Articles, Blog

The problem with race-based medicine | Dorothy Roberts

December 19, 2019


15 years ago, I volunteered
to participate in a research study that involved a genetic test. When I arrived at the clinic to be tested, I was handed a questionnaire. One of the very first questions
asked me to check a box for my race: White, black, Asian, or Native American. I wasn’t quite sure
how to answer the question. Was it aimed at measuring the diversity of research participants’
social backgrounds? In that case, I would answer
with my social identity, and check the box for “black.” But what if the researchers
were interested in investigating some association between ancestry
and the risk for certain genetic traits? In that case, wouldn’t they want to know
something about my ancestry, which is just as much European as African? And how could they make
scientific findings about my genes if I put down my social identity
as a black woman? After all, I consider myself
a black woman with a white father rather than a white woman
with a black mother entirely for social reasons. Which racial identity I check has nothing to do with my genes. Well, despite the obvious
importance of this question to the study’s scientific validity, I was told, “Don’t worry about it, just put down however
you identify yourself.” So I check “black,” but I had no confidence
in the results of a study that treated a critical variable
so unscientifically. That personal experience
with the use of race in genetic testing got me thinking: Where else in medicine is race used
to make false biological predictions? Well, I found out that race runs deeply
throughout all of medical practice. It shapes physicians’ diagnoses, measurements, treatments, prescriptions, even the very definition of diseases. And the more I found out,
the more disturbed I became. Sociologists like me have long explained that race is a social construction. When we identify people as black,
white, Asian, Native American, Latina, we’re referring to social groupings with made up demarcations
that have changed over time and vary around the world. As a legal scholar, I’ve also studied how lawmakers, not biologists, have invented the legal
definitions of races. And it’s not just the view
of social scientists. You remember when the map
of the human genome was unveiled at a White House
ceremony in June 2000? President Bill Clinton famously declared, “I believe one of the great truths to emerge from this triumphant expedition inside the human genome is that in genetic terms, human beings, regardless of race, are more than 99.9 percent the same.” And he might have added that that less than one percent
of genetic difference doesn’t fall into racial boxes. Francis Collins, who led
the Human Genome Project and now heads NIH, echoed President Clinton. “I am happy that today, the only race we’re talking about
is the human race.” Doctors are supposed to practice
evidence-based medicine, and they’re increasingly called
to join the genomic revolution. But their habit of treating patients
by race lags far behind. Take the estimate of glomerular filtration rate, or GFR. Doctors routinely interpret GFR, this important indicator
of kidney function, by race. As you can see in this lab test, the exact same creatinine level, the concentration
in the blood of the patient, automatically produces
a different GFR estimate depending on whether or not
the patient is African-American. Why? I’ve been told it’s based on an assumption that African-Americans
have more muscle mass than people of other races. But what sense does it make for a doctor to automatically assume I have more muscle mass
than that female bodybuilder? Wouldn’t it be far more accurate
and evidence-based to determine the muscle mass
of individual patients just by looking at them? 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. But race also tends to overwhelm
the clinical measures. It blinds doctors to patients’ symptoms, family illnesses, their history, their own illnesses
they might have — all more evidence-based
than the patient’s race. Race can’t substitute
for these important clinical measures without sacrificing patient well-being. Doctors also tell me
race is just one of many factors they take into account, but there are numerous medical tests, like the GFR, that use race categorically to treat black, white,
Asian patients differently just because of their race. Race medicine also leaves
patients of color especially vulnerable to harmful biases and stereotypes. Black and Latino patients
are twice as likely to receive no pain medication as whites for the same painful long bone fractures because of stereotypes that black and brown people
feel less pain, exaggerate their pain, and are predisposed to drug addiction. The Food and Drug Administration has even
approved a race-specific medicine. It’s a pill called BiDil to treat heart failure in self-identified
African-American patients. A cardiologist developed this drug
without regard to race or genetics, but it became convenient for commercial reasons to market the drug to black patients. The FDA then allowed the company, the drug company, to test the efficacy in a clinical trial that only included
African-American subjects. It speculated that race stood in as a proxy
for some unknown genetic factor that affects heart disease or response to drugs. But think about
the dangerous message it sent, that black people’s bodies
are so substandard, a drug tested in them is not guaranteed
to work in other patients. In the end, the drug company’s
marketing scheme failed. For one thing, black patients
were understandably wary of using a drug just for black people. One elderly black woman stood up
in a community meeting and shouted, “Give me what the white
people are taking!” (Laughter) And if you find race-specific
medicine surprising, wait until 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 graduated from the University
of Pennsylvania Medical School. He 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 the 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.” 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. Yet race medicine pretends
the answer to these gaps in health can be found in a race-specific pill. It’s much easier and more lucrative to market a technological fix for these gaps in health than to deal with the structural
inequities that produce them. The reason I’m so passionate
about ending race medicine isn’t just because it’s bad medicine. I’m also on this mission because the way doctors practice medicine continues to promote
a false and toxic view of humanity. Despite the many visionary breakthroughs
in medicine we’ve been learning about, there’s a failure of imagination when it comes to race. Would you imagine with me, just a moment: What would happen if doctors
stopped treating patients by race? Suppose they rejected an 18th-century classification system and incorporated instead
the most advanced knowledge of human genetic diversity and unity, that human beings cannot be categorized
into biological races? What if, instead of using race
as a crude proxy for some more important factor, doctors actually investigated
and addressed that more important factor? What if doctors joined the forefront of a movement to end
the structural inequities caused by racism, not by genetic difference? Race medicine is bad medicine, it’s poor science and it’s a false
interpretation of humanity. It is more urgent than ever to finally abandon this backward legacy and to affirm our common humanity by ending the social inequalities
that truly divide us. Thank you. (Applause) Thank you. Thanks. Thank you.

