Michael J. Montoya

Racialized Genetics and the Study of Complex Diseases: The Thrifty Genotype Revisited

Current debate on the use of population genetic data for complex disease research is driven by the laudable goals of disease prevention and harm reduction for all, especially dispossessed, formerly enslaved, or colonized populations. This article examines one of the oldest gene-based theories of complex disease causation: the thrifty genotype hypothesis (THG). This hypothesis is emblematic of the way in which genetic research into complex disease attracts a high investment of scientific resources while contributing little to our capacity to understand these diseases and perpetuating problematic conceptions of human variation. Although there are compelling reasons to regard the high prevalence of type 2 diabetes mellitus as a by-product of our biological incapacity to cope with modern affluent and sedentary lifestyles, there is at present no consistent evidence to suggest that minority populations are especially genetically susceptible. Nor is it clear why such genetic differences would be expected, given the original pan-species orientation of the TGH. The limitations inherent in current applications of the TGH demonstrate that genetic research into complex disease demands careful attention to key environmental, social, and genetic risk factors operating within and between groups, not the simplistic attribution of between-group differences to racialized genetics. A robust interdisciplinary approach to genetic epidemiological research is proposed.

“You’re too young for this”: Adolescent and Young Adults’ Perspectives on Cancer Survivorship

Adolescent and young adult cancer survivors face unique challenges not systematically addressed by cancer clinicians. Four focus groups and two individual interviews were conducted with 19 survivors to profile experiences and identify key concerns for future interventions. The resultant themes reflect cancer care continuum challenges (such as delays in diagnosis, problems with adherence), psychosocial concerns (such as infertility and reproductive concerns, changing social relationships, financial burden), and the paradox of being diagnosed with cancer as a young adult. Future intervention development for adolescent and young adult survivors should involve patient voices at each stage of the research process.

Dialogical Action: Moving From Community-Based to Community-Driven Participatory Research

Proponents of community-based research advocate for the active involvement and engagement of community members, citing improved construct validity, intervention efficacy, and accountability. However, to create the conditions in which expertise is mutually constructed and in which no one is the object of research, a reconsideration of the fundamental ethos of community involvement and engagement is required. In this article, we seek to accomplish two goals: (a) to briefly assess the definitions of community health, focus groups, and dissemination that are often used in community-based research; and (b) to introduce an application of dialogical action that goes beyond traditional focus group methodology to promote the creation of an evolving and dynamic dialogue among campus and community stakeholders. An urban case study is presented.

Teaching Medical Students about Race

Amedical student in my class last year, let’s call him Victor, insisted that he could tell “what someone was just by looking at them.” “I mean it’s obvious,” he proclaimed to the class. “Someone is either black, white, Latino, or whatever.” He continued with confident certainty that the different disease rates we see in different groups are the result of their culture and their genetic differences from each other. Others in the class weren’t so sure. We were discussing diabetes and high blood pressure in Latinos and African Americans. And we were reading studies that both claimed and refuted that diseases cluster in so-called “racial” groups. All the readings were published in respected academic journals and had been evaluated by experts before being published. But they made opposite claims. One set claimed that groups of people, because they carried genes or bits of genes that were triggered by certain conditions or behaviors, had different rates of a particular disease. Another set of readings claimed that the scientific evidence for this gene-environment trigger was, at best, inconclusive. These studies showed that groups had different rates of a particular disease because their lives were different—they were exposed to different toxins, to different stressors, ate different foods, and had different access to health care. “But we know blacks have higher rates of hypertension, and Latinos higher rates of diabetes,” exclaimed Victor. His medical mind and training, both at stake here, did not accept readings that were not in keeping with what he already knew. He already knew that there was something called “race,” and that blacks, whites, Latinos, Asians, and so on were races. He also already knew that disease rates differed among them. And he already knew that some combination of culture and biology, and behaviors and genes, explained those differences. I had a predicament with Victor. He was the only one in class brave enough to openly challenge what we were reading. The only one to voice the “truths” we all have been told in hundreds of ways. That is, races are real. We can see them with our own eyes. And something about the differences between the races explains rates of disease. I invite such a challenge. How could I argue against that which we all see so clearly, and that everyone already knows? How could I help Victor and his other third-year medical student classmates see that sometimes what we see is wrong? This is, after all, one of the basic lessons in medical education. Victor and his classmates would soon be physicians treating patients, so the importance of addressing the elusive concept of race for me was quite high. If what Victor already knows is true—that someone’s dis-