I Am a Racially Profiling Doctor

May 8, 2002 11:10 AM

I Am a Racially Profiling Doctor "In practicing medicine, I am not colorblind. I always take note of my patient's race. So do many of my colleagues. We do it because certain diseases and treatment responses cluster by ethnicity." (NYTimes link)
posted by Irontom (30 comments total)

Please read the linked article before engaging in the inevitable flamewar...
posted by Irontom at 11:10 AM on May 8, 2002

i have heard many times that members of some ethnic groups are more predisposed to particular ailments. insofar as one does not refer to racial profiling used as a denial of treatment by a doctor, i think it's beneficial. the doctor could then educate another concerning risks and steps to avoid them. of course, insurance companies have used racial profiling to aid methods for denial of treatment, such as instituting higher premiums. (and have been sued. and have lost said lawsuits. see Life Insurance of Georgia.)
posted by moz at 11:18 AM on May 8, 2002

I wonder if some day we'll come to an enlightened, mature view of race. If there's a medically significant difference, there's a medically significant difference. Trying to change scientific truth with words and ideas -- no matter how well intentioned -- is just a fool's game. If I was black and a particular medicine worked either more or less well for me, you better believe I'd want my doctor to take my race into account.
posted by pardonyou? at 11:24 AM on May 8, 2002

Speaking as someone who has already been treated for Hepatitis C and responded well to it, thank goodness, I happen to know that my physician did take ethnicity into consideration, and very openly at that. Besides the fact that she is a black woman, she also had no problem discussing racial statistics with me, based on the same medical findings discussed in the article. I just don't understand what all the hubbub is about. Profiling in this case, is not used without regard for fair treatment. It is used as a medical profile, just as I am profiled as being female and would not be treated the same as a man would. The reasons are legitimate.
posted by Quixoticlife at 11:28 AM on May 8, 2002

Makes total sense to me. Many diseases and conditions do cluster by race. As long as the profiling is used as only a diagnostic heuristic without ruling out other possibilities it will do no harm and probably boost efficiency.

There really isn't much point in testing most young white people who have joint pain for sickle cell anemia unless other more likely possibilities have been ruled out.

However doctors need to be cautious that the heuristics don't become rules becuase statistical clusters are just that and no more. Outliers always exist.
posted by srboisvert at 11:34 AM on May 8, 2002

I agree with everyone else. This isn't "racial profiling" so much as it is informed medicine. Because we all want to be treated as "just people" socially and ethically, does not mean that all people are exactly the same and the only difference is pigmentation.

For example, Lebanese, some other Middle Eastern races and many African races (but not all) are highly reactive to quinine derivatives. Makes them very sick. Whereas most Asian races and most Anglo races have no trouble with it.

There are some conditions which are known to statistically occur more often within some racial types. Should that date just be ignored and those people left to deal with it? If there are no racial differences that are acceptable to be used in medicine, then what standard should be used? That of a white, middle aged male of European heritage? Is that any more valid that the Asian or African or Semite, or list ad infinitum?

Égalité, pas conformité! :)
posted by dejah420 at 12:02 PM on May 8, 2002

No one's going to flame on this post, because for all the teasers about "racial profiling," what this doctor is doing is so clearly benign that I will be perfectly astonished if it manages to snag even a single negative comment. In fact, it's really just an example of the Times' using a hot-button word to get you to read a perfectly ordinary -- in fact, pretty dull and obvious article.
posted by Faze at 12:59 PM on May 8, 2002

No flamewar here irontom. I'm wondering how you view this as racial profiling. This is not a bait but a serious inquiry since you stated it at the top of your post. Personally I'm having a real hard time seeing it but then I may need to see it through different eyes.

