The Problem with Race in Medicine
How My Genetic Testing Experience Raised Questions About the Use of Race in Medicine
Fifteen years ago, I volunteered for a research study that involved a genetic test. When I arrived at the clinic to be tested, I was handed a questionnaire, and one of the very first questions asked me to check a box for my race. This simple question left me feeling unsure about how to answer it. Was it meant to measure the diversity of social backgrounds of research participants? If so, I would answer with my social identity and check the box for “black.” But what if the researchers were interested in investigating some association between ancestry and the risk for certain genetic traits? In that case, wouldn’t they want to know something about my ancestry, which is just as much European as African?
Despite the importance of this question to the study’s scientific validity, I was told not to worry about it and to just put down however I identify myself. So, I checked “black,” but I had no confidence in the results of a study that treated a critical variable so unscientifically.
This experience got me thinking: where else in medicine is race used to make false biological predictions? As I began to look into it, I found that race is deeply ingrained in medical practice. It shapes physicians’ diagnoses, measurements, treatments, prescriptions, and even the very definition of diseases.
As a sociologist, I understand that race is a social construct. When we identify people as black, white, Asian, Native American, or Latina, we’re referring to social groupings with made-up demarcations that have changed over time and vary around the world. It’s not just my view as a social scientist, though. Even President Bill Clinton declared that human beings, regardless of race, are more than 99.9 percent the same in genetic terms.
Despite this knowledge, doctors still use race as a shortcut to determine important factors like muscle mass, enzyme levels, and genetic traits. But race is a bad proxy that can’t substitute for important clinical measures without sacrificing patient well-being. Furthermore, race medicine leaves patients of color vulnerable to harmful biases and stereotypes.
It’s clear that ending race medicine is more urgent than ever. Doctors must reject outdated classification systems and incorporate the most advanced knowledge of human genetic diversity and unity. They must investigate and address the real factors that impact patients’ health and join the forefront of a movement to end the structural inequities caused by racism, not by genetic difference.
Race’s Deep Roots in Medicine: How It Affects Diagnoses, Treatments, and Disease Definitions
It’s no secret that race plays a significant role in many areas of our lives, including medicine. Despite sociologists explaining that race is a social construct, doctors continue to use it as a shortcut in their diagnoses, treatments, and even disease definitions.
Doctors’ habit of treating patients by race lags far behind the evidence-based medicine they are supposed to practice. Take the estimate of glomerular filtration rate (GFR), a crucial indicator of kidney function, for example. Doctors routinely interpret GFR differently depending on whether the patient is African-American or not. This interpretation is based on an assumption that African-Americans have more muscle mass than people of other races. However, this assumption makes no sense since doctors should determine the muscle mass of individual patients by looking at them instead of using race as a proxy.
Race not only adds no relevant information but also tends to overwhelm clinical measures. It blinds doctors to patients’ symptoms, family illnesses, their history, their own illnesses they might have, which are all more evidence-based than the patient’s race. This tendency leaves patients of color especially vulnerable to harmful biases and stereotypes.
But race’s impact on medicine goes beyond misdiagnosing patients. It affects treatments and disease definitions as well. For instance, the Food and Drug Administration approved a race-specific medicine, called BiDil, to treat heart failure in self-identified African-American patients. The drug was developed without regard to race or genetics, but it became convenient for commercial reasons to market the drug to black patients. The FDA allowed the drug company to test the efficacy of the drug in a clinical trial that only included African-American subjects. The trial speculated that race stood in as a proxy for some unknown genetic factor that affects heart disease or response to drugs. However, this dangerous message sent by the trial is that black people’s bodies are substandard, and a drug tested on them is not guaranteed to work in other patients.
Race medicine also diverts attention and resources from social determinants that cause appalling racial gaps in health. Lack of access to high-quality medical care, food deserts in poor neighborhoods, exposure to environmental toxins, high rates of incarceration, and experiencing the stress of racial discrimination are all social factors that cause these gaps in health. Race medicine pretends that the answer to these gaps can be found in a race-specific pill. It’s much easier and more lucrative to market a technological fix for these gaps in health than to deal with the structural inequities that produce them.
