, a subset of the sample studied, seemed to have gained benefit from the drug more often. When a full-fledged African-American Heart Failure Trial involving more than 1,050 black patients was conducted, results showed strong improvement, with a 43 percent reduction in death, a 39 percent decrease in hospitalizations and an overall decrease in symptoms.

Based on the trial, the FDA approved BiDil as a heart failure therapy for black patients 20 months ago. But the study has methodological problems that, for some, cast doubt on the claim that BiDil works for African Americans only.

Some of the researchers who helped lead the BiDil study, including Keith Ferdinand from Emory University, will be among the presenters at the UC conference, as will some of the study’s critics, including Troy Duster from New York University and Charles Rotimi from the National Human Genome Center at Howard University.

The BiDil experience promises to be just the leading edge of a whole new class of therapies tailored to race and ethnic groups that have the potential to pose ethical problems for medicine.

"My role as a philosopher is to evaluate the argument," says Maglo. "I analyze the arguments critically that the scientific and medical sides of this debate are putting forward, and then assess the ethical and social issues that are involved. When we look at whether we should use something or not, we also have to consider: Are we creating huge problems for down the road?"

A full rundown on the lineup for the colloquium is available below.

Besides UC’s Philosophy Department, the colloquium is being supported by the Charles Phelps Taft Research Center, the Office of the Vice President for Academic Research, the Office of the Provost, the Office of the Dean of the McMicken College of Arts and Sciences and the Office of the Dean of the College of Medicine.

Sessions at the colloquium are free and open to the public. For more information, contact UC’s Philosophy Department at 513-556-6324.

Thursday, April 12, 8:30-11:30 a.m.

Opening Remarks

• Sandra Degen, PhD, Vice President for Academic Research, University of Cincinnati

Five Phases in the History of the Science of Race

• Robert Bernasconi, PhD, Department of Philosophy, University of Memphis

Race & Technology: The Case of Spirometry

• Lundy Braun, PhD, Pathology & Laboratory Medicine, Environmental Studies, Africana Studies, Brown University

Thursday, April 12, 2-5:30 p.m.

Race & Its Uses

• Philip Kitcher, PhD, Department of Philosophy, Columbia University

Government Regulation of Race in Biomedical Research: Expansion of Civil Rights & the Imprimatur of Science

• Catherine Lee, PhD, Department of Sociology, Rutgers University

Revisiting Race in the Clinic

• Barbara Koenig, PhD, Medicine & Center of Bioethics, Mayo Clinic & University of Minnesota

Friday, April 13, 8:30-10:45 a.m.

Is Race a Valid Consideration in Clinical Cardiovascular Trials? (Decode Velifl apon Study and A-HeFT Update)

• Keith Ferdinand, MD, Department of Medicine, Emory University

Racial & Ethnic Grouping in Pharmacogenomics: A Facilitator or Hindrance to Personalized Medicine?

• Charles Rotimi, PhD, National Human Genome Center, Howard University

Friday, April 13, 2-5:30 p.m.

Race & Hypertension in Hispanics: Is it Social or Genetic?

• Luisa N. Borrell, DDS, PhD, Department of Epidemiology, Columbia University

Ancestry, ‘Race’ & Complexity in Medical Genetics

• Marcus Feldman, PhD, Department of Biology, Stanford University

A Post-Genomic Surprise: The Molecular Reinscription of Race in Clinical Medicine & Forensic Science

• Troy Duster, PhD, Department of Sociology, New York University

Saturday, April 14, 9 a.m.-12:30 p.m.

Panel Discussion: Applications & Implications

Closing Remarks

• Ranajit Chakraborty, PhD, Center for Genome Information & Department of Environmental Health, University of Cincinnati