100 Comments

  • Reply musicalintentions March 5, 2016 at 9:09 pm

    What is wrong with people? This woman brings to us important information, and she is so well-spoken. Yet the ratio of likes to dislikes is 2:5.

  • Reply F Torrado March 5, 2016 at 9:48 pm

    So many youtube doctors around here, great! But first get your facts straight, you can have more genetic differences between two people native in neighbouring countries or even villages in Africa (or any part of the world, but native Africans have more varied genetics) than between a "caucasian" and an "asian" person, the studies on genomics have proven most assumptions about races have very little meaning in genetics and therefore in medicine.

    So I don't know what you all are shouting about, go see any piece of data from genome mapping

  • Reply TheUltramuppet March 5, 2016 at 10:10 pm

    can someone explain all the hate this is getting?

  • Reply Ebob March 5, 2016 at 10:31 pm

    I don't know why this has so many dislikes. Did people get antsy and start calling her an SJW when she said she "identifies" as black because they were too dense to get the point she was making about how she's just as white as she is black, but is treated as only/mostly black by society? She's not wrong about that, so what's the issue?
    I've never seen a medical questionnaire that didn't have "mixed" as a race option but still, why all the hate?

  • Reply Johanna G March 5, 2016 at 10:39 pm

    I'm 2 and a half minutes in and I don't really get why so many are disliking it. My understanding of it is that she doesn't like how someone who's not fully [this race] genetically can check [this race] on the paper. I'm black/white too and would feel more comfortable checking a "mixed" box or check both "white" and "black" for the sake of the study and my own identification.
    Too lazy to finish the video, so anyone care to explain what's wrong about her statement?

  • Reply Magnus Jørgensen March 5, 2016 at 11:17 pm

    she has a good point. people shouldn't be asked for their race. it should be given by a genetic sample.

  • Reply Max March 5, 2016 at 11:40 pm

    The video was all right for while and makes some good points, but the conclusion that "race is just a social construct" is just idiotic.

  • Reply ketrel815 March 6, 2016 at 1:57 am

    I don't even know where to beguine.

  • Reply ketrel815 March 6, 2016 at 2:23 am

    From the wikipedia on Bidil. "Cohn re-analyzed the data and found a signal that the drug combination appeared to work better in self-identified African-Americans in the V-HeFT trial, and published a paper on that work, and filed a new patent on the use of BiDil in "black" patients.[2][4][5] It had already been known that African-Americans with congestive heart failure (CHF) respond less effectively to conventional CHF treatments (particularly ACE inhibitors) than caucasians.[6]
    The new patent and the old patent were licensed to a company called NitroMed, which ran a clinical called the African-American Heart Failure Trial (A-HeFT), the results of which were published in 2004 in the New England Journal of Medicine.[7] The clinical trial was stopped early because the drug worked so well; it reduced mortality by 43%, reduced hospitalizations by 39%, and improved quality of life markers in African-American patients with CHF."

    So since it worked more effectively on patients that happened to be African American. Racism? Honest? the medicine is racist? Or the doctors who are more effectively saving black lives are racist? Good god this is so disappointing. TED wtf?

  • Reply MindSET March 6, 2016 at 2:31 am

    I think we should now start asking ourselves, how many (not racist…>…mildly racist) white people and white run organizations are there? because asking ourselves the opposite question has proved to be a waste of time.

    I don't even eat out anymore, I stay away from hospitals and pharmaceuticals, and I travel cautiously.

  • Reply Alexander Breems March 6, 2016 at 2:59 am

    She makes some valid points but then swings so far to the other extreme, it undermines her message. At most, race can influence a physician's differential diagnoses. If a young person presents with anemia, and happens to be black, sickle cell would be higher on the differential. Lab work and imaging ultimately guide decisions about care. The real disparities are in access to and affordability of care. But the care itself does not suffer from some kind of racial bias.

  • Reply Kripa Raman March 6, 2016 at 5:57 am

    for genetic ancestry analysis it is common to remove individuals who cannot be classified as one ethnicity so maybe that's why it didn't matter

  • Reply Kripa Raman March 6, 2016 at 6:07 am

    disease prevalence differs based on race/ ethnicity… but there are a lot of other factors that also impact disease prevalence (ie diet, activity, environment etc). As the global population becomes more inter-racial, race may become less important than these other factors

  • Reply DeusExAurum March 6, 2016 at 11:53 am

    TRIGGERED TALKS

  • Reply Vlad Ivanovici March 6, 2016 at 1:11 pm

    You either die a hero or live long enough to see yourself become the villain

  • Reply yakumo961 March 6, 2016 at 3:57 pm

    Please dont tell me this one of those: "We have to deny scientific facts so that we do not hurt anyones feelings." videos…

  • Reply Deep Doubts bout U March 6, 2016 at 4:31 pm

    Francis Collins did not lead the Human Genome Project …..

  • Reply Deep Doubts bout U March 6, 2016 at 4:42 pm

    Let the Bodies Hit the Floor !!!

  • Reply Melody Luna March 6, 2016 at 4:51 pm

    This is a great video.

