Interesting all the places that race shows up.
“Race isn’t a biological factor like age, sex or weight — it’s a social construct.”
This comment gives me concern that this change wasn’t made by scientists seeking better understanding but rather by politicians seeking social justice.
“Race isn’t a biological factor like age, sex or weight — it’s a social construct.”
This comment gives me concern that this change wasn’t made by scientists seeking better understanding but rather by politicians seeking social justice.
“A few years ago, the National Kidney Foundation and American Society of Nephrology prodded laboratories to switch to race-free equations in calculating kidney function.”
.
“Race isn’t a biological factor like age, sex or weight — it’s a social construct.”
This comment gives me concern that this change wasn’t made by scientists seeking better understanding but rather by politicians seeking social justice.
“A few years ago, the National Kidney Foundation and American Society of Nephrology prodded laboratories to switch to race-free equations in calculating kidney function.”
No good deed ever goes unpunished…or the law of unintended consequences…
One of the criticisms of medical tests/recommendations is that often they were developed based on a limited population (e.g. white males). I believe the original intent of the different kidney assessment for black Americans was that their kidney function on average was different. Then push back started several years ago from some black persons who felt singled out by having different criteria, and that this is what prompted those organizations to push for the changes. Which of course engendered pushback from those that said we should follow the science. This is the first I’ve seen that it also led to negative health outcomes for black people, but maybe it did in other respects too?
My understanding is that even when you factor out all the lifestyle factors black Americans still have much higher rates of hypertension than other populations, and all the health sequelae that follow such as kidney disease. I believe some of the involved genes have even been identified. I would guess as we progress, such a crude predictor of disease risk such as race will be replaced with more precise genetic testing.
Another example of this is the use of BMI to predict disease risk. Different populations tend to have different fat distributions. BMI is basically serving as a proxy for the visceral adipose fat depot that appears to be most important for increasing risk of insulin resistance, cardiovascular disease, etc. Some populations tend to have more truncal fat at a given BMI (Hispanics and I believe Asians) than others (black Americans). So for instances a BMI of 27 may have the equivalent risk for diabetes in a Hispanic population that a BMI of 29 does in black American population.
Race is definitely a medical/biological factor in differential diagnosis and treatment. Sickle cell anemia in blacks, Creutzfeldt—Jakob disease in Libyan Jews. Just off the top of my head, I am sure there are no shortage of examples.
- *The APOL1 gene normally plays a role in immunity and is specifically protective against the trypanosoma parasite that causes African sleeping sickness. The APOL1 gene evolved specific changes over the past 10,000 years in people in parts of Africa that provide increased protection from this parasite. People who have moved outside of Africa have taken these genetic variants with them. While these APOL1 variants are protective from parasite infection, people with two *APOL1 *variants, also known as “kidney risk variants,†have an increased risk for kidney disease.Today, APOL1 risk variants occur in people of African ancestry who may self-identify as Black, African American, African, Afro-Caribbean, Hispanic, or Latino. It is important to think broadly about ancestry since many people do not know their genealogy. Approximately 13% of Black Americans have two APOL1 kidney risk variants compared to less than 0.1% for other races. It is estimated that about 15% – 20% of patients with two APOL1 kidney risk variants will develop kidney disease in their lifetime.
From the American Kidney Foundation: " African Americans are more at risk for kidney failure than any other race. More than 1 in 3 kidney failure patients living in the United States are African American. Diabetes is the number one cause of kidney failure. It causes nearly half of all cases of kidney failure in the United States. Diabetes affects African Americans differently. African Americans with diabetes develop kidney failure more often than whites. Diabetes causes heart disease and other problems in African American more often than whites."
From NIH. “Background and objectives: Serum creatinine concentrations tend to be higher in black than white individuals and people of other races or ethnicities. These differences have been assumed to be largely related to race-related differences in body composition, especially muscle mass.”
