Overemphasizing Race is Dangerous in Medicine
Maybe there is an actual genetic polymorphism that causes different blood pressure responses to certain medications, similar to the way sickle cell anemia is a genetic condition more common in black people. However, we would never treat all black people as though they have sickle cell anemia just because it's more common. We would never treat it without testing for its presence first.
I agree that this is a finding that is worth investigating, but it's still in its infancy. The research isn't compelling enough to make it a guideline. By including it in official guidelines, we continue to perpetuate ambiguity over the impact of race on medical outcomes.
At its heart, using race as an identifier is a proxy measure. Researchers like to assume that it has to do with biology but, in reality, the impact that race has on any individual stems from a whole host of things. One study found that black patients and white patients had the same blood pressure responses on an ACE at night while asleep, and that it was only during the day that the black cohort exhibited less benefit. A commenter said, "This finding is difficult to explain."
Well, I have an explanation: On average, black people encounter more stress when they are awake and out working or living in a white-dominated society, which almost surely raises the blood pressure of many. That's just my own postulation, but it illustrates the point that while statistics can prove correlation, they do not prove the cause.
Furthermore, ever since the first rumblings of this differential response between black patients and white patients, unconscious bias on the physician level has caused physicians to misapply the guidelines. Though the current guidelines only refer to initial choice of medication for high blood pressure in the setting of no other medical problems, there were reports of doctors all over the country ceasing to prescribe ACEs and ARBs to black patients at all, even when it is absolutely helpful in both races for patients with kidney damage.
Without being explicit about what it is we're studying when we look at race, it continues to perpetuate a very dangerous concept: that good doctors should take into account skin color when they provide healthcare.
As physicians, we identify as humanitarian scientists. We don't want to have racial biases. However, given the world we live in, it is impossible to see race and not have it impact us. Not admitting this prevents physicians from actually addressing the problem. Physicians frequently encounter patients who are in denial about their medical issues. We sadly shake our heads and try to explain that denial is only delaying necessary care and that in the meantime things will get worse. But it's the same for physicians and racial biases, only the stakes are much higher: in this case, the victims of our denial are our patients.
JESS GUH is a member of ThisCantBeHappening!, the independent, uncompromised, five-time Project Censored Award-winning online alternative news site. Her work, and that of colleagues JOHN GRANT, DAVE LINDORFF, GARY LINDORFF, ALFREDO LOPEZ, LINN WASHINGTON, JR. and the late CHARLES M. YOUNG, can be found at www.thiscantbehappening.net
(Article changed on December 16, 2015 at 10:38)
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