  • Reply Alhoshka March 6, 2016 at 6:51 pm

    Regarding the BiDil "controversy":

    YES, the drug HAS been tested on caucasians (Carson, 1999; Elkayam 2005), and YES, empirical trials HAVE shown that blacks respond BETTER to the treatment (Taylor, 2004; Cheng 2006; Elkayam 2005). Keeping in mind that at the time it had been shown that treatments which worked well on caucasians DID NOT work as well on blacks (Carson, 1999; Taylor, 2004). So, BiDil did indeed represent a better alternative treatment for blacks (Seguin, 2008 –> highly recommend reading this source!).

    I'm sorry Mrs. Roberts, but there is no evil shadowy conspiracy spending millions of dollars on clinical research just so they can indirectly suggest that "black bodies are substandard".

    The irony is that blacks end up receiving substandard care (Séguin, et al. 2008) because idiots like her insist that empirical facts are racist.

    Seriously TED, why do you keep providing these idiots with a platform while shielding them from scrutiny!?

    ——————————————-

    Sources:
    (Youtube does not allow urls, so I'm citing the papers instead. Just copy-paste the title in google scholar)

    Carson, Peter, et al. "Racial differences in response to therapy for heart failure: analysis of the vasodilator-heart failure trials."
    Journal of cardiac failure 5.3 (1999): 178-187.

    Taylor, Anne L., et al. "Combination of isosorbide dinitrate and hydralazine in blacks with heart failure."
    New England Journal of Medicine 351.20 (2004): 2049-2057.

    Elkayam, Uri, and Fahed Bitar. "Effects of nitrates and hydralazine in heart failure: clinical evidence before the African American Heart Failure Trial." The American journal of cardiology 96.7 (2005): 37-43.

    Cheng, Judy WM. "A review of isosorbide dinitrate and hydralazine in the management of heart failure in black patients, with a focus on a new fixed-dose combination." Clinical therapeutics 28.5 (2006): 666-678.

    Seguin, B., et al. "Bidil: recontextualizing the race debate."
    The pharmacogenomics journal 8.3 (2008): 169.

  • Reply Jakub B March 6, 2016 at 9:42 pm

    She was making a good point on how the questioner is unscientific and thus pointless.

  • Reply Juliano Correa March 6, 2016 at 10:40 pm

    News for you: that guy probably isn't your father. I know a lot of mixed race couples and the offspring is usually mid term, but it is very hard to identify strong european traces on you as it should be excepted if you were 50/50%. That said the researches work because when you hit black it is already excepted that you are an african-american and not a native african. Of course there will be some statisically insignificant number of people who are actually native african, but it is all about statistics. Your video is a fail.

  • Reply Juliano Correa March 6, 2016 at 10:45 pm

    You got it women. Your video has so much nonsense and simplistic thinking showing a high incapability to understand complex and concepts that you managed to be probably the only TED video with more unlikes than likes.

  • Reply Meshal A March 6, 2016 at 11:02 pm

    #اصحاب_ثنيان

  • Reply Linda Schreiber March 6, 2016 at 11:04 pm

    Perfect! Thank you, Didn't know that some of this stupidity was still going on. I should have expected it, I suppose….
    Outside of very limited genetic diseases, that CAN NOT be defined by physical appearance or social history, only by the actual genetic data, any medical use of race is bogus.
    We are all mutts,. That is good!
    Without the grand shuffle-and-mash-up of our genes over a great many thousands of years, we wouldn't be us. And we wouldn't be spread across most of the globe.
    Humans….

  • Reply PKM101 March 7, 2016 at 1:34 am

    Usually the comments under Ted Talk videos maintain a fair level of respect. I guess certain topics attract certain individuals, in this case the ones who write comments before even watching the video.

  • Reply yakumo961 March 7, 2016 at 3:25 am

    Ok. So looking at things individually is the way to go. I totally agree, which is why I call bullshit on assumptions like: "Oh you are so priviliged because you're white" or "Black people need to get extra help because they are as a collective oppressed."
    However, when scientific fact shows that race does matter, I dont think it should be ignored, which is why I do not think race based medicine should be dismissed, just because it is race based. What if, for example, scientists find that people of a certain race genetically lack a certain enzyme for example and are therefore incapable of digesting certain substances. Wouldnt it be a lot better to use that to create medicine that can be digested for that race instead of calling it racist?
    And finally: Really? Race is a social construct? So you're telling me a pale white person can "identify" as black? I get that it is a construct in the sense that we as society decided to divide groups by race, but you cannot deny that the aspects to your racial identity arent purely arbitrary.

  • Reply yakumo961 March 7, 2016 at 3:33 am

    Also, what if the example with the lung capacity is true? Not saying it is, but as you are making a principle argument against race based science, I will use it as an example as to why it might be necessary. What if, your race actually determines not just average, but literally determines that you will have a lower lung capacity? Wouldnt the scientific way be to either judge each one individually OR make use of a pattern if its causation can be linked to race, instead of calling it racist?

  • Reply ucheucheuche March 7, 2016 at 4:27 am

    The majority of comments sound stupid.

  • Reply BlessU Now March 7, 2016 at 6:53 am

    Imho, if anything from then until now it seems more like "Race Experimentation's" through the generations of different ethnic groups. Not to worry though, the future IS here, they already have, "One size fits all" programmable chip pills. Peace.

  • Reply Philippos Costa March 7, 2016 at 9:25 am

    Such BS. Its based on scientific data the difference in creatinine between races. Its a fact that blacks have a resistence to certain anti-hypertension drugs. Its medicine based on evidence, nobody invented those claims. They are facts found on studies.

