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that the changes the author fronts could increase costs. —Michael Rethman, Prescott, AZ EDITOR’S NOTE You ask: Do we disregard what we’ve learned about subgroups? The question may be: Is what we think we know about subgroups actually true? Because race isn’t a biological category, experts believe that it is not a good proxy for understanding differences in people’s kidney function. It may take time to find a good, cheap replacement for existing tests that use race adjustments— but that work is already being done (go to CR.org/kidney0221 for more information). And some scientists argue that using the existing (inexpensive) tests, sans the race factor, is accurate.
THE PRACTICE OF across-theboard adjustments to medical test results based on race is outrageous. Dr. Roberts correctly dismisses “the idea that Black people as a race are distinguishable biologically— just because of their race—from other human beings.” It seems that these principles are not taught in medical schools. Yes, skin color is a genetic trait, as are “differences in measures of organ function,” resistance to malaria, and undoubtedly others. Dark skin, resistance to malaria, and high retention of
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CR.ORG FEBRUARY 2021
salt are more common in people of African descent, but they’re not caused by the same gene. You can’t take an individual with a particular shade of skin and predict resistance to malaria, the need to adjust a glomerular filtration rate (GFR) blood test score, or anything else. Medicine needs to be a lot more individualized than that. —Robert Moss, Bloomfield, NJ BACK WHEN I was a scientist and biomedical research institute director, I recall political pressures forcing the National Institutes of Health to include nested subgroups (e.g., gender, race, etc.) in comparative studies to help assure more granular info on the effects of treatment interventions on individuals.
This approach was applauded because it was thought that it would improve both individual and overall outcomes. It necessitated larger (and thus more expensive) studies to assure adequate experimental and statistical power. So which is it? Do we disregard what we’ve learned about subgroups? Or do we replace inexpensive GFR screening [which indicates how fast a person’s kidneys can filter blood] as a queue qualifier and replace it with an approach that carefully measures every suspect individual’s GFR? And when it comes to some notable medical institutions dropping what they’ve learned from nested racial subgroups, does this make sense in terms of costs v. benefits? Consider
I’VE RECENTLY REALIZED that when the word “black” is used in print to recognize African-Americans as a racial group, it uses a capital “B” as in “Black.” But when “white” is used to recognize those of Caucasian race, I guess, “white” is not capitalized. You used this distinction in your article on how race can affect medical care. When did this change occur? Who made the determination? Or has it evolved as a consequence of increased awareness that Black lives matter? Just asking. —Tom Eells, Milwaukee EDITOR’S NOTE We announced the style guide change in June following a thorough and thoughtful discussion on the use of terms in the style guide, specifically related to race. Like many other journalistic enterprises, CR has largely followed the AP style guide over the years, which had recommended lowercase for the adjectives “black” and “white.” CR makes adjustments as both language and society change. After careful consideration, we decided to change the editorial
ICONS: ELIAS STEIN
“How Your Race Can Change Your Medical Care” (December 2020) revealed that some lab tests give one result if a patient is Black and another if they’re not—and those different results can affect your treatment. Here, readers weigh in. To comment, go to CR.org/med0221.