This pretty much sums it up for me:

''Rather than casting our net broadly, doctors quickly focus on a problem by recognizing patterns that have clinical significance,''
posted by KevinSkomsvold at 1:16 PM on May 8, 2002

Somewhere--on a letters page? a blog? where?--I read a very sensible response to this article by a physician, who pointed out that what Satel represented as radically anti-PC behavior was in fact standard medical procedure. (In other words, she was nowhere near as interesting, or provocative, as she thought she was.)
posted by thomas j wise at 1:17 PM on May 8, 2002

This isn't racial profiling in the traditional sense. There's nothing to take exception to here. There are all sorts of genetic disorders that only afflict individuals of a certain lineage -- be they African, Eastern European Jewish, Asian, etc. It's just good medicine.
posted by donkeyschlong at 1:17 PM on May 8, 2002

Correction -- not "only," but "statistically more often."
posted by donkeyschlong at 1:19 PM on May 8, 2002

All right, in the interests of toastying up this thread a bit:

What we seem to be saying is that it's OK to take race into account in a medical diagnosis because it's in the best interest of the patient ("client"). Doctors being the professionals that they are, they've gotta take every possibility into account. OK so far.

Policemen are also professionals, also deal in life or death situations, and need to keep what's in their client's (IE, the tax-payin' public's) best interest at the top of their priority list. So, if 90% of the crimes in a community are committed by blacks, well, it's in the best interest of the community (IE, our policeman's top priority, client satisfaction) to lock up all the black people.

And hey, it might work. It might (not saying "will", saying "might", hypothetically) cut crime by 90%. But it would do so *at the cost of doing the morally wrong thing.* Just because the technique works and saves lives does not make it the right thing to do.

For what it's worth, my father died of Hep C because it wasn't a disease that anybody expected to find in a middle-class, middle-aged white male.
posted by hob at 1:37 PM on May 8, 2002

Except profiling patients doesn't punish "innocent" people, whereas criminal profiling often does (just look at all the death row snafus coming to light) ... and our legal system is founded on a principle of presumed innocence ... or am I wrong?

I think it's comparing apples and oranges. The doctor mentioned in the article is trying to be provocative by mischaracterizing something beneficial.
posted by artifex at 1:42 PM on May 8, 2002

Race is a confusing word. E.g., Tay-Sachs disease, a heritable metabolic disorder, is caused by mutations in both alleles of a gene (HEXA) on chromosome 15. This genetic marker is commonly associated with Ashkenazi Jews and the French Canadians of Southeastern Quebec. It would be just as logical to lump these populations into a "race" based on that marker. If this population demonstrated signs of Tay-Sachs, profiling would indicate screen gene 15 first. No big deal.
What races would exist in a world of the blind?
posted by quercus at 1:46 PM on May 8, 2002

Hey, that's a good question, quercus. What racial cues to blind people perceive, if any? I mean, aside from the obvious, i.e. if a person has a broad speaking accent, or something.
posted by Faze at 1:52 PM on May 8, 2002

The doctor mentioned in the article is trying to be provocative by mischaracterizing something beneficial.

Well, so am I, dammit, stop queering my spin ;)

Actually, I think I gave an example at the bottom there of what harm this sort of thing can do. If criminal racial profiling can result in mis-conviction, then medical profiling can result in mis-diagnosis. Which is just as unfair, just as deadly, and just as frustrating.
posted by hob at 1:54 PM on May 8, 2002

True -- medical profiling is only useful as a tool in the aresenal of inquiry; it shouldn't be a be-all-end-all solution.
posted by artifex at 2:01 PM on May 8, 2002

medical profiling does not strike me as such a terribly worrisome phenomenon, however. patients are mostly not told "you have this disease"; they are told "you have these symptoms, and you have such and such chances of having this or that disease." while i would not normally consider race a "symptom" i would consider it a directly correlative factor that the doctor should mention along with other symptoms to strengthen or weaken a theory. it would seem to me that your doctor would have to be grossly ignorant to simply tell you that you have this disease (and that you need this procedure), which can and does happen. there are legal methods in place to handle this scenario, though. sue for malpractice. racial profiling by policemen seems to me like a potentially much broader problem with fewer options for the victim.
posted by moz at 2:10 PM on May 8, 2002

while i would not normally consider race a "symptom" i would consider it a directly correlative factor that the doctor should mention along with other symptoms to strengthen or weaken a theory.

