Why do doctors practice race-based medicine?

by Dorothy Roberts, guest contributor

Biological scientists established decades ago that the human species can’t be divided into genetically discrete races. Social scientists have shown that the racial classifications we use today are invented social groupings. And historians of medicine have traced doctors’ current practice of treating patients by race to justifications for slavery. Doctors I’ve talked to readily concede that race is a “crude” proxy for patients’ individual characteristics and clinical indicators. Countless patients have been misdiagnosed and treated unjustly because of their race.

So why do doctors cling so fiercely to race-based medicine?

BWSyringe2One reason is force of habit. For generations, beginning in the slavery era, medical students have been taught to take the patient’s race into account. Race is built into the foundations of medical education, which assumes that people of different races are biologically distinct from each other and suffer from diseases in peculiar ways. What’s more, medical students aren’t given much latitude to question the lessons they are taught about race.  Without a radical disruption, these students go on to train the next generation of doctors with the same flawed racial dogmas.

Another reason is that doctors aren’t immune from commonly-held racial stereotypes and misunderstandings. Most Americans believe some version of a biological concept of race, and doctors are no exception. In fact, the entire field of biology has been plagued by controversy and confusion over the meaning of race. It is not surprising that the medical profession would be influenced by racial thinking that has been perpetuated in U.S. education, culture, and politics for centuries.

In addition, there are institutional and commercial incentives to continue practicing medicine by race. Starting in the 1980s, the federal government required the scientific use of racial categories to ensure greater participation of minorities in clinical research and to address health disparities. Unfortunately, this effort to diversify clinical studies focused on biological rather than social inequalities and has reinforced genetic definitions of race.  In 2005, the federal Food and Drug Administration approved the first race-specific drug, a therapy for African-American patients with heart failure, that was repackaged as a race-based pill to enable the cardiologist who developed it to obtain a patent. Labeling drugs by race may be financially advantageous to pharmaceutical companies by providing a marketing niche and an avenue for FDA approval. The biomedical research and pharmaceutical industries have tremendous influence over how medicine is practiced.

Doctors are quick to bristle at any suggestion that treating patients by race results from their own racial prejudice. They disavow any connection to blatantly racist medicine of the past—the horrific treatment of enslaved Africans; unethical medical experimentation on African Americans, such as the Tuskegee Syphilis Study and use of Henrietta Lacks’ cancer cells; Jim Crow segregation of medical services; and mass sterilization of black, Mexican-origin, Puerto Rican, and Native American women in the 1960s and 1970s.

Doctors argue that they are using race for benevolent reasons or, at most, as a benign way to classify their patients. But race is not a benign category. Race was invented to support racism and it is inextricably tied to racial oppression and the struggle against it. There is no biological reason to divide human beings into white, black, yellow, and red. Race seems natural only because we have been taught to see each other this way. Sometimes, when I speak to doctors about this topic, I can see their physical discomfort with giving up their reliance on race. It feels like asking deeply religious people to give up their belief in their deity. Race is more than an ordinary medical feature—it is part of people’s deeply-held identities, their sense of their place in society, and their view of how the world is ordered. This is why ending race-based medicine will require a great leap of imagination, a new vision of humanity tied to a movement for racial justice.

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Global scholar, University of Pennsylvania civil rights sociologist, and law professor Dorothy Roberts exposes the myths of race-based medicine in her TEDMED 2015 talk.

Magic Medicine? The wonders of nanomedicine

by Daniel Kohane

The content, views and opinions expressed in this blog post are those of the author(s) and do not imply endorsement by TEDMED. By inviting guest bloggers, TEDMED hopes to share a variety of perspectives that provoke and engage our community in discussion and debate.

Imagine being able to treat your medical condition immediately when you need to, safely, and without input from anybody else. No waiting to see your doctor, no wondering whether that extra dose of medicine will be too much.

Sound like magic? Well, that is exactly what many of us scientists in nanomedicine believe is right around the corner. And we are proposing the use of a “wand” to make it happen.

“Sometimes you can achieve big things by thinking very small.” Daniel Kohane at TEDMED 2014

“Sometimes you can achieve big things by thinking very small.” Daniel Kohane at TEDMED 2014

Here’s how it would work in a patient with chronic pain. Such a patient would likely have pain that would wax and wane throughout the course of the day and during the night. His/her need for relief would also fluctuate, depending on activity and effort level. Currently, oral pain pills would generally be used to treat the condition, which would take effect sooner or later, and might or might not make the patient adequately comfortable. In some cases, the medicines could make the patient too comfortable, or effectively stoned. The wand could make all of this so much better.