“Race isn’t a biological factor like age, sex or weight — it’s a social construct.”
This comment gives me concern that this change wasn’t made by scientists seeking better understanding but rather by politicians seeking social justice.
This comment gives me concern that you’re more interested in social justice than evaluating the validity of using the 1998 study of creatinine measurements in a small number of black people to apply to the clinical evaluation of anyone who has the darker skin appearance that black people have.
Edit: And per @NormM, that’s a valid dicussion.
These differences have been assumed to be largely related to race-related differences in body composition,** especially muscle mass.**"
Would be cool to figure out the actual causative factors…if it’s muscle mass, then muscle mass metrics could be used instead of using skin melatanin as a proxy for muscle mass. That could theoretically benefit everyone subject to this kind of evaluation.
These differences have been assumed to be largely related to race-related differences in body composition,** especially muscle mass.**"
Would be cool to figure out the actual causative factors…if it’s muscle mass, then muscle mass metrics could be used instead of using skin melatanin as a proxy for muscle mass. That could theoretically benefit everyone subject to this kind of evaluation.
Another issue is the cost of finding out. Race you just need to ask someone, BMI you just need height and weight, a lot cheaper than doing something to measure someone’s muscle mass or visceral adipose tissue.
“Race isn’t a biological factor like age, sex or weight — it’s a social construct.”
This comment gives me concern that this change wasn’t made by scientists seeking better understanding but rather by politicians seeking social justice.
This comment gives me concern that you’re more interested in social justice than evaluating the validity of using the 1998 study of creatinine measurements in a small number of black people to apply to the clinical evaluation of anyone who has the darker skin appearance that black people have.
Edit: And per @NormM, that’s a valid dicussion.
My understanding is that the pushback against using a different GFR for black people was from black people objecting to it, so at least the initial resistance was a “social justice” issue.
That doesn’t mean the science around it couldn’t be poor but at least from what I’ve seen over the years that wasn’t the original basis of the objections.
Another issue is the cost of finding out. Race you just need to ask someone, BMI you just need height and weight, a lot cheaper than doing something to measure someone’s muscle mass or visceral adipose tissue.
Right, but it could be targeted. I’m talking-out-of-ass because I don’t know crap about eGFR. But say your result comes back marginal, or just over the threshold. Before we introduce medical interventions, lets look a little closer if you might be just fine because your muscle mass is larger. Applies to everyone. I’m going to assume Kenyan marathoners maybe don’t have that extra muscle mass - would suck to be told they’re just fine because they have dark skin even though maybe they have a serious kidney issue. Or say Jacked McSwole white dude shows up with a result way over the threshold and is put on some drug even though he’s actually just fine - just has tons of muscle.
My understanding is that the pushback against using a different GFR for black people was from black people objecting to it, so at least the initial resistance was a “social justice” issue.
That doesn’t mean the science around it couldn’t be poor but at least from what I’ve seen over the years that wasn’t the original basis of the objections.
True. My point is that some here, I think put anything “social justice” in the “bad” bucket.
But if the science is poor, then that’s, to me, valid social justice. Make a stink to force people to actually review the science rather than just keeping doing it “because it’s the way we do it.”
Another issue is the cost of finding out. Race you just need to ask someone, BMI you just need height and weight, a lot cheaper than doing something to measure someone’s muscle mass or visceral adipose tissue.
Right, but it could be targeted. I’m talking-out-of-ass because I don’t know crap about eGFR. But say your result comes back marginal, or just over the threshold. Before we introduce medical interventions, lets look a little closer if you might be just fine because your muscle mass is larger. Applies to everyone. I’m going to assume Kenyan marathoners maybe don’t have that extra muscle mass - would suck to be told they’re just fine because they have dark skin even though maybe they have a serious kidney issue. Or say Jacked McSwole white dude shows up with a result way over the threshold and is put on some drug even though he’s actually just fine - just has tons of muscle.
