Race Cannot Be Used To Predict Heart Disease, Scientists Say (nytimes.com) 97
Doctors have long relied on a few key patient characteristics to assess risk of a heart attack or stroke, using a calculus that considers blood pressure, cholesterol, smoking and diabetes status, as well as demographics: age, sex and race. Now, the American Heart Association is taking race out of the equation. From a report: The overhaul of the widely used cardiac-risk algorithm is an acknowledgment that, unlike sex or age, race identification in and of itself is not a biological risk factor. The scientists who modified the algorithm decided from the start that race itself did not belong in clinical tools used to guide medical decision making, even though race might serve as a proxy for certain social circumstances, genetic predispositions or environmental exposures that raise the risk of cardiovascular disease.
The revision comes amid rising concern about health equity and racial bias within the U.S. health care system, and is part of a broader trend toward removing race from a variety of clinical algorithms. "We should not be using race to inform whether someone gets a treatment or doesn't get a treatment," said Dr. Sadiya Khan, a preventive cardiologist at Northwestern University Feinberg School of Medicine, who chaired the statement writing committee for the American Heart Association, or A.H.A. The statement was published on Friday [PDF] in the association's journal, Circulation. An online calculator using the new algorithm, called PREVENT, is still in development.
The revision comes amid rising concern about health equity and racial bias within the U.S. health care system, and is part of a broader trend toward removing race from a variety of clinical algorithms. "We should not be using race to inform whether someone gets a treatment or doesn't get a treatment," said Dr. Sadiya Khan, a preventive cardiologist at Northwestern University Feinberg School of Medicine, who chaired the statement writing committee for the American Heart Association, or A.H.A. The statement was published on Friday [PDF] in the association's journal, Circulation. An online calculator using the new algorithm, called PREVENT, is still in development.
Re: On the other hand... (Score:4, Interesting)
Re: (Score:3, Informative)
At least I can provide citation for my claims, what do you have do back your bullshit?
Race, Ethnicity, Culture, and Disparities in Health care [nih.gov]
Leonard E Egede, MD, MS
In spite of significant advances in the diagnosis and treatment of most chronic diseases, there is evidence that racial and ethnic minorities tend to receive lower quality of care than nonminorities and that, patients of minority ethnicity experience greater morbidity and mortality from various chronic diseases than nonminorities. The Institute
Re: (Score:2, Flamebait)
Yes, it is kind of odd.
When I grew up the Republican adults around me were of the Joe Friday, "Just the facts Ma'am" variety and they derided the "left" for being controlled by their feelings
Now, we see a 180 degree flip with the Republicans being completely controlled by "beliefs and feelings (usually rage)", which are demonstrated to lead to poor decision making [nih.gov]
I honestly would not believe it if I had not seen it personally
Re: (Score:2)
Well, the lunatic fringe moves around generation to generation. People get displaced when groups they formerly were part of shift consensus on, say, civil rights, which drove the Lost Cuase and KKK types away from the Democrats back in the 60s to the the Republicans. Many neocons were socialists who were alienated by the New Left's shift away from traditional left wing labor politics to issues like feminism, gay rights and enviromentalism. Modern Republican anti-science rhetoric is just old Marxist anti-
Re: On the other hand... (Score:1)
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You can't scientifically pinpoint an illness to a race because "race" doesn't have a consistent scientific definition. For example, under some concepts of "whiteness" Irish need not apply [wikimedia.org]. Irish folk just didn't look white to some early "scientific racists".
But of course Irish people may *look* white to you, so does that make them white? Well, does Barack Obama seem clearly of the black race to you? Probably, because he's genetically almost exactly 50% African, and that's more African than many African
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There is a significant element of truth in what you say. We need to recognize and acknowledge that. But completely abandoning the concept of race is not the answer. There are significant health issues that are impacted by race. Sickle cell anemia and melanoma are two easy examples that correlate with race for different reasons, neither of which is related to social issues.
The popular concept of race was never particularly scientific, and the issue is absolutely muddied by historical prejudices. Most classif
Re: On the other hand... (Score:4, Interesting)
Views have changed partly because the people represented by the parties have changed.
The Republican Party used to be the urban elite, and the Democrats represented white working-class people who lived in trailer parks.