The wand would actually be a laser, or another powerful light source. The patient would place the laser over the painful area and press a button, firing near-infrared light into the affected tissue, where the patient’s physician had injected or implanted a reservoir of drugs. That reservoir would have been built with light-sensitive nanostructures (like those in my TEDMED talk) so that it would respond to a specific light fired by the laser by releasing those drugs. So, using the wand would cause pain medications to be released at the site where the pain is – and only there; no getting stoned with this treatment. And by varying the intensity and duration of the light beam, the patient would be able to determine exactly how much pain relief is delivered, and for how long.

This approach need not be limited to pain; it could be used for a wide range of diseases, in many parts of the body. And the wand need not use light. Scientists have shown that similar effects can be achieved with oscillating magnetic fields, ultrasound, electricity, and many other energy sources. In fact, people are now looking at drug-releasing devices that would not even require the wand component – there would be indwelling sensors on the device that could sense when a drug needed to be released. Alternatively, the devices could have computerized programming that would enable complex patterns of drug release suitable for a particular disease. That process would remove the burden from the patient of having to self-administer injectable drugs several times a day.

As nanoscience gets increasingly sophisticated, it opens up possibilities for medicines that are specific, targeted, with fewer side effects, and easier to deploy. While the potential is not truly magical, they are certainly parts of this field that previous generations of physicians, scientists, and patients would have thought impossible.

At TEDMED 2014, Daniel Kohane, Professor of Anesthesia at Harvard Medical School and a Senior Associate in Pediatric Critical Care at Boston Children’s Hospital, revealed some of the amazing work he’s doing with nanoparticle technology to transform the power, safety, and specificity of drugs. 

2015’s Research Scholars: Another Peek into What Makes a Great TEDMED Talk

Earlier this year, we shared details around some of the critical elements that support TEDMED’s editorial process. Specifically, we shared our core values, code of ethics, speaker selection process and the addition of TEDMED’s inaugural Editorial Advisory Board (EAB). As we explained, our EAB members advise TEDMED on topics, themes and speakers that should be considered when creating our annual stage program.

Now, as we prepare to announce this year’s program and speaker line-up, we want to give you a peek into another significant group that contributes to our editorial process: the TEDMED 2015 Research Scholars.

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When TEDMED curates the talks that are being considered for the stage each year, topics range literally from A (autoimmune disease) to Z (zona pellucida). To assist us with reviewing and researching the deep science behind potential topics, themes and speakers, TEDMED relies on outside feedback from our Research Scholars who are a diverse group of carefully selected experts.

Our Scholars are equipped with the professional training, objective knowledge and institutional credibility required to give TEDMED a wealth of insights, informed perspectives and thoughtful suggestions for further queries and investigation. TEDMED assembles Research Scholars from across the biomedical spectrum: university faculty, post-docs, grad students, public health professionals, entrepreneurs, science journalists and medical students from leading institutions and associations.

It’s no mystery why our Scholars break away from their busy schedules to volunteer their time in support of TEDMED’s mission. Each is a person of extraordinarily generous spirit; and, each is passionate about making a difference in health and medicine. We are proud to count the TEDMED Research Scholars as valued members of the TEDMED community…and we thank them for their outstanding contributions.

Without further ado…we are honored to recognize the Research Scholars for TEDMED 2015. See the full list here.

Stay informed as details around TEDMED 2015 continue to be shared. Follow us on Twitter and Facebook, and consider registering today for TEDMED 2015 in Palm Springs, November 18-20, at the beautiful historic La Quinta Resort! We’ll begin announcing details of the program next week.

Healing Metaphors – A Q&A with Abraham Verghese

At TEDMED 2014, physician and author Abraham Verghese shared a compelling and original perspective on the impact of language on medicine. In the Q&A below, he reveals more about how embracing our creative selves can help preserve the humanity in healthcare.

Abraham shares why it's important to breathe life back into medical language. [Photo: Kevork Djansezian, for TEDMED]

Abraham shares why it’s important to breathe life back into medical language. [Photo: Kevork Djansezian, for TEDMED] 

Why does this talk matter now? What impact do you hope the talk will have?