  • Reply TheSacred March 7, 2016 at 9:30 am

    error 404 lack of proof

  • Reply Royston E. Smythe March 7, 2016 at 1:22 pm

    Any points she has that may be valid are drowned in her social justice victim creation life's work.

    Perhaps a medical doctor or a geneticist could talk about this issue instead of someone with no formal medical training.

  • Reply Elivasfq March 7, 2016 at 4:48 pm

    Though as a possible SJW there are a lot of BS in here, non the less she pointed out some valid points.
    I don't get the dislikes to this vid, as there are much stupider TED talks then this one with much less dislikes than this one.

  • Reply Alarich Herzner March 7, 2016 at 8:55 pm

    U want some facts? here u go: http://www.the-scientist.com/?articles.view/articleNo/38950/title/On-Race-and-Medicine/
    "These and related findings clearly support the presence of race-related
    variations in disease risk, disease progression, treatment response, and
    treatment-related side effects"

  • Reply Shoshana McKinney March 8, 2016 at 1:15 am

    My Dr. treats me like a whole person, not just a race or gender.
    Pick your Dr. wisely and see how they listen to you.
    <3

  • Reply ProteanView March 8, 2016 at 7:15 am

    Race is a social construct, and yet white folks are more likely to get osteoporosis and Huntington's whilst blacks are more likely to get sickle cell. Someone had better tell these diseases that race is but a social construct.

  • Reply Not Me March 8, 2016 at 2:38 pm

    I am pretty sure there are races.. If not, why do we have different skin colors? I mean, I AM NOT RACIST AT ALL. But isn't it a bit ignorant to say there are no races? Maybe I don't understand this concept. But, It's like saying there are no dog races. There are no huskies, cockers, etc. She was just saying how racist the medicine is. BUT, she wasn't argumenting the idea that there are no races. Cand someone explain me please, how are there no races? Seriously 🙂 Thanks.

  • Reply SBFloppie March 8, 2016 at 4:01 pm

    All you need to know about this talk can be found from 8:53. In this woman's worldview, a functional and accurate diagnostic instrument can't be used because its inventor held racist views in the 1850s. She dismisses the idea that black people have lower lung capacity than whites without offering a single argument to support her claim. Apparently scientific findings should be disallowed if they don't pass muster with this woman.

    edit: to clarify. She makes no case for the device being inaccurate. She simply acts as if we should be appalled at the use of something built by a racist.

  • Reply Whhat Nooh March 9, 2016 at 1:21 am

    Can someone explain what she said that was wrong to get so many dislikes?
    Dorothy is correct that race is playing a role in medicine that it should not be playing.

  • Reply Rick Holden March 9, 2016 at 4:39 am

    This is shocking! I can't believe that it's common practice for doctors to practice this psuedo-science.

  • Reply wumboscorner March 9, 2016 at 9:25 am

    waht

  • Reply SolPhoebusApollo March 9, 2016 at 4:05 pm

    Brilliant talk! I'm dreaming of that day in medicine too, where doctors practice what has been scientific fact for years; there is only one human race.

  • Reply ivan date March 9, 2016 at 4:47 pm

    don't put sociologist in medical decision position ….
    half of the population will die …

  • Reply Enzo Francescoli March 9, 2016 at 5:22 pm

    This is absurdly stupid

  • Reply Herbert Origas March 9, 2016 at 6:51 pm

    conjecture this and circumstantial that… This is really the kind of emotional and non-evidence based arguement relegated to a platform at say, a TEDX talk.

  • Reply Lief Theorine March 10, 2016 at 1:33 am

    Wow I can't believe the resistance this is having. There is data confirming all of her points. I've read in the past about doctors not giving black patients the same amounts of anaesthetics as white patients due to preconceived notions of blacks people having a higher pain tolerance, just for one example

  • Reply Delsur27 March 10, 2016 at 5:44 am

    People hate when they are shown that race can't be biological category, especially when when mix race people don't fit the race-based medicine frame work. As she said, race is a social construct, not a biological one, and trying to extrapolate that to science medicine doesn't work well and creat incongruency in the frame work and methology, like when categorization problem show up.

  • Reply ketrel815 March 10, 2016 at 7:41 am

    Okay so if a person in the hospital refuses medicine based on it being more effective on them because of their race or genetic predispositions, I think we should let them. The genetic pool needs less stupid.

  • Reply Val Tozer March 10, 2016 at 10:32 am

    "Genetics, Race and Ethnicity. It is well known that some diseases are more common in particular racial or ethnic groups than in others, for example, cystic fibrosis among people of European ancestry, sickle cell disease among those of African and Mediterranean ancestry, and Tay-Sachs disease among Ashkenazi Jews." google search. ? OK now I'm confused

  • Reply ויאמר סבבה! March 10, 2016 at 8:12 pm

    Would they mind if we just used "ancestry from area _"?
    That's some more words, removes this idiotic fear of connecting people's origins with biology.

  • Reply cindy Queen March 11, 2016 at 5:46 pm

    From what i'm getting, white people don't like it when black people talk about race. That's why we get NOWHERE as far as race relations goes.

  • Reply Ellis Abram March 11, 2016 at 6:35 pm

    There is a difference between how melinated people and non melinated people respond to chemicals, whether it be medical or otherwise. It's not as basic as race.

  • Reply Karim El-houssami March 13, 2016 at 4:01 pm

    But then why is it so hard to find matching transplant donors for mixed race people or that you and the other race have to be the same? Or is this unrelated ?