Those allegiances have flipped.
Re: On the other hand... (Score:1)
Re: (Score:2, Troll)
It is much worse than that. The former alleged president made his followers feel good about being stupid. This is the same crowd that believes pro wrestling is sport, Jesus is a'coming any minute so we can fuck up the Earth to our heart's content, that Covid vaccines are inferior to hydroxychloroquine or that the vaccines are some nefarious plot to kill people. As if that idiot actually cares about "real people" instead of just himself.
Ever wonder why he corrupts everything he touches. His "business sense"
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"give up the malt liquor"
Nice dog whistle, did this get linked to Stormfront?
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A citation would typically be used where it supports a claim. This paper does not. The authors are critiquing studies that purport to show connections between outcomes based on race.
> Although the findings of these studies are highly relevant, there are inherent limitations in most research studies on ethnic differences that need to be highlighted. There is good evidence that socioeconomic position is a stronger determinant of health-related outcomes than race. Several studies have shown that the effect
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"There is good evidence that socioeconomic position is a stronger determinant of health-related outcomes than race."
That is consistent with this.
https://abcnews.go.com/Health/... [go.com]
https://www.usnews.com/news/he... [usnews.com]
https://www.huronconsultinggro... [huronconsultinggroup.com]
Accessing healthcare in rural America has been compared to finding healthy food in food deserts and the situation is only getting worse. Over 600 rural hospitals are vulnerable to closure, leaving rural Americans, who are sicker, poorer and older than the rest of the
Re: On the other hand... (Score:1)
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What rock have you been living under? *Lifestyle choices* apparently consist of not getting decent paying jobs with medical care due to inherent racism in hiring. Yeah, I'm sure their *lifestyle choices* were to avoid good paying jobs, or being able to afford college. Dolt.
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>"not getting decent paying jobs with medical care due to inherent racism in hiring"
Yawn. Disparate outcomes does not automatically (or now even typically) equate to racism.
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you fucking idiot (Score:2, Interesting)
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Why do you think that you can ignore Basketball?
Maybe watching an well produced documentary would help [wikipedia.org]
FYI, there is one race, human, and it has been demonstrated that skin color can change over generations, in isolated genetic groups, based on the sunlight they are exposed to. [biomedcentral.com]
Re: (Score:3, Interesting)
It is genuinely intriguing to watch American left be as insane as this. It's a well established and utterly uncontroversial fact internationally that different ethnic groups have different risk factors.
But American left is stuck in the "race is the skin color" mode, from it's origin days of KKK. Just like they genuinely believe that "white" is a race, they think "black" is a race too.
What are Egyptians? Somalis? Albanians? Tatars? Heck, my ethnic group was called "Mongols" by American left because they coul
Re: (Score:2)
>>It is genuinely intriguing to watch
Self reflection may be helpful for people who are projecting [wikipedia.org]
>>But American left is stuck in the "race is the skin color"
You are mistaking the boxes that people fill out as a result of a multitude of lawsuits, federal regulation and laws for what anybody in left or center "thinks", they are the result of persistent attempts to get around those laws. Again read up on projection
>>What are Egyptians? Somalis? Albanians? Tatars?
Cultures, yes those would li
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>Self reflection may be helpful for people who are projecting [wikipedia.org]
Agreed. I'm one of the most self-reflective people you'll ever meet. I'm always open to being wrong, even on fundamental issues. It took me over decade of psychological training specifically aimed at being like this to be able to handle it. Most people can't. I can recommend it, as it opens up understanding of reality before normative consensus reaches the point of understanding. Being ahead of the curve is fun and interesting i
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It is genuinely intriguing to watch American left be as insane as this. It's a well established and utterly uncontroversial fact internationally that different ethnic groups have different risk factors.
It's certainly possible that race is a significant risk factor for certain health conditions but not for other conditions. This story is about a specific type of disease, not all diseases in general.
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As I noted above, it's INTERNATIONALLY uncontroversial that sub Saharan Africans (blacks in US lingvo) have a significantly elevated risk for heart disease and hypertension compared to Europeans. This is actively used in mapping out risk groups, diagnosing correctly and applying remedies where possible and necessary.
