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September 15, 2004

Race to death

TechCentralStation has a piece up titled Drugs and Race, in this case, a heart medication that seems to have great efficacy for African Americans, but less so for whites (we've blogged this before). We do touch human population differences on this blog on occasion, and their real life importance (to be mild about it).

The topic of the use of population based information to make decisions about individuals is touchy. We addressed it in the context of hiring & firing and admitting, and the possibility that one might have to set to higher standards for individuals who are members of typically lower performing groups because of "testing error." Griffe has fleshed this idea out already. Needless to say, it is controversial. There are issues of basic fairness and justice, not to mention the possibility of social disruptions if it is common knowledge that people are being judged by "different standards." I share those reservations.

But what does this have to do with medicine? Simple, it's all about information. Humans aren't omniscient and our information is always imperfect. If you know someone attended a Christian evangelical university, usually you assume they are a Christian evangelical, even if they have given you no other indication of their religious beliefs. You take the information you have and make the "best" (read: most accurate) assessment. In the case of hiring or admitting individuals to a university, this makes sense when viewed alone, but must be tempered by the reality that the decisions are being made in a social context where there are interlocking sets of values and outcomes. But the medical context differs, the relevance of medical diagnoses and treatments is life or death. This is important when weighing the implications a particular treatment regime may have socially, social impacts are usually hypothetical possibilities, medical impacts are clear & dried inevitabilities (you live or die). Of course, we can't save people "at all costs." For example if you are kidnapping paupers and "harvesting" their organs, there are basic issues of human rights that are relevant outside the context of the patient-doctor relationship. On the other hand, if you take an individual's self-reported race into account you are just adding more information into the process of weighing various hypotheses which may decide the course of treatment for an individual. Needless to say, quibbles about moral self-worth and dignity pale when set against the fact that one might not have time to consider these questions if one is no longer living. Unlike a unviersity admissions office or human resources department, the medical establishment has the interests of the patient at heart. That is, potentional employees and students are self-interested and will puff their resumes up, there is "good" inaccuracy for them that is "bad" inaccurarcy for the evaluator. On the other hand, patients have all the interest in being as accurate as possible about the information they offer, information is "good" only if it is accurate and "bad" if it is inaccurate.

I think in the case of medical science the variables are clear: higher morbidity of individuals in the interests of ameliorating theroetical social ailments, that is, that race as a biologically significant concept will become more acceptable in public discourse. There is I think a practical objection to the second point, the knowledge will already be out there even if medical practioners are asked to ignore it for 'ethical' reasons and granting agencies do not give money to race conscious trials. The victory might only be symbolic, but it will come at the cost of human lives.

Being an individual who is genetically dissimilar from most of my co-citizens, I am well aware that this is a handicap when it comes to 'organ matching' if this is needed at some point in the future for me. If I knew that if I acknowledged that I am genetically dissimilar, and this would result in a targeted matching attempt overseas, but that the cost might be prejudice after my recuperation (people would now know that I am 'different'), I would accept the prejudice as the cost of my life (people already know I am different I suspect!). In this way, I am trying to put in perspective the possible downsides, they just don't measure up next to life. Additionally, one might argue that few people will need tailored medicine or organs, but with the progress of modern medical science I suspect that we all will know someone (or be that someone) who will make recourse to medical treatment that might benefit from genetic information input at some point in our lives.

There may come a day in the future when personal genomic sequencing and the cheap manufacture of individually tailored drugs might become a reality. On that day we can discard the use of aproximates like race. But until that time, we could only reject this information at the cost of human life. It makes no sense to express solidary with principles that reject racial discrimination if the individuals who might be subjects of said discrimination experience a lower quality of life and possible diminishment of their life span. People are the test of ideas.

Link via Vinod.

Posted by razib at 05:12 PM