Misuse of Race in Medical Diagnosis

I was going through my old email, and cam across something my anthro of American culture professor (otherwise known as the Great Satan) sent me last semester. Sorry, I don't have an exact link to it, but it came with some archival information.

This article from The Chronicle of Higher Education (http://chronicle.com) was forwarded to you from:

a*****y@g******l.edu

From the issue dated 5/9/2003

The Misuse of Race in Medical Diagnosis

By RICHARD S. GARCIA

I am a 39-year-old Hispanic male born in Stockton, Calif.,
to a mother who -- after many years of unwise eating -- has
recently been diagnosed with diabetes and to a father I didn't
know who floated away at the end of a needle in his sister's
garage. I prefer being called Mexican to Hispanic, though I've
never been to Mexico. I eat a fat American's diet. Speak
American English. Although I don't smoke, I have been living
in a big city with polluted air. An American city where I
recently was an assistant professor of pediatrics, working in
a profession that tries to define my indefinable race without
asking for my input.

I helped train medical students and residents who are all
taught, as I was when I was a medical student, to assess each
patient first in terms of age, race, and gender. Always in
that order. A 52-year-old white female, a 3-month-old Asian
male, a 39-year-old Hispanic male. The actual identity of
patients remains ignored: A 47-year-old African-American
female -- who's never been to Africa and prefers to call
herself black if ever asked by a white doctor, though none
ever asks -- two-pack-a-day smoker, still living with her
mother in South Central Los Angeles, presents with fatigue.

The doctor asks the patient -- or the parent of the patient,
if you're a pediatrician -- for his or her age. The gender is
determined during the physical exam. But the doctor usually
just assumes the patient's race by looking at the person. My
professors told me, and current textbooks still say, that
knowing the patient's race helps the doctor make an accurate
diagnosis. So the doctor looks at the patient's skin, nose,
hair, lips -- the silent mouth -- and defines ancestry in a
single word: Asian, Hispanic, white, African-American. I
smiled when one doctor described the Nigerian father of a
patient as an African-American. The Nigerian father didn't
smile.

The textbooks say that a patient's race can, and should,
influence the doctor's thinking about possible diagnoses. An
Ashkenazic Jewish baby might have Tay-Sachs disease. A black
boy might have sickle cell anemia. A Southeast Asian girl
might have thalassemia. Of course, I know that Ashkenazic Jews
get Tay-Sachs, but the only baby I ever saw with Tay-Sachs was
a Mexican child. I didn't misdiagnose the disease because he
was Mexican instead of Jewish.

Do all Hispanics have the same genetic risk for asthma? Do
Mexicans and Puerto Ricans eat the same diet? What about a
patient from Spain -- is he Hispanic in the same way that I
am?

My childhood friend Lela wasn't diagnosed with cystic fibrosis
until she was 8 years old. Over the years, her doctors had
described her as a "2-year-old black female with fever and
cough ... 4-year-old black girl with another pneumonia. Lela
is back." Had she been a white child, or had no visible "race"
at all, she would probably have gotten the correct diagnosis
and treatment much earlier. Only when she was 8 did a
radiologist, who had never seen her face to face, notice her
chest X-ray and ask, "Who's the kid with CF?"

An emergency-room physician referred a patient to me with this
history: "A 14 y.o. black male from South Central LA with a
positive tox screen presents with headache. He's probably in a
gang." I ordered a CT scan of the patient's head and
discovered a large cyst that had blocked the normal flow of
cerebral spinal fluid until the fluid had backed up and
squashed his brain against his skull. Yes, he had a headache,
and he had smoked a joint before going to the hospital.

Those are just two examples of incorrect diagnoses caused by
doctors who use racial assumptions to arrive at incorrect
medical conclusions. As a physician, such misdiagnoses disturb
me. I am also concerned as a father. I am Mexican from
California, and my wife is black from Los Angeles. Our
daughter is blonde with green eyes and pale skin. I have no
known white ancestors, and that kind of heritage -- even if it
is just a legend -- would not be left out of my family's
stories. In my wife's case, her mother is now tracing their
family's roots back through American history; as of 1843, she
has not found a single white ancestor. But my wife's relatives
generally have fair skin, and I suspect that my mother-in-law
will eventually find a slave owner or overseer or some other
white man who is responsible for that, and for my daughter's
appearance.

What concerns me is that many years from now, when she is old
enough to see a doctor with neither me nor my wife present,
the doctor will use what he assumes is her race to misdiagnose
her: "A 19-year-old white female presents with irritability."

Here is the crux of the problem: My daughter's race can never
be known. Her genetic risk for this or that disease is
necessarily imprecise because she is a person, not a race.

Americans used to define anyone who had "one drop of Negro
blood" as a Negro, but we now know that definition makes no
sense. We learn nothing if we group together as
Asian-Americans a man in Seattle who was born in the far
eastern portion of the former Soviet Union, a Korean woman
living in Toronto, and a child in California with maternal
grandparents who immigrated from China and a father whose
ancestors came to New Jersey from Europe. There are almost as
many definitions of Hispanic as there are Hispanics. Do I have
the same genetic risk for sickle cell anemia as a Puerto
Rican, a Spaniard, or a Mayan? What about my daughter, and the
millions like her in this country, whose racial and ethnic
ancestry defies geography and time?

If by using a patient's ancestry in medical discourse we can
narrow the range of possible diagnoses, then at least we must
be careful to describe accurately the genetic, ethnic,
cultural, or geographical variables involved; guessing what
category a person fits in is not acceptable. And when "race"
cannot possibly matter, let us omit it. What difference does
it make if it is an African-American or an Asian who has an
earache or ingrown toenail?

Medical-school professors must teach students that a Hispanic
is not real. That an Asian-American doesn't exist. That whites
exist only in America: They are Irish in Ireland, Italian in
Italy, Spaniards in Spain. That harm -- real, physical harm --
can come from calling a child with cystic fibrosis an
African-American.

Race does exist in America, alas. It's why my daughter's
history here starts in slavery. It's why my Mexican face
identifies me to strangers before they know I'm an educated
member of the middle class. It's why nobody dares to ask for
details about anybody else's identity.

Richard S. Garcia is a pediatrician at a medical center in
Stockton, Calif. He was an assistant professor of pediatrics
at the University of Nevada School of Medicine at Las Vegas.