  • Reply Kate S March 15, 2016 at 3:37 pm

    There are biological differences between different populations of humans. It is good to take them into account when you make medicines. But how race is usually classified is a mistake for sure: in US even person with much less than 50% of African DNA will be considered "black", and given medicines for blacks, even though probably, genetically he or she can be more European than African

  • Reply Not Matt March 16, 2016 at 8:55 pm

    Her point is good and clear but we can't completely ignore race/ancestry in medicine. The physiological differences between races go deeper than the skin, and that, I think, is beautiful, although it also complicates things. The color of the skin is just the first differing word in a story that the person is as a biological entity. Thou shall not ignore the patient's ancestry and genetic heritage when manipulating his/her biology.

  • Reply Eleanor Muzzy March 17, 2016 at 3:42 am

    I find the statistic at 6:52 interesting. There are similar reports of women's pain not being taken seriously. I've heard lots of anecdotal evidence of people having to go to multiple doctors before finally getting a proper diagnosis and care.

  • Reply ausieking March 18, 2016 at 4:33 pm

    this is it the video that marks the beginning of the end for TED talks

  • Reply generic goose March 19, 2016 at 4:04 pm

    … is that it doesn't kill all non-whites

  • Reply retnemmoc101 March 20, 2016 at 2:20 pm

    Sickle cell anemia is a social construct right?

  • Reply Eu March 21, 2016 at 1:55 pm

    So do you guys wanna explain sickle cell anemia to this woman or should I?

  • Reply jayfulf March 21, 2016 at 7:47 pm

    Different races are more susceptible to certain diseases and can be affected differently from certain medications.

  • Reply Nik Zanzev March 22, 2016 at 3:21 pm

    There, I fixed the description:
    Social justice whiner and law "scholar" Dorothy Roberts has a vague and idiotic message: Medicine is not something I understand, and science is hard, but my feewings tell me that medicine is racist! 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, probably because it is impossible to measure pain objectively and there are numerous studies that show that ethnic groups respond differently to pain (http://www.ncbi.nlm.nih.gov/pubmed/23687518). In this cringe inducing talk, Roberts fails to understand the reasons behind race-based medicine-and invites us to be part of her ignorance. "It is more urgent than ever to finally abandon this backward legacy," she whines, "and to affirm our common humanity by ending the social inequalities that truly divide us. Therefore, white people suck."

    TEDTalks is a daily video podcast of some of the most cringe inducing talks and whinging performances from the TED Conference, where the world's leading thinkers and doers have to compete for time with the world's most idiotic crybabies, and give the talk of the their lives in 18 minutes (or less). Look for talks on Technology, Entertainment and Design — plus science, business, global issues the arts, but you won't find them. Instead, we give you social justice whiners, regressive leftist, corporate shills, and moronic race-baiters. Find closed captions and translated subtitles in many languages on out website, but why would anyone bother, I don't know.

  • Reply Evil Tree March 27, 2016 at 7:45 am

    Thanks now I have internet cancer, Ted.

    Unsubbed.

  • Reply BlueEmber March 27, 2016 at 12:54 pm

    You can thank the Rockefeller's for current state of medicine. Their job is to murder while gaining a buck.

  • Reply VikingII March 27, 2016 at 11:08 pm

    It's always embarrassing when you get Blacks speaking on intellectually high-powered issues; They end up looking like ignorant children.

  • Reply Kwabena Kesseh March 28, 2016 at 9:50 pm

    People are really missing the point! Listen!

  • Reply Badplum25 April 2, 2016 at 4:19 pm

    Everyone who disliked didn't watch the whole video… Shes saying that you cant give medication based on race which is correct.

  • Reply Аlex Nelson April 7, 2016 at 1:51 pm

    This is one of the worst TED Talks I have ever seen.

  • Reply Dzidzai R April 9, 2016 at 12:36 am

    I should know better by now to watch the video before I read the comments.

  • Reply TheSpoonKing April 9, 2016 at 8:59 am

    I DON'T CARE WHETHER THERE IS ACTUAL PROOF FOR SOMETHING! IT OFFENDS ME AND THAT IS NOT OKAY!

  • Reply TheBaybunie April 9, 2016 at 5:58 pm

    Please visit my google+ page to read my comment on a race based medicine issue that was removed from this comment section.
    https://plus.google.com/111769994016300473908/posts

  • Reply Efrain Ovalles April 10, 2016 at 1:30 am

    i was good until she said race is a social construction. bleh.

  • Reply KaZzY April 15, 2016 at 3:30 am

    She has a great point, but she is adding in social justice things, I started to notice at around over 5 minutes.
    EDIT:
    Lower lung capacity? Many of these sprinters are non-white from what I know, although I don't watch them.

  • Reply Allen Chan April 15, 2016 at 4:00 am

    As an Asian finishing up my practicum as a Med Lab student, I need to disagree with her on a few levels. Categories of age, race, weight, and height are used because it IS useful information! Its not because we're attacking you personally! Like people mentioned in the comments below -sickle cell, thalassemia, lactose intolerance. All are examples of population genetics.

    I'm all for seeing everyone as equal. BECAUSE WE ARE! But when a patient doesn't want to disclose their race, age, sexual activity, height, it makes it 10x to treat the illness. I've never felt disclosing my ethnicity as a controversy. I'm Chinese. So what.

  • Reply Alex Trofimov April 21, 2016 at 5:12 am

    Thumbs up. It saddens me so much that this particular video doesn't have good ratings. I'm going to tell myself it's because Dorothy isn't a very good speaker. But I believe her message is true. In scientific, medical and political endeavors using race as a statistical proxy is too crude of a measure.