It's harmful when racially motivated due to progressive takeover US institutions go against the international consensus for reasons of domestic politics, because it introduces pointless obstacle
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I think that you are misapplying the behavior of some pro athletes, regardless of race, to people who you have a particular dislike for
Feelings Science (Score:5, Insightful)
That's what this sounds like. If you're deliberately ignoring medical and scientific results in the name of equality people are going to die.
I don't care if it's because my race typically is exposed to X that I might get X disease or not, that should make them more aware of it to better treat me. It doesn't matter to me if it's because of my genetics, or the region I typically live in.
If you've actually found medical and scientific evidence now that it actually doesn't apply to the results, then the math should show that which would make it irrelevant and you wouldn't need to remove it from being listed.
People are going to die for someone elses feelings.
Re: Feelings Science (Score:4, Insightful)
Re: Feelings Science (Score:2)
Now find some science to back up your imagination.
Re: Feelings Science (Score:1)
Re: Feelings Science (Score:5, Insightful)
You can't appeal to science when it comes to race because science says there is no such thing. HTH, HAND
This is the reason given to exclude race as documented in their statement:
Because race is a social construct and an historically fraught proxy representing various lived experiences, there is the potential for the harmful interpretation that it represents a biological risk factor when included in risk prediction, which may result in race-specific treatment decisions. Therefore, it was decided a priori not to include race as a predictor in the development of PREVENT and to use the recently developed race-free equations for eGFR on the basis of serum creatinine (CKD-EPI 2021 [Chronic Kidney Disease Epidemiology Collaboration]).
This means race was not excluded because it does not contribute to better evaluate the risk prediction, but to avoid potential "misinterpretations". They even recognize that there are indeed disparities:
In this regard, it is important to note that there continue to be disparities in CVD risk factors and CVD incidence, with Black individuals having higher levels and rates, respectively.
So if you are black, your risk prediction *should* be calculated higher, because that's the reality of things. They decided to remove it to try to include some of the underlying reasons that they believe cause that higher risk, but they also acknowledge at the moment this approach is potentially lacking:
However, despite interest in inclusion of measures that more directly reflect risk related to racism (eg, residential segregation, perceived racial discrimination) and additional individual- and place-based measures of social drivers (eg, income, education, residential green space), the lack of standardized assessment and capture in data sources was a key limitation. Therefore, although the PREVENT equations represent a critical step forward, integration of the social deprivation index is only a first step; the inclusion of relevant measures that represent individual experiences of discrimination, structural and systemic racism, and individual- and place-based SDOH should be a priority in risk prediction moving forward.
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>"This is the reason given to exclude race as documented in their statement: "Because race is a social construct and an historically fraught proxy representing various lived experiences"
Race is not a "social construct" in many aspects. "Culture" is, and the two should not be confused. So separate the two when possible. I will point to sickle cell anemia and ask if that is a "social construct", as well. "Race" is less and less meaningful, as the lines continue to blur, genetically, but to pretend tha
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Whatever gives me better care. I'll take better medical care with information that's pertains to my race than dying for your ideology and feelings. They can vote me down all the want.
Each person who supports this, can go to the doctors that have information that excludes race. I'll go to the ones that have the information that's medically and scientifically relevant. The problem will sort itself out.
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"You can't appeal to science when it comes to race because science says there is no such thing."
That was Scientific American's official position right up until George Floyd.
Then they decided race was real and the most important thing ever.
Did they change their minds again?
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I don't care if it's because my race typically is exposed to X that I might get X disease or not, ...
Another reason to not use Twitter -- I mean, X. :-)
Disappointing (Score:5, Interesting)
Race in some ways is a doubling up of some of the other statistics. For example, more African Americans may have heart disease, but more African Americans do have diabetes than other ethnicities (14.7% of Native Americans, 12.5% for non-hispanic black, 11.8% hispanic, 9.5% asian, 7.4% white). Diabetes is a much more likely indicator of heart disease, so health information of course is more important. But there are significant lifestyle differences between the different ethnic groups in the US, and knowing that creates an opportunity for a more targeted preventative solution, as diabetes care for the white community is likely sourced from different lifestyle/diet issues than diabetes for the African American community. So if the action is "try to get people to change so they're not diabetic", a generic solution may not be the problem.
