0:00:00.800,0:00:06.056
15 years ago, I volunteered[br]to participate in a research study

0:00:06.080,0:00:08.616
that involved a genetic test.

0:00:08.640,0:00:10.647
When I arrived at the clinic to be tested,

0:00:10.672,0:00:12.320
I was handed a questionnaire.

0:00:13.080,0:00:17.296
One of the very first questions[br]asked me to check a box for my race:

0:00:17.320,0:00:20.920
white, black, Asian, or Native American.

0:00:21.680,0:00:24.560
I wasn't quite sure[br]how to answer the question.

0:00:25.200,0:00:27.576
Was it aimed at measuring the diversity

0:00:27.600,0:00:31.176
of research participants'[br]social backgrounds?

0:00:31.200,0:00:34.816
In that case, I would answer[br]with my social identity,

0:00:34.840,0:00:36.840
and check the box for "black."

0:00:37.480,0:00:41.016
But what if the researchers[br]were interested in investigating

0:00:41.040,0:00:47.136
some association between ancestry[br]and the risk for certain genetic traits?

0:00:47.160,0:00:51.696
In that case, wouldn't they want to know[br]something about my ancestry,

0:00:51.720,0:00:54.976
which is just as much European as African?

0:00:55.000,0:00:59.616
And how could they make[br]scientific findings about my genes

0:00:59.640,0:01:03.680
if I put down my social identity[br]as a black woman?

0:01:04.480,0:01:09.616
After all, I consider myself[br]a black woman with a white father

0:01:09.640,0:01:13.056
rather than a white woman[br]with a black mother

0:01:13.080,0:01:15.360
entirely for social reasons.

0:01:15.800,0:01:18.256
Which racial identity I check

0:01:18.280,0:01:21.120
has nothing to do with my genes.

0:01:22.080,0:01:25.456
Well, despite the obvious[br]importance of this question

0:01:25.480,0:01:27.976
to the study's scientific validity,

0:01:28.000,0:01:30.536
I was told, "Don't worry about it,

0:01:30.560,0:01:33.440
just put down however[br]you identify yourself."

0:01:34.200,0:01:36.576
So I check "black,"

0:01:36.600,0:01:40.296
but I had no confidence[br]in the results of a study

0:01:40.320,0:01:44.520
that treated a critical variable[br]so unscientifically.

0:01:46.360,0:01:50.696
That personal experience[br]with the use of race in genetic testing

0:01:50.720,0:01:52.296
got me thinking:

0:01:52.320,0:01:58.040
where else in medicine is race used[br]to make false biological predictions?

0:01:58.720,0:02:04.976
Well, I found out that race runs deeply[br]throughout all of medical practice.

0:02:05.000,0:02:08.015
It shapes physicians' diagnoses,

0:02:08.039,0:02:10.656
measurements, treatments,

0:02:10.680,0:02:12.296
prescriptions,

0:02:12.320,0:02:15.480
even the very definition of diseases.

0:02:16.400,0:02:20.360
And the more I found out,[br]the more disturbed I became.

0:02:21.720,0:02:24.816
Sociologists like me have long explained

0:02:24.840,0:02:27.736
that race is a social construction.

0:02:27.760,0:02:34.256
When we identify people as black,[br]white, Asian, Native American, Latina,

0:02:34.280,0:02:37.016
we're referring to social groupings

0:02:37.040,0:02:40.736
with made up demarcations[br]that have changed over time

0:02:40.760,0:02:43.296
and vary around the world.

0:02:43.320,0:02:46.536
As a legal scholar, I've also studied

0:02:46.560,0:02:48.976
how lawmakers, not biologists,

0:02:49.000,0:02:52.840
have invented the legal[br]definitions of races.

0:02:54.640,0:02:58.096
And it's not just the view[br]of social scientists.

0:02:58.120,0:03:00.736
You remember when the map[br]of the human genome

0:03:00.760,0:03:05.016
was unveiled at a White House[br]ceremony in June 2000?

0:03:05.040,0:03:08.656
President Bill Clinton famously declared,

0:03:08.680,0:03:10.856
"I believe one of the great truths

0:03:10.880,0:03:14.056
to emerge from this triumphant expedition

0:03:14.080,0:03:15.896
inside the human genome

0:03:15.920,0:03:17.776
is that in genetic terms,

0:03:17.800,0:03:20.616
human beings, regardless of race,

0:03:20.640,0:03:24.160
are more than 99.9 percent the same."

