When Should Medicine Talk About Race?

Ilana Yurkiewicz, Scientific American, August 25, 2012

Race is everywhere in medicine. Most health statistics are broken down by race. We routinely characterize diseases by which populations they affect more and less and medications by which ethnicities respond better or worse.

It’s so ubiquitous that it’s easy to take for granted as justified. But the use of race in medicine is a subject that is vigorously debated. Whenever a new study comes out stratifying results by race, there are inevitably supporters and critics.

The question under debate: is there a place for race in medicine?

There’s a growing number who say we should toss this way of thinking entirely. Many scholars now contend that race is closer to a social construct than a biological category, and there’s the legitimate fear that pointing out differences between races sends the message that the difference is biological. Even if there are certain genetic differences among populations, we know that self-reported race is at best a crude proxy for indicating them. Moreover, studies often do not adjust for all other variables besides genetics, such as socioeconomic status, culture, and discrimination—meaning if differences are shown, the knee-jerk tendency to think biology might overshadow important environmental disparities that deserve our attention. There are social concerns too, in that historically ethnicity in research has been abused by pseudoscientists with racist agendas of demonstrating the superiority of certain people over others. In light of that history, profound sensitivity toward using race as a variable in medicine is understandable and warranted.

{snip}

{snip} There have been cases where thinking about race, even as a rough guide, has led to benefits for patients. Knowing that sickle cell anemia is more prevalent among populations of sub-Saharan African ancestry can tip physicians off for earlier and thereby more effective diagnosis and management. Since Tay-Sachs is a genetic disease with increased prevalence among Ashkenazi Jews, Jewish communities early on welcomed genetic testing for prospective parents and by doing so dramatically reduced the incidence of the disease. Individuals of Asian descent are more likely to carry certain genetic polymorphisms resulting in slower drug metabolism—meaning patients need lower doses to achieve the desired effects and avoid toxicity. There are many more examples. While it is such an important point that I’ll say it again—that race is only a very imperfect proxy for genetics—there has been demonstrated medical value in being aware of these trends.

{snip} With the recognition that heuristics [such as race] can lead to biases, the solution is not to discard them but rather to make doctors more cognizant of biases so they can work to eliminate them and use heuristics more effectively.

The use of race in medicine is a deeply sensitive issue and should be treated as such. One thing to note is that in contrast to shameful periods in history that focused on race with unethical agendas, the vast majority of current research is completely well-intentioned, toward the goal of optimally tailoring medical care to a diverse patient population. Those on both extremes of the debate are looking out for patients. So where does that leave us? While there is a place for race in medicine, the literature also remains rife with studies with seem to point out differences with no valid reason for pointing out differences, and my sense is that there’s a greater tendency to overuse race when it’s not appropriate than to neglect it when it is. The burden should be on every medical researcher who wants to talk about race to be explicit as to what contribution this data would make to the world. And, if those measures fail, it would behoove readers and patients to apply just as critical an eye.

 

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  • Church_of_Jed

    “We should talk about race differences only when absolutely necessary,” and only after we have reinforced the message that Whites are to blame for whatever is the cause of the latest Diversity complaint. 

  • Are there genetic conditions for which White people are predisposed?

    •  Success.

      • The Worlds Scapegoat

         Scapegoat

    • ILOVEMYRACE

      There are dozens of conditions for which White people are predisposed.

      Each subspecies of human evolved in a slightly different habitat — some hot, some cold, some dry, some wet.   As a result, evolution adapted the genetics of each race/subspecies to perform well in their home habitat.   That is why Tibetians and Peruvians survive well at high altitudes and other populations cannot.

      White missionaries died like flies when they traveled to the tropics to “save” the dark saveges.   Graveyards in the tropics are full of such Europeans — entire familis who perished from strange tropical diseases within months of arriving.  Yet, the natives survived, because they had evolved partial or full immunity to those diseases.

      I could give 20 similar examples — each race/subspecies is genetically distinct and differently adapted.  That’s called Diversity, and we should celebrate it. 

      • The Worlds Scapegoat

         “I love my race wrote – White missionaries died like flies when they traveled to the tropics to “save” the dark savages. ”

        Ironically it hasn’t changed. Whites are still dying like flies trying to save dark savages. The only difference is now whites bring the savages here, so when the white is killed, they will be buried at home.

