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Recorded at	November 18, 2015
Event	TEDMED 2015
Duration (min:sec)	14:23
Video Type	TED Stage Talk
Words per minute	129.1 very slow
Readability (FK)	31.72 very difficult
Speaker	Dorothy Roberts
Country	United States of America
Occupation	lawyer
Description	public intellectual and social justice advocate


1	00:12	15 years ago, I volunteered to participate in a research study
2	00:18	that involved a genetic test.
3	00:20	When I arrived at the clinic to be tested,
4	00:22	I was handed a questionnaire.
5	00:25	One of the very first questions asked me to check a box for my race:
6	00:29	White, black, Asian, or Native American.
7	00:33	I wasn't quite sure how to answer the question.
8	00:37	Was it aimed at measuring the diversity
9	00:39	of research participants' social backgrounds?
10	00:43	In that case, I would answer with my social identity,
11	00:46	and check the box for "black."
12	00:49	But what if the researchers were interested in investigating
13	00:53	some association between ancestry and the risk for certain genetic traits?
14	00:59	In that case, wouldn't they want to know something about my ancestry,
15	01:03	which is just as much European as African?
16	01:07	And how could they make scientific findings about my genes
17	01:11	if I put down my social identity as a black woman?
18	01:16	After all, I consider myself a black woman with a white father
19	01:21	rather than a white woman with a black mother
20	01:25	entirely for social reasons.
21	01:27	Which racial identity I check
22	01:30	has nothing to do with my genes.
23	01:34	Well, despite the obvious importance of this question
24	01:37	to the study's scientific validity,
25	01:40	I was told, "Don't worry about it,
26	01:42	just put down however you identify yourself."
27	01:46	So I check "black,"
28	01:48	but I had no confidence in the results of a study
29	01:52	that treated a critical variable so unscientifically.
30	01:58	That personal experience with the use of race in genetic testing
31	02:02	got me thinking:
32	02:04	Where else in medicine is race used to make false biological predictions?
33	02:10	Well, I found out that race runs deeply throughout all of medical practice.
34	02:17	It shapes physicians' diagnoses,
35	02:20	measurements, treatments,
36	02:22	prescriptions,
37	02:24	even the very definition of diseases.
38	02:28	And the more I found out, the more disturbed I became.
39	02:33	Sociologists like me have long explained
40	02:36	that race is a social construction.
41	02:39	When we identify people as black, white, Asian, Native American, Latina,
42	02:46	we're referring to social groupings
43	02:49	with made up demarcations that have changed over time
44	02:52	and vary around the world.
45	02:55	As a legal scholar, I've also studied
46	02:58	how lawmakers, not biologists,
47	03:01	have invented the legal definitions of races.
48	03:06	And it's not just the view of social scientists.
49	03:10	You remember when the map of the human genome
50	03:12	was unveiled at a White House ceremony in June 2000?
51	03:17	President Bill Clinton famously declared,
52	03:20	"I believe one of the great truths
53	03:22	to emerge from this triumphant expedition
54	03:26	inside the human genome
55	03:27	is that in genetic terms,
56	03:29	human beings, regardless of race,
57	03:32	are more than 99.9 percent the same."
58	03:36	And he might have added
59	03:38	that that less than one percent of genetic difference
60	03:42	doesn't fall into racial boxes.
61	03:45	Francis Collins, who led the Human Genome Project
62	03:49	and now heads NIH,
63	03:50	echoed President Clinton.
64	03:52	"I am happy that today,
65	03:54	the only race we're talking about is the human race."
66	04:00	Doctors are supposed to practice evidence-based medicine,
67	04:04	and they're increasingly called to join the genomic revolution.
68	04:08	But their habit of treating patients by race lags far behind.
69	04:14	Take the estimate
70	04:15	of glomerular filtration rate, or GFR.
71	04:18	Doctors routinely interpret GFR,
72	04:22	this important indicator of kidney function, by race.