Ladies and gentlemen of the jury, I would like to direct your attention to the following statistics...
posted by hob at 2:17 PM on May 8, 2002

What racial cues to blind people perceive, if any?

This is a provocative question. My intuition tells me that blind people sense racial differences but what they see in their "mind's eye" would be completely different (especially for the blind-since-birth). Although, a blind person may be able to tell a black from white person, they don't have the color associations of white = pure/good and black/brown = dirty/bad that we seeing people have.
posted by plaino at 2:24 PM on May 8, 2002

be they African, Eastern European Jewish, Asian,

But "African" or "Asia" and "Eastern European Jewish" are not parallels. Eastern European Jewish consists of, what, a few hundred thousand people? A few miillion maybe? And geographically, the area is relatively small. Africa is enormous, with thousands of localized populations. There is much more genetic diversity in "Africa" than in the small population you try to compare it to.

The problem isn't "race" per se, but color. Race is a vague term. There are absolutely some diseases that are prevalent within a specific gene pool. The problem is that there are many populations that look the same at first glance, but which are completely separate from one another. If you say someone is "black" you don't know if they're ancestry is Jamaican or Kenyan or Aboriginal Austrailian. And the diversity between those ethnic groups is enormous.

Similarly, if I come from an African-American community, for example, but have extremely light skin due to some recessive genes, I still may be at increased risk for sickle-cell anemia. But you'd "never tell by looking at me". That's where generalizing based on color becomes dangerous.
posted by jpoulos at 2:33 PM on May 8, 2002 [1 favorite]

Although, a blind person may be able to tell a black from white person, they don't have the color associations of white = pure/good and black/brown = dirty/bad that we seeing people have.

Plaino, though I haven't talked to any blind people about this, I would guess the opposite might be more true.

A person who has been blind since birth in the Western world has undoubtedly heard of some of the concepts associated with specific colors. Wedding dresses are white, bad guys wear black, etc.

However, that person has never actually seen the colors "white" and "black." There is no visual component to that person's idea of the meaning of those words. Therefore, all they can associate with the name of the color is the culturally linked concept, not the actual color.

As for the main thread, well, I would hope that doctors are using reliable means of diagnosis and asking questions when necessary. If the light-skinned person in jpoulos' example displayed symptoms of sickle-cell anemia, for example, perhaps that would be an appropriate time for the doctor to ask about that person's ancestry.
posted by gohlkus at 2:51 PM on May 8, 2002

Policemen are also professionals, also deal in life or death situations, and need to keep what's in their client's (IE, the tax-payin' public's) best interest at the top of their priority list. So, if 90% of the crimes in a community are committed by blacks, well, it's in the best interest of the community (IE, our policeman's top priority, client satisfaction) to lock up all the black people.


Well, there is a circular argument here. Especially with the war on drugs it is interesting that public health studies reveal almost equal rates of drug use and drug trading based on ethnicity while legal documents show disproportionate arrests and convictions of African Americans.

Race is a scientifically difficult concept. After all, people who are from different cultures classify the world very differently in regards to race. A very crude joke from an earlier time jokes that you can't shake any family tree in the United States without a slave and an Irishman falling out of the branches. As a result, most attempts to actually quantify race by using genetics or skeletal features tends to yield probabilities rather than absolute categories.
posted by KirkJobSluder at 2:57 PM on May 8, 2002

it is interesting that public health studies reveal almost equal rates of drug use and drug trading based on ethnicity while legal documents show disproportionate arrests and convictions of African Americans.