  • Reply 1111 May 12, 2016 at 5:06 pm

    The fact that this video gets so many dislikes is disturbing. Some people are almost trained to shoot down anything that even postulates equality even if it is scientifically better for everyone.

  • Reply ATL July 9, 2016 at 2:38 am

    Maybe to begin with it would be good to define what is race and what is race based medicine. I got 4 mins in and still no idea what she's talking about exactly.

    Maybe giving some example when referring thins like doctors ability to treat patients by race. What does that mean. Is this problem in some specific countries or some specific individuals or what's the case because I haven't heard about this being common where I live.

    Only thing to me that comes to mind when someone says race based medicine is that some medicine works better for black people since physiological differences(melatonin). If she's referring to something else I think it would be useful to establish that there's a problem instead of starting with personal story(which makes a good point, but doesn't by anyway establish if this was common problem with scientific studies or one in a million case or something in between.)

  • Reply Julio Alacarte July 27, 2016 at 2:52 am

    "Race is a social construct and has nothing to do with medicine".
    Yes? Tell that to all the Ashkenazi Jews and the higher incidence of some cancers on them. Tell that to the people from Mediterranean and their higher incidence of thalassemia. Tell that to some groups of Asian people that cannot tolerate alcohol because they do not express the enzyme like the western people, and the list goes on and on.
    Humans have been spreading through the world for centuries, and during these centuries, they have been exposed to different natural selection factors, such as climate, diet, infections, local predators and parasites. These factors, over time, affected and selected the penetrance and expressivity of some different genes in different groups. It is utterly insane to imagine that there is no biological difference between human groups after centuries of different exposures.
    Of course it is politically correct to call race "a social construct" or to pretend that our organisms work 100% the same way. But real life and biology does not care about good intentions my dear Dr. Even if you don't call it "race" because your politically correct social justice warrior limits does not allow you to, the fact is that deep biological and biochemical differences exist among different population groups. What you should say is: your skin color does not necessarily correlates to your complete genotype (and in such case you would be right). But you are saying something different: you are almost saying that "race does not exist and we are all biologically equal", and that is far from truth.
    I do understand your fear. You don’t want any lunatic justifying the social control of one group over other based in pure biological criteria. That’s totally fine and that’s why we have a constitution that says that, under law, everyone is equal. However, that does not allow you to pretend that some differences do not exist in the biological level when in fact they do. If we discover a treatment that reduces the development of cancer in Ashkenazi Jews but not in other groups, should we not use it because “it is racist”? That seems like a bad idea. If we think that a woman is more likely to have an autoimmune disease than a man are we being misogynist? Or are we just using common empirical sense (confirmed by numerous populational studies)?
    Even in humanities the social justice agenda has very little to do with logic, it is more about bigotry. We should be careful when using it in biology and medicine.

  • Reply noni cole October 7, 2016 at 12:32 pm

    I am so confused as to why people are so mad? Everyone in the comments is a scientific genius now? LMAO no one in the comments seems to be able to grasp even a small part of the message… and it has nothing to do with SJW lol actually SJW are infamous for rejecting science hahaha ignorance wow

  • Reply grubbymanz October 19, 2016 at 12:03 am

    Doctors collect a ton of information that isn't really relevant, and often not used. It's incredibly important though to understand ancestry and if not known then race is the next best substitute. It's important to understand african ancestry to include/exclude sickle cell anemia, and a Semitic background could include/exclude Tay-Sachs, caucasian males are predisposed toward cycstic fibrosis. And what is much more important is gender, doctors can't pretend to not care about whether someone was born with two XX chromosomes or XY, whether they have ovaries and a uterus or not. If doctors are racist that's one thing, and that's a problem, sickle cell crises is far too often called medication seeking. However bc of a social belief you'd limit information that could be relevant, we're not going to genotype everyone that comes to a general practitioners office, so we need to approximate genetic variation by knowing asian, african american, jewish, man, woman, child etc. All of that could be relevant. If this woman was a doctor she could have these exact same beliefs but also would recognize the need for some form of ancestry approximation.

  • Reply amytulip February 15, 2017 at 2:00 am

    Please don't waste your time. She is not a doctor and does not know whey she is talking about. Many trials are analyzed based on race and have strikingly different effects depending on race. Though this might not be the ideal way to analyze data, this is how it's done and this is much of what evidence based medicine is based on.

  • Reply Kameron Hansen February 18, 2017 at 1:10 pm

    Heard this on NPR, and was appalled… she made no sense at all. So glad and happy to see that it was rejected by everyone.

  • Reply Abhimanyu Karnawat March 13, 2017 at 3:16 am

    summary:i will ignore reality because feelings feelings feelings

  • Reply Ed B April 12, 2017 at 10:07 pm

    How about all your idiots go to the TED website and actually read some of the references in the Speaker's Footnotes.

  • Reply Thomas Smith April 20, 2017 at 2:36 am

    I'm tired of racist pill poppers

  • Reply JoMarie 87 July 21, 2017 at 6:16 pm

    I cant wait to get her book!

  • Reply Julie Torfin September 1, 2017 at 4:38 pm

    Related reading: Racial Differences in Response to Antihypertensive Therapy: Does One Size Fits All?
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3075515/ "

  • Reply Kokuzuma December 24, 2017 at 10:55 pm

    Don't even bother with this comment section. Take a deep breath and walk away. Do something constructive, creative. Leave your comfort zone. Expand your experiences. But don't look down this toilet of pseudo-scientists, whatever you decide to do.