There is a value in knowing how ethnic groups are affected by this, from a sociological point of view, as it might highlight certain avenues for improvement. Disappointing.
Re:Disappointing (Score:4, Interesting)
What does race even mean in 2023 though?
What percentage of your ethnicity needs to be from Africa, and how far back, to be considered an "African-American"?
Do we need to run an ancestry DNA analysis every time someone goes to the doctor?
Just because two people both have dark skin does not mean their genomes are related. That may have been true 150 years ago but it certainly is not today.
Re:Disappointing (Score:5, Insightful)
It's not binary, you can treat things as percentage odds.
What you're looking for is the most probable cause for a condition, and diagnostically it is best to go from most likely to least, moving along the list as you eliminate each possibility in order.
Anything else means, at best, an increased average time and number of tests before a correct diagnosis and treatment which means statistically worse outcomes.
This is political correctness actually hurting people in ways you will be able to measure.
Re: (Score:3)
My health insurance provides genetic testing to identify known abnormalities related to particular diseases
It also included a map of my genetic background, that was eye-opening
I believe that this will become the new standard of care
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What does race even mean in 2023 though?
It does not matter here. We don't need any deep meaning for the word. The context is the United States, which has for whatever reason collected statistics based on
certain categories. If people can be consistently allocated to a category, and that allocation is more predictive of certain outcomes than other available information, then it is useful. It only stops being useful when we have sufficient more detailed information, such as lifestyle, diet, blood pressure, what genes are present, etc.
Stat
"Race" is something we made up (Score:1)
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I think that the Dr Seuss story about the star-bellied sneetches [wikipedia.org]is one of the most insightful explorations of race I have encountered, particularly when it proposes a method to eliminate the physical identifiers of race
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It is true that the concept of race has spread into so many areas that it perhaps shouldn't, and to that degree the very idea of race is confusing. There are all sorts of poor racial stereotypes that are just wrong and hurtful, and the most common issue is the difference between race and culture. Culture is a set of behaviors, but race/ethnicity is something more concrete.
And when it comes to healthcare, race IS a thing. Sickl
Given that race was a useful proxy (Score:5, Insightful)
So if they've decided to remove this apparently useful proxy, I assume they will now start tracking all those factors for which race was providing a proxy? Because, if not, this is going to make cardiac care worse for members of those races - not better.
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So if they've decided to remove this apparently useful proxy, I assume they will now start tracking all those factors for which race was providing a proxy? Because, if not, this is going to make cardiac care worse for members of those races - not better.
They tried to incorporate some of the underlying factors, but acknowledge the new approach is currently limited:
However, despite interest in inclusion of measures that more directly reflect risk related to racism (eg, residential segregation, perceived racial discrimination) and additional individual- and place-based measures of social drivers (eg, income, education, residential green space), the lack of standardized assessment and capture in data sources was a key limitation. Therefore, although the PREVENT equations represent a critical step forward, integration of the social deprivation index is only a first step; the inclusion of relevant measures that represent individual experiences of discrimination, structural and systemic racism, and individual- and place-based SDOH should be a priority in risk prediction moving forward.
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"Decided from the start"? (Score:5, Insightful)
From TFS: "The scientists who modified the algorithm decided from the start that race itself did not belong in clinical tools used to guide medical decision making, even though race might serve as a proxy for certain social circumstances, genetic predispositions or environmental exposures that raise the risk of cardiovascular disease."
I'm not sure what this sentence is supposed to mean. Ethnic background is an independent predictor of risk for several common diseases-- for example, prostate cancer (more prevalent in Black people, less prevalent in northern Europeans, even less prevalent in Asians). For certain genetic diseases (e.g. sickle-cell disease, Tay-Sachs), ethnic background is a *strong* predictor. You ignore it at your peril.
I don't know if ethnic background is an independent predictor of heart disease, or just a proxy for multiple other things. But that's a side issue, since the quoted sentence says "race does not belong in clinical tools used to guide medical decision-making". The prohibition isn't specific to heart disease.
"Deciding things at the start" is a poor way to go about doing science.
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That line alone reeks of the old, "Find evidence to support your hypothesis" trap.
I'm certainly no expert in the field, and as a 40+ white European guy I probably have even less to say in this matter, but if skin color in any way whatsoever helps you determine likelihood of a disease, include skin color in your calculations!
