The problem with race-based medicine
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0:01 - 0:0615 years ago, I volunteered
to participate in a research study -
0:06 - 0:09that involved a genetic test.
-
0:09 - 0:11When I arrived at the clinic to be tested,
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0:11 - 0:12I was handed a questionnaire.
-
0:13 - 0:17One of the very first questions
asked me to check a box for my race: -
0:17 - 0:21White, black, Asian, or Native American.
-
0:22 - 0:25I wasn't quite sure
how to answer the question. -
0:25 - 0:28Was it aimed at measuring the diversity
-
0:28 - 0:31of research participants'
social backgrounds? -
0:31 - 0:35In that case, I would answer
with my social identity, -
0:35 - 0:37and check the box for "black."
-
0:37 - 0:41But what if the researchers
were interested in investigating -
0:41 - 0:47some association between ancestry
and the risk for certain genetic traits? -
0:47 - 0:52In that case, wouldn't they want to know
something about my ancestry, -
0:52 - 0:55which is just as much European as African?
-
0:55 - 1:00And how could they make
scientific findings about my genes -
1:00 - 1:04if I put down my social identity
as a black woman? -
1:04 - 1:10After all, I consider myself
a black woman with a white father -
1:10 - 1:13rather than a white woman
with a black mother -
1:13 - 1:15entirely for social reasons.
-
1:16 - 1:18Which racial identity I check
-
1:18 - 1:21has nothing to do with my genes.
-
1:22 - 1:25Well, despite the obvious
importance of this question -
1:25 - 1:28to the study's scientific validity,
-
1:28 - 1:31I was told, "Don't worry about it,
-
1:31 - 1:33just put down however
you identify yourself." -
1:34 - 1:37So I check "black,"
-
1:37 - 1:40but I had no confidence
in the results of a study -
1:40 - 1:45that treated a critical variable
so unscientifically. -
1:46 - 1:51That personal experience
with the use of race in genetic testing -
1:51 - 1:52got me thinking:
-
1:52 - 1:58Where else in medicine is race used
to make false biological predictions? -
1:59 - 2:05Well, I found out that race runs deeply
throughout all of medical practice. -
2:05 - 2:08It shapes physicians' diagnoses,
-
2:08 - 2:11measurements, treatments,
-
2:11 - 2:12prescriptions,
-
2:12 - 2:15even the very definition of diseases.
-
2:16 - 2:20And the more I found out,
the more disturbed I became. -
2:22 - 2:25Sociologists like me have long explained
-
2:25 - 2:28that race is a social construction.
-
2:28 - 2:34When we identify people as black,
white, Asian, Native American, Latina, -
2:34 - 2:37we're referring to social groupings
-
2:37 - 2:41with made up demarcations
that have changed over time -
2:41 - 2:43and vary around the world.
-
2:43 - 2:47As a legal scholar, I've also studied
-
2:47 - 2:49how lawmakers, not biologists,
-
2:49 - 2:53have invented the legal
definitions of races. -
2:55 - 2:58And it's not just the view
of social scientists. -
2:58 - 3:01You remember when the map
of the human genome -
3:01 - 3:05was unveiled at a White House
ceremony in June 2000? -
3:05 - 3:09President Bill Clinton famously declared,
-
3:09 - 3:11"I believe one of the great truths
-
3:11 - 3:14to emerge from this triumphant expedition
-
3:14 - 3:16inside the human genome
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3:16 - 3:18is that in genetic terms,
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3:18 - 3:21human beings, regardless of race,
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3:21 - 3:24are more than 99.9 percent the same."
-
3:25 - 3:26And he might have added
-
3:27 - 3:30that that less than one percent
of genetic difference -
3:30 - 3:33doesn't fall into racial boxes.
-
3:33 - 3:37Francis Collins, who led
the Human Genome Project -
3:37 - 3:39and now heads NIH,
-
3:39 - 3:41echoed President Clinton.
