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TEDMED 2015

Dorothy Roberts: The problem with race-based medicine

Filmed:

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."

- Professor, author and social justice advocate
Global scholar, University of Pennsylvania civil rights sociologist and law professor Dorothy Roberts exposes the myths of race-­based medicine. Full bio

15 years ago, I volunteered
to participate in a research study
00:12
that involved a genetic test.
00:18
When I arrived at the clinic to be tested,
00:20
I was handed a questionnaire.
00:22
One of the very first questions
asked me to check a box for my race:
00:25
White, black, Asian, or Native American.
00:29
I wasn't quite sure
how to answer the question.
00:33
Was it aimed at measuring the diversity
00:37
of research participants'
social backgrounds?
00:39
In that case, I would answer
with my social identity,
00:43
and check the box for "black."
00:46
But what if the researchers
were interested in investigating
00:49
some association between ancestry
and the risk for certain genetic traits?
00:53
In that case, wouldn't they want to know
something about my ancestry,
00:59
which is just as much European as African?
01:03
And how could they make
scientific findings about my genes
01:07
if I put down my social identity
as a black woman?
01:11
After all, I consider myself
a black woman with a white father
01:16
rather than a white woman
with a black mother
01:21
entirely for social reasons.
01:25
Which racial identity I check
01:27
has nothing to do with my genes.
01:30
Well, despite the obvious
importance of this question
01:34
to the study's scientific validity,
01:37
I was told, "Don't worry about it,
01:40
just put down however
you identify yourself."
01:42
So I check "black,"
01:46
but I had no confidence
in the results of a study
01:48
that treated a critical variable
so unscientifically.
01:52
That personal experience
with the use of race in genetic testing
01:58
got me thinking:
02:02
Where else in medicine is race used
to make false biological predictions?
02:04
Well, I found out that race runs deeply
throughout all of medical practice.
02:10
It shapes physicians' diagnoses,
02:17
measurements, treatments,
02:20
prescriptions,
02:22
even the very definition of diseases.
02:24
And the more I found out,
the more disturbed I became.
02:28
Sociologists like me have long explained
02:33
that race is a social construction.
02:36
When we identify people as black,
white, Asian, Native American, Latina,
02:39
we're referring to social groupings
02:46
with made up demarcations
that have changed over time
02:49
and vary around the world.
02:52
As a legal scholar, I've also studied
02:55
how lawmakers, not biologists,
02:58
have invented the legal
definitions of races.
03:01
And it's not just the view
of social scientists.
03:06
You remember when the map
of the human genome
03:10
was unveiled at a White House
ceremony in June 2000?
03:12
President Bill Clinton famously declared,
03:17
"I believe one of the great truths
03:20
to emerge from this triumphant expedition
03:22
inside the human genome
03:26
is that in genetic terms,
03:27
human beings, regardless of race,
03:29
are more than 99.9 percent the same."
03:32
And he might have added
03:36
that that less than one percent
of genetic difference
03:38
doesn't fall into racial boxes.
03:42
Francis Collins, who led
the Human Genome Project
03:45
and now heads NIH,
03:49
echoed President Clinton.
03:50
"I am happy that today,
03:52
the only race we're talking about
is the human race."
03:54
Doctors are supposed to practice
evidence-based medicine,
04:00
and they're increasingly called
to join the genomic revolution.
04:04
But their habit of treating patients
by race lags far behind.
04:08
Take the estimate
04:14
of glomerular filtration rate, or GFR.
04:15
Doctors routinely interpret GFR,
04:18
this important indicator
of kidney function, by race.
04:22
As you can see in this lab test,
04:27
the exact same creatinine level,
04:31
the concentration
in the blood of the patient,
04:36
automatically produces
a different GFR estimate
04:40
depending on whether or not
the patient is African-American.
04:45
Why?
04:51
I've been told it's based on an assumption
04:53
