The concept of race has a long and problematic history in medicine. It’s not uncommon for medical students to be taught that a specific illness is race specific. One of the best known examples is sickle cell anemia, which is often declared a “black disease” but actually occurs in many white populations as well.
While modern genetic science has largely demolished the validity of racial categories—our genes show that while there is variation in the human family, there are few sharp divides between peoples as is suggested by the concept of race.
Nonetheless racial categories are still actively relied upon in the delivery of medical care and that is coming under increasing scrutiny, as was detailed in a recent opinion piece in The New York Times.
Sickle cell anemia is one of the top examples of how racial concepts shape medicine, but it is by no means alone:
- African-Americans are widely considered to be more susceptible to kidney disease. But in fact, not all African-Americans carry the gene variants that cause kidney problems.
- And there is a substantial body of research indicating that blacks and other minorities are less likely than whites to receive treatment for pain.
Pointing to these and other examples, many argue that the concept of race in healthcare should be discarded, saying it is too unwieldy, too imprecise and has too much baggage to be useful anymore. And, not incidentally, it can lead to bad medicine, such as failure to do the appropriate screening for sickle cell among white populations. Or incorrectly discarding kidneys provided to donor programs by African-Americans.
Given these and other problems, critics say it’s time to focus on the genes important to whatever medical puzzle is being addressed — an approach often called “precision” or “personalized” medicine.
But others say that’s not practical and point to cases such as
Prostate Cancer: African-Americans have a higher risk than whites and the test for it, which looks at prostate-specific antigen, is known to yield many false positives. In this instance, though race might be a crude marker, some argue it’s still a usable one for determining how care should be provided.
Hypertension: African-Americans suffer from high blood pressure more often than whites do. Yet Africans in Africa don’t generally have high blood pressure leading to suggestions that experiencing racism is what’s raising blood pressure.
This is just a brief summary of this debate and how it affects how medicine is both taught and administered. Read the full piece from The New York Times here.