Time to Abandon Racial Categories in Medicine?

Newly minted doctors take the Hippocratic Oath pledging to “do no harm,” but what if the harm they cause results not from the failure to correctly apply what they learned in medical school but from racially-based ideas they learned there, or from racial stereotypes formed long before they ever started their studies?

These and other questions about how race factors into the delivery of healthcare were the focus of a recent opinion piece in The New York Times.

Racial categories—such Negroid, Caucasoid or Mongoloid—have a long history both in academic use and popular discourse. In Biology, the article in the Times notes, race is roughly analogous to the idea of subspecies. And there is no shortage of examples of how race has been used in medicine, often with negative results:

• Sickle cell anemia was labeled a “black” disease, but in fact it afflicts many people who would be considered “white.”
• 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 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. Instead, 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 brief summary just scratches of this debate and how it affects how medicine is both taught and administered. Read the full piece from The New York Times here.