WILLisms.com: Trivia Tidbit Of The Day: Part 264 -- Race & Medicine.

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Trivia Tidbit Of The Day: Part 264 -- Race & Medicine.

Race & Public Health-

Most of us, as modern Americans, wish to live in a truly colorblind society. Increasingly, and ironically for some, it is conservatives rather than liberals who are more likely to judge individuals on the content of their character rather than the color of their skin. Think about affirmative action, or about the way certain African-American Republicans are treated by liberals.

But people are different. There are differences between and among races. Biologically. Culturally. And so on. The great American melting pot hasn't changed that.

We've seen numerous collegiate football coaches and commentators in recent years get in trouble for suggesting there are physical differences between and among races, or that African-Americans are great athletes.

But aren't there physical differences between and among racial groups, on average?

Don't answer that one. It was rhetorical.

We'd all prefer a colorblind society, especially with regard to our laws and the enforcement thereof, but ignoring well-known racial differences when treating patients for the sake of some vague sense of social justice and harmony strikes me as odd, counterproductive, and ultimately very detrimental to health.

For example, African-Americans are more likely to have/develop sickle-cell anemia, diabetes, and other ailments. White people are more likely to have/develop other diseases. It's just statistics. We can either ignore the facts, or use them to help us.

Fascinatingly, smoking impacts different racial groups in different ways:

Cigarette smoke may not be an equal opportunity carcinogen. According to a report in last week's New England Journal of Medicine, the same amount of cigarette smoke was associated with higher rates of lung cancer in African-Americans and Native Hawaiians than other groups. Despite comparable low-to moderate exposure, whites were about half as likely to develop lung cancer and Latinos and Asians were about half as likely as whites to develop it.

Differences. Based on racial groupings.

These bits of information, rather than being used to discriminate against African-Americans, are important for our public health professionals. Some people, astoundingly, consider these sorts of studies to be racist:

"This [study] feeds into the 19th-century notion that these categories really separate people in terms of their physical and biological characteristics," said Troy Duster of New York University. (Only the most scientifically illiterate today believe this straw man of race. As early as the 1770's, Johann Friedrich Blumenbach, considered the father of physical anthropology, remarked that "innumerable varieties of mankind run into each other by insensible degrees.")
Bioethicist Jeffrey Kahn of the University of Minnesota told the Washington Post that he worried the findings could be used to further discriminate: "The danger would be to sort of view lung cancer as a minority disease, and so something we don't have to worry as much about."

Ugh.

No.

This really should not be a political issue. Pragmatism, people. Come on.

Interestingly, white and black patients, culturally, or for some other unknown reason, behave differently:

Lung cancer was the subject of "bias" speculation when Peter Bach and colleagues at Memorial Sloan Kettering Cancer Center published a 1999 study in which they examined records of over 10,000 Medicare patients who received diagnoses of operable lung cancer. Seventy seven percent of white patients underwent surgery compared with 64% of black patients. Five years later, one-third of the white patients, but only one-quarter of the black patients, were still alive.
Those numbers understandably aroused concern, but many unanswered questions remained. One question was whether black patients refuse surgery more often than whites? The answer is yes. In 2003 researchers at the Philadelphia Veterans Affairs Medical Center presented their survey of over six hundred patients with pulmonary disease from three veterans hospital sites across the country. They found that more blacks than whites (61 percent versus 29 percent) maintained the folk belief that the spread of lung cancer was accelerated when the tumor was exposed to air during surgery and would oppose surgery because of this (19 percent versus 5 percent). A study of patients with operable lung cancer conducted at Detroit's Henry Ford Health System found refusal of surgery by black patients over three times more common than by whites. (Both whites and blacks were offered the surgery at similar rates.)

Differences. That we can address responsibly. Or ignore.

Researchers, physicians and readers of newspaper health stories appreciate the complexity of race. That is, at minimum, they grasp that social aspects and biological aspects are intertwined. One can't help but think that it is the professional handwringers, like sociologist Duster and bioethicist Kahn, who keep worrying the thorn of racial discrimination. The public displays a common sense desire to improve health through many viable pathways and has moved past politically correct clichés.

Too often, President Bush and other Republicans are accused of neglecting the needs and concerns of African-Americans. Meanwhile, the modern Democratic Party includes, as part of its nonsensical, contradictory, tenuous coalition, the kind of folks that want to neglect the needs and concerns of African-Americans, for the sake of equality.

