TEDMED 2015
Dorothy Roberts: The problem with race-based medicine
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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."
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. Full bio
Global scholar, University of Pennsylvania civil rights sociologist and law professor Dorothy Roberts exposes the myths of race-based medicine. Full bio
Double-click the English transcript below to play the video.
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15 years ago, I volunteered
to participate in a research study
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:
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.
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?
social backgrounds?
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In that case, I would answer
with my social identity,
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
were interested in investigating
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some association between ancestry
and the risk for certain genetic traits?
and the risk for certain genetic traits?
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In that case, wouldn't they want to know
something about my ancestry,
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
scientific findings about my genes
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if I put down my social identity
as a black woman?
as a black woman?
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After all, I consider myself
a black woman with a white father
a black woman with a white father
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rather than a white woman
with a black mother
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
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."
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
in the results of a study
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that treated a critical variable
so unscientifically.
so unscientifically.
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That personal experience
with the use of race in genetic testing
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?
to make false biological predictions?
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Well, I found out that race runs deeply
throughout all of medical practice.
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.
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,
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
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.
definitions of races.
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And it's not just the view
of social scientists.
of social scientists.
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You remember when the map
of the human genome
of the human genome
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was unveiled at a White House
ceremony in June 2000?
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
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
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."
is the human race."
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Doctors are supposed to practice
evidence-based medicine,
evidence-based medicine,
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and they're increasingly called
to join the genomic revolution.
to join the genomic revolution.
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But their habit of treating patients
by race lags far behind.
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.
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,
in the blood of the patient,
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automatically produces
a different GFR estimate
a different GFR estimate
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depending on whether or not
the patient is African-American.
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
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?
than that female bodybuilder?
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Wouldn't it be far more accurate
and evidence-based
and evidence-based
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to determine the muscle mass
of individual patients
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.
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,
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.
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.
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 --
they might have --
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all more evidence-based
than the patient's race.
than the patient's race.
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Race can't substitute
for these important clinical measures
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
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
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
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
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,
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.
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.
African-American patients.
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A cardiologist developed this drug
without regard to race or genetics,
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.
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
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,
the dangerous message it sent,
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that black people's bodies
are so substandard,
are so substandard,
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a drug tested in them
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is not guaranteed
to work in other patients.
to work in other patients.
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In the end, the drug company's
marketing scheme failed.
marketing scheme failed.
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For one thing, black patients
were understandably wary
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,
in a community meeting and shouted,
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"Give me what the white
people are taking!"
people are taking!"
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(Laughter)
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And if you find race-specific
medicine surprising,
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,
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.
of Pennsylvania Medical School.
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He practiced in the Deep South
before the Civil War,
before the Civil War,
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and he was a well-known expert
on what was then called "Negro medicine."
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
suffer from different diseases
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and experience
common diseases differently.
common diseases differently.
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Cartwright argued in the 1850s
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that slavery was beneficial
for black people
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,
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
sent to the brain
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that liberates their minds
when under the white man's control,
when under the white man's control,
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and it is the want of sufficiency
of red vital blood
of red vital blood
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that chains their minds to ignorance
and barbarism when in freedom."
and barbarism when in freedom."
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To support this theory,
Cartwright helped to perfect
Cartwright helped to perfect
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a medical device for measuring breathing
called the spirometer
called the spirometer
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to show the presumed deficiency
in black people's lungs.
in black people's lungs.
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Today, doctors still
uphold Cartwright's claim
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.
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.
according to his or her race.
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It's a well-known function
called "correcting for race."
called "correcting for race."
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The problem with race medicine
extends far beyond misdiagnosing patients.
extends far beyond misdiagnosing patients.
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Its focus on innate
racial differences in disease
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:
racial gaps in health:
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lack of access
to high-quality medical care;
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.
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
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,
biological consequences,
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but because of the impact
of social inequality on people's health.
of social inequality on people's health.
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Yet race medicine pretends
the answer to these gaps in health
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.
inequities that produce them.
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The reason I'm so passionate
about ending race medicine
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.
a false and toxic view of humanity.
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Despite the many visionary breakthroughs
in medicine we've been learning about,
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?
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
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?
into biological races?
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What if, instead of using race
as a crude proxy
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?
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
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.
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.
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.
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ABOUT THE SPEAKER
Dorothy Roberts - Professor, author and social justice advocateGlobal 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."
Dorothy Roberts | Speaker | TED.com