that African-Americans
have more muscle mass
04:56
than people of other races.
04:59
But what sense does it make
05:02
for a doctor to automatically assume
05:04
I have more muscle mass
than that female bodybuilder?
05:08
Wouldn't it be far more accurate
and evidence-based
05:12
to determine the muscle mass
of individual patients
05:16
just by looking at them?
05:20
Well, doctors tell me
they're using race as a shortcut.
05:24
It's a crude but convenient proxy
05:27
for more important factors,
like muscle mass,
05:30
enzyme level, genetic traits
05:33
they just don't have time to look for.
05:36
But race is a bad proxy.
05:39
In many cases, race adds
no relevant information at all.
05:42
It's just a distraction.
05:46
But race also tends to overwhelm
the clinical measures.
05:49
It blinds doctors to patients' symptoms,
05:55
family illnesses,
05:59
their history, their own illnesses
they might have --
06:02
all more evidence-based
than the patient's race.
06:06
Race can't substitute
for these important clinical measures
06:11
without sacrificing patient well-being.
06:16
Doctors also tell me
race is just one of many factors
06:21
they take into account,
06:25
but there are numerous medical tests,
06:27
like the GFR,
06:29
that use race categorically
06:30
to treat black, white,
Asian patients differently
06:34
just because of their race.
06:38
Race medicine also leaves
patients of color especially vulnerable
06:41
to harmful biases and stereotypes.
06:47
Black and Latino patients
are twice as likely
06:50
to receive no pain medication as whites
06:53
for the same painful long bone fractures
06:57
because of stereotypes
07:02
that black and brown people
feel less pain,
07:04
exaggerate their pain,
07:08
and are predisposed to drug addiction.
07:10
The Food and Drug Administration has even
approved a race-specific medicine.
07:14
It's a pill called BiDil
07:20
to treat heart failure in self-identified
African-American patients.
07:22
A cardiologist developed this drug
without regard to race or genetics,
07:27
but it became convenient
07:33
for commercial reasons
07:36
to market the drug to black patients.
07:38
The FDA then allowed
07:42
the company, the drug company,
07:44
to test the efficacy in a clinical trial
07:47
that only included
African-American subjects.
07:51
It speculated
07:56
that race stood in as a proxy
for some unknown genetic factor
07:58
that affects heart disease
08:04
or response to drugs.
08:07
But think about
the dangerous message it sent,
08:11
that black people's bodies
are so substandard,
08:15
a drug tested in them
08:19
is not guaranteed
to work in other patients.
08:21
In the end, the drug company's
marketing scheme failed.
08:26
For one thing, black patients
were understandably wary
08:30
of using a drug just for black people.
08:34
One elderly black woman stood up
in a community meeting and shouted,
08:38
"Give me what the white
people are taking!"
08:42
(Laughter)
08:44
And if you find race-specific
medicine surprising,
08:47
wait until you learn
08:52
that many doctors in the United States
08:54
still use an updated version
08:57
of a diagnostic tool
09:00
that was developed by a physician
during the slavery era,
09:02
a diagnostic tool that is tightly linked
09:06
to justifications for slavery.
09:09
Dr. Samuel Cartwright graduated
09:13
from the University
of Pennsylvania Medical School.
09:16
He practiced in the Deep South
before the Civil War,
09:19
and he was a well-known expert
on what was then called "Negro medicine."
09:23
He promoted the racial concept of disease,
09:28
that people of different races
suffer from different diseases
09:31
and experience
common diseases differently.
09:35
Cartwright argued in the 1850s
09:39
that slavery was beneficial
for black people
09:43
for medical reasons.
09:47
He claimed that because black people
have lower lung capacity than whites,
09:49
forced labor was good for them.
09:54
He wrote in a medical journal,
09:57
"It is the red vital blood
sent to the brain
10:00
that liberates their minds
when under the white man's control,
10:03
and it is the want of sufficiency
of red vital blood
10:07
that chains their minds to ignorance
and barbarism when in freedom."
10:11
To support this theory,
Cartwright helped to perfect