In conclusion, race’s deep roots in medicine have led to misguided diagnoses, treatments, and disease definitions. It’s high time that doctors reject outdated classification systems and incorporate the most advanced knowledge of human genetic diversity and unity. They must investigate and address the real factors that impact patients’ health and join the forefront of a movement to end the structural inequities caused by racism, not by genetic difference.
Race as a Social Construct: Understanding Its True Nature
The concept of race has been a source of controversy for centuries. However, sociologists have long explained that race is not a biological category, but rather a social construct. When we identify people as black, white, Asian, Native American, or Latina, we’re referring to social groupings with made-up demarcations that have changed over time and vary around the world.
As a legal scholar, I’ve also studied how lawmakers, not biologists, have invented the legal definitions of races. Even President Bill Clinton famously declared at the White House ceremony in June 2000 that in genetic terms, human beings, regardless of race, are more than 99.9 percent the same.
Francis Collins, who led the Human Genome Project and now heads NIH, echoed President Clinton, stating that the only race we’re talking about is the human race. This assertion supports the view that race is not a biological category that naturally produces differences because of genetic difference. Instead, it is a social category that has staggering biological consequences due to the impact of social inequality on people’s health.
The concept of race is not only scientifically incorrect but also has real-world consequences. The use of race as a shortcut in medical diagnoses, treatments, and disease definitions has led to misguided assumptions and dangerous stereotypes. It has resulted in vulnerable patients of color being subjected to harmful biases and assumptions.
Therefore, it’s essential to understand the true nature of race as a social construct and how it has been used to perpetuate harmful practices in medicine. This understanding will help doctors to reject outdated classification systems and incorporate the most advanced knowledge of human genetic diversity and unity. By doing so, they can address the real factors that impact patients’ health and join the forefront of a movement to end the structural inequities caused by racism, not by genetic difference.
The Use of Race as a Shortcut in Medicine: Why It’s Problematic
Doctors often use race as a shortcut to make assumptions about their patients’ health. They assume that certain racial groups have more muscle mass, enzyme levels, or genetic traits, without taking the time to investigate these factors for each individual patient. However, this approach is a bad proxy for important factors that impact a patient’s health.
For instance, doctors routinely interpret glomerular filtration rate (GFR), an important indicator of kidney function, by race. As a lab test shows, the exact same creatinine level, the concentration in the blood of the patient, can produce a different GFR estimate depending on whether or not the patient is African-American. This estimate is based on the assumption that African-Americans have more muscle mass than people of other races, which is not always the case.
Using race as a shortcut can lead to misdiagnoses and misguided treatments that do not consider important clinical measures, including a patient’s symptoms, family illnesses, history, and own illnesses they might have. Moreover, it can cause a distraction and blind doctors to their patients’ real needs.
Doctors might argue that race is just one of many factors they take into account, but there are numerous medical tests, like the GFR, that use race categorically to treat black, white, Asian patients differently just because of their race. This approach is problematic, as it can leave patients of color vulnerable to harmful biases and stereotypes.
Therefore, it’s crucial for doctors to acknowledge the limitations of using race as a shortcut in medical practice. Instead, they should focus on individual patient characteristics and important clinical measures to make accurate diagnoses and treatments. By doing so, doctors can provide better healthcare to their patients and ensure that race is not used as a proxy for factors that impact a patient’s health.
Race Medicine and its Harmful Impact on Patients of Color
Race medicine is a practice that uses race as a proxy for important factors that impact a patient’s health. Unfortunately, this approach can leave patients of color vulnerable to harmful biases and stereotypes that can affect the quality of their healthcare.
For example, black and Latino patients are twice as likely to receive no pain medication as whites for the same painful long bone fractures because of stereotypes that black and brown people feel less pain, exaggerate their pain, and are predisposed to drug addiction. Such stereotypes are not only untrue but also harmful, as they lead to unequal treatment and contribute to the overall health disparities that exist between different racial groups.
Moreover, the Food and Drug Administration has approved a race-specific medicine called BiDil to treat heart failure in self-identified African-American patients. However, the development of this drug was not based on genetic or biological differences between racial groups, but on marketing convenience. The company that developed the drug marketed it to black patients, and the clinical trial that tested the drug included only African-American subjects. This approach sends a dangerous message that black people’s bodies are so different that a drug tested in them is not guaranteed to work in other patients.
