- March 8, 2022
University of California, San Francisco (UCSF)-Stanford CERSI
Tuesday, March 8, 2022
Esteban Burchard, M.D., M.P.H.
Professor, Medicine and Pharmacy
Director, UCSF Center for Genes, Environments & Health
Director, UCSF Asthma Collaboratory
About the Presentation
In the context of the national debate over the use of race/ethnicity in clinical medicine and biomedical research, some have recommended a race/ethnicity-blind approach to medicine. This recommendation is based on the premise that race and ethnicity, as social constructs, have no utility in medicine for clinical decisions and its use perpetuates racism and health inequities.
We contended that race and ethnicity are social constructs that capture a wide array of social and cultural exposures. Thus, race and ethnicity represent the biological embodiment of these exposures, and thus, affect health outcomes. Furthermore, we argued that because race/ethnicity is correlated with genetic ancestry, it may capture information about the likelihood of having genetic variants for many genes. These genetic variants may have clinical significance in medicine and biomedical research. We therefore reasoned that race and ethnicity are complex and multidimensional variables that capture information about discrimination, socioeconomic position, access to healthcare, environmental exposures, and genetic variation, all of which are important for clinical decisions and outcomes.
As a result, we recommended careful consideration when interpreting the relationship between race/ethnicity and clinical outcomes, as well as the use of race/ethnicity in clinical risk algorithms and prediction equations for physiological normal functions. In particular, we advise that researchers and clinicians should carefully weigh whether the inclusion of race/ethnicity is evidence-based and results in improved and fairer decisions for clinical outcomes. Moreover, to address valid criticisms related to the history and effects of providers’ bias and structural racism in medicine, we propose that race/ethnicity be included in clinical algorithms, such as in risk scores to predict disease or response to treatment rather than to adjust the test results for race/ethnicity. Therefore, we advocated for the continuous use of race/ethnicity in clinical and biomedical research until the emergence of a better biological predictor or social risk score capturing its information. We concluded that the removal of race/ethnicity in medicine and biomedical research would likely increase, or even create new, health inequities, which we aimed to address and, ultimately, eliminate in our society.
About the Presenter
Dr. Esteban G. Burchard is a physician-scientist at the University of California, San Francisco (UCSF). He is a Professor of Medicine and Pharmacy. Dr. Burchard is the Director and founder of the UCSF Asthma Collaboratory, the largest gene-environment study of asthma in minority children in the U.S. He directs a large interdisciplinary research program focusing on minority children and gene-environment interactions for asthma. He is also the Director of the Center for Genes, Environments & Health, which focuses on population genetics and precision medicine in racially diverse populations. Dr. Burchard is well known for his genetic research and the use of genetic ancestry to improve the diagnosis of lung disease among racially/ethnically populations. Dr. Burchard’s research has focused on understanding the complex issues surrounding race, genetic ancestry, and health disparities.
Dr. Burchard earned his M.D. from Stanford University School of Medicine. He completed an internship and internal medicine residency at Harvard’s Brigham and Women's Hospital. He then completed a sub-specialty fellowship in Pulmonary and Critical Care Medicine at the University of California, San Francisco. He earned a Master’s in Public Health in Epidemiology at the University of California, Berkeley. Dr. Burchard has formal training and expertise in internal medicine, pulmonary and critical care medicine, epidemiology, molecular genetics, genetic and clinical research. He initiated and now directs the largest gene-environment study of asthma in minority children in the U.S.
Dr. Burchard’s team was the first to leverage genetic ancestry to identify novel genetic and environmental risk factors for lung disease and poor drug response among minority children with asthma. He is the Principal Investigator of the Asthma Translational Genomics Collaborative (ATGC), the largest whole-genome sequencing study of asthma in the world. Dr. Burchard is also the Principal Investigator of PRIMERO: Puerto Rican Infant Metagenomic and Epidemiologic study of Respiratory Outcomes. PRIMERO is Puerto Rico’s first birth cohort study. The goal of PRIMERO is to identify the early life origins of severe respiratory disease and asthma.
In 2016 Dr. Burchard served as an advisor on President Obama’s Precision Medicine Initiative. In May of 2016 Dr. Burchard was presented with the Lifetime Achievement Award from the American Thoracic Society. In 2018 Dr. Burchard received the Lifetime Achievement Award from the National Medical Association (NMA), Allergy and Immunology Section. He was also inducted in the Alumni Hall of Fame at San Francisco State University. Dr. Burchard delivered the Keynote Address to the Society for Advancement of Chicanos/Hispanics and Native Americans in Science (SACNAS) National Conference in 2019.
Play recording (58 mins)
Please contact LaToya Richardson at Latoya.Richardson@fda.hhs.gov.