Mar 30, 2023 05:19 PM
https://dnascience.plos.org/2023/02/09/w...ansplants/
INTRO: Choosing a medical treatment based on patient traits historically used to define races is fundamentally flawed, because race in the context of humans is a social construct, while medicine is based on biology. Race-based prescribing robs some individuals of drugs that could help them, while prescribing them to people who likely will not respond, or even be harmed. Fortunately, the practice of basing treatment decisions on the superficial traits used to define human races is on the decline.
Blood thinners and blood pressure medications have for decades dominated discussions of race-based prescribing. A more recent example of the dangers of using superficial features as guidelines for providing appropriate care is flawed interpretation of a standard measure of kidney function, used to prioritize patients for kidney transplants. Due to a fudge factor of sorts, until very recently Blacks have been given lower priority on the lists for organs.
Perhaps the starkest example I’ve encountered of race obscuring delivery of adequate health care comes from California-based pediatrician Richard Garcia, who wrote in The Chronicle of Higher Education in 2003 “The Misuse of Race in Medical Diagnosis”:
“My childhood friend Lela wasn’t diagnosed with cystic fibrosis until she was 8 years old. Over the years, her doctors had described her as a ‘2-year-old black female with fever and cough’ and ‘a 4-year-old black girl with another pneumonia. Lela is back.’ Had she been a white child, or had no visible ‘race’ at all, she would probably have gotten the correct diagnosis and treatment much earlier. Only when she was 8 did a radiologist, who had never seen her face to face, notice her chest X-ray and ask, ‘Who’s the kid with CF?’”
Today, Lela would have been diagnosed and treated much sooner, because all newborns in the US are screened for CF. Although Dr. Garcia’s essay was published two decades ago, I still hear newscasters, actors in TV medical dramas, and others say that sickle cell disease (SCD) is a black disease and cystic fibrosis a white disease.
Of course people of shared ancestry tend to look somewhat alike if they have children within their group, restricting the range of gene variants. Another force for similarity within groups is that genes that are near each other on a chromosome tend to be inherited together. But at the single gene level, a sequence of DNA building blocks that encodes a salt channel (CF) or a blood protein (SCD) doesn’t consider the color of a person’s skin or shapes of facial features. It follows Mendel’s first law.
And so a Black child can have CF and a white child sickle cell disease. Garcia offered another example. “I know that Ashkenazic Jews get Tay-Sachs, but the only baby I ever saw with Tay-Sachs was a Mexican child.”
Until recently, prescribing drugs to treat hypertension was the classic example of how race-based medicine can do harm. The story is more complex than for single-gene conditions like CF and SCD because individual differences in blood pressure are more influenced by environmental factors than are salt channels and blood proteins... (MORE - details)
INTRO: Choosing a medical treatment based on patient traits historically used to define races is fundamentally flawed, because race in the context of humans is a social construct, while medicine is based on biology. Race-based prescribing robs some individuals of drugs that could help them, while prescribing them to people who likely will not respond, or even be harmed. Fortunately, the practice of basing treatment decisions on the superficial traits used to define human races is on the decline.
Blood thinners and blood pressure medications have for decades dominated discussions of race-based prescribing. A more recent example of the dangers of using superficial features as guidelines for providing appropriate care is flawed interpretation of a standard measure of kidney function, used to prioritize patients for kidney transplants. Due to a fudge factor of sorts, until very recently Blacks have been given lower priority on the lists for organs.
Perhaps the starkest example I’ve encountered of race obscuring delivery of adequate health care comes from California-based pediatrician Richard Garcia, who wrote in The Chronicle of Higher Education in 2003 “The Misuse of Race in Medical Diagnosis”:
“My childhood friend Lela wasn’t diagnosed with cystic fibrosis until she was 8 years old. Over the years, her doctors had described her as a ‘2-year-old black female with fever and cough’ and ‘a 4-year-old black girl with another pneumonia. Lela is back.’ Had she been a white child, or had no visible ‘race’ at all, she would probably have gotten the correct diagnosis and treatment much earlier. Only when she was 8 did a radiologist, who had never seen her face to face, notice her chest X-ray and ask, ‘Who’s the kid with CF?’”
Today, Lela would have been diagnosed and treated much sooner, because all newborns in the US are screened for CF. Although Dr. Garcia’s essay was published two decades ago, I still hear newscasters, actors in TV medical dramas, and others say that sickle cell disease (SCD) is a black disease and cystic fibrosis a white disease.
Of course people of shared ancestry tend to look somewhat alike if they have children within their group, restricting the range of gene variants. Another force for similarity within groups is that genes that are near each other on a chromosome tend to be inherited together. But at the single gene level, a sequence of DNA building blocks that encodes a salt channel (CF) or a blood protein (SCD) doesn’t consider the color of a person’s skin or shapes of facial features. It follows Mendel’s first law.
And so a Black child can have CF and a white child sickle cell disease. Garcia offered another example. “I know that Ashkenazic Jews get Tay-Sachs, but the only baby I ever saw with Tay-Sachs was a Mexican child.”
Until recently, prescribing drugs to treat hypertension was the classic example of how race-based medicine can do harm. The story is more complex than for single-gene conditions like CF and SCD because individual differences in blood pressure are more influenced by environmental factors than are salt channels and blood proteins... (MORE - details)