Race medicine, therefore, not only perpetuates harmful stereotypes and biases but also diverts attention and resources from the social determinants that cause appalling racial gaps in health, such as lack of access to high-quality medical care, food deserts in poor neighborhoods, exposure to environmental toxins, high rates of incarceration, and experiencing the stress of racial discrimination.
As such, it’s important for healthcare providers to acknowledge the negative impact of race medicine and instead focus on evidence-based medicine that takes into account individual patient characteristics and important clinical measures. By doing so, doctors can provide equitable healthcare to patients of all racial backgrounds and help to reduce the health disparities that exist in our society.
The Approval of Race-Specific Medicine by the FDA Sends a Dangerous Message
In an effort to treat heart failure in self-identified African-American patients, the Food and Drug Administration approved a race-specific medicine called BiDil. The drug was developed by a cardiologist without regard to race or genetics, but for commercial reasons, it became convenient to market it to black patients. The FDA allowed the drug company to test the efficacy of the drug in a clinical trial that only included African-American subjects. The drug company speculated that race stood in as a proxy for some unknown genetic factor that affects heart disease or response to drugs. However, this approval sent a dangerous message that black people’s bodies are substandard and that a drug tested in them is not guaranteed to work in other patients. The marketing scheme failed as black patients were understandably hesitant to use a drug just for black people. This incident highlights the problem with race medicine and the urgent need to end this backward legacy that promotes a false and toxic view of humanity.
Outdated Diagnostic Tool Used by Some Doctors Was Developed During the Slavery Era
It’s hard to imagine that some doctors still use a diagnostic tool that dates back to the slavery era. Dr. Samuel Cartwright, a well-known expert in “Negro medicine” during that period, developed the tool. He claimed that people of different races suffer from different diseases and experience common diseases differently, promoting the racial concept of disease. Cartwright even argued that slavery was beneficial for black people because it forced them into labor, which increased the red vital blood sent to the brain and supposedly “liberated their minds.” To support his claim, Cartwright helped perfect a medical device called the spirometer, which measures breathing capacity, to show the presumed deficiency in black people’s lungs. Today, some doctors still uphold Cartwright’s claim that black people have lower lung capacity than white people. Even worse, some doctors use modern-day spirometers that have a button labeled “race,” which adjusts the measurement for each patient based on their race. It’s a well-known function called “correcting for race,” which is still used today by some doctors.
Race Medicine: A Distraction from Social Determinants of Health
Despite mounting evidence that social factors such as poverty, access to healthcare, and discrimination have a significant impact on health outcomes, race medicine continues to focus on innate racial differences in disease. This narrow focus diverts attention and resources away from addressing the root causes of appalling racial gaps in health.
By emphasizing the supposed genetic differences between racial groups, race medicine perpetuates the false idea that race is a biological category with clear-cut boundaries. This flawed perspective can lead doctors to overlook the social determinants that contribute to health disparities.
For example, rather than prescribing medications based on an individual’s unique medical history and symptoms, doctors may prescribe a race-specific drug that ignores the complex interplay between social factors and health. This approach not only fails to address the underlying causes of health disparities but can also perpetuate harmful stereotypes and biases about certain racial groups.
To truly address racial gaps in health, we must recognize that race is a social construct and focus on the social determinants of health. By addressing the structural inequities that lead to poor health outcomes for certain populations, we can create a more equitable and just healthcare system for all.
Conclusion
The use of race in medicine is a complex and controversial issue that has been a topic of discussion for many years. While medical professionals have used race as a tool for diagnosis and treatment, it has been shown to be an inaccurate and dangerous approach. The social construct of race does not accurately reflect biological differences, and the use of race in medicine can lead to harmful biases and stereotypes.
It is important for medical professionals to recognize that the use of race in medicine can cause harm to patients and undermines their trust in the healthcare system. There is a need for further research to develop more accurate and effective diagnostic tools and treatment strategies that consider individual genetic and environmental factors, rather than relying on broad racial categorizations.
Ultimately, addressing the issue of race in medicine requires a larger societal effort to address the root causes of racial disparities in health, including social determinants of health such as poverty, discrimination, and lack of access to healthcare. By acknowledging and addressing these underlying factors, we can work towards a more equitable and just healthcare system for all.