Yeah, you would hope a clinician making a medical diagnosis or treatment decision would understand that. It’s like I always teach about BMI as a proxy for body fat. Just use your eyes, if BMI is telling you someone is overweight or obese, yet they are heavily muscled and lean, it’s a bad metric for predicting body fat.
https://apnews.com/...aab2fe8e18b2a5432135
Interesting all the places that biology shows up.
FIFY
If that’s how you see it. You’ve come at me twice, so I guess you’re looking for a response. I’m guessing you want to review “The Bell Curve” with me?
If you want to specify ethnicity and the specific genes tied to it as having an impact on health conditions, we can do that. You will have more luck looking at specific ethnic groups, particularly those who limit/have had limited intermarriage as that facilitates more genetic homogeneity.
The most ethnically diverse place on the planet is central Africa. The genetic homogeneity it would require to be conclusively predictive doesn’t exist. Not in Africa, not in Europe, not in Asia…
To look at race as predictive would be to divide people into four categories and based on which one they are in, make decisions on their care. Human beings are much, much more diverse than that.
Unless you’re uncomfortable being the same species as the other 8 billion of us?
https://apnews.com/...aab2fe8e18b2a5432135
Interesting all the places that biology shows up.
FIFY
If that’s how you see it. You’ve come at me twice, so I guess you’re looking for a response. I’m guessing you want to review “The Bell Curve” with me?
If you want to specify ethnicity and the specific genes tied to it as having an impact on health conditions, we can do that. You will have more luck looking at specific ethnic groups, particularly those who limit/have had limited intermarriage as that facilitates more genetic homogeneity.
The most ethnically diverse place on the planet is central Africa. The genetic homogeneity it would require to be conclusively predictive doesn’t exist. Not in Africa, not in Europe, not in Asia…
https://www.washingtonpost.com/...y-diverse-countries/
To look at race as predictive would be to divide people into four categories and based on which one they are in, make decisions on their care. Human beings are much, much more diverse than that.
Unless you’re uncomfortable being the same species as the other 8 billion of us?
For me, it either works or it doesn’t. Sure race might be a social construct that subsumes all kind of actual biological variability into a self-identified sort of folk ethnicity but if it can be used reliably to predict disease risk for a large percentage of people that identify as members of that race I don’t know why you wouldn’t use it? If down the road it becomes practical to use some sort of assessment that does a better job of predicting disease risk making race superfluous as a predictive variable than stop using it then. If it doesn’t work now, then don’t use it.
These differences have been assumed to be largely related to race-related differences in body composition,** especially muscle mass.**"
Would be cool to figure out the actual causative factors…if it’s muscle mass, then muscle mass metrics could be used instead of using skin melatanin as a proxy for muscle mass. That could theoretically benefit everyone subject to this kind of evaluation.
*Yes, absolutely. Whatever maximizes diagnostics, what the testing results means for the individual and what follow up makes sense. I remember when I was in my late 20’s early 30’s I was heavily into lifting weights like a body builder and my Creatinine levels were elevated as well as my C-Reactive protein levels. The doctor was not concerned due to my age, **physique, and the fact that I had a hard workout the previous day to drawing blood and the rest of the blood work numbers. *
*Yes, absolutely. Whatever maximizes diagnostics, what the testing results means for the individual and what follow up makes sense. I remember when I was in my late 20’s early 30’s I was heavily into lifting weights like a body builder and my Creatinine levels were elevated as well as my C-Reactive protein levels. The doctor was not concerned due to my age, **physique, and the fact that I had a hard workout the previous day to drawing blood and the rest of the blood work numbers. *
Yup, good doctors are probably quite used to making informed judgment.
For me it’s always:
<Doctor/nurse looks at the pre-surgery HR display with some concern.>
“Are you an athlete?”
“Runner, rower, and cyclist for 35 years.”
<Doctor/nurse starts mashing on the button to lower the alarm threshold, look of concern disappears>