    (Current medicine is based on the health of individuals, not the health of your so-called "races".)

  • Reply OkU2 January 2, 2018 at 10:08 pm

    This lady is brilliant!

  • Reply 小小白 March 6, 2018 at 8:21 am

    This is the exact problem with a lot of people in this country! The whole health care system is trying to provide the best care to this race, yet they victimize themselves by saying we are practicing racing medicine. Fine then, we can of course give you the anti HTN medicine that doesn't work on you, we can of course judge your GFR based on everybody else which is not accurate on you. How about we give you the same criteria for college admission and job recruitment? Shouldn't you be the one suing google and youtube by excluding white and asian males since you are not treated the same like them? Why don't you feel offended by that? Trying to pick a fight and not even know what to fight for. That is pathetic.

  • Reply Brantopias October 22, 2018 at 6:22 pm

    I'm sad I have to listen to this for my grade.

  • Reply Marcara081 October 29, 2018 at 6:14 am

    In America, 3/4 of blacks will develop hypertension while ~1/2 of whites will. This appears to be due to a higher sensitivity to salt. Furthermore, medication effective for whites isn't as effective for blacks. For this reason, different medications are prescribed ACCORDING TO RACE (then followed up according to individual efficacy).

    Not to mention that the race of the patient (in such settings) is determined through self-identification, meaning that we're very good at visual genome mapping when it comes to race. We could do it better, but is that a road you want to go down? You're going to find that evolution didn't stop at the neck and lots of things you wish you could attribute to society or your own personality are better attributed to your genes. Propensity toward violence, for example.

  • Reply Daniel Hansen October 30, 2018 at 3:34 am

    I appreciate the enthusiasm with which Ms. Roberts is confronting the difficult issue of inequalities within medicine regarding race. Unfortunately, I believe her efforts are misdirected in this case. A key Tennent of medicine is that doctors must abide by the principle of non-maleficence, that they will not harm patients, physically or psychologically. For those who have experienced racism first hand, a race-based drug could make someone weary, mistrusting, and inflict more psychological harm. I won’t pretend to know that feeling and am open to hearing more from those who have suffered through it and their views on this topic. The problem here is that by focusing in on a couple of instances where the inclusion of race into medical diagnostics may not be justified, she attempts to discredit the many real instances where it is immensely valuable. It would be both irresponsible and immoral, disregarding the promise of non-maleficence, for a physician to disregard valuable science to avoid appearing racist. Doctors have a moral imperative to help heal their patients, along with a legal obligation. If a doctor was examining a young child with Ashkenazi Jewish heritage who was displaying neurological deterioration, should they not be more inclined to strongly consider Tay Sachs disease? It is well documented that the HEXA gene is far more likely to be mutated within that population (https://www.genome.gov/10001220/learning-about-taysachs-disease/). It should not be racist to use facts, and there absolutely is a scientific precedent for practicing race-based medicine. If doctors did not utilize every tool at their disposal to help patients, they could become dangerously close to being negligent. A few factors define medical negligence. A physician simply not doing what you would expect a physician of average skill and competence to do is one of them.
    Ms. Roberts stated race-based medicine cannot be a substitute for evidence-based medicine. Race-based medicine is not inherently distinct from evidence based medicine and are often one in the same. There was no basis to claim BiDil marketing meant African-American physiology was deemed inferior, so the medication would not work as well on other races. Different does not equate to inferior, and that is a dangerous association to make. That is really the point we should be making to irradiate true racism. I did enjoy her final statements, and I agree that using race as the “quick and dirty” method for physicians should not be enough. We should dig deeper and look at the reasons behind the differences. Do more research into the exact genetic variations that cause the different outcomes we observe. In the meantime, however, we should treat patients with all the resources and information we have available. There are many places where racism in medicine is a real problem, and Ms. Roberts addressed a few of them. Those are the areas where I would love to hear more about the issues and solutions. Denying genetic variations amongst individuals and general population trends takes the focus away from where our efforts could truly make a difference.

  • Reply Emily McGovern November 1, 2018 at 5:14 am

    I would like to start by thanking Ms. Roberts for tackling a very important, timely and sensitive issue. In her discussion about race-based medicine, Ms. Roberts is addressing one of the four ethical principles followed by the medical community – justice. As healthcare providers, every physician vows to treat their patients with justice, that is to say, with fairness regardless of differences in race, social or economic status, etc. To pledge justice is to pledge fair and equal distribution of resources and treatments among all groups of patients. Ms. Roberts essentially argues that race-based medicine violates this ethical principle because certain racial groups like African Americans and Latino/as are subject to biases/stereotypes.

    However, genetic background can actually play a major role in disease risk and prevalence. Because it is not quite feasible to test everyone’s genome, physicians deduce this genetic background by asking for patients’ race. Race is one of many tools to help determine how to best screen, evaluate data, or make a diagnosis for a patient. This brings up another important ethical principle of beneficence – acting in the patient’s best interest. Knowing the race of an individual is a piece to the diagnostic puzzle and truly helps physicians do the most good for the patient. For instance, Tay-Sachs disease is more prevalent in the Ashkenazi Jewish population, African American males are at greater risk for prostate cancer, and those of the African descent have a higher frequency of sickle cell anemia. If you knew you were at a greater risk for a disease based on your racial/ancestral background, wouldn’t you want your physician to be aware of your background so they could help to better monitor, diagnose, and treat you?

