Uncovering the Flawed Science Behind Race-Based Medicine

Dr. Andrea Deyrup, a professor of pathology at Duke University, is challenging one of the core tenets taught to medical students – that a patient’s race is a key factor in diagnosing and treating disease. In a recent episode of NPR’s Code Switch podcast, Dr. Deyrup explains how race-based medicine is not only scientifically unsound but can lead to dangerous misdiagnoses and delays in care.

“Really, pretty much anybody can get any disease,” says Dr. Deyrup, who also serves as course director for pathology at Duke University School of Medicine. Yet medical textbooks and board exams continue to teach aspiring doctors that certain races are more prone to specific illnesses, from cystic fibrosis in white patients to sickle cell disease in black patients.

Dr. Deyrup has been digging into the origins of these race-based associations, often finding that they are rooted in racist 19th century beliefs rather than actual science. In one example, she traced the oft-cited statistic that up to 16% of black people get keloid scars back to a single, non-peer-reviewed observation from 1931 in the Belgian Congo. By contrast, a study from the same year found a 13% keloid rate in Switzerland, but that figure was ignored.

“Just because it’s in the textbook doesn’t mean students learn it. They learn it because it’s on the test,” Dr. Deyrup notes. She has been meeting with major medical examining boards to push for removing race from exam questions, but so far they have refused.

In a 2017 analysis of one widely used medical school test prep company’s materials, Dr. Deyrup found that nearly every time Native Americans were mentioned, it was in the context of a “Native American disease” like severe combined immunodeficiency or gallstones. The prep materials mentioned white patients 86% of the time, far more than their 62% share of the U.S. population, indicating a centering of whiteness as a medical norm.

The consequences of race-based medicine are serious. Doctors may miss diagnosing cystic fibrosis in black children or gallstones in Native American women because they’ve been taught those groups don’t get those diseases. Universal genetic screening tests often only look for cystic fibrosis mutations common in white populations.

Dr. Deyrup shares an anecdote of an 8-year-old African American girl who had cystic fibrosis but went undiagnosed for years because “African Americans don’t get cystic fibrosis is what they had been taught.” Early diagnosis and treatment is critical for cystic fibrosis outcomes.

She also cites the problematic belief, dating back to Thomas Jefferson, that African Americans have poor lung function. A black female patient was once praised for her “impressive” breathing test results because “African Americans don’t typically have very good pulmonary function” – a racist myth with no basis in biology.

While some defend using race as a diagnostic shortcut in time-crunched medical settings, Dr. Deyrup has a stark reply: “I say people are dying. And people are suffering. And you came into medicine first to do no harm.” She urges doctors to take the time to understand each patient as an individual, and encourages patients to question physicians who make race-based assumptions.

Ultimately, Dr. Deyrup argues, race-based medicine will only become a relic when society recognizes our common humanity. “We’re all 99.9% the same,” she says, “and the more we can recognize that we are really all pretty much the same and we all need to help each other out, the better it would be.”

(For more on Dr. Deyrup’s work debunking medical myths around race, visit her website at pathologycentral.org.)