I was struck by the colorful metaphors that peppered medical descriptions in years past – the “strawberry” tongue, the “Mulberry” molar, the “Apple core” lesion of the colon, and so many more. I’ve found it so hard to believe that – with the avalanche of new diseases, new science and new technology – we simply haven’t developed new metaphors quite as colorful as the “saber-shinned tibia” or the “crackpot’s skull” of years past. It’s a peculiar atrophy of the imagination at a time when our scientific imagination knows no bounds. I think our right brains are churning, wanting to label and make colorful and to connect, but the imagined constraints of science and data have introduced a peculiar self-consciousness. I’m hoping that my talk encourages us to create more eponyms, more metaphors, and more colorful ways of capturing this incredible time we live in.

What is the legacy you want to leave?

I’d like to think that, in the era of tremendous advances in science and in medicine, I tried to keep us from losing sight of the patient, that vulnerable human being who gave us the great privilege of being with them at their time of need. What that human being needs in addition to our robotic technology, our beautiful diagnostic tools, is a caring relationship with another human being. I’d like to think that I spoke strongly for that and that I introduced a generation or more of students to the bedside and to that special privilege.

William Osler is quoted as saying that he desired no other epitaph “…than the statement that I taught medical students in the wards, as I regard this as by far the most useful and important work I have been called upon to do.” I don’t know that he actually used that on his tombstone, but I understand the sentiment. Every single student I work with at the bedside (even though the process might seem inefficient to be working with just one or two students) has the potential to go out and, in a lifetime, care for hundreds and thousands of patients. So, if you influence them well, you truly have leveraged something in the best sense of that word. I’d like my legacy to be about that work, both at the physical bedside but also metaphorically, and having brought readers and listeners to that sacred space and having perhaps conveyed in every manner that I could, the romance and passion and privilege of being in medicine. It’s not a business and never will be. Even though it enriches a lot of people, and even though it seems to be very much a business, medicine will always be a calling.

What’s next for you?

I have in mind the shaping of something I am calling “The Center for the Patient and Physician,” which I think of as a place to explore every aspect of the patient-physician relationship. At one level it will be pedagogy, teaching at the bedside and refining methods for teachers. But it will also be bringing in folks from a multitude of disciplines. For example from anthropology and ethnography to look at the patient-physician interaction, or tapping into bioengineering and design schools to look at the spaces where we interact. Perhaps, using population health sciences to look at influences on large populations of certain styles of physician-patient relationship. Or serving as a locale where postdocs and scholars who are interested in any aspect of this, can develop their craft – from studying empathy, compassion and caring to developing the next generation of pocket tools.

Are there any action items that you want your viewers to take?

Invent a metaphor that captures the work you do! If something could be named after you, what would it be? Go ahead, don’t feel shy!

What is Culinary Medicine? Q&A with John La Puma

Nutrition specialist, chef, author, and practicing physician John La Puma lives and works on an organic farm in California. He makes his garbanzo guacamole recipe on the TEDMED stage while sharing his philosophy that the food we eat is as important as the pills we take, a key component of preventive health and our well being.  On the TEDMED Blog, John elaborates on culinary medicine and what role patients may have taking charge of their health and even educating their physicians about how to consider nutrition as part of the treatment plan.

John La Puma on culinary medicine

“Food is the most important healthcare intervention we have against chronic disease.” John La Puma, TEDMED 2014. Photo: Jerod Harris for TEDMED.

Why does this talk matter now?

Patients who ask their doctors, “What should I eat for my condition?” really want answers. Meanwhile, clinicians are clamoring for more and better information and training on nutrition. Culinary medicine is a new evidence-based field in medicine that blends the art of food and cooking with the science of medicine to yield high-quality meals and beverages which aim to improve the patient’s condition. It is already being taught in both undergraduate and postgraduate medical education.

What impact do you hope the talk will have?

I hope that the talk will help accelerate the cultural shift in healthcare towards wellness and well-being as primary goals in medicine. People need to know that some physicians care deeply about helping them become well with what they eat.

What is the legacy you want to leave?

Our mission is to inspire health-conscious consumers to look, feel and actually be measurably healthier by what they eat. The opportunity to use culinary medicine to prevent and treat disease is substantial, and culinary medicine should be considered as part of both the medical history and treatment plan in medicine.

How would medicine change if your ideas become reality?

All clinicians should be able to write culinary medicine prescriptions and know how food, like medicine, works in the body. I’d like to see condition-specific food and lifestyle measures become something that clinicians can offer, effectively, before prescription medication for most chronic conditions.

What is your core belief about culinary medicine?

