Most of us insist that we are members of the human race, a claim which is nonsensical. ‘Race’ is a term developed to accentuate the differences between people, rather than their common features. A more accurate statement would be that we are all members of the species Homo sapiens. Unfortunately, even that designation has been undermined by some ‘scientists’ insisting that modern humans should be classified as Homo sapiens sapiens. The subtle message is that we, or at least some of us, are a finer, more sophisticated version of the species than those brutish creatures who came before us. Genetic studies, unfortunately, do not support the notion that over the past tens of thousands of years we have changed for the better or evolved into separate subspecies.
Even before our ancestors wandered north out of the Rift Valley of eastern Africa, various groups undoubtedly insisted that they and their relatives were superior to virtually identical collections of people with whom they competed for resources. The notion that ‘my people’ are superior to ‘your people’ is pervasive in our species, even though our genes establish that we all have pretty much the same mix of abilities and disabilities. The prejudice that you are superior to the folks who look different from you and your relatives provides no survival advantage, but it has fueled conflicts that date back to the earliest historical records and beyond. The view that one group deserves a greater share of the planet’s resources than other groups has fostered little more than advances in weaponry. This competition, rather than proving that any one version of humanity is superior to others, has left all of us poised on the brink of self-extinction.
More than two thousand years ago, the intellectual elite of the Han Dynasty in what is now China described fair-skinned, blonde-haired, green-eyed invaders from the west as barbarians descended from monkeys. More than a thousand years later, serious observers of humanity, especially in Europe, insisted that there were substantial, measurable, irrevocable differences between groups of people, and they arbitrarily labelled different groups they defined using these characteristics as ‘races.’ Some claimed there were four or five such ‘races.’ Others insisted there were more than thirty. Inevitably, those concocting these racial categories concluded that the ‘race’ they and their relatives belonged to was the most advanced, most gifted, most worthy of dominion over all others.
Implicit in this view was that not all men are created equal. This prejudice has had repercussions for centuries and still appears in unexpected venues, including healthcare.
There are obvious disparities in healthcare in many, if not most, communities in the United States and around the world, but some truly defy logic. These disparities are not necessarily related to economic factors, religious beliefs, distribution challenges, or even patient acceptance. Some exist and persist for long-forgotten ‘racial’ views so deeply ingrained in medical practice that they go unrecognized by even those least burdened by prejudice.
For centuries, physicians and the people they train to provide healthcare have described the people they treat according to age, race, and gender. The typical medical record starts with, “This 76 year-old, black male complains of…etc.” Healthcare providers embrace the importance of ‘race,’ even though we know it lacks real meaning. The continued insistence on attributing a specific racial category to a patient, my colleagues will argue, is appropriate, however, because of the frequency of certain diseases in identifiable groups.
I worked in a hospital that attracted many people of the Jewish faith from Eastern Europe. This group had a relatively high incidence of a very rare genetic disease, called Tay-Sachs disease. I also worked in a hospital in a community with many patients with ancestors from equatorial Africa, a group with a relatively high incidence of a specific type of anemia, called sickle cell anemia. The argument for attributing a specific ‘racial’ category to each patient was that it helped identify what problems should be considered in their assessment. That, of course, was nonsense since a ‘white,’ Jewish man with anemia would be assessed for a variety of blood disorders, including sickle cell disease, and a deeply-pigmented [aka, ‘black’] child with failure to thrive would be checked for a variety of genetic disorders, including Tay-Sachs disease. Simply put, identifying a patient as a member of a ‘race’ is archaic, uninformative, and misleading, but it does have real consequences.
Although patients categorized as ‘black’ or ‘African-American’ have a higher rate of kidney failure than people categorized as ‘white’ or ‘Caucasian,’ the rate of kidney transplants provided to those described as white is substantially greater than the rate of transplants provided to those described as black. For several decades this disparity was attributed to more healthcare options for ‘whites’ compared to ‘blacks,’ but even in facilities that eliminated socioeconomic barriers to comparable care, the disparity persisted. The underlying problem was that laboratory tests of kidney function had normal and abnormal values based on population studies that included ‘racial’ considerations. Classifying a person with kidney disease as black or white affected whether or not his or her kidney functions warranted an urgent transplant. That you were described as ‘black’ affected the interpretation of blood tests being checked to measure your kidney function. What was supposed to be a purely objective measure had the subjective element of ‘race’ so baked into it that physicians using the test results were being misled with regards the patient’s kidney function by long-invalidated ‘racial’ considerations.
We, humans, all have thousands of genes responsible for our characteristics and vulnerabilities. The genes responsible for skin pigmentation, hair characteristics, and eye color are some of the least important descriptors of a person. After all, my ancestors were probably amongst the light-skinned, blonde-haired, green-eyed invaders that unsuccessfully harassed the Chinese during the Han dynasty, but I have none of the agility of a monkey. Perhaps it is those Neanderthal genes that I and most Europeans carry that make me so clumsy.
Dr. Lechtenberg is an Easton resident who graduated from Tufts University and Tufts Medical School in Massachusetts and subsequently trained at The Mount Sinai Hospital and Columbia-Presbyterian Medical Center in Manhattan. He worked as a neurologist at several New York Hospitals, including Kings County and The Long Island College Hospital, while maintaining a private practice, teaching at SUNY Downstate Medical School, and publishing 15 books on a variety of medical topics. He worked in drug development in the U.S., as well as in England, Germany, and France.
