The murder of #GeorgeFloyd and the racial profiling of #ChristianCooper while birdwatching have me thinking about how I can do allyship better, particularly as a #medicaleducator. Some thoughts for #medtwitter...(a thread)

As an undergrad student in the humanities, it seemed clear to me that race was a social construct. But when I started med school I was taught that spirometry required a “race correction” or that ACEi shouldn’t be given to Black patients.

Mired in my own impostor syndrome, I felt confused about the lines between science and ideology.

As Kay Young McChesney writes, “to teach students about the social construction of race, teachers must first know enough science to teach students that race is not biological”.

If you’re an MD – and more importantly if you’re a physician educator – one small step you can take as an ally is to read her piece on The Science You Need to Know to Explain Why Race is not Biological: https://bit.ly/3etQwI1 

Medicine has a long history of entrenched racism. Many of the seemingly benign “facts” we perpetuate today in clinical practice stem from fallacies conceived of by doctors to bolster “scientific” support for slavery, segregation and everything that follows.

These ‘facts’ have seeded our medical literature and persist as sanitized and seemingly banal teachings in our core understandings of physiology and disease. See this essay https://nyti.ms/3eqwez5  by @lindavillarosa in New York Times magazine as part of the excellent 1619 Project

When examined more closely, these facts have little basis in science. Let’s take the example of sickle cell disease.

The CDC states “About 1 in 13 Black or African-American babies is born with sickle cell trait (SCT)”. And the WHO tells us “sickle cell disease predominates in Africa”. Every practice exam question you will write about SCD will feature a Black patient.

So wait. How on earth can race be a social construct? Well the first problem is our tendency to consider the continent of Africa as monolithic.

If we look more closely at the data on SCD, we see that, in fact, prevalence of the sickle-cell trait ranges between “10% and 40% across equatorial Africa and decreases to between 1% and 2% on the north African coast and <1% in South Africa” (WHO)

This means, babies born in Johannesburg have, on average, the same risk of SCT as babies born in Oslo. So how do we explain the increased prevalence of sickle cell trait in countries like Ghana, Nigeria, and Uganda where most people have black skin?

It has nothing to do with skin colour, and much to do with the survival advantage of heterozygotes in regions of endemic malaria.

That is – sickle cell trait confers tolerance to malaria. You may still acquire malaria, but you are far less likely to die from it. Over time, in areas with high prevalence of falciparum malaria (deadliest type), selective pressure has seen the reproductive advantage of SCT.

And this is where our medical approach so often goes awry.
If you have sickle cell trait, you are far more likely to originate from (yourself or your ancestors) an area of the world where most people have black skin. But...

...your blackness is not the risk factor. It is a highly visible confounder. And if you are Xhosa from South Africa, your blackness has as much to do with SCD as my whiteness does.

The reality is, that try as we might, we are not nearly as good at delineating clear racial categories as we might think. Skin colour is heritable, but it’s expression is as a continuous variable, not a categorical one.

McChesney speaks of lining up students to demonstrate the difficulty of defining categories along a spectrum. An exercise that harkens back French colonizers' phrenology in Rwanda, characterization of Jews by Nazi Germany, and many more examples of White supremacy pseudoscience

Relying on visible differences to ascribe biological risk of disease is a cognitive bias we all fall into. And it is obscured by the very real risks of poor health outcomes that result from systemic inequality and structural violence.

The fact that Black mothers in the United States are more than twice as likely to die in childbirth than their White counterparts has everything to do with their Blackness and nothing to do with their biology ( https://bit.ly/2ZXsLUT ).

And this is why it is not helpful to be “colourblind”. Race and racism are real, but they are rooted in politics, power, and the history of White Supremacy, not biology.

Talking about about race as it impacts health and health care matters, because your black students and patients live with the very real risk of police officers choking them to death. It matters because, if you’re White like me, no one is calling the cops when you're birding.

Questioning the shaky foundations of medical science as they relate to race, and reading deeply about race as a social problem strikes me as an essential first step.

So #medtwitter – what have you been taught about race that has no scientific basis? What have you read that helped you better understand the social problem and our role in it? #BlackLivesMatter #JusticeForGeorgeFloyd