WEBVTT

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15 years ago, I volunteered
to participate in a research study

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that involved a genetic test.

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When I arrived at the clinic to be tested,

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I was handed a questionnaire.

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One of the very first questions
asked me to check a box for my race:

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white, black, Asian, or Native American.

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I wasn't quite sure
how to answer the question.

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Was it aimed at measuring the diversity

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of research participants'
social backgrounds?

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In that case, I would answer
with my social identity,

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and check the box for "black."

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But what if the researchers
were interested in investigating

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some association between ancestry
and the risk for certain genetic traits?

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In that case, wouldn't they want to know
something about my ancestry,

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which is just as much European as African?

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And how could they make
scientific findings about my genes

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if I put down my social identity
as a black woman?

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After all, I consider myself
a black woman with a white father

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rather than a white woman
with a black mother

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entirely for social reasons.

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Which racial identity I check

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has nothing to do with my genes.

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Well, despite the obvious
importance of this question

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to the study's scientific validity,

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I was told, "Don't worry about it,

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just put down however
you identify yourself."

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So I check "black,"

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but I had no confidence
in the results of a study

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that treated a critical variable
so unscientifically.

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That personal experience
with the use of race in genetic testing

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got me thinking:

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where else in medicine is race used
to make false biological predictions?

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Well, I found out that race runs deeply
throughout all of medical practice.

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It shapes physicians' diagnoses,

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measurements, treatments,

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prescriptions,

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even the very definition of diseases.

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And the more I found out,
the more disturbed I became.

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Sociologists like me have long explained

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that race is a social construction.

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When we identify people as black,
white, Asian, Native American, Latina,

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we're referring to social groupings

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with made up demarcations
that have changed over time

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and vary around the world.

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As a legal scholar, I've also studied

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how lawmakers, not biologists,

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have invented the legal
definitions of races.

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And it's not just the view
of social scientists.

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You remember when the map
of the human genome

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was unveiled at a White House
ceremony in June 2000?

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President Bill Clinton famously declared,

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"I believe one of the great truths

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to emerge from this triumphant expedition

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inside the human genome

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is that in genetic terms,

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human beings, regardless of race,

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are more than 99.9 percent the same."

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And he might have added

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that that less than one percent
of genetic difference

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doesn't fall into racial boxes.

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Francis Collins, who led
the Human Genome Project

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and now heads NIH,

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echoed President Clinton.

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"I am happy that today,

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the only race we're talking about
is the human race."

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Doctors are supposed to practice
evidence-based medicine,

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and they're increasingly called
to join the genomic revolution,

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but their habit of treating patients
by race lags far behind.

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Take the estimate

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of glomerular filtration rate, or GFR.

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Doctors routinely interpret GFR,

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this important indicator
of kidney function, by race.

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As you can see in this lab test,

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the exact same creatinine level,

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the concentration
in the blood of the patient,

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automatically produces
a different GFR estimate

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depending on whether or not
the patient is African-American.

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Why?

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I've been told it's based on an assumption

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that African-Americans
have more muscle mass

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than people of other races.

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But what sense does it make

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for a doctor to automatically assume

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I have more muscle mass
than that female bodybuilder?

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Wouldn't it be far more accurate
and evidence-based

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to determine the muscle mass
of individual patients

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just by looking at them?

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Well, doctors tell me
they're using race as a shortcut.

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It's a crude but convenient proxy

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for more important factors,
like muscle mass,

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enzyme level, genetic traits

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they just don't have time to look for.

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But race is a bad proxy.

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In many cases, race adds
no relevant information at all.

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It's just a distraction.

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But race also tends to overwhelm
the clinical measures.

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It blinds doctors to patients' symptoms,

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family illnesses,

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their history, their own illnesses
they might have,

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all more evidence-based
than the patient's race.

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Race can't substitute
for these important clinical measures

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without sacrificing patient well-being.

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Doctors also tell me
race is just one of many factors

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they take into account,

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but there are numerous medical tests,

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like the GFR,

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that use race categorically

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to treat black, white,
Asian patients differently

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just because of their race.

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Race medicine also leaves
patients of color especially vulnerable

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to harmful biases and stereotypes.

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Black and Latino patients
are twice as likely

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to receive no pain medication as whites

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for the same painful long bone fractures

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because of stereotypes

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that black and brown people
feel less pain,

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exaggerate their pain,

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and are predisposed to drug addiction.

