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- Race is a social construct, not a biological construct.
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It's an ever-changing and ill-defined categorization
to describe a group of people.
Ta-Nehisi Coates has said,
"Race is the child of racism, not the father."
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During the summer of 2020,
initially many of the news outlets
were talking about perhaps a biological mechanism
for the disproportionate number of Latinx
and African American individuals
who were being impacted by COVID,
but it became very clear that it was much more about
differences in access to care, food insecurity,
discrimination on the job, crowded housing,
having to go into work in a public-facing job.
COVID laid bare all of the social factors
that influence health
and so that's what prompted me to write an op-ed.
It appeared in Stat News called
"It's time to stop using skin color and race in medicine."
When I was in medical school, and even currently today,
it was very commonplace to use race
to calculate the risk of someone progressing
in their cardiovascular disease or even kidney disease.
We do see differences in health outcomes
between different racial groups,
and the presumption was that those differences
are because of innate biological differences.
What we do know now is through the genomic revolution
that that's simply not true.
That skin color or other traits
that are associated with certain racial groups,
that those genes are not linked to health-related genes
or physiologic genes.
But unfortunately medicine hasn't caught up yet
and so we still are implementing race based assessments,
even race based treatments.
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My dad dad was born to Irish American parents in Boston
and it was at a time when inter-racial marriage
was extremely rare.
In fact, it was illegal in 16 states
when he met my mom, who's Black
and was born in Memphis, Tennessee in the Jim Crow South.
Growing up I wasn't really aware of being biracial
or really having any concept of race,
that was a luxury,
until I was around five or six years old
when I went to kindergarten
and people were trying to size me up
and looking at me quizzically
and wondering, "Who are you, what are you?"
And I didn't know how to answer that question.
So that continued, that sense of not really knowing
where I fit in and which racial category I fit in.
When I was a medical student,
I often wondered how this would apply to me.
I wondered,
if I had been on the other side of the exam table,
how the doctor would've perceived me.
Would they look at how I registered?
Would I have an opportunity to self-identify to them
or would they just use their own perception of my race?
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I'm not advocating for removing race
from medicine completely.
I think it's really important to gather those data
so that we can see the ways in which racism
is playing out in the institution that's providing the care.
At Stanford, we have a vision for Precision Health
and the idea is that we have the technology
to understand the unique physiology of our patients
that will allow us to select the right intervention
for the right patient at the right time.
And so I do see a future in medicine
where we will finally be able to abandon
this crude categorization using race
as a proxy for so many other things.
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The combination of Precision Health
then also having a better understanding
of the impact of society and social determinants of health,
in addition to expert skills in communication
so that we can instill the trust
that patients have been looking for with their provider,
we'll be able to really advance
what we're doing in medicine.
And so I am very encouraged, like I've never been before,
about what's possible.
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