How Doctors Got a Vitamin D Deficiency Epidemic So Wrong
Vitamin D deficiency is a very serious medical condition that can lead to bone mineralization problems if not addressed. In children, it causes the condition known as rickets, and in adults, it can contribute to osteoporosis. That’s why the medical profession started paying close attention when an unusually high rate of Vitamin D deficiency was observed in the Black community, suggesting that there was a growing epidemic and it was important to determine the root cause in order to improve health outcomes. Given the significant health disparities between people of color and the white community, identifying issues like these is critical.
However, it turns out that there was no epidemic. Those tests showing low levels of Vitamin D were wrong, and the cause of the erroneous results was a simple protein found commonly in the blood of people of African descent. Since the tests were designed and implemented with a “standard patient” in mind, they missed the fact that genetic inheritance can have a significant influence on test results. In fact, the Black community has some of the best bone health overall, which runs utterly contrary to claims of an epidemic of Vitamin D deficiency.
What happened here, and why?
These findings illustrate a known issue in the medical community: racism. Medical research, design and development is conducted through the use of “standard patients” who are designed to serve as generic stand-ins. They’re typically white, and they also usually fit within specific socioeconomic groups, because this allows pharmaceutical companies, test designers and researchers to cut down on the variables involved in their research, ensuring standardized outcomes that will in theory be applicable to a wide group of patients.
While this works well for some things, it doesn’t work well for others. Women have been agitating against the standard patient model for decades, arguing that the focus on men has led to a poor understanding of female anatomy and physiology, and that this in turn has created more adverse health outcomes for women. Some diseases affect men and women differently, and only studying men means that researchers miss out on learning the signs, symptoms and treatment options for women. The classic example can be found in cardiology, where signs of a heart attack look radically different in women than men, and consequently, women are diagnosed later.
The standard patient isn’t just a gendered problem, though. It’s also a racial one, because genetic heritage can play a huge role in disease susceptibility, blood chemistry and more. The same traits that make people of African descent more susceptible to sickle-cell anemia, for example, can also confer malaria resistance. People of Jewish descent are more likely to develop Tay-Sachs disease. And, it turns out, people of African descent carry a Vitamin D-binding protein that can skew the results of tests designed for use on a white population.
A similarly racialized outcome can be seen with breast cancer in Black women. Black women are 40% more likely to die of breast cancer than white women because they’re typically screened later and offered less aggressive treatments when they’re diagnosed. The result is an epidemic of cancer among a population that doesn’t fit the profile of the standard patient, creating a substantial health disparity.
Medical researchers and advocates are increasingly aware of the standard patient problem, and they’re pushing for changes in health development and health policy. They want to see race and gender factors considered in the development of testing, treatment and care protocols to reduce disparities in medicine. But the issue is two-pronged.
In addition to confronting the problem on the development end, advocates also need to work directly with care providers to address racism, much of which is unconscious. While a provider may not explicitly decide to deny care or refuse to discuss certain options with a patient on the basis of race or gender, the provider may subconsciously interact differently with patients of differing backgrounds, which compounds disparities.
Fighting that requires bringing anti-racism into medical schools and continuing education, to push medical professionals to examine internalized racism and consider its role in their decisionmaking.
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