-
3:41 - 3:43"I am happy that today,
-
3:43 - 3:47the only race we're talking about
is the human race." -
3:48 - 3:52Doctors are supposed to practice
evidence-based medicine, -
3:52 - 3:56and they're increasingly called
to join the genomic revolution. -
3:56 - 4:01But their habit of treating patients
by race lags far behind. -
4:02 - 4:03Take the estimate
-
4:03 - 4:07of glomerular filtration rate, or GFR.
-
4:07 - 4:10Doctors routinely interpret GFR,
-
4:10 - 4:15this important indicator
of kidney function, by race. -
4:16 - 4:19As you can see in this lab test,
-
4:20 - 4:25the exact same creatinine level,
-
4:25 - 4:29the concentration
in the blood of the patient, -
4:29 - 4:33automatically produces
a different GFR estimate -
4:33 - 4:38depending on whether or not
the patient is African-American. -
4:39 - 4:40Why?
-
4:41 - 4:45I've been told it's based on an assumption
-
4:45 - 4:48that African-Americans
have more muscle mass -
4:48 - 4:50than people of other races.
-
4:51 - 4:53But what sense does it make
-
4:53 - 4:56for a doctor to automatically assume
-
4:56 - 5:00I have more muscle mass
than that female bodybuilder? -
5:01 - 5:05Wouldn't it be far more accurate
and evidence-based -
5:05 - 5:09to determine the muscle mass
of individual patients -
5:09 - 5:11just by looking at them?
-
5:12 - 5:16Well, doctors tell me
they're using race as a shortcut. -
5:16 - 5:19It's a crude but convenient proxy
-
5:19 - 5:22for more important factors,
like muscle mass, -
5:22 - 5:24enzyme level, genetic traits
-
5:24 - 5:27they just don't have time to look for.
-
5:28 - 5:30But race is a bad proxy.
-
5:30 - 5:35In many cases, race adds
no relevant information at all. -
5:35 - 5:36It's just a distraction.
-
5:38 - 5:42But race also tends to overwhelm
the clinical measures. -
5:43 - 5:47It blinds doctors to patients' symptoms,
-
5:48 - 5:49family illnesses,
-
5:50 - 5:55their history, their own illnesses
they might have -- -
5:55 - 5:58all more evidence-based
than the patient's race. -
6:00 - 6:05Race can't substitute
for these important clinical measures -
6:05 - 6:08without sacrificing patient well-being.
-
6:10 - 6:13Doctors also tell me
race is just one of many factors -
6:13 - 6:15they take into account,
-
6:15 - 6:17but there are numerous medical tests,
-
6:17 - 6:19like the GFR,
-
6:19 - 6:22that use race categorically
-
6:22 - 6:26to treat black, white,
Asian patients differently -
6:26 - 6:28just because of their race.
-
6:30 - 6:35Race medicine also leaves
patients of color especially vulnerable -
6:35 - 6:38to harmful biases and stereotypes.
-
6:39 - 6:42Black and Latino patients
are twice as likely -
6:42 - 6:45to receive no pain medication as whites
-
6:45 - 6:50for the same painful long bone fractures
-
6:50 - 6:52because of stereotypes
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6:52 - 6:56that black and brown people
feel less pain, -
6:56 - 6:58exaggerate their pain,
-
6:58 - 7:01and are predisposed to drug addiction.
-
7:02 - 7:08The Food and Drug Administration has even
approved a race-specific medicine. -
7:08 - 7:10It's a pill called BiDil
-
7:10 - 7:15to treat heart failure in self-identified
African-American patients. -
7:16 - 7:22A cardiologist developed this drug
without regard to race or genetics, -
7:22 - 7:24but it became convenient
-
7:24 - 7:26for commercial reasons
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7:26 - 7:29to market the drug to black patients.