Everyone has a right to clean, healthful, delicious, real food that both satisfies their appetite and makes or keeps them well…before it may be too late to offer more than comfort food.

Please share anything else you wish you could have included in your talk.

70% of heart disease, stroke, diabetes, memory loss, premature wrinkling and impotence are preventable. 80% of cancers and much of asthma and lung disease are preventable, and from environmental causes, like toxin exposure or diet.*  Knowing more about what’s in your food and how it got there can help you take your own health into your own hands, save you money and provide joy and energy for those you love. With culinary medicine, health-conscious people can live life to its youngest.

Ask your doctor, “What do I eat for my condition?”  If he or she doesn’t know, do your own research- here’s my list of resources.

Now it’s time to try John’s Luscious & Rich Garbanzo Guacamole recipe!

1 ripe medium avocado, preferably Haas

1 medium clove of garlic, peeled, diced and creamed with lime zest

1 medium serrano chile pepper, stemmed and diced, but not seeded

1/4 teaspoon minced lime zest, preferably organic

2 tablespoons fresh lime juice (about 1 medium lime)

1 tablespoon extra virgin olive oil, COOC preferred

1/2 cup cooked chickpeas, rinsed and drained

1/2 teaspoon yellow curry powder, such as Madras curry

1/4 teaspoon black pepper

5 sturdy springs cilantro or Italian flat leaf parsley (optional)

Cut the avocado in half long-wise around the pit and separate the halves. Remove the pit.

Use a spoon to scoop around the flesh and remove it in one piece.

Place upside down on a cutting board, dice into large chunks. Scoop up and place in a large stainless steel bowl.

Add the garlic, chile, zest, juice and oil, and mix by hand with a fork or a tablespoon.

Smash the chickpeas with the flat side of a chef’s knife, to break the skin. Sprinkle the curry and black pepper on the garbanzos, add to the bowl, mix again, and top with herb garnish if desired.

Serve with corn tortillas or toasted chips, sliced jicama triangles and sliced cucumber circles. Enjoy!

Nutritional Data Per Serving (3 servings):193 calories, 17 g carbs, 14 g fat, 3 g protein, 125 mg sodium, 7 gram fiber.

Adapted from La Puma J. “ChefMD’s Big Book of Culinary Medicine”, Crown, 2008.

(c) John La Puma, MD, Santa Barbara, CA, 10.2013

*See John’s TEDMED bio page for references and resources that support these claims.

How ultrasound became a disruptive innovation

Resa Lewiss, Director of Point-of-Care Ultrasound and Associate Professor of Emergency Medicine and Radiology at the University of Colorado School of Medicine, unlocked imaginations about ultrasound applications in her talk at TEDMED2014. She explained why and how ultrasound at the bedside has become a game changer for clinical care.

She recently took a moment from her duties in Denver to share more about her work and impressions of TEDMED.

Resa Lewiss: How Ultrasound Has Become a Disruptive Innovation

Reas Lewiss at TEDMED2014. Photo by Sandy Huffaker for TEDMED

What motivated you to speak at TEDMED?

I attended TEDMED2013 in Washington DC. I was inspired by the people, the space and the vision of TEDMED. I believe that the arts inspire creativity and innovation. And innovation begets innovation. I live the aphorism mens sana in corpore sano, [a sound mind in a sound body]. TEDMED does too.

Why does this talk matter now? What impact do you hope the talk will have?

This talk will hopefully deconstruct healthcare silos. Point-of-care in partnership with ultrasound can be a concept that is difficult to comprehend. I hope to have connected the dots between the technology and the resultant improvement in patient care- for health care providers, people in tech and people in the world. The safety profile, time efficiency and cost effectiveness are self-evident.

Tell us about the top 3 TEDMED2014 talks or performances that left an impression with you.

Jill Vialet: Sobering reminder for ourselves and loved ones. Play is healthy.

Barbara Natterson-Horowitz: Back to basics, obvious and inherent and yet never quite articulated in this way before.

Bob Carey: Honest and emotional. Much respect for his willingness to show his vulnerability; a sobering performance.

Robin Guenther: She hit it on the head. Who is looking out for the healing and healers? Thank goodness she is. Mens sana in corpore sano.

What is the legacy you want to leave?

One of quality, integrity, justice, honesty, excellence, and mindfulness.

Contact Resa to learn more about how to encourage point-of-care ultrasound curricula integration at all medical schools and for all providers.

Resa Lewiss at TEDMED2014. Photo by Sandy Huffaker for TEDMED.