In the context of a discussion of a misleading New York Times article of a problematic PNAS paper, Peter Dorman writes:
What I find really disturbing about both the study and the way it was used by the NYT is that they support the claim that medical people in some general sense believe that physical racial differences make Blacks less susceptible to pain. We are seeing that a lot these days, “white people,” “the culture,” etc. are racist.
Racism is an immense social problem. To characterize it—and misrepresent research accordingly—as a generic, undifferentiated force is really letting true racists off the hook. I have no doubt there are some racist doctors. It would be useful to have a sense of how many there are and to what extent it influences their treatment. That would mean doing research designed around capturing differences across medical people. And that would take us back to a longstanding issue, the fixation on finding average effects when the structure of effect differences is what we ought to be interested in.
I agree. Dorman’s comment touches on several important issues:
1. Sophisticated—or, I guess I should say, sophisticated-seeming—social science can be a distraction from big obvious issues. There are lots of arguments of the form, “X’s are the real racists.” But that takes away from the central point that racists are the real racists.
2. Variation is important. Lots of social science has the form of, “People be like X” or, perhaps, “People who be like X do Y.” We need more of “Some people be X, some people be not-X, some people don’t care about X,” and so on.
3. That said, racism—and lots of other things—are societal issues, even if they manifest themselves through individual differences. In a game of musical chairs, not everyone will find a seat when the music stops. You can focus on who finds a seat or you can just count the number of people and the number of chairs. Racism isn’t just about racists, it’s also about who’s got mortgages on those chairs.
P.S. Just a coincidence that this post, which I wrote awhile ago, happened to pop up the day after Lizzie posted on the challenges of biological research in the context of racism and naive anti-racism.
Andrew said, “That said, racism—and lots of other things—are societal issues, even if they manifest themselves through individual differences. In a game of musical chairs, not everyone will find a seat when the music stops. You can focus on who finds a seat or you can just count the number of people and the number of chairs. Racism isn’t just about racists, it’s also about who’s got mortgages on those chairs.”
+1 The problem in any discussion of racism is that people are talking about several different phenomena, i.e., (1) the ideology of racism, (2) personal prejudice, (3) discrimination along racial lines, and (4) structural inequalities in society that are the result of racial discrimination in the past. I agree with Peter that there are a group of people in our society that adhere to racist ideology and are dangerous, and we shouldn’t dilute that message by confusing them with those who merely act on prejudice. On the other hand, there are probably more children harmed by lead pipes or poor sanitation because of #4, than are harmed by white supremacists. We ought to be able to talk about all forms of racism without confusion.
I agree too, but agency and structure interact with each other; they aren’t competing explanations. The patterns we may find across individuals (like MDs) are important not just for identifying the bad guys, but also as clues to the specific structural mechanisms that facilitate, reward or just allow them to behave as they do. Like, would you find bigoted assumptions about pain tolerance to be more widespread in some regions or institutions than others? Or might they depend on the immediate causal factors responsible for pain—trauma vs disease, for instance? That could be a clue to the role of specific cultural narratives.
Group averages and broad structural formations (the criminal justice system, the medical profession, “the culture”) are black boxes to be unpacked.
That sounds a bit like Scott Alexander’s definitions of racism by motives, beliefs or consequences:
https://slatestarcodex.com/2017/06/21/against-murderism/
I think there is also (5) deep unease with increasing racial diversity that threatens our national identity as being overwhelmingly of European origin. The conflict over mask mandates in Enid, Oklahoma, seems to be about that (https://www.nytimes.com/2021/12/26/us/oklahoma-masks.html), as does a lot of current politics.
+1
I was really surprised when the COVID vaccine trials were delayed to recruit more Black participants. I thought it’d be preposterous that a vaccine could work for white people but not for Black people. But then I found this: https://www.goodrx.com/bidil/bidil-heart-medication-for-black-patients
[quote]
When BiDil was first studied, it didn’t show a significant benefit across the study population, which was over 70% white. In fact, the FDA didn’t approve the manufacturer’s new drug application (NDA) — the step needed for FDA approval — for this reason. But when researchers looked at how the medication worked in Black people specifically, it showed a positive effect on survival rate.
This resulted in another study called the African-American Heart Failure Trial (A-HeFT) that only included self-identified Black people with heart failure. The results showed that BiDil, when taken with other heart failure medications, could lower death by 43%. Hospitalizations for heart failure were also significantly less in the BiDil group. This was compared to a placebo group that did not receive the medication.
This is why the medication was ultimately FDA-approved — but only for self-identified Black people with heart failure. It’s also important to acknowledge that the study authors received support from NitroMed, the manufacturer of BiDil.
[/quote]
So we have the social sciences positing that race is a social construct, which it surely is to some extent. But then we also seemingly have data from clinical trials that suggest drugs do have different effects on people of different races — and we might be failing to prescribe effective drugs because we didn’t pick up the effect in a predominantly white sample. Conversely, of course, we might also be prescribing ineffective drugs to minority patients based on data from predominantly white samples. So, perhaps, it is not only a social construct, and calling on doctors and medical researchers to make no distinction with regard to race may ultimately end up harming minority patients. To the extent that there are any differences in drug effectiveness, treatments would be based on those who make up the majority of clinical trials (and the population: 80% of Americans are white).
Moreover, although the PNAS study actually found no difference, the NYT article still made the implicit assumption that doctors have an accurate understanding of white people’s pain. But what if they had an accurate understanding of Black people’s pain and overestimated white people’s pain instead? As a result, they would overprescribe opioids to white patients… which seems to match what happened pretty well. In that case, people might have been better off if the results in perceived pain had been accurate and doctors treated white patients like Black patients, rather than vice-versa.
The 19th century view of “race” is not the 21st century view of “populations”. The 21st century view of “populations”, in genetics anyway, is not a social construct. I remember Lynn Jorde, in one of the 1000 genomes lectures, saying something like, “Race, or populations, as we prefer to say, is a blurry but biologically useful idea”.
The scientific idea is simple, there are differences in your genome based on ancestry, and these translate in differences in your biology.
The obvious example is sickle cell anemia. But you can pick many simple “Mendelian” diseases, where ancestry gives higher or lower odds of having these conditions. Likewise for polygenic traits.