    • Self-destructive humanitarianism.

      • holyflower

        aka “pathological altruism”

    • Church_of_Jed

      We should talk about race differences all the time, as long as we are talking about our anti racism duty to eliminate White privilege.

      http://whitepeoplecollectionagency.tumblr.com/post/30207250119/so-if-i-have-white-privilege-its-fair-enough-to-say

      “White privilege is a reality. It is a corollary of systemic racism. To deny your white privilege is to deny modern systemic racism, is to play right into its hands.”This is what Whites are taught in school, essentially that Whiteness equals racism, and racism is the worst evil immaginable since Auschwitz.

      If a White dares mention “black privilege” or “Diversity privilege,” he will be disappeared into a psych ward of the local hospital and come out a week later demanding that his White girlfriend start sharing her womb with “aspiring rap stars from the beloved community of color”.

      If you are denying your White privilege, you are invested in systemic racism, and you are deemed a racist, and are most likely a closet Klu Klux who hangs nooses, white crosses, confederate flags, and Nazi swastikas in your family room.

      • ed91

        it isn’t so much that ‘white priviledge’ exists, it’s more that in comparison blacks, who can’t plan ahead or organize thoughts, look like such fools.

        perhaps we should call it  ‘black loser proclivity’  instead of  ‘white priviledge’.

      • Sherman_McCoy

        “If you are denying your White privilege, you are invested in systemic racism, and you are deemed a racist, and are most likely a closet Klu Klux who hangs nooses, white crosses, confederate flags, and Nazi swastikas in your family room.”

        Is that bad?

    • WhiteGuyInJapan

       Ah, inventing almost everything of value in the past few hundred years, creating societies that everyone else finds desirable.

    •  Not being awake as a third stage of being too successful.

    •  Misguided altruism. Side effect: aiding and abeting known and declared parasites.

    • OPersephone

      Multiple sclerosis is most frequent among people descended from the north of the UK — Anglo-Scottish ancestry seems to be a predisposition.

    • MekongDelta69

      Higher IQ and pathological (to the point of self-destruction) altruism.

  • anarchyst

    It is a medical fact that many pharmaceuticals have differing “success rates” depending on the race of the patient.  How long will scientists claim that we are all alike?? This flies in the face of increasing evidence that susceptibility to disease and that there are differing reactions to drugs depending on race..
    A prominent example is that of African blacks that rarely contract malaria because their “sickle-cell” disease has evolved into a “protection” against malaria.

  • JackKrak

    If there were a desirable or beneficial trait that blacks exhibited – stop laughing! – then I doubt very much that the scientific & medical communities would have such qualms about publicizing it every chance they got.

    • Exactly.

      When are we allowed to discuss race? When it benefits blacks.

  • MekongDelta69

    1. Just keep deluding yourself that “race is a social construct” Ilana.

    2. Tell your publication to substitute “Politically Correct” or “Spineless” or “Groveling” for “Scientific”. (Your choice)

    The rest of the article might as well been written by an “Oppressed Studies” ‘professor'[sic].

  • ILOVEMYRACE

    A science journal can do many things, but the ONE thing it should never do is lie about science.

    Science has proven 100% that race exists.  In fact, using the 75% rule for subspecies, it is clear that there are many human subspecies.  The 75% rule for determining subspecies states that if one can mix individuals from 2 different populations, and then correctly sort 75% of them back to their own groups, then they should be called “sub-species”.    With Europeans and Africans, one can determine the correct population virtually 100% of the time; far beyond the 75% criteria.

    Scientific America might as well claim that the Earth is flat or that the sun revolves around the Earth.
    This example just shows how entrenched political correctness is.   We actually subvert truth for political correctness.   The problem is that all truths are interconnected.   When a scientist lies, it distorts all truths.

  • ILOVEMYRACE

    Why does Scientific America want to hide genetic Diversity?   I thought Diversity was our greatest strength.  

    Dear Marxists, liberals, commies, and fellow travelers, please tell me: is there or is there not Diversity?   Why then try to deny it?

    If Diversity is a great strength (and the one thing that will save America and the world) then why try to hide it?

  • haroldcrews

    I just learned of this disease that appears to affect only Asians today.

    http://atlanta.cbslocal.com/2012/08/25/researchers-find-mysterious-new-aids-like-disease/ 

    • The__Bobster

      Some Asians can’t tolerate alcohol either.

