The following excerpt is taken from Heather Mac Donald’s new book When Race Trumps Merit now available from DW Books.
Medicine’s Racial Reckoning
The a priori truth that health disparities are necessarily the product of systemic racism has devalued basic science and encumbered medical research with red tape. The fight against cancer has been particularly affected.
Cancer grant applications must now specify who, among a lab’s staff, will enforce diversity mandates and how the lab plans to recruit underrepresented researchers and promote their careers. White and Asian oncologists are assumed to be part of the problem of black cancer mortality, not its solution, absent corrective measures. According to the NIH, leadership of cancer labs should match national or local demographics, whichever has a higher percentage of minorities. In Baltimore, which is over 60 percent black, only 10 percent of black eighth graders can read proficiently. Should Johns Hopkins’s comprehensive cancer center nevertheless have 60 percent black physician-administrators?
Grant applicants seek the services of the burgeoning diversity-consulting profession to make sure that their proposals sound the right diversity notes. As with the Howard Hughes Medical Institute’s Freeman Hrabowski scholarships, an insufficiently robust diversity plan means that a cancer research proposal will be rejected, regardless of its scientific merit. Discussions about how to beef up the diversity section of a grant proposal have become more important than discussions about tumor biology, reports a physician-scientist. “It is not easy summarizing how your work on cell signaling in nematodes applies to minorities currently living in your lab’s vicinity,” the researcher says. Mental energy spent solving that conundrum is mental energy not spent on science, he laments, since “thinking is always a zero-sum game.”
A lab’s diversity gauntlet has just begun, however. The NIH insists that participants in drug trials must also match national or local demographics. If a cancer center is in an area with few minorities, the lab must nevertheless present a plan for recruiting them into its study, regardless of their local unavailability. Genentech, the creator of lifesaving cancer drugs, held a national conference call with oncologists in April 2022 to discuss products in the research pipeline. Half of the call was spent on the problem of achieving diverse clinical trial enrollments, a participant reported. Genentech admitted to having run out of ideas.
There is no evidence that racist researchers are excluding minorities from drug trials on nonmedical grounds, nor has anyone presented a theory as to why they would. The barriers to such drug trial diversity include a higher incidence among blacks of disqualifying comorbidities, more challenging personal lives, and a suspicion of the medical profession (which that same profession constantly amplifies with its drumbeat about racism). Those barriers to drug-trial diversity are not recognized by grant evaluators, however.
In May 2022, a physician-scientist lost her NIH funding for a drug trial because the trial population did not contain enough blacks. The drug under review was for a type of cancer that blacks rarely get. So there were almost no black patients with that disease to enroll in the trial in the first place. It’s better, however, to foreclose development of a therapy that might help predominantly white cancer patients than to conduct a drug trial without black participants.
The diversity-driven requirement of racial proportionality in drug trials is perplexing, since diversity advocates insist that race is a social construct, without biological reality. Suggesting that genetic differences exist between racial groups will brand you a racist. The AMA’s Organizational Strategic Plan to Embed Racial Justice and Advance Health Equity sneers that “much of medicine still looks for cultural, behavioral or even genetic explanations” to explain racial gaps in life expectancy. Such a focus rests on “discredited and racist ideas about biological differences between racial groups,” according to the AMA. In May 2022, the American Association of Pediatrics announced that it was eliminating “race-based” medicine, defined as including a patient’s race in assessments of some health risks. If race does not exist, as received wisdom now has it, then the racial makeup of clinical trials should not matter.
The idea that race is merely a social construct is anti-scientific, however. DNA analyses show that there are at least five distinguishable races. The refusal to acknowledge race is also anti-health. Blacks with sub-Saharan roots have a high rate of kidney disease, for example, thanks in part to a more frequent genetic mutation. Drug companies have sought a treatment for that mutation. The reaction to that research has been unhinged. A lecturer in ethics at Columbia University and author of the book Medical Apartheid told the New York Times in May 2022 that knowledge about the genetic variant might drive the medical establishment toward “a blame-the-victim approach signaling an inherent flaw in African Americans.” This is fictional. No one thinks that possessing a genetic mutation means that the possessor is inherently flawed.” The activists are terrified, however, that work in basic science will supplant the political crusade against white supremacy. They would rather stop medical progress than improve blacks’ quality of life, if doing the latter acknowledges biological reality.
Biological reality comes into play in another kidney-related area. A common blood test for kidney health understates healthy kidney function in black patients. Nephrologists therefore adjusted the test results for black patients to estimate their kidney function with greater accuracy. Then the activists showed up, arguing that this correction must be abolished. The American Society of Nephrology and the National Kidney Foundation announced that they no longer supported the separate reporting of the kidney function measure for black patients. The University of Pennsylvania health system, among others, proudly presented its changed reporting protocol as part of the fight against medical racism. A more complicated diagnostic formula was widely adopted. But no patient was damaged by the original, more straightforward formula, nor was that original formula based on racism.
This is an excerpt taken from Heather Mac Donald’s new book When Race Trumps Merit now available from DW Books. Used with permission.
Heather Mac Donald is the Thomas W. Smith Fellow at the Manhattan Institute, a contributing editor of City Journal, and a New York Times bestselling author. She is a recipient of the 2005 Bradley Prize. Her writing has appeared in the Wall Street Journal, Washington Post, New York Times, Los Angeles Times, The New Republic, and The New Criterion.
The views expressed in this piece are those of the author and do not necessarily represent those of The Daily Wire.