This past November I had the opportunity take part in TEDMED as a TEDMED Scholar. The week consisted of numerous talks from exceptional leaders in the field of health, medicine and innovation. There was also time set aside for discussion and debate. Few were as compelling as the presentation by Professor Dorothy Roberts.
Her poignant talk centered around how we view race in medicine. During her talk, which was just released, Professor Roberts suggests that we revisit the concept of race when it comes to delivering health care and conducting research on health.
I had a chance to ask Professor Roberts some follow-up questions around this very important topic as part of a three-part series interviewing engaging speakers from TEDMED -- speakers that aimed to push the envelope in their work, and innovate the world of health and medicine today and into the future.
AK: You gave an incredible TEDMED talk last month. Before we get into discussing some of the issues you described, do you mind sharing what inspired you to look deeper into understandings of race in medicine? Did you run into any resistance from the medical profession?
DR: I began my TEDMED talk with an experience I had in 2000 that made me curious about the way race is misused in medical research. As part of my participation in a clinical trial that involved a genetic test, I was asked to fill out a questionnaire that required that I check a box for my race. It seemed to me the researchers might be incorrectly treating race as a genetic rather than a social category.
That experience coincided with the mapping of the human genome in the early 2000s, which was predicted to end the use of race as a variable in human genomic research and medical practice. Yet I began to notice newspaper reports about genomic studies that not only continued to use race as if it were a biological category, but looked for genetic differences between human races to explain health inequities.
I document and criticize this misuse of race in scientific research and medical practice in my 2011 book, Fatal Invention: How Science, Politics, and Big Business Re-create Race in the Twenty-first Century.
As I've lectured around the country about the use of race in medical practice, I've encountered resistance from some doctors. Doctors tend to give me excuses for treating their patients according to race.
Some believe there are illnesses or conditions that naturally differ by race. Others tell me that race is a crude, but convenient, proxy for more important clinical factors they don't have time to look for in their patients. I am calling on doctors to work instead on replacing the biological concept of race with more scientific and less harmful ways of treating patients.
AK: You bring up some interesting points -- many studies analyze respondents ethnic background; a separation needs to be called into question. You described the idea of "race medicine" -- can you shed light on this concept for our readers?
DR: I use "race medicine" to refer to the practice of defining, diagnosing and treating diseases according to race. For centuries, medical students in the United States have been taught to identify the race of their patients and to treat patients differently because of their race.
Behind the practice of race medicine is a racial concept of disease -- that people of different races suffer from different diseases and experience common diseases differently. Defining disease in racial terms has played an essential part in legitimizing racial inequality by making it seem natural.
White slaveholders argued that enslavement was beneficial for black people for medical reasons. Today, some doctors still use a modern day version of the spirometer, a device to measure breathing developed during the slavery era, with a button labeled "race" so the machine automatically adjusts its measurements depending on the patient's race.
Race medicine promotes the false belief not only that human beings are naturally divided into races but also that racial inequality is caused by innate racial differences we must accept rather than social inequities we must change. Race is not a biological category that produces health disparities because of genetic differences, but racism has negative biological effects on people's bodies.
AK: Thank you -- so now I have a related question. We know that two people from different racial groups may have a more similar genetic makeup, compared to two people from the same racial group -- why has medical research not seemed to recognize this?
DR: Scientists established decades ago that there is more genetic variation within populations we identify as races than between them. Homo sapiens share most of their genes and genetic variation in the human species is not divided into discrete groups we can identify as biological races.
Most doctors in the United States were raised in the same dominant culture as other Americans that instills a false biological concept of race and they were taught a medical school curriculum that emphasizes the racial concept of diseases rather than the structural causes of health inequities. There are also commercial incentives to conduct biomedical research that will produce a pharmaceutical product rather than address structural inequities.
In 2006, the federal Food and Drug Administration approved a medication specifically for black patients with heart failure that was developed without regard to race but was converted into a race-specific drug for commercial reasons.
AK: Some proponents of "personalized medicine," might argue that factors such as race and ethnicity might be important to better target therapies for some people, in order to achieve better outcomes for these subgroups -- why might we need to re-examine this idea?
DR: I don't see how medicine can be personalized if it is practiced according to the patient's race. To me, treating one patient differently than another because of race and not because of the patient's own clinical indications makes it less, not more, personalized.
Race is relevant because structural racism helps to determine who will have access to personalized medicine and how its benefits and disadvantages will be distributed. Personalized medicine can't be the solution to health inequities that are caused by differences in social conditions and access to health care, not genes.
AK: Looking at the other side of this debate around race and medical research -- a large criticism of clinical trials has been the lack of "representation" from various ethnicities. Is this an appropriate criticism?
DR: For most of U.S. history, people of colour were exploited in medical experiments that injured or stigmatized them while they were excluded from clinical trials designed to improve health.
The purpose of diversifying clinical studies should be to correct this injustice, not to find innate differences among racial groups.
AK: How would you advise new trainees, who may hope to provide personalized care, while also maintaining a critical lens towards existing dogma with respect to race in medicine? Would you advise the same for patients?
DR: I advise medical trainees, first, to be skeptical when they are taught about race-based differences in diagnosis and treatment of disease. Students can form their own alternative reading groups to learn from social science and humanities disciplines to be more aware of the ways racism is embedded in institutions, including medicine.
Second, trainees can create alliances with students in other professions who serve the same vulnerable patients to imagine creative ways to better address the structural forces that affect patients' health.
Third, trainees can participate in organizations within and outside the medical profession that are tackling the structural causes of health inequities. My advice to challenge race medicine and structural racism inside and outside the doctor's office applies to patients, as well.
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