    I understand Ms. Robert’s dissonance with having to check a box for race – as this must be especially confusing and seemingly inappropriate for someone of mixed racial descent. Perhaps asking a patient to list ancestral background (instead of being forced to check one box) would be a possible solution to this problem. Doctors may need to be more transparent with patients and explain the importance of knowing the ancestral background – this knowledge is ultimately for the benefit of the patient.

    I have the utmost respect for Ms. Roberts and her work with the important and sometimes controversial topic of race in medicine. This is clearly an issue that affects many aspects of the doctor-patient relationship and I think it warrants continued discussion and study.

  • Reply Lindsay Ellson November 1, 2018 at 2:23 pm

    “The Problem with Race Based Medicine” by Dorothy Roberts discusses how despite the fact that race is almost wholly biologically irrelevant, it can greatly influence an individual’s healthcare. Doctors are tasked with and entrusted to know a large amount of information. One way in which clinicians manage this challenge is to categorize patient test results and corresponding treatment by characteristics such as age, BMI, race, and so on. Race, unlike the others mentioned, is a social construct that is chosen by the patient based upon what they most closely identify with. Roberts states that race is “a crude, but convenient proxy for some greater factor,” citing certain tests indicate different parameters depending on the race of the patient. This statement is supported by Richard Lewontin, who surmises that race is often mistaken for heritage. If doctors are basing treatment off of a construct that does not accurately represent a patient’s genetics, this could lead to the improper allocation of resources. In these cases, patients may be deserving of treatments that precedent denies them. Roberts uses the treatment of long bone fractures as an example of the implications of race based medicine: Black and Latino patients were significantly less likely to receive pain medication than white patients with the same injury. Here, one would expect these groups to have received relatively similar levels of resources – in this case, pain medications. Rather, resources were not allocated justly because standards of care were based on “stereotypes that black and brown people feel less pain, exaggerate their pain, and are predisposed to drug addiction.” This systemic bias could prevent even the most impartial physicians from fulfilling the beneficence of the patient. That’s not to say that medical guidelines should be disbanded entirely. Rather, as Roberts suggests, guidelines should be based directly upon the [greater factors] such as muscle mass, or other appropriate physiological conditions. Admittedly, we may have to wait for genomic medicine to advance. Clinicians use race is to represent certain hereditary factors that can be determined only through sequencing that is not readily available. However, short cuts that are more biologically pertinent are still preferable. Physicians would be able to more accurately provide treatment in the best interest of the patient and more adequately allocate resources. Further, self-identified race may not be entirely clinically inconsequential because the “inequities caused by racism” are so extensive. For example, race could give some information as to the social pressures an individual has experienced. In this context, a clinician could gain a small amount of understanding in regards to the psychosocial aspect of the patient. Race is not an adequate biological indicator in healthcare and should not be included in medical guidelines nonetheless. Without this bias, clinicians will be more likely to deliver patient care in a manner that properly allocates resources and is congruent with beneficence.

  • Reply Garrett Clement November 2, 2018 at 5:28 am

    Treating individuals differently based on race has led to some of the most atrocious human rights violations in history, so it is incredibly important to discuss how race is used in medicine and evaluate whether or not its use is warranted. Dorothy Roberts’ overview of race-based medicine brings with it at least one accurate critique. Her example that that racial stereotypes can lead physicians to prescribe fewer pain medications to African-Americans and Latinos with long bone fractures when compared with Caucasian patients has validity and one that physicians must work to fix. However, many of her arguments seem to confuse “use of race” with “racism.” Merriam-Webster dictionary states that racism is “a belief that race is the primary determinant of human traits and capacities and that racial differences produce an inherent superiority of a particular race” (https://bit.ly/2gA53Hm). Using race in a way that injures patients could certainly be categorized as racism, but what if the evidence-based use of race benefits the patient?

    In medical ethics, one of the core principles of care that guide physicians in their treatment of patients is the concept of beneficence. Beneficence is the moral obligation to always act in a way that benefits the patient. If research has shown that race is a factor in the contraction of a disease or condition, the physician has a moral obligation to include race in their screening method for the benefit of the patient.

    There are many race-based associations that have been made using evidence-based research methods. For example, the prevalence of hypertension is higher in African American populations than in Caucasian populations (https://bit.ly/2QcKQGx). This knowledge allows doctors to educate their African American patients and teach them that their bodies retain sodium at a higher rate, enabling them to change their diet to decrease their sodium intake if they would like to lower their risk for cardiovascular disease. For patients that are of Ashkenazi Jewish descent, physicians can recommend tests that can identify Tay-Sachs disease due to its high prevalence within that sub-population.

    Someday, genetic testing may reach a point where all risk factors for diseases can be surmised from a patient’s unique DNA. For now, eliminating race from patient care is premature and risks hurting patient care because it removes a valuable positive correlation that benefits patients.

  • Reply itshardmakinganamefo January 20, 2019 at 2:02 am

    “Automatically assume I have more muscle mass than that female body builder”. 1) They don’t cause the body builder isn’t average. 2) makes sense black people are more muscular than anyone. Look at professional sports. 3) if you think this is a remotely accurate statement you evidently do not possess the intelligence to have authority on anything medical

  • Reply Princess Jauregui-Hansen March 31, 2019 at 3:00 pm

    And OF COURSE there will be loads of dislikes on this video.
    Oh well, great talk Ms. Roberts ❤

  • Reply Danielle Danielle October 10, 2019 at 8:26 pm

    The comments below demonstrate the exact problem Dorothy has identified with her research.

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