73	04:27	As you can see in this lab test,
74	04:31	the exact same creatinine level,
75	04:36	the concentration in the blood of the patient,
76	04:40	automatically produces a different GFR estimate
77	04:45	depending on whether or not the patient is African-American.
78	04:51	Why?
79	04:53	I've been told it's based on an assumption
80	04:56	that African-Americans have more muscle mass
81	04:59	than people of other races.
82	05:02	But what sense does it make
83	05:04	for a doctor to automatically assume
84	05:08	I have more muscle mass than that female bodybuilder?
85	05:12	Wouldn't it be far more accurate and evidence-based
86	05:16	to determine the muscle mass of individual patients
87	05:20	just by looking at them?
88	05:24	Well, doctors tell me they're using race as a shortcut.
89	05:27	It's a crude but convenient proxy
90	05:30	for more important factors, like muscle mass,
91	05:33	enzyme level, genetic traits
92	05:36	they just don't have time to look for.
93	05:39	But race is a bad proxy.
94	05:42	In many cases, race adds no relevant information at all.
95	05:46	It's just a distraction.
96	05:49	But race also tends to overwhelm the clinical measures.
97	05:55	It blinds doctors to patients' symptoms,
98	05:59	family illnesses,
99	06:02	their history, their own illnesses they might have --
100	06:06	all more evidence-based than the patient's race.
101	06:11	Race can't substitute for these important clinical measures
102	06:16	without sacrificing patient well-being.
103	06:21	Doctors also tell me race is just one of many factors
104	06:25	they take into account,
105	06:27	but there are numerous medical tests,
106	06:29	like the GFR,
107	06:30	that use race categorically
108	06:34	to treat black, white, Asian patients differently
109	06:38	just because of their race.
110	06:41	Race medicine also leaves patients of color especially vulnerable
111	06:47	to harmful biases and stereotypes.
112	06:50	Black and Latino patients are twice as likely
113	06:53	to receive no pain medication as whites
114	06:57	for the same painful long bone fractures
115	07:02	because of stereotypes
116	07:04	that black and brown people feel less pain,
117	07:08	exaggerate their pain,
118	07:10	and are predisposed to drug addiction.
119	07:14	The Food and Drug Administration has even approved a race-specific medicine.
120	07:20	It's a pill called BiDil
121	07:22	to treat heart failure in self-identified African-American patients.
122	07:27	A cardiologist developed this drug without regard to race or genetics,
123	07:33	but it became convenient
124	07:36	for commercial reasons
125	07:38	to market the drug to black patients.
126	07:42	The FDA then allowed
127	07:44	the company, the drug company,
128	07:47	to test the efficacy in a clinical trial
129	07:51	that only included African-American subjects.
130	07:56	It speculated
131	07:58	that race stood in as a proxy for some unknown genetic factor
132	08:04	that affects heart disease
133	08:07	or response to drugs.
134	08:11	But think about the dangerous message it sent,
135	08:15	that black people's bodies are so substandard,
136	08:19	a drug tested in them
137	08:21	is not guaranteed to work in other patients.
138	08:26	In the end, the drug company's marketing scheme failed.
139	08:30	For one thing, black patients were understandably wary
140	08:34	of using a drug just for black people.
141	08:38	One elderly black woman stood up in a community meeting and shouted,
142	08:42	"Give me what the white people are taking!"
143	08:44	(Laughter)
144	08:47	And if you find race-specific medicine surprising,
145	08:52	wait until you learn
146	08:54	that many doctors in the United States
147	08:57	still use an updated version
148	09:00	of a diagnostic tool
149	09:02	that was developed by a physician during the slavery era,
150	09:06	a diagnostic tool that is tightly linked
151	09:09	to justifications for slavery.
152	09:13	Dr. Samuel Cartwright graduated
153	09:16	from the University of Pennsylvania Medical School.
154	09:19	He practiced in the Deep South before the Civil War,
155	09:23	and he was a well-known expert on what was then called "Negro medicine."
