Dorothy Roberts: What's Race Got to Do with Medicine?
GUY RAZ, HOST:
So sometimes getting better results in medicine isn't just about developing new technology or drugs. Sometimes getting better results is about looking at patients in a different way.
DOROTHY ROBERTS: Yes, exactly.
RAZ: This is Dorothy Roberts.
ROBERTS: Professor of Africana studies and law and sociology at the University of Pennsylvania.
RAZ: About 15 years ago, Dorothy had an experience when she was pregnant with her fourth child.
ROBERTS: I was 44 years old when I had him, and I was considered to be a high-risk, high-maternal age.
RAZ: So her doctor had her sign up for a clinical trial.
ROBERTS: That involved a genetic test.
RAZ: And one of the first questions she was asked was about her race.
ROBERTS: They just asked me to check the box. And my question is, why use race?
RAZ: In other words, why use race when it doesn't tell us anything about our genes? Here's Dorothy Roberts on the TED stage.
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ROBERTS: Well, doctors tell me they're using race as a shortcut. It's a crude but convenient proxy for more important factors, like muscle mass, enzyme level, genetic traits, they just don't have time to look for. But race is a bad proxy. In many cases, race adds no relevant information at all. It's just a distraction. Race medicine also leaves patients of color especially vulnerable to harmful biases and stereotypes. And if you find race-specific medicine surprising, wait till you learn that many doctors in the United States still use an updated version of a diagnostic tool that was developed by a physician during the slavery era, a diagnostic tool that is tightly linked to justifications for slavery.
Dr. Samuel Cartwright practiced in the Deep South before the Civil War. And he was a well-known expert on what was then called negro medicine. He promoted the racial concept of disease, that people of different races suffer from different diseases and experience common diseases differently. Cartwright argued in the 1850s that slavery was beneficial for black people for medical reasons. He claimed that because black people have lower lung capacity than whites, forced labor was good for them. He wrote in a medical journal it is the red vital blood sent to the brain that liberates their minds when under the white man's control, and it is the want of sufficiency of red vital blood that chains their minds to ignorance and barbarism when in freedom.
To support this theory, Cartwright helped to perfect a medical device for measuring breathing called the spirometer to show the presumed deficiency in black people's lungs. Today, doctors still uphold Cartwright's claim that black people as a race have lower lung capacity than white people. Some even use a modern-day spirometer that actually has a button labeled race so the machine adjusts the measurement for each patient according to his or her race. It's a well-known function called correcting for race.
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RAZ: Wow, that's crazy. So this tool, this spirometer, which they used during the time of slavery, a version of it is still being used by some doctors today.
ROBERTS: Absolutely. And in fact, part of the argument now for paying attention to race is because of this long legacy of discriminating against black patients. There's this racial concept of disease that comes out of slavery that people of different races have peculiar diseases that sort of belong to that race.
RAZ: OK. So where has this led us? I mean, like, what are some of the modern consequences of making assumptions and, you know, making a diagnosis using race?
ROBERTS: Well, one example that comes out of the medical literature is the true case of a little African-American girl who had persistent respiratory problems. And you can look at her file and see 2-year-old African-American girl, you know, back in emergency room for respiratory problems; 4-year-old African-American girl with another pneumonia. And then when she was 8 years old, a radiologist looked at the X-ray of her chest without knowing her race and said, who's the kid with cystic fibrosis? Now, if she had been white, the doctors would have diagnosed her right away, you know, as a baby as having cystic fibrosis and treat it accordingly.
RAZ: And is that because statistically speaking white people are much more likely to have cystic fibrosis?
ROBERTS: Yes, that's true. So because she was black, they assumed she couldn't have cystic fibrosis even though she had the symptoms of cystic fibrosis.
RAZ: You know, I wonder about certain examples that we hear of like Tay-Sachs - right? - happens to affect people of European Jewish ancestry or that sickle cell anemia affects people, you know, from North Africa or the Mediterranean. So, I mean, what would be a better way to start to think about those things?
ROBERTS: Well, for one thing, just in the way you asked the question, you slipped from a relatively small group that was not a racial group - you mentioned Ashkenazi Jews - and then you also put together North Africa and the Mediterranean, which is not a racial group. So one better way would be to do away with these large social groupings and consider people's actual ancestry and how ancestry is related to disease.
RAZ: I mean, things like geography or lifestyle, those would be more relevant.
ROBERTS: Well, that's the basic reason why we find that certain races have a higher propensity to a particular disease because the disease very often is some consequence of a genetic mutation that was advantageous in that particular part of the world. And so linking the disease to race is a very crude way of thinking about how certain populations evolve to be predisposed to certain diseases or resistant to certain diseases.
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ROBERTS: The problem with race medicine extends far beyond misdiagnosing patients. Its focus on innate racial differences in disease diverts attention and resources from the social determinants that cause appalling racial gaps in health - lack of access to high-quality medical care, food deserts in poor neighborhoods, exposure to environmental toxins, high rates of incarceration and experiencing the stress of racial discrimination. You see, race is not a biological category that naturally produces these health disparities because of genetic difference. Race is a social category that has staggering biological consequences but because of the impact of social inequality on people's health.
RAZ: So does race ever help a doctor in diagnosing a condition?
ROBERTS: I don't think it does. I think that race is always standing in for something else, and it would always be better for the doctor to learn that something else. So, you know, instead of using race as a proxy for diet, ask the patient what the patient's diet is. Instead of using race as a proxy for genetic difference, either do a genetic test or ask about the patient's family history.
RAZ: So why isn't this happening? Why is race still being used?
ROBERTS: Well, I think doctors - most anyway - go into the profession to help to heal people, you know. But I think that race is such a powerful construct. It's a kind of delusion that's reinforced by so many aspects of our society. And so they really have to think about patients outside of the biological concept of race. The fact that it is constructed means we can construct something else, and I believe human beings are capable of that.
RAZ: That's Dorothy Roberts, a professor at the University of Pennsylvania. You can hear her entire talk at ted.com.
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