0:03:24.920,0:03:26.496
And he might have added

0:03:26.520,0:03:30.216
that that less than one percent[br]of genetic difference

0:03:30.240,0:03:32.760
doesn't fall into racial boxes.

0:03:33.440,0:03:37.096
Francis Collins, who led[br]the Human Genome Project

0:03:37.120,0:03:38.816
and now heads NIH,

0:03:38.840,0:03:40.896
echoed President Clinton.

0:03:40.920,0:03:42.856
"I am happy that today,

0:03:42.880,0:03:46.720
the only race we're talking about[br]is the human race."

0:03:48.400,0:03:52.376
Doctors are supposed to practice[br]evidence-based medicine,

0:03:52.400,0:03:56.336
and they're increasingly called[br]to join the genomic revolution,

0:03:56.360,0:04:01.240
but their habit of treating patients[br]by race lags far behind.

0:04:02.200,0:04:03.416
Take the estimate

0:04:03.440,0:04:06.696
of glomerular filtration rate, or GFR.

0:04:06.720,0:04:10.256
Doctors routinely interpret GFR,

0:04:10.280,0:04:14.520
this important indicator[br]of kidney function, by race.

0:04:15.840,0:04:19.079
As you can see in this lab test,

0:04:19.720,0:04:24.896
the exact same creatinine level,

0:04:24.920,0:04:28.696
the concentration[br]in the blood of the patient,

0:04:28.720,0:04:33.176
automatically produces[br]a different GFR estimate

0:04:33.200,0:04:37.680
depending on whether or not[br]the patient is African-American.

0:04:39.120,0:04:40.320
Why?

0:04:41.280,0:04:44.536
I've been told it's based on an assumption

0:04:44.560,0:04:47.656
that African-Americans[br]have more muscle mass

0:04:47.680,0:04:49.880
than people of other races.

0:04:50.880,0:04:52.696
But what sense does it make

0:04:52.720,0:04:56.176
for a doctor to automatically assume

0:04:56.200,0:05:00.080
I have more muscle mass[br]than that female bodybuilder?

0:05:00.600,0:05:04.576
Wouldn't it be far more accurate[br]and evidence-based

0:05:04.600,0:05:08.616
to determine the muscle mass[br]of individual patients

0:05:08.640,0:05:10.680
just by looking at them?

0:05:12.360,0:05:15.776
Well, doctors tell me[br]they're using race as a shortcut.

0:05:15.800,0:05:18.536
It's a crude but convenient proxy

0:05:18.560,0:05:21.816
for more important factors,[br]like muscle mass,

0:05:21.840,0:05:24.216
enzyme level, genetic traits

0:05:24.240,0:05:26.520
they just don't have time to look for.

0:05:27.600,0:05:30.376
But race is a bad proxy.

0:05:30.400,0:05:34.536
In many cases, race adds[br]no relevant information at all.

0:05:34.560,0:05:36.440
It's just a distraction.

0:05:37.600,0:05:42.480
But race also tends to overwhelm[br]the clinical measures.

0:05:43.440,0:05:47.120
It blinds doctors to patients' symptoms,

0:05:47.760,0:05:49.440
family illnesses,

0:05:50.440,0:05:54.776
their history, their own illnesses[br]they might have,

0:05:54.800,0:05:58.320
all more evidence-based[br]than the patient's race.

0:05:59.920,0:06:04.696
Race can't substitute[br]for these important clinical measures

0:06:04.720,0:06:08.400
without sacrificing patient well-being.

0:06:09.800,0:06:13.456
Doctors also tell me[br]race is just one of many factors

0:06:13.480,0:06:15.016
they take into account,

0:06:15.040,0:06:17.176
but there are numerous medical tests,

0:06:17.200,0:06:18.936
like the GFR,

0:06:18.960,0:06:22.216
that use race categorically

0:06:22.240,0:06:26.216
to treat black, white,[br]Asian patients differently

0:06:26.240,0:06:28.320
just because of their race.

0:06:29.680,0:06:35.176
Race medicine also leaves[br]patients of color especially vulnerable

0:06:35.200,0:06:38.000
to harmful biases and stereotypes.

0:06:38.600,0:06:41.896
Black and Latino patients[br]are twice as likely

0:06:41.920,0:06:45.416
to receive no pain medication as whites

0:06:45.440,0:06:50.016
for the same painful long bone fractures

0:06:50.040,0:06:52.256
because of stereotypes

0:06:52.280,0:06:56.136
that black and brown people[br]feel less pain,

0:06:56.160,0:06:58.096
exaggerate their pain,

0:06:58.120,0:07:00.840
and are predisposed to drug addiction.