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7:30 - 7:33The FDA then allowed
-
7:33 - 7:36the company, the drug company,
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7:36 - 7:39to test the efficacy in a clinical trial
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7:39 - 7:44that only included
African-American subjects. -
7:45 - 7:47It speculated
-
7:47 - 7:53that race stood in as a proxy
for some unknown genetic factor -
7:53 - 7:55that affects heart disease
-
7:55 - 7:58or response to drugs.
-
8:00 - 8:03But think about
the dangerous message it sent, -
8:03 - 8:07that black people's bodies
are so substandard, -
8:08 - 8:09a drug tested in them
-
8:09 - 8:13is not guaranteed
to work in other patients. -
8:15 - 8:19In the end, the drug company's
marketing scheme failed. -
8:19 - 8:23For one thing, black patients
were understandably wary -
8:23 - 8:26of using a drug just for black people.
-
8:26 - 8:30One elderly black woman stood up
in a community meeting and shouted, -
8:30 - 8:32"Give me what the white
people are taking!" -
8:33 - 8:34(Laughter)
-
8:36 - 8:39And if you find race-specific
medicine surprising, -
8:40 - 8:42wait until you learn
-
8:42 - 8:45that many doctors in the United States
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8:45 - 8:48still use an updated version
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8:48 - 8:50of a diagnostic tool
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8:50 - 8:55that was developed by a physician
during the slavery era, -
8:55 - 8:58a diagnostic tool that is tightly linked
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8:58 - 9:00to justifications for slavery.
-
9:02 - 9:04Dr. Samuel Cartwright graduated
-
9:04 - 9:08from the University
of Pennsylvania Medical School. -
9:08 - 9:11He practiced in the Deep South
before the Civil War, -
9:11 - 9:15and he was a well-known expert
on what was then called "Negro medicine." -
9:16 - 9:19He promoted the racial concept of disease,
-
9:19 - 9:23that people of different races
suffer from different diseases -
9:23 - 9:27and experience
common diseases differently. -
9:28 - 9:31Cartwright argued in the 1850s
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9:31 - 9:35that slavery was beneficial
for black people -
9:35 - 9:37for medical reasons.
-
9:37 - 9:42He claimed that because black people
have lower lung capacity than whites, -
9:42 - 9:45forced labor was good for them.
-
9:46 - 9:48He wrote in a medical journal,
-
9:48 - 9:52"It is the red vital blood
sent to the brain -
9:52 - 9:56that liberates their minds
when under the white man's control, -
9:56 - 10:00and it is the want of sufficiency
of red vital blood -
10:00 - 10:04that chains their minds to ignorance
and barbarism when in freedom." -
10:05 - 10:08To support this theory,
Cartwright helped to perfect -
10:08 - 10:13a medical device for measuring breathing
called the spirometer -
10:14 - 10:18to show the presumed deficiency
in black people's lungs. -
10:20 - 10:25Today, doctors still
uphold Cartwright's claim -
10:25 - 10:28the black people as a race
-
10:28 - 10:31have lower lung capacity
than white people. -
10:32 - 10:37Some even use a modern day spirometer
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10:37 - 10:40that actually has a button labeled "race"
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10:40 - 10:43so the machine adjusts the measurement
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10:43 - 10:47for each patient
according to his or her race. -
10:47 - 10:51It's a well-known function
called "correcting for race." -
10:54 - 10:59The problem with race medicine
extends far beyond misdiagnosing patients. -
11:00 - 11:04Its focus on innate
racial differences in disease -
11:04 - 11:07diverts attention and resources
-
11:08 - 11:10from the social determinants
-
11:10 - 11:14that cause appalling
racial gaps in health: -
11:14 - 11:17lack of access
to high-quality medical care; -
11:18 - 11:20food deserts in poor neighborhoods;
-
11:21 - 11:24exposure to environmental toxins;
-
11:25 - 11:27high rates of incarceration;
-
11:28 - 11:32and experiencing the stress
of racial discrimination. -
11:33 - 11:37You see, race is not a biological category
-
11:37 - 11:40that naturally produces
these health disparities -
11:40 - 11:43because of genetic difference.