10:17
a medical device for measuring breathing
called the spirometer
10:20
to show the presumed deficiency
in black people's lungs.
10:26
Today, doctors still
uphold Cartwright's claim
10:31
the black people as a race
10:37
have lower lung capacity
than white people.
10:40
Some even use a modern day spirometer
10:44
that actually has a button labeled "race"
10:48
so the machine adjusts the measurement
10:52
for each patient
according to his or her race.
10:55
It's a well-known function
called "correcting for race."
10:59
The problem with race medicine
extends far beyond misdiagnosing patients.
11:05
Its focus on innate
racial differences in disease
11:11
diverts attention and resources
11:16
from the social determinants
11:19
that cause appalling
racial gaps in health:
11:21
lack of access
to high-quality medical care;
11:25
food deserts in poor neighborhoods;
11:29
exposure to environmental toxins;
11:33
high rates of incarceration;
11:37
and experiencing the stress
of racial discrimination.
11:39
You see, race is not a biological category
11:45
that naturally produces
these health disparities
11:48
because of genetic difference.
11:52
Race is a social category
11:55
that has staggering
biological consequences,
11:57
but because of the impact
of social inequality on people's health.
12:01
Yet race medicine pretends
the answer to these gaps in health
12:07
can be found in a race-specific pill.
12:11
It's much easier and more lucrative
12:14
to market a technological fix
12:17
for these gaps in health
12:20
than to deal with the structural
inequities that produce them.
12:22
The reason I'm so passionate
about ending race medicine
12:29
isn't just because it's bad medicine.
12:34
I'm also on this mission
12:37
because the way doctors practice medicine
12:39
continues to promote
a false and toxic view of humanity.
12:42
Despite the many visionary breakthroughs
in medicine we've been learning about,
12:48
there's a failure of imagination
12:54
when it comes to race.
12:57
Would you imagine with me, just a moment:
13:00
What would happen if doctors
stopped treating patients by race?
13:04
Suppose they rejected
13:12
an 18th-century classification system
13:14
and incorporated instead
the most advanced knowledge
13:18
of human genetic diversity and unity,
13:22
that human beings cannot be categorized
into biological races?
13:25
What if, instead of using race
as a crude proxy
13:32
for some more important factor,
13:37
doctors actually investigated
and addressed that more important factor?
13:39
What if doctors joined the forefront
13:46
of a movement to end
the structural inequities
13:49
caused by racism,
13:53
not by genetic difference?
13:55
Race medicine is bad medicine,
14:01
it's poor science
14:05
and it's a false
interpretation of humanity.
14:07
It is more urgent than ever
14:11
to finally abandon this backward legacy
14:14
and to affirm our common humanity
14:18
by ending the social inequalities
that truly divide us.
14:22
Thank you.
14:28
(Applause)
14:29
Thank you. Thanks.
14:31
Thank you.
14:34

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About the Speaker:

Dorothy Roberts - Professor, author and social justice advocate
Global scholar, University of Pennsylvania civil rights sociologist and law professor Dorothy Roberts exposes the myths of race-­based medicine.

Why you should listen

Internationally recognized scholar, public intellectual and social justice advocate Dorothy Roberts studies the interplay of gender, race and class in legal issues. She has been a leader in transforming public thinking and policy on reproductive health, child welfare and bioethics.

Professor of Africana Studies, Law & Sociology at the University of Pennsylvania, Dorothy directs the Penn Program on Race, Science and Society. She has authored and co­-edited ten books, including the award-­winning Killing the Black Body and Shattered Bonds. Her latest book is Fatal Invention: How Science, Politics, and Big Business Re­-create Race in the Twenty­-First Century. She received the 2015 Solomon Carter Fuller Award from the American Psychiatric Association for "providing significant benefit for the quality of life for Black people."

More profile about the speaker
Dorothy Roberts | Speaker | TED.com