0:07:02.320,0:07:07.976
The Food and Drug Administration has even[br]approved a race-specific medicine.

0:07:08.000,0:07:10.416
It's a pill called BiDil

0:07:10.440,0:07:15.080
to treat heart failure in self-identified[br]African-American patients.

0:07:15.640,0:07:21.816
A cardiologist developed this drug[br]without regard to race or genetics,

0:07:21.840,0:07:24.096
but it became convenient

0:07:24.120,0:07:26.016
for commercial reasons

0:07:26.040,0:07:28.760
to market the drug to black patients.

0:07:30.360,0:07:32.616
The FDA then allowed

0:07:32.640,0:07:35.696
the company, the drug company,

0:07:35.720,0:07:39.336
to test the efficacy in a clinical trial

0:07:39.360,0:07:43.920
that only included[br]African-American subjects.

0:07:44.760,0:07:46.536
It speculated

0:07:46.560,0:07:52.656
that race stood in as a proxy[br]for some unknown genetic factor

0:07:52.680,0:07:55.456
that affects heart disease

0:07:55.480,0:07:58.240
or response to drugs.

0:07:59.560,0:08:03.016
But think about[br]the dangerous message it sent,

0:08:03.040,0:08:07.496
that black people's bodies[br]are so substandard,

0:08:07.520,0:08:09.216
a drug tested in them

0:08:09.240,0:08:12.720
is not guaranteed[br]to work in other patients.

0:08:14.840,0:08:18.656
In the end, the drug company's[br]marketing scheme failed.

0:08:18.680,0:08:22.656
For one thing, black patients[br]were understandably wary

0:08:22.680,0:08:26.056
of using a drug just for black people.

0:08:26.080,0:08:30.016
One elderly black woman stood up[br]in a community meeting and shouted,

0:08:30.040,0:08:32.496
"Give me what the white[br]people are taking!"

0:08:32.520,0:08:34.000
(Laughter)

0:08:35.559,0:08:39.360
And if you find race-specific[br]medicine surprising,

0:08:40.200,0:08:42.135
wait until you learn

0:08:42.159,0:08:44.976
that many doctors in the United States

0:08:45.000,0:08:48.136
still use an updated version

0:08:48.160,0:08:50.056
of a diagnostic tool

0:08:50.080,0:08:54.536
that was developed by a physician[br]during the slavery era,

0:08:54.560,0:08:57.856
a diagnostic tool that is tightly linked

0:08:57.880,0:09:00.240
to justifications for slavery.

0:09:01.560,0:09:04.216
Dr. Samuel Cartwright graduated

0:09:04.240,0:09:07.616
from the University[br]of Pennsylvania Medical School.

0:09:07.640,0:09:11.216
He practiced in the Deep South[br]before the Civil War,

0:09:11.240,0:09:15.360
and he was a well-known expert[br]on what was then called "Negro medicine."

0:09:16.120,0:09:19.336
He promoted the racial concept of disease,

0:09:19.360,0:09:23.056
that people of different races[br]suffer from different diseases

0:09:23.080,0:09:26.720
and experience[br]common diseases differently.

0:09:27.880,0:09:31.136
Cartwright argued in the 1850s

0:09:31.160,0:09:35.176
that slavery was beneficial[br]for black people

0:09:35.200,0:09:37.256
for medical reasons.

0:09:37.280,0:09:42.176
He claimed that because black people[br]have lower lung capacity than whites,

0:09:42.200,0:09:44.760
forced labor was good for them.

0:09:45.840,0:09:48.096
He wrote in a medical journal,

0:09:48.120,0:09:51.536
"It is the red vital blood[br]sent to the brain

0:09:51.560,0:09:55.896
that liberates their minds[br]when under the white man's control,

0:09:55.920,0:09:59.656
and it is the want of sufficiency[br]of red vital blood

0:09:59.680,0:10:04.080
that chains their minds to ignorance[br]and barbarism when in freedom."

0:10:05.160,0:10:08.296
To support this theory,[br]Cartwright helped to perfect

0:10:08.320,0:10:13.160
a medical device for measuring breathing[br]called the spirometer

0:10:14.240,0:10:18.280
to show the presumed deficiency[br]in black people's lungs.

0:10:19.880,0:10:25.416
Today, doctors still[br]uphold Cartwright's claim

0:10:25.440,0:10:28.056
the black people as a race

0:10:28.080,0:10:31.080
have lower lung capacity[br]than white people.