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Actually, it is using an existing Thesis to propose an Antithesis to, and is fairly common
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The sheer number of women that have died because scientists all assumed they responded the same ...
You can replace "women" with "men" (or "elderly" or many other words) and it is still true. Simplifying assumptions are always needed. Stop with the identity wars please.
what happened to evidence based medicine?
Actually, I'd like to see some evidence for the scale of your vague claim, and some acknowledgement of *why* women are under-represented in early-stage clinical trials. The problem is hardly a secret.
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I think they're saying that race is often used as a proxy for multiple other factors, like you suggested. And they don't think that's a good idea. They want to shift the models to more directly use the factors that really matter.
I don't think they're trying to avoid using it in cases where it clearly does matter.
I dissagree (Score:1)
US racial categories are broken anyway (Score:2)
Consider the Hispanic category. It literally means that you grew up speaking Spanish. Your parents could be Chinese, African, or Apache. Doesn't matter, you can identify as Hispanic.
Then there's "Asian", which lumps Sri Lankans and Japanese into the same category. Probably Australian aborigines too.
Humans in Africa have more genetic diversity that the rest of the species, so an homogeneous "Black" category almost certainly misses important variations.
And don't get me started on mixed-race definitions.
So no,
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I don't know what Canadian doctors use, but the official police categories are "white" and "non-white".
You know what? I don't care if it is genetically accurate... If you look 'hispanic' and cops are looking for you, they ought to be able to put 'hispanic' in the occurrence notes.
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You can't "look Hispanic" by the US definition, because the US definition of Hispanic is people from Spanish-speaking countries in the Americas irrespective of race. A black Cuban, a native Mexican and a white Colombian are all "Hispanic" according to the US definition.
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A black Cuban, a native Mexican and a white Colombian are all "Hispanic" according to the US definition.
Did they walk into a bar?
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Consider the Hispanic category. It literally means that you grew up speaking Spanish. Your parents could be Chinese,
Technically, historically yes, but not in US English, where it is an ethnic term. It specifically refers to people from Latin America. Brazilians are usually included.
Antonio Banderas in not hispanic, or "of colour". Louis CK is Hispanic.
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Colloquially it might meet Latin American, but officially (and thus on medical forms) it means speaking Spanish. Hence the Antonio Banderas saga: https://www.npr.org/2020/02/09... [npr.org]
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Hence the Antonio Banderas saga: https://www.npr.org/2020/02/09... [npr.org]
I tend to agree with the Spanish there, that "the US has an absurd obsession with race", and unfortunately that applies increasingly to other Anglophone countries too.
More accurate for all, eventually? (Score:2)
gonna stick my hand (Score:4, Insightful)
Fact: one of the VERY FEW actual, documented, totally-for-real racial differences is in the amount of melanin that are produced by a person's melanocyte cells.
Fact: there are melanocyte cells located in a person's heart.
Ok, here's the point where I make massive disclaimer statements, to try and avoid a torch-wielding mob at my door. I'm not for or against any specific race. I'm not saying anything about "good" or "bad" or "something in between". No value judgements here. Everyone is a unique individual. Etc. etc.
But skin-color actually correlates to melanocyte differences, and THERE ARE MELANOCYTES IN THE HEART. Are we absolutely sure race doesn't play a role in heart function? This isn't some white guy pontificating about how great it would be to classify people by race, with light skinned people at the top. I would imagine that most people, regardless of skin color, would really like to know if something about their biology points to potential heart issues in the future. Are we absolutely sure we want to apply hard-left DEI policies here and go totally racially blind?
Jews have a well-documented genetic predisposition for Gaucher disease. White people in general have a well-understood tendency to alcoholism that's caused by their genetics. Is it a good idea to go absolutely colorblind when it comes to medical issues?
Maybe I'm being racist here and I'm totally off base. If so, please, educate me. I can change.
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>"Are we absolutely sure we want to apply hard-left DEI policies here and go totally racially blind?"
Yes, far left is DEI and such. But going racially blind is NOT a left-wing concept anymore, it is a right-wing concept now. Funny how that works. Might depend on context, but, socially, if you want to not care about someone's race, you can't be a leftist.