      • bluffcreek1967

        I think Native Americans too cannot tolerate alcohol.

        • The__Bobster

          Oh, they tolerate it all too well. This is the condition I was referring to:

          http://www.mydr.com.au/gastrointestinal-health/liver-and-alcohol-breakdown

          About 50 per cent of East Asian people have a genetic variation which means that their ALDH enzyme doesn’t work properly. These people can’t process alcohol in the normal way, and shortly after drinking alcohol their acetaldehyde level rises.

          Acetaldehyde is a toxic substance that can cause an unpleasant reaction when it builds up. Symptoms you might experience if your ALDH enzyme does not function properly include flushing of the face, hot sensations, nausea and palpitations (an awareness of your heart beating faster than normal).

          • crystal evans

            A lot of Asians are also lactose intolerant.

          • WhiteGuyInJapan

             In the post-WWII era, the Japanese have started eating cheese regularly and their stomachs have adapted rather quickly.  Rates of lactose intolerance have gone down quite a bit here. 

            The weakness towards alcohol is caused by the Japanese lacking a specific enzyme that helps to break down alcohol.  Forget the exact name, sorry. 

            They have a half a cocktail and their faces turn boiled lobster red.   Freaked me out the first time I saw it!

  • I have a hunch that Russian, Chinese and Japanese scientists won’t have similar inhibitions.

    • bluffcreek1967

      Very true. They don’t have the same debilitating disease of multi-culturalism that we in the west have.

      • WhiteGuyInJapan

         Most East Asian nations practice eugenics, er, genetic screening on a regular basis.  Often a standard procedure to check for any potential genetic disorders.

      • Formerly_Known_as_Whiteplight

         Russia, as post- Soviet Russia does actually.  It was a multicultural , multiracial empire.

  • It is truly pathetic that such lengths are taken in SCIENCE to be politically correct. If  a poodle were susceptible to a certain disease and other breeds of dogs were not would any “scientist” try to say it was socioeconomic or environmental factors?  It sickens me when hard science is politicized.

  • anmpr1

    SA has had a liberal agenda at least since the 70s.  Maybe even before that.  I remember subscribing, back in the day, until I couldn’t stand it anymore.  The final straw was an article promoting food stamps disguised as a scientific study. 

    Race as an open topic became pretty much taboo after WW II.

  • SarahConnor

    “the literature also remains rife with studies with seem to point out differences with no valid reason for pointing out differences,”I would like to see this so called literature that points out differences with no valid reason. Seems to me in medical  literature there is usually a reason it is produced. And I would think with the mapping of the genome, race would become more important as they map the molecular differences. 

  • IKantunderstand

     This is how I translate this article: You Whites do everything you can to help people of race specific medical maladies whilst pretending no such thing as race specific maladies exist. Got it? Because if you don’t, obviously, you are a racist. 

  • The__Bobster

    Should someone care if their black doctor isn’t a doctor at all? It wouldn’t be PC to question his strange diagnoses.

    http://www.nydailynews.com/news/national/fake-doctor-accused-practicing-medicine-friend-stolen-identity-article-1.1145228

  • crystal evans

    Black women are more likely to die of breast cancer than women of any other race. The reason for this is that the tumors are found later and this limits the treatment options that are available.

  • mobocrat

    The science establishment has shown it will ruthlessly hound even its most eminent members who stray beyond what is “absolutly necessary” when discussing the “social construct”- James Watson, the genius who co-discovered the double-helix structure of the DNA molecule was dumped from his post as chancellor of the Cold Springs Harbor Laboratory for comments that were not “social construct-friendly”…

    • Formerly_Known_as_Whiteplight

       I think he actually said that scientists are hounded to the point that even its most eminent members….

      The pressure inside the halls of academia are very heavy. 

      • mobocrat

        Your syntax improvement clarified my point- thanks

  • Once upon a time my father gave me some sage advice: “If you’re ever in a fight with a black, never hit him in the head. You’ll break your hand. They have thick skulls.” My buddy’s mom was a nurse she said when x-raying blacks she had to crank up the power a bit as they have thicker bones. In boot camp during “drown-proof” training the instructor told the blacks in the swimming pool, “You guys have to try harder, your bones are heavier and you will sink faster.” Ever wonder why forensic scientistist and investigators can look at a bone and tell you the deceased was of African descent? If we have physical and medical differences could we also have mental differences too? Could certain portions of the brain be more or less developed between the races? Could one race be more prone to certain types of behavior based on these differences? Kinda makes ya wonder..don’t it? I was done wondering a long time ago.

