Dorothy Roberts: The problem with race-based medicine

Recorded atNovember 18, 2015
EventTEDMED 2015
Duration (min:sec)14:23
Video TypeTED Stage Talk
Words per minute129.1 very slow
Readability (FK)31.72 very difficult
SpeakerDorothy Roberts
CountryUnited States of America
Descriptionpublic intellectual and social justice advocate

Official TED page for this talk


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."

Text Highlight (experimental)
100:12 15 years ago, I volunteered to participate in a research study
200:18 that involved a genetic test.
300:20 When I arrived at the clinic to be tested,
400:22 I was handed a questionnaire.
500:25 One of the very first questions asked me to check a box for my race:
600:29 White, black, Asian, or Native American.
700:33 I wasn't quite sure how to answer the question.
800:37 Was it aimed at measuring the diversity
900:39 of research participants' social backgrounds?
1000:43 In that case, I would answer with my social identity,
1100:46 and check the box for "black."
1200:49 But what if the researchers were interested in investigating
1300:53 some association between ancestry and the risk for certain genetic traits?
1400:59 In that case, wouldn't they want to know something about my ancestry,
1501:03 which is just as much European as African?
1601:07 And how could they make scientific findings about my genes
1701:11 if I put down my social identity as a black woman?
1801:16 After all, I consider myself a black woman with a white father
1901:21 rather than a white woman with a black mother
2001:25 entirely for social reasons.
2101:27 Which racial identity I check
2201:30 has nothing to do with my genes.
2301:34 Well, despite the obvious importance of this question
2401:37 to the study's scientific validity,
2501:40 I was told, "Don't worry about it,
2601:42 just put down however you identify yourself."
2701:46 So I check "black,"
2801:48 but I had no confidence in the results of a study
2901:52 that treated a critical variable so unscientifically.
3001:58 That personal experience with the use of race in genetic testing
3102:02 got me thinking:
3202:04 Where else in medicine is race used to make false biological predictions?
3302:10 Well, I found out that race runs deeply throughout all of medical practice.
3402:17 It shapes physicians' diagnoses,
3502:20 measurements, treatments,
3602:22 prescriptions,
3702:24 even the very definition of diseases.
3802:28 And the more I found out, the more disturbed I became.
3902:33 Sociologists like me have long explained
4002:36 that race is a social construction.
4102:39 When we identify people as black, white, Asian, Native American, Latina,
4202:46 we're referring to social groupings
4302:49 with made up demarcations that have changed over time
4402:52 and vary around the world.
4502:55 As a legal scholar, I've also studied
4602:58 how lawmakers, not biologists,
4703:01 have invented the legal definitions of races.
4803:06 And it's not just the view of social scientists.
4903:10 You remember when the map of the human genome
5003:12 was unveiled at a White House ceremony in June 2000?
5103:17 President Bill Clinton famously declared,
5203:20 "I believe one of the great truths
5303:22 to emerge from this triumphant expedition
5403:26 inside the human genome
5503:27 is that in genetic terms,
5603:29 human beings, regardless of race,
5703:32 are more than 99.9 percent the same."
5803:36 And he might have added
5903:38 that that less than one percent of genetic difference
6003:42 doesn't fall into racial boxes.
6103:45 Francis Collins, who led the Human Genome Project
6203:49 and now heads NIH,
6303:50 echoed President Clinton.
6403:52 "I am happy that today,
6503:54 the only race we're talking about is the human race."
6604:00 Doctors are supposed to practice evidence-based medicine,
6704:04 and they're increasingly called to join the genomic revolution.
6804:08 But their habit of treating patients by race lags far behind.
6904:14 Take the estimate
7004:15 of glomerular filtration rate, or GFR.
7104:18 Doctors routinely interpret GFR,
7204:22 this important indicator of kidney function, by race.
7304:27 As you can see in this lab test,
7404:31 the exact same creatinine level,
7504:36 the concentration in the blood of the patient,
7604:40 automatically produces a different GFR estimate
7704:45 depending on whether or not the patient is African-American.
7804:51 Why?
7904:53 I've been told it's based on an assumption
8004:56 that African-Americans have more muscle mass
8104:59 than people of other races.
8205:02 But what sense does it make
8305:04 for a doctor to automatically assume
8405:08 I have more muscle mass than that female bodybuilder?
8505:12 Wouldn't it be far more accurate and evidence-based
8605:16 to determine the muscle mass of individual patients
8705:20 just by looking at them?
8805:24 Well, doctors tell me they're using race as a shortcut.
8905:27 It's a crude but convenient proxy
9005:30 for more important factors, like muscle mass,
9105:33 enzyme level, genetic traits
9205:36 they just don't have time to look for.
9305:39 But race is a bad proxy.
9405:42 In many cases, race adds no relevant information at all.
9505:46 It's just a distraction.
9605:49 But race also tends to overwhelm the clinical measures.
9705:55 It blinds doctors to patients' symptoms,
9805:59 family illnesses,
9906:02 their history, their own illnesses they might have --
10006:06 all more evidence-based than the patient's race.
10106:11 Race can't substitute for these important clinical measures
10206:16 without sacrificing patient well-being.
10306:21 Doctors also tell me race is just one of many factors
10406:25 they take into account,
10506:27 but there are numerous medical tests,
10606:29 like the GFR,
10706:30 that use race categorically
10806:34 to treat black, white, Asian patients differently
10906:38 just because of their race.
11006:41 Race medicine also leaves patients of color especially vulnerable
11106:47 to harmful biases and stereotypes.
11206:50 Black and Latino patients are twice as likely
11306:53 to receive no pain medication as whites
