Social Diversity in Humans: Implications and Hidden Consequences for Biological Research

Humans are both similar and diverse in such a vast number of dimensions that for human geneticists and social scientists to decide which of these dimensions is a worthy focus of empirical investigation is a formidable challenge. For geneticists, one vital question, of course, revolves around hypothesizing which kind of social diversity might illuminate genetic variation—and vice versa (i.e., what genetic variation illuminates human social diversity). For example, are there health outcomes that can be best explained by genetic variation—or for social scientists, are health outcomes mainly a function of the social diversity of lifestyles and social circumstances of a given population? Indeed, what is a “population,” how is it bounded, and are those boundaries most appropriate or relevant for human genetic research, be they national borders, religious affiliation, ethnic or racial identification, or language group, to name but a few? For social scientists, the matter of what constitutes the relevant borders of a population is equally complex, and the answer is demarcated by the goal of the research project. Although race and caste are categories deployed in both human genetics and social science, the social meaning of race and caste as pathways to employment, health, or education demonstrably overwhelms the analytic and explanatory power of genetic markers of difference between human aggregates.Two contradictory magnetic poles pull medical research on humans in opposite directions, producing a tension that will never be resolved. On the one hand, there is a universalizing impulse—based on a legitimate assumption that human bodies are sufficiently similar that vaccines, catheters, pasteurizing processes, and tranquilizers that work in one population will work in others. On the other hand, and unless and until research protocols establish and confirm specific similarities across populations, there is sufficient human variation that targeting medicines for specific populations can be a legitimate—even vital—empirically driven task. The theoretical question, of course, is why a particular population or subpopulation is to be so targeted? Because of folk theories about different groups’ biological difference, or because of their social and political standing? Age, gender, and race leap to the forefront. The history of research on ailments as disparate as breast and prostate cancer (Rothenberg 1997; Wailoo 2011), heart disease (Cooper et al. 2005), and syphilis (Jones 1981; Reverby 2009) provides strong evidence that the answer is not either/or but both. So, on what grounds do we choose one strategy over the other?And it is precisely on this point that Steven Epstein (2007) raises the most fundamental question:

Out of all the ways by which people differ from one another, why should it be assumed that sex and gender, race and ethnicity, and age are the attributes of identity that are most medically meaningful? Why these markers of identity and not others? (Epstein 2007, p. 10)

The answer is profoundly social and political, economic, and cultural. The United States is the only country in the world that, as public health policy, does not operate on the assumption of the single standard human.Moreover, by highlighting certain categories, there is the unassailable truth that other categories are thereby ignored. But more to the theoretical point, because each of the categories noted above has a potential or real biological base in either scientific or common sense understandings (Schutz 1962), when scientists report findings indicating differences, the danger is that these findings can seductively divert policymakers from seeking alternative interventions that could better address health disparities (Krieger 2011).The goal of Epstein’s monograph was to (a) better understand how ways of thinking about differences in human populations paved the way to try to “improve medical research by making it inclusive,” and (b) explain how and why the strategies of exclusiveness got institutionalized:

Academic researchers receiving federal funds, and pharmaceutical manufacturers hoping to win regulatory approval for their company''s products, are now enjoined to include women, racial and ethnic minorities, children, and the elderly as research subjects in many forms of clinical research … and question the presumption that findings derived from the study of any single group, such as middle-aged white men, might be generalized to other populations. (Epstein 2007, p. 5)

This shift has occurred only in the last two and a half decades, beginning with regulations that were developed first in 1986. Once again, it is important to restate the relatively unique feature of this development as it applies mainly to the United States (Epstein 2007, p. 7). The rest of the world has continued to act on the presupposition of the standard human, at least until now. As we shall see, that is about to change.