    • bluffcreek1967

      Great points!

    • ILOVEMYRACE

      I’m an evolutionary biologists (university professor), and Luca is correct.   One can easily tell race from just a few bones, particularly the skull, because the skeletons of the different races are amazingly different.   This is due to underlying genetic differences.  A great many other physical, physiological, behavioral, and life-history also differ among the races, or subspecies of humans.  This is also the case in virtually all living species, so why should it be different in humans?

      • Formerly_Known_as_Whiteplight

         Do you agree that the reason genetic studies analyzing dna are NOT getting much media attention because of the problems with the results in relationship to political and cultural bias against race realism?

    • crystal evans

      This is probably why black woman are not suceptable to osteoporous.

      • OPersephone

        I think it’s part of it. I think the other factor is that black women tend to have higher levels of testosterone than white women do. Hormones play a significant role in osteoporosis.

  • Detroit_WASP

    Race is a social construct, didn’t science get the memo?

    • ILOVEMYRACE

      Society is a racial construct.    — as is culture.

  • Although facts are not political, all facts that are relevant to political opinions are nonetheless facts.

    Is it any wonder some politicised people are uncomfortable with facts?

    • ILOVEMYRACE

      Facts be raciss!

  • TomIron361

    Anyone with an ounce of sense can see with their naked eye there are major differences within the human race, just as there are major differences within the animal world. I don’t think anyone would confuse a tiger with an alley cat, yet they’re both felines. Same with an eagle and a sparrow, yet they’re both birds, Etc., Etc., Etc.

    • MekongDelta69

      See – that’s the problem. You’re assuming she has an ounce of common sense.
      /sarcasm

      ‘Scientific’ American has devolved into just another leftist rag. Look at some of their other articles in their past Issues. (e.g. “Why Homosexuality In Nature Is Normal” (or something close to that.)) And endless more like it.

      ‘Scientific’ American is no more ‘Scientific’ anymore than an “Oppressed Studies” class in college.

  • Shawn_thefemale

    In my twenties I had THE most wonderful doctor. He was a middle-aged Jewish man, and I wish he’d never retired. I complained of heart issues, and after tests, etc. he explained to me I had a VERY active case of mitral valve prolapse; one that I felt the sensations of  strongly, while most who had it never even noticed it.  He explained, “It is most common in young, slender, white females.”

    Told me all I needed to know.

  • People should do more research, including on the canidates.

    http://www.youtube.com/watch?v=IGFAph3lWqw

  •  Yes. And I still have the six scratches in my back to prove it.

  • Formerly_Known_as_Whiteplight

     I might point out that the traditions in medicine and health care in general via the Hippocratic Oath have long provided a moral base for the idea that one treats the patient regardless of who they are or even what they may be guilty of;  patient is a patient.  Of course, this is only the general rule.  It is more in the lower levels of delivery and administration where racism, and other forms of “unprofessionalism” most often appear.

  • Formerly_Known_as_Whiteplight

     In fact, 15,000 Americans die from medical mistakes a month.  This is the Medicare number alone, the actual overall death rate is higher.  Wonderful health care system we have here in the U.S., 38th best in the world.

    http://www.georgiainjurylawyerblog.com/2010/11/medical_errors_kill_15000_medi.html

  • Athling

    How about just dropping all the butt kissing of minorities? How ’bout that idea Ms Yurkiewicz? They’re already handled with kid gloves as it is. You’re also talking out of both sides of your mouth as if you can’t make your own mind up. What lengths do we have to go to keep this warm and fuzzy tolerance, inclusion, we’re all the sameness, lie floating around?

    Yes, race is real…

    Face reality.

  • MekongDelta69

    One other thing about the ‘scientific prowess’ of the authorette:

    “Ilana Yurkiewicz is a second year student at Harvard Medical School… She graduated with a B.S. in biology from Yale University… Following graduation, she received an AAAS Mass Media Fellowship to become a science reporter for The News & Observer in Raleigh, North Carolina… She is… currently conducting ethics research at Harvard after previously interning at the Presidential Commission for the Study of Bioethical Issues.