>"Maybe I'm being racist here and I'm totally off base. If so, please, educate me. I can change."
You are not being racist. Although the definition
What's next? And then next? (Score:3)
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Did you just assume the gender of those birthing people?
maybe use data? (Score:2)
I'd be perfectly fine if they said "we checked and there is NO MEANINGFUL STATISTICAL CORRELATION between race and heart disease" or it wouldn't even have to be that categorical...it could be that race suggests a relationship, but in fact this only proxies a collection of other factors which could be independently checked instead of using the imprecise aggregation of something as vague as "race".
Then by all means, remove it.
But they don't seem to mention anywhere that they used data to determine this , they
Death in the name of woke ideology (Score:3)
I was at least expecting a merit based argument for the change to be expressed. What I found instead was woke language and direct admission change were decided in advance for political reasons.
Woke "modifiable" gibberish:
Direct admission changes were NOT merit based:
What gets me is the obvious difference (skin color) appears to getting overlooked even though there is a substantial body of evidence linking trivially treatable impacts to relevant risk factors (e.g. diabetes and hypertension).
https://www.mdpi.com/1660-4601... [mdpi.com]
https://www.ncbi.nlm.nih.gov/p... [nih.gov]
The very notion ideology should trump reality when ignorance of reality is actively harmful to people is something I don't know how to justify. It seems evil and absurd on its face.
Inclusion that kills (Score:1)
I'm all for inclusion. But ignoring factors with a scientific and statistical basis because it hurts people in the feels is not the way to help under served communities or racial groups. This seems very much like the kind of attempt at inclusion that will lead to worse outcomes for those it is attempting to help.
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Yeah. The same thing happened in the social sciences, and is now spreading into hard sciences. It doesn't matter that sex, ethnicity, or culture may be relevant to outcomes - simply ignore them, forgoing solutions that may otherwise have been found.
It has one advantage in that we can save a lot of money on research if we simply assume differing outcomes are due to either racism, sexism, or whatever the current day istaphobia is. Factors like wealth and lifestyle choices after all rarely rise to significance
What is missing is class (Score:2)
Sure yer white? (Score:2)
If only I could be honest about income on forms too.
Race might used to have meant skin color. But is this context, race of the participant it is what box says that the individual checked. Is this verified? How? What, again, is race and how do to identify it using specific metrics that can be compared apples-to-apples so to speak or in this case the intentional differences of apples from oranges and oranges from plums? I might suggest DNA rather than identity, it might even contain nutritional identification
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>But is this context, race of the participant it is what box says that the individual checked.
As a proxy for social factors, this works wonderfully. For probable genetic factors, it's a lot weaker... but chances are nobody's calling themselves 'black' if their ethnicity is 'Indian'.
What you're more likely to get is people who are of mixed heritage and have a strong personal association with one ancestral ethnic category and write that down - which still tells you they're more likely to have genes known
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>Except that race is not a social construct
You're going to need to rethink that, because race is when you call someone black, or Jewish, or white, or whatever. And that is not only loosely correlated with genetics, the definition of what puts someone in a racial category varies by where you are and the local standards.
It is a social construct.
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First, since when is 'jewish' a race? It is a RELIGION. For you to call someone that and think that it means race, implies that you are a racist.
Secondly, as to black/white/etc, far too many ppl think that skin color is what makes up race. It is does not. Ancestry is what makes up race. A race is determined by a closed genetic group. Long ago that was the case. Now, in places like America, we are bulworthing things, but we still have it to a large degree. For exam
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for example, gout used to be thought of as white disease, but it is not. It is rich person disease. There are many different diseases that were falsely correlated with wrong indicators becaus
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"decided from the start" (Score:3)
>"The scientists who modified the algorithm decided from the start that race itself did not belong..."
Welcome to the new "science", where researchers decide, in advance, what data belong and don't belong, to support their feelings and social agenda. What the conclusion will be, regardless of the data. There is any wonder why people are trusting "the science" less and less.
Disgusting.
And for each disclosure like this, rest assured there are many, many others we don't know about.
Seems dumb (Score:2)
Really really dumb decision - can we keep politics out of science, please?
not "cannot" (Score:2)
No it still can be used, and it does work. What the cognoscenti ruled is that it MUST not.