This is exactly my point. We assume in the above statement that the health studies are accurate and do not reflect bias while the legal studies are accurate and do reflect bias. What happens when we're told that a physician (or, by extension, a researcher) is more likely to screen for Condition X if the patient is of Ethnicity A than if he or she is of Ethnicity B? Well, the rates of Condition X found among Ethnicity A wil come across as being statistically higher than among Ethnicity B, even if the real rates are near equal, *because* it is looked for more often.

Is it possible that, perhaps, *more* whites than blacks use drugs, but we don't see that because blacks are more likely to get asked and/or tested to see if they use drugs than whites? Well, we don't know, 'cause we're being told that yes, indeed, the numbers are skewed.
posted by hob at 3:15 PM on May 8, 2002

Jpoulos and quercus got it.... Skin color does not equal race. Genetic profiling would be more accurate than racial profiling, as skin color can be deceiving. Actually though, my doctor brought up this point with my mother one time when I was in the office, that often times when doctors have a group of patients that come in with similar illnesses, they start to look for that illness in patients that don't have it, and it leads to misdiagnosis. Doctors are only human, and they can't help but search for patterns, but it is a dangerous game.
posted by banished at 3:23 PM on May 8, 2002

What happens when we're told that a physician (or, by extension, a researcher) is more likely to screen for Condition X if the patient is of Ethnicity A than if he or she is of Ethnicity B? Well, the rates of Condition X found among Ethnicity A wil come across as being statistically higher than among Ethnicity B, even if the real rates are near equal, *because* it is looked for more often.

where did it start then, hob? people didn't always screen more often for certain conditions among ethnicities, i would suppose. perhaps the CDC wonder could help.
posted by moz at 3:27 PM on May 8, 2002

where did it start then, hob?

Where did what start? Racial inequality? I think the whole point is that nobody can really say "how it started," definitively, but that doesn't mean we can't try to figure out how to stop and get off.

Do you mean, where did racial inequality start to affect medical science? What was the name of the 18th century scientist who "proved" that blacks weren't human by studying a chimpanzee skeleton?
posted by hob at 3:42 PM on May 8, 2002

Doctors are only human, and they can't help but search for patterns, but it is a dangerous game.

Searching for patterns is also the entire basis for any diagnosis.
posted by rushmc at 5:06 PM on May 8, 2002

Ah, the conservative-sponsored Sally Satel spouts again. Just a well-meaning physician, taking on even the horrors of "political correctness" for the sake of her patients, right?

Wrong.

Ivan Oransky calls Satel a "conservative ideologue in a doctor's white lab coat". Reviewer Sherwin Nuland noted that there "...is something disquieting about the presence of her own politics and their absoluteness...So determined is she that she allows her intellectual standards to suffer...Worse yet, they make the reader suspect that she, too, has yielded to a political agenda, as pernicious in its own way as the one that she attacks with such diligence.." Dr. Jessie Gruman commented that "reaching conclusions about...health policy based on the individual behavior of her [Satel's] psychiatric patients or on anecdotal evidence is...good fodder for talk shows, but it isn't science."

Her bigoted little screed (linked above) was titled "I Am A Racially Profiling Doctor", but it really should have been "I Am a Racially Profiling Doctor, AND I'm a Fellow of the American Enterprise Institute (senior AEI staff have included Robert Bork, Lynne Cheney...and...wait for it...Enron's Kenneth Lay), AND I'm a Former Fellow at the Ethics and Public Policy Center (whose mission is to "reinforce the Judeo-Christian moral tradition in public debate over domestic and foreign policy"), AND My Own Web Site Is Sponsored by The Manhattan Institute (described by the NY Times as "founded as a free-market education and research organization by William Casey, who then went off to head the CIA in the Reagan Administration...").

Now that we've established who's really associated with a lot of her bullshit, let's look at Satel's little diatribe in more detail, shall we?

