In the Atlantic Monthly , which no longer has any reason for existence, since there’s really no point in placing a computer screen on the bottom of a birdcage, Jason Silverstein – a doctoral candidate in anthropology at Harvard – has a piece explaining that genes don’t cause racial health disparities – society does! Moreover, it’s immoral to even look for such genetic explanations.
I guess he should have gotten this published earlier, since we’ve already found some of those naughty genes – pretty important ones. So it’s too late.
Probably the biggest well-understood case involves two common variants of APOL1, a gene that mostly transports lipids, but also zaps trypanosomes – the cause of sleeping sickness. Humans with the standard form of APOL1 are immune to most trypanosomal infections, but two strains have evolved resistance to the standard form of APOL1 – they’re the ones that cause sleeping sickness in humans In response, two variants of APOL1 that block one of the strains of sleeping sickness that infects humans (Trypanosoma brucei rhodesiense) have become common in central and west African populations, and their diaspora.
Unfortunately, these protective variants are hell on your kidneys. And they’re common: > 30% of African-Americans carry a risk variant. It increases the risk of kidney failure ( by a lot) in several conditions (focal segmental glomerulosis(FSGS), HIV-associated nephropathy (HIVAN), and diabetes-associated nephropathy). Altogether, African-Americans develop kidney disease at a rate 4-5 times higher than other groups. It is worth noting that African-Americans that don’t have these APOL1 variants appear to have a risk similar to that of whites. You have to give the Man credit for focusing the bad health effects of racism in a way that could easily fool people into thinking that genes matter – even more so considering that nobody discovered these APOL1 variants until 2010. I think we’re talking secret underground labs: probably the same guys that taught chimps to make war and brainwashed chimpettes into liking dolls instead of trucks.
There are of course diseases in which one or a few genes of major effect play a major role in disease among African Americans, like sickle-cell anemia. There are other diseases that have very different incidence and outcomes in blacks and whites, but have not been pinned to a single locus. In some of those cases, the difference may be caused by several genes, or perhaps many genes of small effect rather than a couple of major-effect variants. For example, hypertension goes up strongly with the amount of African ancestry: some of that is probably caused by the APOL1 variants, but there is also evidence that differences in how blacks handle salt and water conservation also contribute – they have high-risk angiotensin variants, and a more active version of NKCC2, a NA,K, Cl cotransporter. Blacks often have a salt-sensitive form of hypertension. They also have lower urine volume, higher urine concentrations, 30% lower Ca excretion, expanded plasma volume, etc.
Age-adjusted sarcoidosis mortality is 12 times higher in blacks than whites: of course we don’t even know what causes that one. Hate, maybe. Or possibly the luminiferous ether.
Historically, we know that many infectious diseases had different courses in blacks and whites – for example, blacks were considerably more likely to survive yellow fever than whites, presumably because of oppression, but there’s been less work on that subject in recent years, partly because many of those diseases are well-controlled and partly because most researchers have enough sense to avoid working with anything so dangerous.
To sum up, race is indeed a factor in health differences. We know quite a lot about it , and are learning more. Sometimes that new knowledge helps you figure out better treatments. I don’t think finding out things is immoral, with the possible exception of an easy method of inducing vacuum decay in the comfort of your own home.
Which means that Silverstein is a jackass. Nothing stopped him from digging into biomedical research to see if his thesis was substantially true: he didn’t bother. But why is he a jackass? Born that way, probably.