We know better but what the heck...

I read an interesting embargoed article in JAMA. Initially I was just going to wait for the embargo to lift today at 11:00 a.m. and share across a few platforms but I had a few days to think about the findings. With time to kill I read a few of the citations.

The quote from DeSantis CE and colleagues inadvertently describes the tension quite succinctly. We know what we are reporting is of low value because the real cause of disparity is social and political constructs but--what the hell--everyone else is doing it.

We recognize that race is a social construct; however, because much US health data are reported by race, racial classification remains useful for describing general patterns of health within the nation. Although we use the terms African Americans and blacks interchangeably, the data provided herein are for those identified by black race and exclude those of Hispanic
ethnicity when possible.--Cancer statistics for African Americans, 2016: Progress and opportunities in reducing racial disparities

In the United States, African Americans bear a disproportionate share of the cancer burden, having the highest death rate and shortest survival of any racial or ethnic group for most cancers. The causes of these inequalities are complex and reflect social and economic disparities more than biological differences.

For example, in 2014, 26% of blacks, compared with 10% of non-Hispanic whites, were living below the federal poverty level, and 22% of blacks had completed 4 years of college compared with 36% of non-Hispanic whites.1,2 Persons with lower socioeconomic status are more likely to engage in behaviors that increase cancer risk, in part because of marketing strategies that target these populations as well as environmental and community factors, such as fewer opportunities for physical activity and less access to fresh fruits and vegetables.--Cancer statistics for African Americans, 2016: Progress and opportunities in reducing racial disparities

The data is a bit out of date in the cancer trends graphic. I am working on updating from my data sources but my point here is we have enough data to start looking with deeper granularity. Racial data tells us very little. Understanding  that our genes sort based on geographical origins not the color of our skin is an important pivot in our understanding. 

The recent research letter (embargoed until 11:00 a.m. ET) explains why assumptions and continuous misinterpretation of social vs. biologic proxies (that do not exist) serve no-one...

Laboratory Eligibility Criteria as Potential Barriers to Participation by Black Men in Prostate Cancer Clinical Trials

The data above are unambiguous in reporting incidence of prostate cancer in black men. Vastola, Yang, et al. report in JAMA oncology potential barriers that may exist in disproportionally preventing black patients from participating in clinical trials. The Research Letter stated:

We investigated the use of serum creatinine (sCr) alone instead of race-adjusted measurements for renal function and the use of an absolute neutrophil count (ANC) threshold that could exclude men with benign ethnic neutropenia. Black patients have higher sCr for any given renal function, and using this measurement may falsely underestimate their renal function.Similarly, the 6.7% to 8.0% of black patients with benign ethnic neutropenia, a condition defined as neutropenia
(ANC<1.5 Å~ 109 cells/L)without attributable cause, may be excluded despite healthy immune systems.

JAMA Oncology Published online February 8, 2018 Laboratory Eligibility Criteria as Potential Barriers
to Participation by Black Men in Prostate Cancer Clinical Trials

​There are differences and variations in laboratory measures but we certainly wouldn't be able to sort participants by race accurately based on serum creatinine (sCr) alone. Identifying the actual biologic differences and not aggregating patients solely based on skin color is as critical as not using race as a substitute for identifying and measuring social determinants of health.

While adopting race-based differences in trial criteria may add slight logistical challenges when ensuring that patients meet trial eligibility, these adjustments would prevent healthy individuals
from being excluded solely because of benign laboratory differences caused by their race.
​[[I would substitute ancestry for race]]-- Laboratory Eligibility Criteria as Potential Barriers
to Participation by Black Men in Prostate Cancer Clinical Trials