Most scientists and physicians make assertions based on series of studies that show a particular phenomenon, dismissing personal anecdotes as...well...personal anecdotes. Yet here comes Satel, quoting a single study showing different outcomes to treatment by a particular ACE-inhibitor called enalapril. The study to which she refers notes that "despite similar doses of drug in the two groups, enalapril therapy... was associated with a 44 percent reduction in the risk of hospitalization for heart failure among the white patients but with no significant reduction among black patients."

Now, according to Satel, that difference *must* result from some genetic difference in blacks that account for their increased hospitalization. That'd be fine as her hypothesis, but the study merely reports outcomes -- not mechanisms -- and neither Satel nor any other researcher has shown ANY genetic differences that would account for such a finding. So what could acount for such different outcomes? Are the environments experienced by blacks and whites the same? Here are some more studies...studies that indicate differences in health status are related to the tangible, obvious differences stemming from racism...differences that have been apparent for over three hundred years:

50% of black women received a first breast cancer diagnosis after the malignancy had become untreatable, compared with 8 percent of white women. (Garrett, 1994). Blacks are 2-3 times more likely than whites to die from heart attack...were less likely to have bystander-initiated CPR...or be admitted to the hospital (Becker et al, 1993). Men growing up in Bangladesh have a better chance of surviving to their 65th birthday than do black men in Harlem, the Bronx, or Brooklyn, with disease, poverty, and inequitable access to medical care as the primary factors responsible for the high death rate among these black men (McCord/Freeman, NEJM 322:173-177, 1990). A Health Care Financing Administration study concluded that "...with blacks, race and not income appear to be the determining factor on access to care." (American Medical News, Nov 20, 1995, v38 n43, pg 10.) In Veterans Affairs Medical Centers in the United States, black veterans were less likely than white veterans to receive major coronary procedures. This study indicates that race can affect medical care in ways that are not simply related to socioeconomic status, because racial differences occurred in a system where care is free and black and white patients are more similar in socioeconomic status than in the general population." (Peterson et al JAMA. 1994:271:1175-1180).

Next we encounter Satel's anecdotes about blacks as slow metabolizers of Prozac/fluoxetine. For some reason, the drug insert for fluoxetine in the PDR doesn't note any special precautions for African Americans taking fluoxetine, nor is there any mention about such precautions in "The Manual of Clinical Psychopharmacology". Where'd Satel get her information? Who knows...she doesn't say. Instead of focusing on her patient's skin color, she might consider asking questions about their reaction to other antidepressants, or about family response to that class of drugs. In other words, she might consider treating her patients as individuals, not as members of a "race".

Her next anecdote is the case of the beer-swilling Asian with low potassium. Satel would have us understand this patient has been diagnosed solely from "observation" of his racial characteristics. Remind me never to go to this hospital. Hey Sally, ask your buddy if he's ever heard of a chem-7 (a routine test of electrolytes typically ordered on EVERY hospitalized patient while they're still in the ER). No doubt (hopefully) the diagnosis was really made on the basis of the patient's potassium level, and not on the shape of his patient's eyes.

Finally, Ms. Anecdote quotes a conversation with an anesthesiologist friend, who provides her final tidbit of slightly less than double-blind, journal-published, peer-reviewed, scientific wisdom: blacks "salivate" more than white people. (One wonders if Satel would have similarly parroted the old Southerners with their anecdotes about "stinking blacks.")

Well, two can play at her game of personal anecdote. After reading Satel's essay, I placed an emergency phone call to my own anesthesiologist friend, asking nervously if it's true that blacks drool more. Rest easy, he said. "It's mostly conservative-funded, upper-class, white, psychiatrist-cum-authors who really dribble excessively from their mouths."

I wonder if it's genetic...
posted by fold_and_mutilate at 12:45 AM on May 9, 2002

fold_and_mutilate: calm down sunshine...
posted by prototype_octavius at 12:16 AM on May 10, 2002