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How Neglecting Minorities in Medical Research Has Led to Deadly Outcomes

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Re: How Neglecting Minorities in Medical Research Has Led to Deadly Outcomes

#71

Post by infosample »

gozur88 wrote: post #52
charlescearl wrote: post #38

Earlier quoted context omitted.

Or generally if historically oppressed minorities get poorer health outcomes. It seems a complex question that has many facets. Two tickets that come to mind: 1. When US sociologists and political scientists talk about “systemic and structural racism” this is one of the manifestations. That in general the well being of Native peoples in the US, of African Americans is devalued. It is witnessed in the exclusion in dru…

>When US sociologists and political scientists talk about “systemic and structural racism” this is one of the manifestations. Which has always bothered me, since there are other explanations (lifestyle habits, genetics, poverty) that would explain the difference, in whole or in part. It's a politically convenient assumption that goes contrary to Occam's Razor.

Occam's Razor: among competing hypotheses, the one with the fewest assumptions should be selected.

You dismissed one assumption and named three more. Please explain which applies to Occam's razor.

If you can then explain how your selection isn't related to structural racism and isn't politically convenient for you, I'd appreciate it.

Re: How Neglecting Minorities in Medical Research Has Led to Deadly Outcomes

#72

Post by cabaalis »

blaurenceclark wrote: post #4

I'm the founder of HDP Health, if you have any questions or want clarifications please ask away!

Which would have a better outcome:

(1) Identify various medications that are most likely to be effective between the different races

or

(2) Identify the differences between the races that is causing various medications to not be effective

Re: How Neglecting Minorities in Medical Research Has Led to Deadly Outcomes

#73

Post by blaurenceclark »

cabaalis wrote: post #72
blaurenceclark wrote: post #4

I'm the founder of HDP Health, if you have any questions or want clarifications please ask away!

Which would have a better outcome: (1) Identify various medications that are most likely to be effective between the different races or (2) Identify the differences between the races that is causing various medications to not be effective

Honestly I have no idea which would have a better outcome, but I know both would have a great impact. My assumption would be the second one if I had to pick though, for example as an African American I have a sickle-cell trait and thus I shouldn't have kids with someone who also has that trait, and African American's in general have a higher likelihood of that trait. This is fortunately one of the well understood minority cases and therefore I can take action on it, but for many other genetic/ethnic dispositions to harm, they are quite unknown.

If I ever figure out which would be better I'll let you know! Or if someone else chimes in.

Re: How Neglecting Minorities in Medical Research Has Led to Deadly Outcomes

#74

Post by blaurenceclark »

yipopov wrote: post #65
blaurenceclark wrote: post #4

I'm the founder of HDP Health, if you have any questions or want clarifications please ask away!

What's the relevance of the minority status? Would a drug proven effective for whites and ineffective for blacks in the US suddenly become effective for blacks and ineffective for whites if administered in Zimbabwe? Or do you mean "minorities" in the "there are too many minorities in my waterpark" sense?

It would mean that if a drug was inefficient on an African American of Zimbabwe descent, the same drug would be unlikely to be efficient on the black people Zimbabwe. There are measurable genetic traits these can be attributed to, although unfortunately they are less understood for minority populations.

Re: How Neglecting Minorities in Medical Research Has Led to Deadly Outcomes

#75

Post by cabaalis »

blaurenceclark wrote: post #73
cabaalis wrote: post #72

Earlier quoted context omitted.

Which would have a better outcome: (1) Identify various medications that are most likely to be effective between the different races or (2) Identify the differences between the races that is causing various medications to not be effective

Honestly I have no idea which would have a better outcome, but I know both would have a great impact. My assumption would be the second one if I had to pick though, for example as an African American I have a sickle-cell trait and thus I shouldn't have kids with someone who also has that trait, and African American's in general have a higher likelihood of that trait. This is fortunately one of the well understood min…

Since development of medications is such a heavily regulated industry, it seems to me the correct course of action is through regulation. Require a testament of some sort of the drugs' tested effects on different races. Or maybe require that test groups be representative of the population.

Re: How Neglecting Minorities in Medical Research Has Led to Deadly Outcomes

#76

Post by blaurenceclark »

cabaalis wrote: post #75
blaurenceclark wrote: post #73

Earlier quoted context omitted.

Honestly I have no idea which would have a better outcome, but I know both would have a great impact. My assumption would be the second one if I had to pick though, for example as an African American I have a sickle-cell trait and thus I shouldn't have kids with someone who also has that trait, and African American's in general have a higher likelihood of that trait. This is fortunately one of the well understood min…

Since development of medications is such a heavily regulated industry, it seems to me the correct course of action is through regulation. Require a testament of some sort of the drugs' tested effects on different races. Or maybe require that test groups be representative of the population.

110% agree. The government has actually had a mandate out for publicly funded research since 1993, but only have enforcement rules been enacted and we have yet to see if they will be followed through on.

For research done by private institutions (Pharma, Biotech, etc.) there is no mandate and it's on the researcher to make it a thing.

Re: How Neglecting Minorities in Medical Research Has Led to Deadly Outcomes

#77

Post by gozur88 »

infosample wrote: post #71
gozur88 wrote: post #52

Earlier quoted context omitted.

>When US sociologists and political scientists talk about “systemic and structural racism” this is one of the manifestations. Which has always bothered me, since there are other explanations (lifestyle habits, genetics, poverty) that would explain the difference, in whole or in part. It's a politically convenient assumption that goes contrary to Occam's Razor.

