> Race isn’t a biological factor like age, sex or weight — it’s a social construct.
> In 1999, an equation used to calculate eGFR was modified to adjust Black people’s results compared to everyone else’s, based on some studies with small numbers of Black patients and a long-ago false theory about differences in creatinine levels.
> Black Americans are over three times more likely than white people to experience kidney failure.
so, is some racial metric reasonable or not? why are black Americans more likely to experience kidney failure - social issue, or biological?
was the study with a small number of participants repeated with a larger number?!
Interesting conjecture there AP, but I don't buy it. Surely race is a biological factor. Maybe not for kidney health specifically but wouldn't race be inextricably tied to a person's biology, heritage, medical history?
Race is determined at birth by parents' biology, therefore is biological. Not _everything_ that makes people different from one another is a purely social construct.
Don't black people get sickle cell at higher rates than other races? Race is important in a lot of medical contexts.
Great that they fixed the kidney thing but don't throw the baby out with the bathwater, or the next headline will be "excess deaths due to incorrect treatment of <condition> for <race>".
By all means if the race-based heuristics are unsound, throw them out, but the article makes mention of a bunch more that are under scrutiny. Are they really all inaccurate or are we discounting biology in favor of social justice?
Except that "black people" describes the color of someone's skin, and sickle cell prevalence is more properly tied to things that are much more specific than skin color, like the geographic origins of sickle cell disease. Which is why black people in Ethiopia and South Africa have low prevalence, and white people on mediterranean towns like Orchomenos have high prevalence. It's your social construct that lumps the idea of "black people" into a racial category in the first place and then associates that with sickle cell disease.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3708126/
https://web.archive.org/web/20140917070248/https://www.thegu...
Or melanoma? According to this, "white, non-hispanic" people develop melanoma at a rate of 26.1 per 100k while "black, non-hispanic" people develop it at a rate of 0.8 per 100k.
It seems apparent to me that there are at least _some_ cases where the social construct of "race" is useful in a clinical setting.
People generally don't consider dark skinned Indians and dark skinned Nigerians and dark skinned Peruvians to be the same race because they all have dark skin. They're just as different from each other as they are from me despite having more melanin.
> It seems apparent to me that there are at least _some_ cases where the social construct of "race" is useful in a clinical setting.
The concept of skin pigmentation is useful for things related to skin pigmentation. The concept of "race" is still artifice and absolutely the least useful proxy there is for whatever you're actually trying to measure in any given moment.
> Playing Devil's Advocate here
Please don't. https://bofh.org.uk/2018/10/25/devils-advocacy-without-tears...
But it seems we agree that my highly generalized social construct wouldn't invalidate the biological factors at play that expose more specific racial groups to higher/lower risk of certain conditions.
My fear is that we have to make certain we are only removing the social constructs and not the biological ones when we purge racial considerations from medicine. Quality of patient care will inevitably suffer otherwise.
There are always biological factors at play, but this premise of "race" as applied by anyone ever is always basically mythological and not related to biological differences in a meaningful way that isn't (at the risk of sounding dismissive, for which I apologize up front) racist. Sickle cell is actually the perfect example of this. The people of Namibia and Angola look the same to me. They're even from neighboring countries. And yet their cultures are very different certainly, their languages are different, one has high sickle cell prevalence and the other does not... So are black people from Namibia and Angola the same race if they don't have that genetic variation in common? What about other genetic things they don't share? What about the genetic things they share with white Americans? Are a black person from Tamil Nadu, a black person from Ethiopia, a black person from Mali, and a black person from Papua New Guinea the same "race"? They don't look the same to me aside from having dark skin. Are my black neighbors the same race? They also don't look the same aside from having dark skin. Probably none of them are carriers of sickle cell trait. Is there something identifiable they all share that they don't also often share with white populations?
But race is just one specific grouping. There's nothing magic about it. It's not even consistent over space or time what the categories are or who gets categorized into which. When people say race is constructed, one thing they are saying is that our culture has produced this one grouping dominates our thinking of the variability between humans. And that critically we have embedded that into our society in a way that creates outcomes based on race.
When it comes to disease, "black" in particular is a TERRIBLE category, because there are a huge number of population groups that all get labelled black, even though they have different genetics, different issues, different ethnic behaviors. It's maybe hard to to better in the US given that the slave trade erased people's knowledge of where they came from and accelerated mixing. But also nobody is really trying to do better because racial categorization and anti-blackness is so embedded in American thinking. Compare this situation to where "white" Americans often know (or at least have some way to try to know some fraction) of their European ancestry.
Yes; e.g. melanoma is 30x more prevalent in non-Hispanic white people than in black people.
If you define "race" to mean a population with a similar genetic diversity as Caucasians, then there are 4 to 5 black races within Africa alone.
that sounds like if a child grows in different social environment it may have different skin color, eye shape and other attributes ascribed to the race. Btw, in USSR in 194x-195x similar theory was a prevalent biological theory (professor Lysenko) greatly supported by the Communist Party against the "bourgeois theory of genetics", and the people who dared to challenge that theory were ostracized, fired, sent to GULAG.
*Beyond the degree that everyone is related.
I need to ask: what is race, specifically?
Living beings don't inherit traits in a consistent manner, otherwise all siblings would have been identical.
Most likely there are people who have parents of different skin tones who inherited the darker of the two but not the vulnerability to sickle cell anemia.
Actually looking this up, seems the notion of race as social vs biological is hotly contested. This is new to me! Fair to say it's a social construct with a biological cause and potential biological implications, then?
I'm all for knocking down biases, just don't want to throw out good data in the process. What's the margin of error on dark skinned people with sickle cell?
Or perhaps more relevant - black people's kidneys were thought to be _healthier_ when it turns out they're 3x more likely to have kidney disease. At first glance this sounds like a very large error but I'm interested in how much of that is biological vs societal risk. Is it really as big of an error as it sounds? What if they start out with healthier kidneys, the +3x comes from somewhere else, and we're correcting far too late in the game when we jostle the transplant line?
Clusters on the biological spectrum of the human species formed on the basis of easily recognizable superficial phenotypical traits?
Race is roughly correlated with ancestry especially in places where mating between races was discouraged. So often race is a close enough measure of family history, but make no mistake, there is no pure members of a race.
If there is a biological race like construct it doesn't match with whatever races your country's census records.
Black people are much more likely to have sickle cell disease. White people are much more likely to have melanoma. Ashkenazi Jews (and the Cajun) are much more likely to have Tay-Sachs.
Newspaper descriptions of people frequently say if they are 2D or 4D, especially if crime is involved. Job applications ask if you are 2D or 4D. There have to be laws banning 2D and 4D discrimination because it's so common.
You tell them it's crazy that they spend so much time worrying about 2D vs 4D. That it hardly matters! In return they tell you of course digit-race exists! You can easily measure it, and it's partly heritable. In fact it's scientifically unsound to ignore digit-race because it correlates with so many health issues [1].
Your cries that those health issues would be better understood with other ways of thinking about populations are ignored.
How would cystic fibrosis pick its targets based on a social construct? Look up its very imbalanced prevalence.
So, if the prevalence of cystic fibrosis is indeed race-based, then we can't just assume that kidney function isn't.