11406:57 for the same painful long bone fractures
11507:02 because of stereotypes
11607:04 that black and brown people feel less pain,
11707:08 exaggerate their pain,
11807:10 and are predisposed to drug addiction.
11907:14 The Food and Drug Administration has even approved a race-specific medicine.
12007:20 It's a pill called BiDil
12107:22 to treat heart failure in self-identified African-American patients.
12207:27 A cardiologist developed this drug without regard to race or genetics,
12307:33 but it became convenient
12407:36 for commercial reasons
12507:38 to market the drug to black patients.
12607:42 The FDA then allowed
12707:44 the company, the drug company,
12807:47 to test the efficacy in a clinical trial
12907:51 that only included African-American subjects.
13007:56 It speculated
13107:58 that race stood in as a proxy for some unknown genetic factor
13208:04 that affects heart disease
13308:07 or response to drugs.
13408:11 But think about the dangerous message it sent,
13508:15 that black people's bodies are so substandard,
13608:19 a drug tested in them
13708:21 is not guaranteed to work in other patients.
13808:26 In the end, the drug company's marketing scheme failed.
13908:30 For one thing, black patients were understandably wary
14008:34 of using a drug just for black people.
14108:38 One elderly black woman stood up in a community meeting and shouted,
14208:42 "Give me what the white people are taking!"
14308:44 (Laughter)
14408:47 And if you find race-specific medicine surprising,
14508:52 wait until you learn
14608:54 that many doctors in the United States
14708:57 still use an updated version
14809:00 of a diagnostic tool
14909:02 that was developed by a physician during the slavery era,
15009:06 a diagnostic tool that is tightly linked
15109:09 to justifications for slavery.
15209:13 Dr. Samuel Cartwright graduated
15309:16 from the University of Pennsylvania Medical School.
15409:19 He practiced in the Deep South before the Civil War,
15509:23 and he was a well-known expert on what was then called "Negro medicine."
15609:28 He promoted the racial concept of disease,
15709:31 that people of different races suffer from different diseases
15809:35 and experience common diseases differently.
15909:39 Cartwright argued in the 1850s
16009:43 that slavery was beneficial for black people
16109:47 for medical reasons.
16209:49 He claimed that because black people have lower lung capacity than whites,
16309:54 forced labor was good for them.
16409:57 He wrote in a medical journal,
16510:00 "It is the red vital blood sent to the brain
16610:03 that liberates their minds when under the white man's control,
16710:07 and it is the want of sufficiency of red vital blood
16810:11 that chains their minds to ignorance and barbarism when in freedom."
16910:17 To support this theory, Cartwright helped to perfect
17010:20 a medical device for measuring breathing called the spirometer
17110:26 to show the presumed deficiency in black people's lungs.
17210:31 Today, doctors still uphold Cartwright's claim
17310:37 the black people as a race
17410:40 have lower lung capacity than white people.
17510:44 Some even use a modern day spirometer
17610:48 that actually has a button labeled "race"
17710:52 so the machine adjusts the measurement
17810:55 for each patient according to his or her race.
17910:59 It's a well-known function called "correcting for race."
18011:05 The problem with race medicine extends far beyond misdiagnosing patients.
18111:11 Its focus on innate racial differences in disease
18211:16 diverts attention and resources
18311:19 from the social determinants
18411:21 that cause appalling racial gaps in health:
18511:25 lack of access to high-quality medical care;
18611:29 food deserts in poor neighborhoods;
18711:33 exposure to environmental toxins;
18811:37 high rates of incarceration;
18911:39 and experiencing the stress of racial discrimination.
19011:45 You see, race is not a biological category
19111:48 that naturally produces these health disparities
19211:52 because of genetic difference.
19311:55 Race is a social category
19411:57 that has staggering biological consequences,
19512:01 but because of the impact of social inequality on people's health.
19612:07 Yet race medicine pretends the answer to these gaps in health
19712:11 can be found in a race-specific pill.
19812:14 It's much easier and more lucrative
19912:17 to market a technological fix
20012:20 for these gaps in health
20112:22 than to deal with the structural inequities that produce them.
20212:29 The reason I'm so passionate about ending race medicine
20312:34 isn't just because it's bad medicine.
20412:37 I'm also on this mission
20512:39 because the way doctors practice medicine
20612:42 continues to promote a false and toxic view of humanity.
20712:48 Despite the many visionary breakthroughs in medicine we've been learning about,
20812:54 there's a failure of imagination
20912:57 when it comes to race.
21013:00 Would you imagine with me, just a moment:
21113:04 What would happen if doctors stopped treating patients by race?
21213:12 Suppose they rejected
21313:14 an 18th-century classification system
21413:18 and incorporated instead the most advanced knowledge
21513:22 of human genetic diversity and unity,
21613:25 that human beings cannot be categorized into biological races?
21713:32 What if, instead of using race as a crude proxy
21813:37 for some more important factor,
21913:39 doctors actually investigated and addressed that more important factor?
22013:46 What if doctors joined the forefront
22113:49 of a movement to end the structural inequities
22213:53 caused by racism,
22313:55 not by genetic difference?
22414:01 Race medicine is bad medicine,
22514:05 it's poor science
22614:07 and it's a false interpretation of humanity.
22714:11 It is more urgent than ever
22814:14 to finally abandon this backward legacy
22914:18 and to affirm our common humanity
23014:22 by ending the social inequalities that truly divide us.
23114:28 Thank you.
23214:29 (Applause)
23314:31 Thank you. Thanks.
23414:34 Thank you.