From race-based to race-conscious medicine: how anti-racist uprisings call us to act.
From race-based to race-conscious medicine: how anti-racist uprisings call us to act.
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DOI：
10.1016/s0140-6736(20)32076-6
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发表时间：
2020-10-10
期刊：
影响因子：
--
通讯作者：
Tsai J
中科院分区：
文献类型：
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作者：
Cerdeña JP;Plaisime MV;Tsai J
雅各布·布莱克（Jacob Blake）的残暴和乔治（George弗洛伊德）、布雷娜·泰勒（Breonna Taylor）、艾哈茂德·阿伯里（Ahmaud Arbery）、托尼·麦克达德（Tony McDade）以及无数其他人的谋杀--再加上关于新冠肺炎对黑人和棕色人种社区造成的负面影响的可怕统计数据--迫使美国和世界考虑结构性种族主义如何影响生存。虽然临床医生经常把自己想象成慈善的照顾者，但越来越清楚的是，医学不是一个不受种族不平等影响的独立机构，而是一个结构性种族主义的机构。这种参与的一个普遍例子是基于种族的医学，该系统将种族作为一个重要的生物变量的研究转化为临床实践，导致不公平的护理。在本观点中，我们讨论了基于种族的医学的例子，它是如何学习的，以及它如何使医疗保健的差异永久化。我们引入种族意识医学作为一种替代方法，强调种族主义，而不是种族，作为疾病和健康的关键决定因素，鼓励提供者只关注最相关的数据，以减轻健康不平等。临床医学和流行病学的研究需要明确的假设;然而，涉及种族的假设往往是隐含的和循环的，依赖于传统的智慧，即黑人和棕色人种在遗传上不同于白色人。[1]这一常识源于欧洲殖民主义，当时种族被发展为一种工具，用于在世界范围内划分和控制人口。因此，种族是一种社会和权力结构，其含义随着时间的推移而发生变化，以适应政治目标，包括断言深肤色人口的生物劣势。[2]事实上，种族并不能很好地代表人类的差异。用于识别种族群体的身体特征因地理而异，并不符合基本的生物特征。遗传学研究表明，人类不能分为生物学上不同的亚类。此外，种群之间持续的重叠和混合侵蚀了任何有意义的遗传差异。[5]尽管种族和遗传之间缺乏有意义的对应关系，但种族在临床医学中被反复用作捷径。例如，假定黑人患者比其他种族的患者具有更大的肌肉质量，并且相应地调整了对他们的肾功能的估计。6基于亚洲患者的内脏体脂肪比其他种族的人更高的理解，他们被认为在较低的体重指数下有患糖尿病的风险。7血管紧张素转换酶（ACE）抑制剂在黑人患者中的疗效低于白色患者，因此不能用于黑人高血压患者（表）。1，6 - 28我们认为，这种方法是有害的和不必要的，有助于他们打算帮助的确切人群之间的卫生保健差距。新兴的学术界强调了这些种族调整做法的危害，29，30即使有些人继续为他们辩护，吹捧他们有能力捕捉种族群体之间临床测量中尚未理解的差异。31，32然而，基于种族的医学的传播促进了种族陈规定型观念，减少了对确定更精确的生物标志物的研究的需要，并宽恕了关于黑人和棕色人种生物学劣势的错误观念。因此，即使有重大发现或临床轶事支持使用针对种族的做法，也应该对其进行严格的批评，并对结构条件等中介变量进行相应的分析。许多医学…
The brutalisation of Jacob Blake and murders of George Floyd, Breonna Taylor, Ahmaud Arbery, Tony McDade, and countless others—coupled with horrifying statistics about the dispro portionate burden of COVID-19 on Black and Brown communities—have forced the USA and the world to reckon with how structural racism conditions survival. Although clinicians often imagine themselves as beneficent caregivers, it is increasingly clear that medicine is not a stand-alone institution immune to racial inequities, but rather is an institution of structural racism. A pervasive example of this participation is race-based medicine, the system by which research charac terising race as an essential, biological variable, translates into clinical practice, leading to inequitable care. In this Viewpoint, we discuss examples of race-based medicine, how it is learned, and how it perpetuates health-care disparities. We introduce raceconscious medicine as an alternative approach that emphasises racism, rather than race, as a key determinant of illness and health, encouraging providers to focus only on the most relevant data to mitigate health inequities. Research in clinical medicine and epidemiology requires explicit hypotheses; however, hypotheses involving race are frequently implicit and circular, relying on conventional wisdom that Black and Brown people are genetically distinct from White people. 1 This common knowledge descends from European colonialisation, at which time race was developed as a tool to divide and control populations worldwide. Race is thus a social and power construct, with meanings that have shifted over time to suit political goals, including to assert biological inferiority of dark-skinned populations. 2 In fact, race is a poor proxy for human variation. Physical characteristics used to identify racial groups vary with geography and do not correspond to underlying biological traits. Genetic research shows that humans cannot be divided into biologically distinct subcategories. 3, 4 Furthermore, ongoing overlap and mixture between populations erodes any meaningful genetic difference. 5 Despite the absence of meaningful correspondence between race and genetics, race is repeatedly used as a shortcut in clinical medicine. For instance, Black patients are presumed to have greater muscle mass than patients of other races and estimates of their renal function are accordingly adjusted. 6 On the basis of the understanding that Asian patients have higher visceral body fat than do people of other races, they are considered to be at risk for diabetes at lower bodymass indices. 7 Angiotensin-converting enzyme (ACE) inhibitors are considered less effec tive in Black patients than in White patients, and they might not be prescribed to Black patients with hypertension (table). 1, 6–28 We argue that such approaches are harmful and unnecessary, contributing to health-care disparities among the exact populations they are intended to help. Emerging scholarship underscores the harms of these race-adjusted practices, 29, 30 even as some continue to defend them, touting their ability to capture yet-understood differences in clinical measures between racial groups. 31, 32 However, propagation of race-based medicine promotes racial stereotyping, diminishes the need for research identifying more precise biomarkers underpinning disparities, and condones false notions about the biological inferiority of Black and Brown people. Hence, even if significant findings or clinical anecdotes support the use of racially tailored practices, they should be rigorously critiqued and mediating variables, such as structural conditions, should be analysed accordingly. Many medical …