Racial Differences in Beliefs about Genetic Screening among Patients at Inner-City Neighborhood Health Centers. DISCUSSION

Neighborhood Health Centers DISCUSSION

As indicated in Table 4, lower perceived health status, belief that genetic testing will lead to racial discrimination, belief that all pregnant women should have genetic tests, and belief that God’s Word is the most important source for moral decisions were significantly associated with race when controlling for other factors.

The perception of lower health status among the African-American respondents is not surprising for several reasons. First, racial disparities occur in many diseases, including cancer incidence and mortality, AIDS incidence, obesity prevalence, and diabetes mellitus incidence and prevalence. Second, unequal access to care due to lack of insurance or inability to pay, is clearly another reason. Third, minorities may participate in medical care less frequently due to greater distrust of and less satisfaction with the medical system. Published studies that have explored the role of trust in participation in medical treatment and/or research have indicated that African Americans have expressed far less trust in healthcare providers than Caucasians. Medication you can afford cialis super active

The finding that this sample of African Americans’ fears that genetic testing would lead to racial discrimination is understandable given that African Americans perceive racial discrimination in other areas of medical care. For instance, discrimination has been reported among those waiting for kidney transplantation and, in quality of healthcare, among hospitalized cardiac patients. Concern about discrimination is most associated with the Tuskegee syphilis study, where it has been most widely publicized but actually predates the Tuskegee incident. From this work and that of others, we believe that concerns about racial discrimination resulting from genetic testing focus on three areas: 1) racially based population control, 2) insurance, and 3) employment. Historically, the eugenics movement in the United States and Europe has given rise to fears of racial discrimination based on genetics and racially based population control. A fear of genocide is another concern expressed in the medical and lay literature related to sickle cell screening programs and to the use of contraceptives in the African-American population.

A second concern is that genetic predispositions to certain diseases would provide a basis for blocking access to societal benefits, such as health insurance or employment. Such concerns are not unfounded. For example, Murray and Herrnstein, in The Bell Curve, suggest that African Americans are less intelligent by nature and thus, less worthy of government programs. Although the limitations and biases of their methodology have been widely discussed, their conclusions are additionally disturbing because of the implication that intelligence is a major measure of human worthiness and value. Lef-fel has rightly stated that, “Any type of discrimination that is connected to one’s genetic endowment represents a gross misuse of scientific research.” Indeed, the ethics of distributive justice indicate that all should have equal access. A committee of the National Academy of Sciences found that, based on the principles of autonomy, privacy, confidentiality and equity, disclosure of genetic information and genetic testing should not be mandated. However, the National Academy of Sciences notes that their position is in conflict with some current practices in insurance, such as life insurance, for which complaints about genetic discrimination have occurred. Suffer no more! Buy levitra professional canada online at a price you can afford.

The third area of concern about genetic testing among African-American respondents is racial discrimination in employment. Approximately one-third of respondents in our study thought employers should be able to see the results of genetic testing before hiring workers. Carrier frequencies for markers of increased susceptibility to diseases from occupational chemical exposure have been documented to vary by race. On the positive side, such testing could assist employers in reducing occupational exposures among those at higher risk for disease, in decreasing liability risks, or in reducing health insurance costs. However, employers might refuse to hire or terminate persons determined to be at higher risk of certain diseases associated with occupational exposures. Genetic testing also could be used to determine those at higher genetic risk for nonoccupational diseases, thereby allowing employers to determine who would result in higher insurance costs. Because of genetic differences, the risk for a number of diseases varies by race; therefore, racial disparities could occur if genetic testing became part of employment decisions.

Given the concerns raised by these respondents about racial discrimination, we were surprised that more African Americans than Caucasians thought that all pregnant women should have genetic testing. On the other hand, similar percentages of respondents of each race thought that only those pregnant women who wanted tests to look for genetic problems should have them. In another study of younger women, African Americans report more acceptance of having a child with Down’s syndrome than other races and are much less likely to consider abortion for Down’s syndrome in either the first (23% vs. 80% for whites) or second (11% vs. 76% for whites) trimester. Furthermore, African Americans are more likely to report as very important avoidance of any risk of miscarriage than are women of other races (i.e., whites, Latinas, Asians and Pacific Islanders). Our divergent findings may be due to the age of our sample (>50 years). We offer two possibilities to explain the apparent differences between our findings and those in the literature. First, given the age of our sample, prenatal genetic testing was unavailable during their child bearing years. Secondly, they may wish to be aware of sickle cell disease—given the publicity about it—and to prepare for potential problems found by testing. We found that African Americans aged >50 more frequently cited “God’s Word” as an important source for moral decisions than did Caucasians. We cannot generalize to younger African Americans outside our sample. Our findings that 76% of people (83% of blacks and 69% of whites) feel religion influences their lives “quite a lot” support prior studies that religion affects decisions about health and healthcare services. For instance, a study of women with breast cancer found that African-American women rely on religiousness as a coping resource to a greater extent than Caucasians. To exclude religion from discussions about genetics may reflect cultural insensitivi-ty and run the risk of increasing racial disparity. A review of ethical concerns about genetic interventions published in religious literature found the most frequently mentioned concerns were family values/parent-child relationships, political tyranny, sanctity of life/abortion and reductionism/human dignity. Other concerns in the religious literature included racial discrimination, “playing God,” confidentiality, impact on biodiversity/gene pool and possible military abuses. Therefore, ignoring or dismissing the active role of religious beliefs with regard to health issues may be perceived as disrespectful or culturally insensitive. Don’t let the pharmacy companies beat you. Buy viagra oral jelly online

Race and ethnicity are complex concepts, involving aspects that are social constructions as well as those that are genetic. In our study, race was self-selected by the respondent using the race and ethnicity designation options required for research sponsored by the U.S. government. Our findings should be interpreted in this context.

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Tags: African Americans, beliefs, disparities, ethics, genetic testing, genetics

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