I’ve seen several articles on this and there is even a patronizing episode of House where he advocates for it.
From what I can tell what is really meant by race based medicine is “country specific ethic group cultural medicine” um doesn’t roll off the tongue. I see two issues with it that make tailoring treatment to “race” problematic to the point of being useless.
1.Race is a social construct and doctors will use their own capricious judgement to place someone’s race, which will likely be hilariously wrong. Bring in mixed race individuals and it seems to be pointless(ignoring the fact almost everyone is of mixed heritage).
2.It presupposes a homogenous lifestyle for all members of a racial group, which is of course total nonsense. Now bring in foreigners and it gets even more inaccurate. It seems like rather than assume you could actually ask someone about their diet and alcohol consumption etc.
If there are individual genes or gene sequences associated with a disease cool test for those, don’t assume someone carries them because they belong to an amorphous group based on nothing concrete.
This seems phrased more like a debate, but I agree with you. It seems more rational to base it on actual genetic markers than haphazard rule of thumb based on racial appearance or even a simple geographical query. But tests are expensive and take effort and doctors seem to take the “throw things at it til it sticks” approach more often than the “identify conclusively then treat appropriately” one.
Any Doper doctors actually use this in your practice, or have access to the relevant protocols?
Other threads addressed this issue. The problem is the inaccuracy of the approach. At least one Doper explained a problem based on a ‘race’ based diagnosis. The medical advocates of this concept also stress the importance of self-identification of race because doctor’s guesses can be very inaccurate, while an individual has a better idea of their lineage. Especially in cases where patients ancestry can extends to different parts of the world.
This approach is likely to yield some good results by chance. Most people who would self-identify as African American will have some African ancestors. As would Asian Americans and other groups. But DNA analysis is taking over the role of ‘race’ identification. But lacking other information to determine a person’s ancestry, it’s at least a good guess to use as a starting point in a diagnosis. Doctors just have to be aware that it provides a guess to be verified, not a conclusion.
Since the cost of sequencing one’s entire genome is already under $5k and soon to hit $1k, any guesswork should soon be a thing of the past. Of course it does open a whole closet full of privacy related Pandora’s boxes, but I suppose we’ll burn that bridge when we come to it.
Essentially, yes, among other potential issues such as employment discrimination.
However it may be possible to give people access to encrypted DNA data without first requiring decryption using homomorphic encryption. I have no idea how this works, but it seems to solve the problem of allowing manipulation of encrypted data without the data ever being decrypted.
Yup, race based medicine is real and valid. People hate hearing it, because it isn’t strictly PC, but there are differences beyond races that go beyond skin depth that influence medical management. Good examples include G6PD and sickle cell in african americans. Also different races tend to react differently to different drugs. Go look into the use of hydralazine and hctz in african americans vs other ethnic groups.
Or, for a physiological difference go google spirometry & race. Apparently African Americans have different thorax to leg length ratios at the same height vs. white Americans (and presumably Africans & Europeans are similar), and consequently white people tend to have higher lung volumes for a given height, so for accurate results (on average) you’d have to use different calculations.
Native American populations can be predisposed to Type 2 Diabetes. If the younger children can be instructed as to making wise food choices and encouraged to be active, kidney disease, transplantation, and dialysis can be delayed or avoided.
Black people are more vulnerable to high blood pressure and can be more inclined to Type 2 Diabetes. Prevention is ALWAYS easier than treatment. Too often people are not diagnosed until after major damage has already been done.
In my never humble opinion, it is not prejudicial to screen target populations for these possible health problems. If it is not in a particular person’s genetic makeup to develop hypertension or Dieabetes, there’s no harm done. However, there is a chance that people who could have escaped early diagnosis are helped.
There are many genetic diseases that are specific for certain populations, and it’s probably better for people to educate themselves as to whether or not they are in those populations. I’m thinking of Sickle Cell and Tay-Sachs disease.
My daughter is pregnant with her second child. By the second trimester, there is an incredible amount of screening done, to determine as to whether or not the fetus has any of a grocery list of genetic diseases. None of these tests are through DNA, nor do they require anything more invasive than bloodwork on Mom. Most is done in conjunction with an incredibly detailed Ultrasound reading in conjunction with the bloodwork, and it’s essentially a statistical probability. I am in awe of the screening available today!
