Open letter to Merrickville’s District Clinic Health Centre

Dear Ruth,

thanx for our conversation on the phone last Wednesday (?), I think it was,..
I finally found some time to read up on things I wanted to check before critiquing your questionnaire CLIENT REGISTRATION FORM, where patients are asked to specify their race/ethnic origin, when a second question right afterwards enquires about their “country of origin” which made me think long and hard. I wanted to at least superficially research this complex which I have been able to just tonight.

Sorry for the delay. Unfortunately I haven’t found anything on the Health Canada pages, which would explain (guidelines? good practise? not really), why such question was required. And besides, Health Canada is already asking that or the like at the border:

http://www.hc-sc.gc.ca/hl-vs/travel-voyage/
general/inspection/index_e.html

As I haven’t been in time yet to try on the phone, I am sending this letter also to the media staff of the health ministry, and some members of the press – I hope a lot of people are going to have a look at or even join in this discussion:

“race”?
I tried to find out where the discussion was at, whether the term “race” is scientifically defined or, at all, describes a scientifically approved concept. I noticed, that nothing much had changed, as I can confirm due to my own work in science as a biologist. This discussion has been going on for longer and I am only referring to one very recent tip of it here:

http://www.iidb.org/vbb/archive/index.php/
t-209684.html

It might serve as a starting point for other interesting sources of information (Richard Dawkins, Jared Diamond etc).

However, we now seem to only share 94 percent of our genes with the Chimpanzee, instead of 98 percent some years ago, according to the latest research.

My summary here:
To know a person’s body’s constitution helps to diagnose and treat patients better – no doubt here as illustrates the above noted web page:

“Sickle cell anemia, most closely identified in the United States with black Americans, is often found in African and Mediterranean peoples, …

Conversely, cystic fibrosis is a common genetic disorder in people of northern European descent, but far less so in Africans.

Those are both diseases that are caused by a single mutation, so the genetic link is clear-cut. [sickle cell and cystic fibrosis]

… , African Americans seem to have a higher frequency of one mutation that reduces the liver’s ability to break down certain tricyclic antidepressant drugs, …

Blacks also have a higher frequency of a mutation that increases the speed at which a newer class of antidepressants, such as Prozac, take effect.

About 8 percent of whites carry a mutation that would cause trouble with warfarin, a blood-thinning drug, compared to 2 or 3 percent of blacks.

Last year, the New England Journal of Medicine published a study showing that African Americans with heart failure were less likely than whites to benefit from a type of drug known as an ACE inhibitor.”

(end of quote of the above web page)

Taking the risk of crashing open doors I can’t but list some points which seem important in this context:

a.
The exterior (phenotype) expression of a “race” – solely out of mid age convenience I’ll stick with the criteria in the internet discussion from above, because I am sure that there are plenty of scientist who would dispute these as defining attributes: nose, hair, skin – represent different alleles on the molecular level, varieties of one gene – that all populations – and to 94 percent even the Chimps – share.
b.
The genetic disposition can be much more diversified as the actual “look” of that person. People can carry two different alleles, coming from their parents gene-disposition, even from far gone by ancestry – somebody’s “race” might not be so easy for any of us to reveal.
c.
The experts argue long and hard, if the molecular disposition of a person allows for conclusions about geographic details of that same person.

The Wikipedia entry on the term offers orientation, too:

“Some argue that although “race” is a valid taxonomic (note of the editor: = classifying) concept in other species, it cannot be applied to humans.[3] Many scientists have argued that race definitions are imprecise, arbitrary, derived from custom, have many exceptions, have many gradations, and that the numbers of races delineated vary according to the culture making the racial distinctions; thus they reject the notion that any definition of race pertaining to humans can have taxonomic rigour and validity.[4] Today most scientists study human genotypic and phenotypic variation using concepts such as “population” and “clinal gradation”. Many anthropologists contend that while the features on which racial categorizations are made may be based on genetic factors, the idea of race itself, and actual divisions of persons into groups based on selected hereditary features, are social constructs.”

It takes considerate writers to find the matching word. We have just tangentially touched the scientific discussion, and it’s already clear, that this is one of the hot spots of social life science and why the term “race” is very disputed and may seem offensive – why not avoid it altogether?

I think there are better ways of accessing that information that is so crucial to provide the right services to your community. On the same note I’d like to express my appreciation for the service that I received when I attended the pap-clinic – everybody was very friendly and helpful. I know the mdchc is trying hard to improve people’s health.

Therefore the following suggestions with my best wishes as a worshipper of appropriate wording and expression, and a scientist:

The second and third paragraph of the questionnaire need to be modified. In order to screen on any infectious potential the question

Where have you been travelling within the last two years?

seems much better suited.

Would that point out a certain increased risk, you could try to obtain details in the one-on-one (have you been exposed to farms, chickens, touched a bird, noticed a strange sting or bite on your skin), as usual.

To screen for potential diseases more common amongst people who share a certain phenotype – well, that poses challenge, and I know that the mdchc has an interest in what is politically correct. Should that really be required here, why don’t you ask your patients what they know about themselves instead of something that is so hard to describe, even for scientists (s.a.):

Please check boxes to indicate (cultural or family) ties with the following regions (multiple possible):

Central America, North America, South America, Middle East, India, Africa, South East Asia, China, Australia, Russia, Europe, Caribbeans, Pacific etc.

Upon registration – is the new patient at least seen by a nurse? The details need a private setting, which can be easily established with the nurse or office manager.

A far as I remember you on the phone as well as the staff lady who was at the counter when I started to try to find out more about the intention of question 2 and 3, explained to me upon my enquiry, that the mdchc was trying to provide an appropriate frame of care according to the conviction or any other personal choices of the individual patient. This can easily be addressed with this question:

Do you prefer a male/female family doctor?

Also here, a one-on-one will reveal necessary details (“Is there anything else we need to know in order to treat you appropriately?”).

Come on, guys!

What in the world could be the reason for using such a dirty and leached out looser of a word as

“race?”

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