0:10:32.280,0:10:36.576
Some even use a modern day spirometer

0:10:36.600,0:10:40.336
that actually has a button labeled "race"

0:10:40.360,0:10:43.016
so the machine adjusts the measurement

0:10:43.040,0:10:47.016
for each patient[br]according to his or her race.

0:10:47.040,0:10:50.880
It's a well-known function[br]called "correcting for race."

0:10:53.880,0:10:59.360
The problem with race medicine[br]extends far beyond misdiagnosing patients.

0:10:59.920,0:11:04.376
Its focus on innate[br]racial differences in disease

0:11:04.400,0:11:07.496
diverts attention and resources

0:11:07.520,0:11:09.736
from the social determinants

0:11:09.760,0:11:13.736
that cause appalling[br]racial gaps in health:

0:11:13.760,0:11:17.080
lack of access[br]to high-quality medical care;

0:11:17.560,0:11:20.400
food deserts in poor neighborhoods;

0:11:21.160,0:11:24.440
exposure to environmental toxins;

0:11:25.000,0:11:27.280
high rates of incarceration;

0:11:27.920,0:11:32.280
and experiencing the stress[br]of racial discrimination.

0:11:33.120,0:11:36.896
You see, race is not a biological category

0:11:36.920,0:11:40.336
that naturally produces[br]these health disparities

0:11:40.360,0:11:42.600
because of genetic difference.

0:11:43.240,0:11:45.856
Race is a social category

0:11:45.880,0:11:49.536
that has staggering[br]biological consequences,

0:11:49.560,0:11:54.480
but because of the impact[br]of social inequality on people's health.

0:11:55.160,0:11:59.296
Yet race medicine pretends[br]the answer to these gaps in health

0:11:59.320,0:12:02.536
can be found in a race-specific pill.

0:12:02.560,0:12:05.296
It's much easier and more lucrative

0:12:05.320,0:12:08.080
to market a technological fix

0:12:08.680,0:12:10.816
for these gaps in health

0:12:10.840,0:12:15.640
than to deal with the structural[br]inequities that produce them.

0:12:17.960,0:12:22.296
The reason I'm so passionate[br]about ending race medicine

0:12:22.320,0:12:25.376
isn't just because it's bad medicine.

0:12:25.400,0:12:27.256
I'm also on this mission

0:12:27.280,0:12:30.216
because the way doctors practice medicine

0:12:30.240,0:12:35.880
continues to promote[br]a false and toxic view of humanity.

0:12:36.840,0:12:42.936
Despite the many visionary breakthroughs[br]in medicine we've been learning about,

0:12:42.960,0:12:45.576
there's a failure of imagination

0:12:45.600,0:12:47.320
when it comes to race.

0:12:48.920,0:12:51.840
Would you imagine with me, just a moment:

0:12:52.600,0:12:58.720
what would happen if doctors[br]stopped treating patients by race?

0:13:00.360,0:13:02.896
Suppose they rejected

0:13:02.920,0:13:06.616
an 18th-century classification system

0:13:06.640,0:13:10.376
and incorporated instead[br]the most advanced knowledge

0:13:10.400,0:13:13.336
of human genetic diversity and unity,

0:13:13.360,0:13:19.520
that human beings cannot be categorized[br]into biological races?

0:13:20.600,0:13:25.376
What if, instead of using race[br]as a crude proxy

0:13:25.400,0:13:27.776
for some more important factor,

0:13:27.800,0:13:32.920
doctors actually investigated[br]and addressed that more important factor?

0:13:34.720,0:13:37.856
What if doctors joined the forefront

0:13:37.880,0:13:41.616
of a movement to end[br]the structural inequities

0:13:41.640,0:13:43.856
caused by racism,

0:13:43.880,0:13:45.960
not by genetic difference?

0:13:49.240,0:13:52.520
Race medicine is bad medicine,

0:13:53.160,0:13:55.296
it's poor science,

0:13:55.320,0:13:58.680
and it's a false[br]interpretation of humanity.

0:13:59.520,0:14:02.096
It is more urgent than ever

0:14:02.120,0:14:06.656
to finally abandon this backward legacy

0:14:06.680,0:14:10.096
and to affirm our common humanity

0:14:10.120,0:14:16.016
by ending the social inequalities[br]that truly divide us.

0:14:16.040,0:14:17.256
Thank you.

0:14:17.280,0:14:19.496
(Applause)

0:14:19.520,0:14:21.400
Thank you. Thanks.

0:14:22.320,0:14:23.520
Thank you.