TRUSTING TREATMENT? An Examination of Race-Based Medicine in the Context of Healthcare Inequities

Abstract

Health disparities have existed across racial groups for several centuries. Black Americans in comparison to their white counterparts have been disproportionately affected by certain health conditions. During slavery and Jim Crow, scientists pointed to innate biological differences to justify these disparities and argued that blacks were naturally inferior. As a result of the Civil Rights Movement, scientists began to reframe how they spoke about these differences, but many nonetheless attributed health inequities to the biological makeup of blacks. In 2000, the completion of the Human Genome Project was announced, demonstrating that humans are 99.9 percent genetically similar. Some academics believed the results of the project would shift how scientists and geneticists explained health disparities. However, the opposite occurred. In 2005, the Food and Drug Administration (FDA) approved BiDil, the first race-specific drug used to treat heart failure in self-identified African Americans. BiDil’s release sparked controversy. While proponents praised the drug as a step towards personalized medicine, others questioned the efficacy of the drug because of its race-specific indication. Moreover, after BiDil’s release, academic critique of race-based medicine increased, yet this literature has not often engaged with research on healthcare inequities. This thesis draws these conversations together by examining how individuals’ experiences of healthcare inequities influence their willingness to accept race-based medicine as a form of treatment. I conducted semistructured interviews with ten patients and two physicians about their past healthcare interactions. Then, patients were presented with a hypothetical scenario, which asked whether they would be willing to use medicine that was specifically tailored for their racial group. As a result of their history of mistreatment within the medical arena, I hypothesized that black patients would be more skeptical about race-based medicine in comparison to white patients across income tiers. The interview results support my hypothesis. Black patients were less inclined to accept race-based medicine, while white patients were not as skeptical about race-based medicine. The thesis concludes with policy recommendations that aim to address how clinical interactions, medical training, and broader institutional structures perpetuate biologically reductive ideas about race and associated racial discrimination. Ultimately, this study contributes to current scholarship by evaluating race-based medicine in the context of healthcare inequities, and offers recommendations that suggest how to provide equitable care to all patients.