-
11:43 - 11:46Race is a social category
-
11:46 - 11:50that has staggering
biological consequences, -
11:50 - 11:54but because of the impact
of social inequality on people's health. -
11:55 - 11:59Yet race medicine pretends
the answer to these gaps in health -
11:59 - 12:03can be found in a race-specific pill.
-
12:03 - 12:05It's much easier and more lucrative
-
12:05 - 12:08to market a technological fix
-
12:09 - 12:11for these gaps in health
-
12:11 - 12:16than to deal with the structural
inequities that produce them. -
12:18 - 12:22The reason I'm so passionate
about ending race medicine -
12:22 - 12:25isn't just because it's bad medicine.
-
12:25 - 12:27I'm also on this mission
-
12:27 - 12:30because the way doctors practice medicine
-
12:30 - 12:36continues to promote
a false and toxic view of humanity. -
12:37 - 12:43Despite the many visionary breakthroughs
in medicine we've been learning about, -
12:43 - 12:46there's a failure of imagination
-
12:46 - 12:47when it comes to race.
-
12:49 - 12:52Would you imagine with me, just a moment:
-
12:53 - 12:59What would happen if doctors
stopped treating patients by race? -
13:00 - 13:03Suppose they rejected
-
13:03 - 13:07an 18th-century classification system
-
13:07 - 13:10and incorporated instead
the most advanced knowledge -
13:10 - 13:13of human genetic diversity and unity,
-
13:13 - 13:20that human beings cannot be categorized
into biological races? -
13:21 - 13:25What if, instead of using race
as a crude proxy -
13:25 - 13:28for some more important factor,
-
13:28 - 13:33doctors actually investigated
and addressed that more important factor? -
13:35 - 13:38What if doctors joined the forefront
-
13:38 - 13:42of a movement to end
the structural inequities -
13:42 - 13:44caused by racism,
-
13:44 - 13:46not by genetic difference?
-
13:49 - 13:53Race medicine is bad medicine,
-
13:53 - 13:55it's poor science
-
13:55 - 13:59and it's a false
interpretation of humanity. -
14:00 - 14:02It is more urgent than ever
-
14:02 - 14:07to finally abandon this backward legacy
-
14:07 - 14:10and to affirm our common humanity
-
14:10 - 14:16by ending the social inequalities
that truly divide us. -
14:16 - 14:17Thank you.
-
14:17 - 14:19(Applause)
-
14:20 - 14:21Thank you. Thanks.
-
14:22 - 14:24Thank you.
- Title:
- The problem with race-based medicine
- Speaker:
- Dorothy Roberts
- Description:
-
Social justice advocate and law scholar Dorothy Roberts has a precise and powerful message: Race-based medicine is bad medicine. Even today, many doctors still use race as a medical shortcut; they make important decisions about things like pain tolerance based on a patient’s skin color instead of medical observation and measurement. In this searing talk, Roberts lays out the lingering traces of race-based medicine -- and invites us to be a part of ending it. “It is more urgent than ever to finally abandon this backward legacy,” she says, “and to affirm our common humanity by ending the social inequalities that truly divide us.”
- Video Language:
- English
- Team:
- closed TED
- Project:
- TEDTalks
- Duration:
- 14:36
Brian Greene edited English subtitles for The problem with race-based medicine | ||
Brian Greene edited English subtitles for The problem with race-based medicine | ||
Brian Greene approved English subtitles for The problem with race-based medicine | ||
Brian Greene edited English subtitles for The problem with race-based medicine | ||
Brian Greene edited English subtitles for The problem with race-based medicine | ||
Brian Greene edited English subtitles for The problem with race-based medicine | ||
Joanna Pietrulewicz accepted English subtitles for The problem with race-based medicine | ||
Joanna Pietrulewicz edited English subtitles for The problem with race-based medicine |