    Ilana welcomes questions and comments about her blog. You can email her directly at [email protected]

    Bottom line – she’s (about) a 22-24 y/o leftist student who’s been completely brainwashed and indoctrinated, like most other college students have been for 45 or so years. (i.e. “There’s no such thing as ‘race’ – uhmm… unless WE want it to be, to play the ‘race card’ against all you ‘evil racists’)

    Like I say all the time, it’s great to post on here (and on other like-minded realist sites), to get things off your (respective) chests, but we’re mostly preaching to the choir.

    What I try to do (and I’m sure some others do to), is:
    1.) Write to the author of these articles (and be rational and polite).
    2.) Leave the (AmRen or Vdare or wherever) link to their article in the email to the author.
    3.) Leave AmRen’s or Vdare’s (or wherever) URL in all (or most) of your posts on other sites.

    I had a subscription to AmRen almost from the beginning (when a friend told me about it) and I’ve been on here since AmRen went online and (obviously) also since they went ‘interactive’ (i.e. they changed from you posting and then seeing your post hours later or the next day, to Disqus). While I miss some of the old posters, I’ve noticed a ton of new names (unless some of the old posters renamed themselves) since those days and that’s a good thing.

    Just keep doing it. We don’t have much choice…

  • Athling

    According to Joel Buxbaum, who studies the molecular basis of disease at Scripps Research Institute in La Jolla, California, “A call to ignore [race] in diagnosis and treatment is a call to ignore biology. Research in the last 35 years has uncovered significant differences among racial and ethnic groups in their rate of drug metabolism, in clinical responses to drugs, and in drug side effects.

    The most definitive evidence is on different levels of certain drug-metabolizing enzymes found in whites, blacks, and Asians. Some of these differences are quite dramatic; for example, Genaissance Pharmaceuticals in New Haven, Connecticut, has found a mutation of a major metabolism-controlling enzyme that occurs in 30% to 40% of Asians and less than 5% of members of other groups. Such findings help explain what many doctors have long observed—that many people of East Asian ancestry need smaller than average doses of a variety of heart, pain, and psychotropic drugs.”

  • Athling

    A cursory examination of the medical literature reveals so much information on racial differentiation that it is difficult to find a good starting point!

    Here’s just a tiny sampling:

    Cardiologist Clyde Yancy of the University of Texas Southwestern Medical Center in Dallas,

    “Blacks don’t have more heart attacks than whites, but in the United States they die sooner from cardiovascular problems -both heart failure and strokes. They also have 10 times the rate of kidney failure, three times the incidence of cardiac hypertrophy, and more than twice the rate of diabetes, a destroyer of blood vessels. High blood pressure, which afflicts almost one-third of the U.S. black population, is the engine that, in large part, drives these related conditions. It leads to excess stress on organs, which respond with hypertrophy, or abnormal cell growth. Intertwined with the problem is a shortage of nitric oxide and, in many cases, excess salt sensitivity that in turn leads to fluid retention. Heart failure in blacks often occurs from damage to the left ventricle, which is responsible for sending freshly oxygenated blood through the body. Indeed,in blacks, heart failure may be a different disease with less favorable outcomes than in whites. (emphasis added)

    Dennis McNamara of the University of Pittsburgh Medical Center says the prevalence of certain versions of these NO genes is “much different in blacks and whites.” The variant that ACE inhibitors work best with is found in 60% of whites but only 30% of blacks, he says.

    Stephen Liggett and colleagues at the University of Cincinnati reported last fall that possessing a combination of two particular versions of alpha and beta adrenergic receptors raised heart failure risk for blacks 10-fold. The high-risk version of the alpha-receptor occurs almost exclusively in people of African origin and is present in about 40% of U.S. blacks, says Liggett. The researchers believe that depressed receptor function leads to excess release of norepinephrine, which is bad for the heart.

    It goes on and on…

    One can only conclude that Ms has an agenda.

  • Screamin_Ruffed_Grouse

    Many scholars now contend that race is closer to a social construct than a biological category…

    Perhaps, but no doctor who is worth his salt contends no such thing. If you find one who does, do yourself and your family a favor and take your health care business elsewhere.