Occam's Razor: among competing hypotheses, the one with the fewest assumptions should be selected. You dismissed one assumption and named three more. Please explain which applies to Occam's razor. If you can then explain how your selection isn't related to structural racism and isn't politically convenient for you, I'd appreciate it.

>You dismissed one assumption and named three more. Please explain which applies to Occam's razor.

Because there is a direct correlation between observable characteristics like obesity and poverty to health outcomes for people of all races. If a fat, poor white woman in Appalachia has heart problems in her 40s and receives low quality care, is that a result of systemic racism?

And as others have pointed out, we don't know the entire scope of genetic effects, but we know they exist to some degree (which was the whole point of the article).

Re: How Neglecting Minorities in Medical Research Has Led to Deadly Outcomes

#78

Post by gozur88 »

blaurenceclark wrote: post #58
gozur88 wrote: post #52

Earlier quoted context omitted.

>When US sociologists and political scientists talk about “systemic and structural racism” this is one of the manifestations. Which has always bothered me, since there are other explanations (lifestyle habits, genetics, poverty) that would explain the difference, in whole or in part. It's a politically convenient assumption that goes contrary to Occam's Razor.

I'm going to quote what someone said below because this is blatantly false "This is not only false, but dangerously false. We are in the process of discovering that certain classes of popularly-prescribed drugs (eg ACE inhibitors for blacks, certain chemotherapy drugs for Asians) are ineffective or even toxic for populations not represented in the relevant drug development research cohorts. It's not identity politics…

... which is why I listed genetics under "other explanations". Did you read the whole comment?

Re: How Neglecting Minorities in Medical Research Has Led to Deadly Outcomes

#79

Post by jsoc815 »

blaurenceclark wrote: post #4

I'm the founder of HDP Health, if you have any questions or want clarifications please ask away!

An incredibly complex issue. I'd be here all day trying to address it and my quibbles w/the article, e.g. "race" ≠ "ethnicity," nor is it uniformly defined across countries, since it's a (BS) social construct...

In any event, my knowledge of the issue leads me to think that the outcome is more a feature than a bug.

That said, while I think the article attempts to link (growing target) population size(s) with an increased need to address the "deadly outcomes," I didn't see anything about wealth. Medicine (in America, at least) is a business. How much money do/will the groups in question have to spend on 'services'? I suspect that unless the answer is (a lot) more than that of the current general focus of research (outcomes) things will remain as they are.

Nevertheless, thanks for raising 'the" issue.

Re: How Neglecting Minorities in Medical Research Has Led to Deadly Outcomes

#80

Post by petroseskinder »

yipopov wrote: post #62

Good luck defending this as long as it's deemed political wrongthink to say there are any biological differences between races. If everyone is the same, why bother with diverse studies?

There's a lot of baggage with "race related medical research."

At least within the US, it is currently deemed wrong think for a number of reasons.

First, how are you defining race? The current American definitions of race are imprecise and sociologically constructed. Since the founding of America, the definition of white has expanded to include various groups that were previously excluded (e.g. Polish, Irish, Jewish people, Italians, Greek) [0].

As far as black/African Americans, the current definition (one drop rule) has its limitations. Sub-saharan Africa is not a monolith. It has been found that the genetic diversity between Sub-saharan African ethnicity groups exceeds other regions of the world [1]. Even as far as physical differences, there is a noticeable physical difference between a Tutsi from Rwanda, a Luhya from Kenya, an Amhara from Ethiopia, and a Yoruba from Nigeria. A very noticeable difference. I can't speak for their "genetic difference." However, it's large enough to warrant further investigation on what categories are used. This distinction is important moving forward. Since 1970, voluntary immigration from Africa has surged from the aforementioned regions [2], with many becoming first, and second generation Americans [3], the current racial assumptions and definitions are a tad archaic.

This is just one racial group within the US. I didn't really even mention how ludicrous bucketing 60% of the world's population as "Asian" is.

Second, and most importantly, the US does not have a great track record with biological research targeting black people, Native Americans, and other minority groups. There is a long history of medical abuse where researchers conduct experiments without the knowledge or consent of black patients. A few notable examples in recent history are the Tuskagee Syphilis Experiments between 1932 and 1972 [3] and DoD's non-consensual whole body radiation experiments on black cancer patients between 1960 and 1971 [4][5]. Even today, this sort of non-consensual racial medical experimentation has not stopped. As recently as 2013, Ethiopian Jews (immigrating from Ethiopia) in Israel were coerced into agreeing to injections of long acting birth control drugs by Israeli medical officials [6]. The apprehension is very much justified.

> If everyone is the same, why bother with diverse studies?

You're tone suggests that you don't understand why people are "dancing" around the subject and trying to be politically correct or whatever. I am under the impression that the American medical research community has, through its actions, fostered distrust in "racial" based medical research. Now, it's stuck in a bind, as a direct consequence of its actions.

[0] https://en.wikipedia.org/wiki/Definitions_of_whiteness_in_th...

[1] cshperspectives.cshlp.org/content/6/7/a008524.full

[2] http://www.pewresearch.org/fact-tank/2017/02/14/african-immi...

[3] https://www.bloomberg.com/view/articles/2015-10-13/it-isn-t-...

[4] https://en.wikipedia.org/wiki/Tuskegee_syphilis_experiment

[5] http://www.nytimes.com/2007/01/23/health/23book.html

[6] https://goo.gl/BbpdhX

[7] https://www.forbes.com/sites/eliseknutsen/2013/01/28/israel-...

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