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The Food and Drug Administration has even
approved a race-specific medicine.

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It's a pill called BiDil

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to treat heart failure in self-identified
African-American patients.

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A cardiologist developed this drug
without regard to race or genetics,

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but it became convenient

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for commercial reasons

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to market the drug to black patients.

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The FDA then allowed

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the company, the drug company,

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to test the efficacy in a clinical trial

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that only included
African-American subjects.

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It speculated

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that race stood in as a proxy
for some unknown genetic factor

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that affects heart disease

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or response to drugs.

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But think about
the dangerous message it sent,

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that black people's bodies
are so substandard,

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a drug tested in them

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is not guaranteed
to work in other patients.

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In the end, the drug company's
marketing scheme failed.

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For one thing, black patients
were understandably wary

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of using a drug just for black people.

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One elderly black woman stood up
in a community meeting and shouted,

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"Give me what the white
people are taking!"

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(Laughter)

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And if you find race-specific
medicine surprising,

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wait until you learn

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that many doctors in the United States

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still use an updated version

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of a diagnostic tool

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that was developed by a physician
during the slavery era,

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a diagnostic tool that is tightly linked

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to justifications for slavery.

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Dr. Samuel Cartwright graduated

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from the University
of Pennsylvania Medical School.

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He practiced in the Deep South
before the Civil War,

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and he was a well-known expert
on what was then called "Negro medicine."

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He promoted the racial concept of disease,

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that people of different races
suffer from different diseases

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and experience
common diseases differently.

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Cartwright argued in the 1850s

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that slavery was beneficial
for black people

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for medical reasons.

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He claimed that because black people
have lower lung capacity than whites,

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forced labor was good for them.

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He wrote in a medical journal,

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"It is the red vital blood
sent to the brain

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that liberates their minds
when under the white man's control,

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and it is the want of sufficiency
of red vital blood

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that chains their minds to ignorance
and barbarism when in freedom."

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To support this theory,
Cartwright helped to perfect

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a medical device for measuring breathing
called the spirometer

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to show the presumed deficiency
in black people's lungs.

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Today, doctors still
uphold Cartwright's claim

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the black people as a race

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have lower lung capacity
than white people.

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Some even use a modern day spirometer

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that actually has a button labeled "race"

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so the machine adjusts the measurement

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for each patient
according to his or her race.

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It's a well-known function
called "correcting for race."

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The problem with race medicine
extends far beyond misdiagnosing patients.

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Its focus on innate
racial differences in disease

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diverts attention and resources

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from the social determinants

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that cause appalling
racial gaps in health:

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lack of access
to high-quality medical care;

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food deserts in poor neighborhoods;

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exposure to environmental toxins;

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high rates of incarceration;

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and experiencing the stress
of racial discrimination.

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You see, race is not a biological category

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that naturally produces
these health disparities

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because of genetic difference.

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Race is a social category

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that has staggering
biological consequences,

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but because of the impact
of social inequality on people's health.

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Yet race medicine pretends
the answer to these gaps in health

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can be found in a race-specific pill.

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It's much easier and more lucrative

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to market a technological fix

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for these gaps in health

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than to deal with the structural
inequities that produce them.

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The reason I'm so passionate
about ending race medicine

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isn't just because it's bad medicine.

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I'm also on this mission

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because the way doctors practice medicine

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continues to promote
a false and toxic view of humanity.

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Despite the many visionary breakthroughs
in medicine we've been learning about,

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there's a failure of imagination

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when it comes to race.

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Would you imagine with me, just a moment:

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what would happen if doctors
stopped treating patients by race?

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Suppose they rejected

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an 18th-century classification system

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and incorporated instead
the most advanced knowledge

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of human genetic diversity and unity,

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that human beings cannot be categorized
into biological races?

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What if, instead of using race
as a crude proxy

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for some more important factor,

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doctors actually investigated
and addressed that more important factor?

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What if doctors joined the forefront

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of a movement to end
the structural inequities

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caused by racism,

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not by genetic difference?

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Race medicine is bad medicine,

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it's poor science,

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and it's a false
interpretation of humanity.

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It is more urgent than ever

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to finally abandon this backward legacy

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and to affirm our common humanity

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by ending the social inequalities
that truly divide us.

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Thank you.

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(Applause)

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Thank you. Thanks.

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Thank you.