There are valid reasons to use race-related screening, but only for prevention, diagnosis, or treatment–certainly NOT to deny anyone medical care, insurance, or employment.
~VOW
I seem to remember some discussion a few years back about the fact that the FDA had approved a heart medication specifically for African-American patients, only, because of an allele that was prevalent among that population. I never did hear how that all shook out.
Race is only a very crude indicator of genotype. You will do much better using “ethnic group”, which slices and dices more finely. Ultimately, though, you want individual genomes.
But back to race, especially African-Americans. That “race” can be anything from someone who derives 100% of his recent ancestry from Africa and someone who derives as little as 25% of his recent Ancestry from African. Obama is a perfect example of the perfect split. You’re a doctor. Do you give Obama the “white medicine” or the “black medicine”?
Obviously some individuals will share characteristics of multiple groups, but it’s still valid to have general diagnostic and treatment guidelines based on group characteristics.
In the real world, look at something like the ALLHAT trial which found significant differences when treating whites and blacks with different anti-hypertensives. It’s all well and good to say “you want individual genomes”, but we may not have any idea which specific gene (or more likely multiple genes) cause this difference.
I’m pretty sure I read right here in the Dope that all Africans actually vary more widely in genes than all the rest of the world (or something). I don’t really know how to search for that, but someone might remember. That would indicate that that knowing someone is “African-American” does not help much in diagnosis.
The problem seems to be: for some things it certifiably* does* help with diagnosis.
Maybe you could see it in the same light as checking if overweight people suffer from diabetes and if women (not men) suffer from PCOS. We don’t really want to divide the world into these categories and the categories will very often not apply, but if there is some use to it…
Other people have basically said it. The differences aren’t social, they’re genetic and based on the humanity’s evolutionary history.
There has been effort to statistically quantify the genetic differences based on race/ethnic group’s evolutionary descent. Differences do in fact exist and inform legitimate medical decisions.
The largest of which I believe is the Human HapMap (haplotype map).
Unfortunately, this requires an all-or-nothing approach that really can be counter-productive.
Testing for sickle-cell is often successful for blacks in the U.S. because the overwhelming numbers of black people who were brought to the U.S. were taken from the region of Africa where sickle-cell is prevalent. Had far more Africans been imported from Madagascar (where black people do not carry the sickle cell gene), than the Gold and Ivory Coasts, (where they do), the tests would be rather meaniningless. As it is, a doctor who focussed on testing blacks for sickle-cell would likely miss sickle cell in the Maltese, Greeks, and Lebanese among whom it is also prevalent.
Similarly, BiDil, the heart medicine that was tested and approved for blacks, probably works just as well for whites in the same physical conditions. The original test that revealed a difference between black and white patients was reviewed about the time that the black-only trials were begun for BiDil. The testers noticed that in the original tests, the black men who improved under its use tended to be older, in poor overall health, and seriously overweight while the white men for whom it showed less promise tended to be younger, in good overall health, and not as overweight, (possibly more stressed from jobs and similar situations). With the “race” distinction noted, the pharmaceutical company jumped for new trials for a “black” medicine while no one bothered to test it for aging couch potatoes across “racial” lines, writing it off for younger Type-A personalities.
There might be a real connection to men with ancestry in the Western sub-Sahara, but we have not actually tested for that condition. And I have no problem with its current usage, in that the condition it treats among black men probably becomes manifest more frequently among older, overweight men in poor health. (I just wonder how many older, overweight white and Asian men are losing out on its benefits because no one chose to test it for them?)
I haven’t seen that episode or even really done much looking into this, but it sounds like it could involve attempting to pigeonhole someone as African American so that they can give them patronizing “ethnic dialect” materials, e.g. “Rememba to be takin’ this 30mg cap befoa you chill for suppah. Don’ be rotatin’ these tires until you unnerstan’ how you feel when using, bro.” or something, or, say, assuming that because someone is African American that they don’t know who their father really is.
I highly doubt pharmaceutical firms are leaving money on the table like this (I work in the industry). Doctors don’t have the time or money to do individual tests (this will be changing shortly, the genomic revolution is coming…) But drug companies aren’t dumb. They have statisticians devoted to this tasks like this.
If they chose to only do a black only test, there was a good scientific reason or economic reason for it.