I’m still thinking about a recent exchange in the context of a larger pattern of strangers both online and irl being condescending to me on topics I’ve studied deeply.

Part of this is bc the subject matter is *controversial*, but also bc Black women are supposed to be unintelligent and thus, must be corrected.

Health disparities research, particularly if you’re from a marginalized background, will quickly thicken your skin. People will treat harm to your community like a thought experiment and expect you to engage them in earnest.

Medical school was where I encountered this most frequently. Classmates, often regurgitating lecturers, would flat out say that race was genetic and a biological determinant of disease.

The 2-week orientation/disparities course was nicknamed “please don’t study”, and students’ requests for longitudinal instruction on social determinants of health were ignored.

Yes, positive changes have been made in the past few weeks, but the harm has already been done. My peers have been taught (and some have internalized) race-based medicine, and they’ll be residents this time next year.

Because this teaching is normalized, people begin to think that it’s correct. And then they treat any challenge against it like a simple debate of no consequence.

The result is that we begin to unconsciously believe that there is something inherently pathological about Blackness. Something that we have to “account” for, whether it’s eGFR or pulmonary function or an assumption that only Black women can have lupus or sarcoidosis.

But structural racism is the risk factor, not Blackness.

Well, don’t Black patients have disproportionately worse outcomes, even after accounting for things (SES, education, etc.) associated with racism?

Yes, but racism is not merely SES or education. It pervades every aspect of society, even the things we don’t measure. In epi, we call this residual confounding.

But bc we lack context, we jump straight to genes, only to find those risk variants account for <10% of a given disease phenotype. And without a critical race lens, all we have left are eugenicist assumptions to explain why those differences are still statistically significant.

And if it’s not biological racism, then it’s behavioral. We blame folks for poor decisions without examining their options.

We publish papers about “physiological” differences in obesity in Black women but say nothing about how residential segregation + multi-institutional divestment creates food deserts in the same communities that lack parks, gyms, intact sidewalks, etc.

Not to mention are also overpoliced such that walking through your neighborhood may result in your spinal cord being severed. Or that going for a jog could get you shot by a vigilante neighbor.

When folks want to die on these hills defending race-based medicine and hide behind *the models*, what they’re saying is, “I don’t care that this is harmful to patients because it’s convenient for me.”

What happened to do no harm?

Look at how we were so quick to jump to genetics to explain COVID disparities.

My family lives in the Black Belt, in a county with one of the highest rates of infection right now. The closest grocery store to my aunt (Wal-Mart) is 15 miles away. The nearest hospital? 25. The closest primary care practice? 30.

Many people are elderly, disabled, and/or do not drive. There is no Shipt or Instacart there. So they rely on neighbors for necessities. Bc there aren’t many jobs, people commute further distances to work.

They are also more likely to be essential workers, which makes remote work impossible. And for those who could, there is no broadband internet, so going into the office is their only option.

Do you think their <0.1% of genetic variation, or the fact that the last grocery story in Ft. Deposit, AL, closed 10 years ago and was replaced by a Dollar General, is the main driver of the high rates of comorbidities?

Do a handful of SNPs have a greater impact on COVID susceptibility than the near impossibility of social distancing?

So think about that before you tell me to read papers I’ve already read that you think support your incorrect hypothesis. And remember that these interlocking systems of oppression (including race-based medicine), are what drive health disparities. Fin.

On the same day I wrote this thread, PBS released a feature on COVID-19 disparities in Lowndes County, AL, the place where my dad is from. Definitely worth a watch: https://www.pbs.org/newshour/show/in-alabama-racial-disparities-in-health-outcomes-predate-the-pandemic