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STS research contributes to understanding disparities in success of medical treatments

Does a person's race or ethnic background affect how he or she responds to medication? Does consideration of race reinforce preconceptions and prevent effective treatment for both minority and majority populations?

"STS can contribute to answering these questions," asserted Dr. David S. Jones, MIT assistant professor in the Program in Science, Technology and Society, during an Oct. 30 lecture on "Can STS be Good Medicine for Medicine?"

New treatments and medical technology can effectively eradicate diseases such as smallpox, yet social and political considerations have hindered similar success with diseases like polio, tuberculosis and AIDS, said Jones, director of MIT's Center for the Study of Diversity in Science, Technology and Medicine. "In 1985, we had all the technology necessary to eradicate HIV. As we all know, that did not happen."

Moreover, there are striking differences among populations on key health markers. Today, according to a recent study in New York City, black men are eight times more likely to die of AIDS than white men, Jones said. Even in this area, the mortality rate per 100,000 population is 530 in the Back Bay, 729 in the South End and 1,167 in South Boston, Jones said. The life expectancy of a Sioux man in South Dakota is 58 years and that of an Asian woman in Bergen County, N.J., is 91 years--a huge difference.

"The silence about this issue continues to amaze me," added Jones, who has degrees in both medicine and history and is author of the 2004 book, "Rationalizing Epidemics: Means and Uses of American Indian Mortality."

Pinpointing a cause for such disparity is, however, extremely difficult. For example, doctors have long recognized that people have individual, idiosyncratic responses to medication, despite medical trends to offer standard responses to standard diagnoses, Jones said. Such different responses can be due to nonadherence to drug regimens, environmental factors or genetic background. And while efforts to map the human genome have found "99.9 percent" similarity among seemingly diverse humans, that 0.1 percent might be responsible for differences among ethnic groups, Jones said.

Some evidence suggests HIV drugs have more serious side effects in African-Americans than whites, but it's not clear why. "Is race something we should consider when trying to close the medical gap?" Jones wondered. "How do you explain variation in drug response? Should we attempt to match drugs to genes?"

African-Americans do suffer higher rates of hypertension than whites. In a controversial move in 2005, the FDA approved the heart medication BiDil, marketed by NitroMed of Lexington, Mass., for those who self-identify as black. Jones, however, questions why drugs that work well among African-Americans weren't marketed to whites when, for decades, drugs tested on white men were considered applicable to all races and often both sexes.

"It's easy to find differences. It's hard to know if the difference is significant," he said. STS, with its focus on history and culture as well as technology, may help answer that question, Jones said.

A version of this article appeared in MIT Tech Talk on November 15, 2006 (download PDF).

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