Hippocrates, Harm, Racism

The Associated Press provides specific examples of Pediatric Academy progress, notably as regards issues with urinary infections and newborn jaundice. There are recognitions by some physicians or scientists that new foundations and guidance may include explanation “of how some of our frequently used clinical aids have come to be — via pseudoscience and racism.” Thus, in a nutshell, those guidance have been longstanding, discriminatory, and not based on science. It is probable, nonetheless, that the groupthink they represent were nonetheless something doctors and society were encouraged to believe, or to "follow" (likely blindly).  

The pediatric group is encouraging others to follow its anti-racist lead. It advocates that "other medical institutions and specialty groups" should similarly address their foundations, premises, and guidance to "work() to eliminate racism in medicine." One source was quoted therein characterized medicine as a "a pipe full of holes," and advocated that plugging one hole (pediatrics) will be merely a start that other specialties and groups must emulate in order to address all of the potential faults (leaks). The implication is that there is systemic racism in a variety of specialties and premises. 

The broader interest being pursued in this regard has also been newsworthy. An excellent example is a 2021 Nature publication Health Inequities and the Inappropriate use of Race in Nephrology. It concludes

"ignoring the biological and social heterogeneity within any racial group and inferring innate individual-level attributes is methodologically flawed"

Heterogeneity is "the quality or state of being diverse in character or content." The criticism is of bias, stereotypes, and race-based assumptions. In short, it seems suggestive that the physician should examine the patient, observe the specifics, define a diagnosis, and instigate treatment without reference to biases, prejudice, or racist group think. That this may seem a novel approach, is troubling and offensive. Treating the patient based upon her/his symptoms, testing, etc. should always have been  our course. Learning that care and treatment has been influenced by prejudice and bias is disturbing.  

The critical point is that humans are each potentially physically distinct or different based upon a variety of causes including personal genetics and biology. Medicine cannot treat each of us identically because we are not identical. As clearly, racism regarding medical diagnosis or treatment is both illogical and inappropriate. One wonders how the scientific community has awaited 2022 to address the false assumptions and foundations that have apparently been heretofore applied. 

In a world in which we are all told to "follow the science," there exist such untoward examples of science and scientists not themselves following the science. There are, instead, instances in which consensus and "group think" have prevailed in a scientific community, to the detriment of some, perhaps many, maybe most. Whether we conclude that the pediatric association's current mandate does or does not include "do(ing) no harm," we must remain aware of the potential for consensus thinking masquerading as science.  

We must applaud any effort to reexamine theories and postulates which may or may not remain appropriate. That such conclusions previously achieved consensus should not dissuade us from reexamination, critical testing, and new science-based postulates when appropriate. When asked to make assumptions or to reach conclusions based upon a person's race, the entire chorus should ask why, challenge and question the science, and decry racism and prejudice. Medicine and science face many challenges, the unknown, the evolving, the pernicious. Racism should not be one of them. 

By Judge David Langham

Courtesy of Florida Workers' Comp