156	09:28	He promoted the racial concept of disease,
157	09:31	that people of different races suffer from different diseases
158	09:35	and experience common diseases differently.
159	09:39	Cartwright argued in the 1850s
160	09:43	that slavery was beneficial for black people
161	09:47	for medical reasons.
162	09:49	He claimed that because black people have lower lung capacity than whites,
163	09:54	forced labor was good for them.
164	09:57	He wrote in a medical journal,
165	10:00	"It is the red vital blood sent to the brain
166	10:03	that liberates their minds when under the white man's control,
167	10:07	and it is the want of sufficiency of red vital blood
168	10:11	that chains their minds to ignorance and barbarism when in freedom."
169	10:17	To support this theory, Cartwright helped to perfect
170	10:20	a medical device for measuring breathing called the spirometer
171	10:26	to show the presumed deficiency in black people's lungs.
172	10:31	Today, doctors still uphold Cartwright's claim
173	10:37	the black people as a race
174	10:40	have lower lung capacity than white people.
175	10:44	Some even use a modern day spirometer
176	10:48	that actually has a button labeled "race"
177	10:52	so the machine adjusts the measurement
178	10:55	for each patient according to his or her race.
179	10:59	It's a well-known function called "correcting for race."
180	11:05	The problem with race medicine extends far beyond misdiagnosing patients.
181	11:11	Its focus on innate racial differences in disease
182	11:16	diverts attention and resources
183	11:19	from the social determinants
184	11:21	that cause appalling racial gaps in health:
185	11:25	lack of access to high-quality medical care;
186	11:29	food deserts in poor neighborhoods;
187	11:33	exposure to environmental toxins;
188	11:37	high rates of incarceration;
189	11:39	and experiencing the stress of racial discrimination.
190	11:45	You see, race is not a biological category
191	11:48	that naturally produces these health disparities
192	11:52	because of genetic difference.
193	11:55	Race is a social category
194	11:57	that has staggering biological consequences,
195	12:01	but because of the impact of social inequality on people's health.
196	12:07	Yet race medicine pretends the answer to these gaps in health
197	12:11	can be found in a race-specific pill.
198	12:14	It's much easier and more lucrative
199	12:17	to market a technological fix
200	12:20	for these gaps in health
201	12:22	than to deal with the structural inequities that produce them.
202	12:29	The reason I'm so passionate about ending race medicine
203	12:34	isn't just because it's bad medicine.
204	12:37	I'm also on this mission
205	12:39	because the way doctors practice medicine
206	12:42	continues to promote a false and toxic view of humanity.
207	12:48	Despite the many visionary breakthroughs in medicine we've been learning about,
208	12:54	there's a failure of imagination
209	12:57	when it comes to race.
210	13:00	Would you imagine with me, just a moment:
211	13:04	What would happen if doctors stopped treating patients by race?
212	13:12	Suppose they rejected
213	13:14	an 18th-century classification system
214	13:18	and incorporated instead the most advanced knowledge
215	13:22	of human genetic diversity and unity,
216	13:25	that human beings cannot be categorized into biological races?
217	13:32	What if, instead of using race as a crude proxy
218	13:37	for some more important factor,
219	13:39	doctors actually investigated and addressed that more important factor?
220	13:46	What if doctors joined the forefront
221	13:49	of a movement to end the structural inequities
222	13:53	caused by racism,
223	13:55	not by genetic difference?
224	14:01	Race medicine is bad medicine,
225	14:05	it's poor science
226	14:07	and it's a false interpretation of humanity.
227	14:11	It is more urgent than ever
228	14:14	to finally abandon this backward legacy
229	14:18	and to affirm our common humanity
230	14:22	by ending the social inequalities that truly divide us.
231	14:28	Thank you.
232	14:29	(Applause)
233	14:31	Thank you. Thanks.
234	14:34	Thank you.

Dorothy Roberts: The problem with race-based medicine