The problem with race-based medicine | Dorothy Roberts

Summary

The speaker critiques the widespread use of race in medical practice, particularly in genetic testing and diagnosis. Drawing on personal experiences, they reveal how race-based assumptions, like using race to estimate kidney function or prescribe medication, often lead to inaccuracies and biases. They argue that race is a social construct, not a biological determinant, and that its use in medicine distracts from addressing the real social factors contributing to health disparities. The speaker advocates for abandoning race medicine in favor of a more equitable and scientifically grounded approach to healthcare.

Takeaways

• 😀 Race is a social construct, not a biological one, and is often used incorrectly in medical practices.
• 😀 In genetic testing, race is used ambiguously and often based on social identity rather than scientific reasoning.
• 😀 Medical practices frequently use race as a shortcut, but it often leads to inaccurate assumptions about patients' health, such as muscle mass in kidney function tests.
• 😀 Race-based medical practices often fail to account for important individual factors and can distract from more relevant clinical measures.
• 😀 The use of race in medicine contributes to harmful stereotypes, such as assuming that black and Latino patients feel less pain, leading to disparities in pain management.
• 😀 Race-specific drugs, like BiDil for African-American heart failure patients, can perpetuate harmful ideas and create distrust among communities.
• 😀 A historical example of race-based medicine involves Dr. Samuel Cartwright, who promoted false medical beliefs about black people's lung capacity to justify slavery.
• 😀 Modern-day spirometers still use race-adjusted measurements, continuing the legacy of race-based health assumptions.
• 😀 Race medicine diverts attention from the real causes of health disparities, such as social inequalities, poor access to healthcare, and environmental factors.
• 😀 To improve health outcomes, doctors must reject race-based medicine and focus on addressing the structural inequities caused by racism, not genetic differences.

Q & A

Why did the speaker find the race question in the genetic testing questionnaire problematic?

The speaker found the race question problematic because it forced them to choose a racial identity that may not accurately reflect their genetic ancestry. They felt that the race question was not scientifically valid for genetic testing, as it was based on social identity rather than genetic information.

What is the key issue the speaker highlights about race and medicine?

The speaker highlights that race is often used in medicine as a proxy for genetic or biological differences, which is scientifically inaccurate and perpetuates harmful stereotypes. Race should not be used to make assumptions about a patient's health or genetics.

How does race affect the measurement of glomerular filtration rate (GFR) in medical practice?

In medical practice, race is used to adjust the glomerular filtration rate (GFR) based on assumptions that African-Americans have more muscle mass than people of other races. This leads to different GFR estimates for the same creatinine level, even though muscle mass varies greatly among individuals.

What is the problem with using race as a shortcut in medical diagnostics?

Using race as a shortcut in medical diagnostics is problematic because it often provides irrelevant information and overlooks more significant clinical factors, such as a patient’s symptoms, family history, and overall health. It can also perpetuate biases and lead to misdiagnoses.

How does race medicine contribute to harmful biases in healthcare?

Race medicine perpetuates harmful stereotypes by assuming that certain racial groups experience pain or respond to treatment differently. This leads to disparities, such as black and Latino patients being less likely to receive pain medication, or being treated differently based on their race.

What was the controversy surrounding BiDil, the race-specific drug?

BiDil was marketed as a heart failure drug specifically for African-American patients, despite the fact that it was developed without considering race or genetics. The controversy lies in the FDA approving the drug based on a study that only included African-American subjects, sending a dangerous message that drugs tested on black patients may not work for others.

What historical figure is mentioned in relation to race-based medicine, and what is his contribution?

Dr. Samuel Cartwright, a physician from the slavery era, is mentioned. He promoted the idea that black people had lower lung capacity than whites and developed a device, the spirometer, to measure lung capacity. This theory is still used in modern medicine, where some doctors adjust lung capacity measurements based on race.

What does the speaker suggest would happen if doctors stopped using race as a factor in medical treatment?

The speaker suggests that if doctors stopped using race as a factor, they could focus on more accurate, individualized assessments based on genetic diversity and clinical measures. This shift would improve patient care and help address the structural inequalities that contribute to health disparities.

What does the speaker say about the relationship between race and health disparities?

The speaker emphasizes that race itself is not a biological factor causing health disparities. Instead, social determinants such as lack of access to care, environmental toxins, and racial discrimination are the root causes of these disparities. Race-based medicine diverts attention away from these social factors.

What is the speaker’s overall stance on race medicine, and why is it important to reject it?

The speaker believes race medicine is bad science and harmful to patient care. It promotes a false view of human biology and perpetuates social inequalities. Rejecting race-based medicine is crucial to improving healthcare and addressing the social determinants of health that create disparities among different racial groups.