Hmm. Might be time to re-think that coalition over there, guys.

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Previous Trivia Tidbit: Wasn't Howard Dean Supposed To Be A Good Fundraiser?.

Posted by Will Franklin · 10 February 2006 10:46 AM

Comments

Colon and Rectal Cancer among African Americans is even worse, but we continue to try to figure out why:

Recent findings by researchers at Roswell Park Cancer Institute in Buffalo, N.Y., may help lower the colon cancer death rate among African Americans by identifying those at an increased risk of developing the disease. Defects in genes that repair DNA ? known as mismatch repair genes ? make cells more prone to becoming cancerous. In this study, the researchers looked for defects in two such genes in African Americans with hereditary nonpolyposis colorectal cancer (HNPCC), an early-appearing type of colorectal cancer that can also lead to malignancies outside the colon, including endometrial, urinary tract, and upper gastrointestinal tract cancers.

Big reason is that blacks have a significantly different diet on average. More about colorectal cancer:

Despite declines in rates of new cases and deaths from colorectal cancer in African Americans, this cancer is still the third leading cause of death in this group. Death rates from colorectal cancer are about 30 percent higher in African Americans than in whites and are more than twice as high as rates in Asian/Pacific Islanders, American Indians and Hispanics.

Add in this information:

Americans of all races tend to eat more and are less active than their ancestors, which, is contributing to the obesity epidemic in the US. Recent statistics show that over half of the US population is overweight or obese. Unhealthy weight trends are even more pronounced among African Americans with 60.1% of African American men and 78% of African American women identified as overweight. In addition, 28.8% of men and 50.8% of African American women are considered obese. The charts below show that black women lead the population both in the numbers who are overweight and obese.

And you see that different populations and different ethnicities/cultures eat differently and have different behaviors. And these behaviors as well as their underlying genetics put them at much greater risk for some diseases.

The net of this is simple. Blacks live shorter lives by several years than other races. To be truly colorblind, we would ignore this simple fact. We would ignore that on average, an entire group of people dies younger than their white counterparts. We would not study them in particullar and try to figure out why they seem to fair poorly.

All people are not the same. And all races are not statistically the same. There is great variation among races. Smart white people and dumn white people. Fast and slow. Light skinned and darker. Same with blacks. But as an average, these groups are genetically and behaviorally different in many ways. If it just as important to have a PC "we are all the same underneath" mentality as it is to have a "we are all also different" mentality. And study both our similarities and differences without the ugliness of stereotyping and prejudice.

But healthcare and science are not colorblind. Doctors cannot be colorblind and not be aware that their patients based on age and ethnicity have different characteristics. Blacks need more encouragement for colorectal screening since 1. they are more prone to die from the disease and 2. they are less likely to get the screening due to behavioral characteristics. If a little bit of "stereotryping" prevents a cancer death, is that so wrong?

Posted by: Justin B at February 10, 2006 01:31 PM

I am all for encouraging anyone with a family history etc. to get check-ups on a regular basis... Health care costs are one of those issues that prevent many people from getting checked. Our health care system has so much technology it keeps advancing at a rapid pace every year. Unfortunately frivolous law suits have made the costs go so high that many people can't afford the X ray, biopsy, blood work etc. required to diagnose these types of diseases... I t is unfortunate to have so much technology and yet there are people who need it that can not afford it...

Posted by: Zsa Zsa at February 10, 2006 02:28 PM

Cancer is one of those diseases that is on my list these days!... Many cancers can be prevented. The money that is spent on finding a cure is phenomenal... The money being spent on treating cancer is even more phenomenal!... Too many people that I have loved have died or been struck with this disease...Alternative treatments are often looked at as taboo. Alternative cancer treatments have to be looked at closer! Vitamin supplements, diet etc. should be tested and looked at much closer as a preventative. Cancer is a big business and we all need to become more aware of options and prevention!...

Posted by: Zsa Zsa at February 10, 2006 02:46 PM

If this is a racist study, then is studying sickle cell anemia racist? Or Tay-Sachs disease? Or any disease that is much more prevalent in particular ethnic/cultural/regional groups?

Next thing you know, it will be sexist to mention that women, on average, are shorter and live longer than men.

Posted by: meep at February 11, 2006 03:40 AM

meep! You sexist rotten stinker!

Posted by: Zsa Zsa at February 12, 2006 04:22 PM