Two leading North American medical associations have just recommended that “race and ethnicity” should no longer be taken into account in all forms of medical research. This parameter could, according to them, increase the risk of discrimination against minorities and lead to minimizing or concealing the role of the environment in public health. In a column in L’Express, Dr. Michel Tibayrenc, doctor of medicine, state doctor of science and director of research emeritus at the Research Institute for Development (IRD)*, worries about this decision. If he praises the anti-racist ulterior motives of the two associations, he points out its limits and the damage that their decision could cause for minorities, contrary to the initial objective. Like other of his colleagues, he recalls on the contrary the need to take into account the genetic diversity of geographical populations in biomedical research.
The debate over the validity of the concept of biological “race” within the human species it’s nothing new. It is not the subject of this forum, which is the impact of this controversy on biomedical research and on the practice of clinical medicine. This problem is indeed coming to the fore again following the decision of two leading North American medical associations, the American Medical Association (AMA) And the American Academy of Pediatrics (AAP)who have just officially recommended that the “race and ethnicity” parameter no longer be taken into account in any medical procedure whatsoever.
In these texts, both associations refer to the categories of “race and ethnicity” identified by the North American Census Bureau, namely white, black or African American, Asian American, Native American/Alaska Native, and Native American. Hawaii/Pacific Islanders. These are categories defined by administrative authorities, doubtless unsatisfactory from a scientific point of view, which the AMA and the AAP do not fail to underline. We can however suspect that the recommendations issued by these two bodies were formulated with moral and political ulterior motives, in the name of anti-racism, which is in itself very estimable. But the ambiguity comes from the fact that what is put forward is not this anti-racist agenda, but rather purely technical, medical and scientific reasons.
The underlying message is that the biological differences between the categories defined by the American census bureau, which roughly correspond to populations of different geographical origins, are negligible and therefore can be overlooked in any approach. medical. The ambiguity and the mixture of genres are enhanced by the fact that the AMA and the AAP provide additional justification for their recommendations with the following argument: to take into account the parameter “race and ethnicity” as a factor of intrinsic risk would increase the risk of discrimination against minorities by leading to minimizing or concealing the role of the environment in public health. We are therefore faced with a double message: scientific and technical on the one hand, moral and political on the other. Both messages are in fact eminently debatable.
First, the categories defined by the US Census Bureau, which overlap, even imperfectly, populations of different continental origins, present notable disparities in terms of their susceptibility to diseases and their treatments. To take one example among many others, African-American children have a much higher frequency of sickle cell disease (sickle cell anemia) than children of European descent. For cystic fibrosis, it is the opposite. Are we going to ban American pediatricians from having this in mind when dealing with their young patients?
Basing research on European sampling alone leads to misunderstanding of many genetic variants of major medical importance specific to African populations.
Then, contrary to what the AMA and the AAP fear, taking into account the race and ethnicity parameter as a statistical risk factor in no way implies ignoring the considerable role played by the environment – nutrition, education, socio-economic status. economic, lifestyle, access to care – in public health. You just have to consider both. It is the rich notion of terrain in medicine, which includes age, gender, lifestyle, etc., but also the geographical origin in certain very specific cases (pathologies are known to have a significant geographical variance ).
In my eyes as a doctor and a scientist, the recommendations of the AMA and the AAP respond to a moral and political agenda, to the detriment of the medical. I will therefore allow myself, respectfully and confraternally, not to adhere to their recommendations, while welcoming their moral and ethical concerns. What I hope and think is that my American colleagues and sisters will know how to receive these recommendations with common sense, and will continue to take into account the ethnicity of their patients, not systematically, but only when it turns out to be relevant.
Many scientists from the rest do not share the views of the AMA and the AAP on this subject and recommend taking into consideration the ethnic and geographical origin of patients in medicine and research. For exemple, a recent article written by five scientists, all of African descent and therefore little suspect of “systemic racism”, defends the idea that the categories “race and ethnicity” must be taken into account in medicine and science precisely to promote better health equity for the benefit of the African-American community. Indeed, the genetic variability within populations of African origin, including African-Americans, is much higher than that observed among Europeans. Basing research on European sampling alone therefore leads to misunderstanding of many genetic variants of major medical importance specific to African populations.
In a study published in 2023, the researcher Lenardo Mariño-Ramírez and his colleagues also insist on the need to take into account the genetic diversity of geographical populations in biomedical research. Another study, published by a team led by Koffi N. Maglo, insists on the need to take into account the key role of the environment while recommending not to neglect ethnicity in the medical approach if this proves to be appropriate. It is interesting to note that these authors give no credence to the biological notion of “race”, which they describe as a “trash taxon”. However, they stick to a very pragmatic approach to the problem, and recommend that doctors still take this “trash taxon” into account. I cite many other examples along the same lines in my book Our human nature (published by Rue de Seine, 2022).
The recommendations of the AMA and the AAP pose a recurring problem: is it acceptable, even desirable, to bend the traditional scientific approach in the name of morality and politics “for the good cause”? The problem is of course even more worrying if the cause is bad (racism, eugenics). We can never repeat it enough: it is crucial not to mix a moral, ethical, ideological and political approach on the one hand, with a scientific approach on the other. This is what I call “reciprocal sanctuary”. The WADA and AAP decisions are an illustrative case of such gender confusion. Judging a scientific issue through the eyes of ideology, morality and emotion is a fundamentally flawed approach. If we scream with indignation in the face of a scientific hypothesis, or if on the contrary we adore it a priori, there is little chance that we will be able to evaluate it calmly.
The “self-confirmation bias”, which leads to retaining only information that supports one’s own views, is wreaking havoc here. Keep in mind that many of the scientific theories that are now popular have triggered waves of indignation in their time and have therefore been considered “false” simply because they appeared to be scandalous. This is the case with heliocentrism (Copernicus), the theory of evolution (Darwin), the high antiquity of man (Boucher de Perthes), infantile sexuality (Freud). Morals, ethics and politics change with place and time. It is therefore not up to them to decide whether a scientific hypothesis is valid or not.
On the other hand, like an exchange of good practices (the “reciprocal sanctuary”), it is the privilege and the exclusive duty of ethics, morals and politics to enact the rules and values of a society. given, for example, in the case of ours, to combat discrimination linked to gender or ethnic origin, whatever the results of science, and whatever other societies decide. To science, the decryption of the material world, the societal remaining the prerogative of morality, ethics and politics. Reciprocal sanctuarization is an ideal to be achieved, too often flouted in the past and in the present time. It requires all our vigilance. A science caught in the act of being put at the service of ideology and politics, even in the name of a very honorable cause, loses all credibility. We certainly do not need this in the current period, where the rigor of the scientific approach is undermined by the “knowledge” drawn in particular from social networks, Facebook, Twitter and other TikTok.