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Medicine must stop using race and ethnicity to interpret test results

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Roberto Cigna

SHOULD your race or ethnicity influence the prescription you get from your doctor? Both are still used in medicine to interpret test results and guide treatment decisions, but the evidence is questionable and the approach can cause serious harm.

Medical guidelines in the US, UK and elsewhere often recommend the use of algorithms that contain adjustments for a person’s race or ethnicity, from tools used to assess bone fracture risk to devices containing embedded racial or ethnic adjustments for measuring lung function. The latter can be partly traced back to the suggestion by US slaveholder Samuel Cartwright in the 1800s that Black people had naturally low lung capacity and so were healthier when enslaved.

These algorithms are finally coming under significant scrutiny. Recently, the US National Kidney Foundation and the American Society of Nephrology formally established a consensus against the use of race adjustment in kidney function equations. A similar race-based kidney test adjustment was also removed from UK medical guidance set by the National Institute for Health and Care Excellence (NICE). These decisions came in response to growing concerns that the race adjustment was contributing to underdiagnosis and undertreatment of kidney disease among Black people.

Yet race-based decisions are still permeating other parts of medicine with little evidence to support them. NICE, for example, has declined to review its guidance on high blood pressure treatment that recommends different drugs for Black people compared with everyone else. The guidance currently says that doctors should prescribe drugs called ACE-inhibitors to people under the age of 55 with high blood pressure – unless they are of “black African or African-Caribbean family origin”, in which case they should receive different drugs.

Dipesh Gopal, a general practitioner who is also at Queen Mary University of London, and his colleagues have written to NICE twice over the past year requesting an urgent review of this guidance, but it declined in both cases, responding that evidence suggests there are “clinically meaningful differences in the effectiveness of treatments for individuals in these family origin subgroups”.

But Gopal and others dispute this evidence, particularly given that race and ethnicity are poorly defined social constructs with no biological basis. Indeed, according to the data, people’s treatment responses quite literally aren’t black and white.

In response to Gopal and his colleagues, and to the content of this article, NICE said that “there is not a clear-cut biological and genetic homogeneity amongst all Black and White people” and that “the guideline does not account for people with mixed heritage”. But it said performing the relevant tests on everyone wasn’t possible due to “the expense, and the additional time”.

Using race or ethnicity as an indicator of biology in this way is lazy and imprecise. NICE and other health organisations globally should start systematic reviews of race-based recommendations across their guidelines immediately. A doctor’s glancing assumption about a person’s race or ethnicity doesn’t offer meaningful biological information that can guide medical decisions. They aren’t biological variables and can’t be used as a proxy for genetic make-up.

This doesn’t mean medicine should become colour blind. Racism clearly drives health inequities in many countries and this must be addressed. But perpetuating harmful and unscientific ideas about biological differences between races in medical guidance isn’t the solution.

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Solar storms may cause up to 5500 heart-related deaths in a given year

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In an approximate 11-year cycle, the sun blasts out charged particles and magnetised plasma that can distort Earth’s magnetic field, which may disrupt our body clock and ultimately affect our heart



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17 June 2022

A solar storm

Jurik Peter/Shutterstock

Solar storms that disrupt Earth’s magnetic field may cause up to 5500 heart-related deaths in the US in a given year.

The sun goes through cycles of high and low activity that repeat approximately every 11 years. During periods of high activity, it blasts out charged particles and magnetised plasma that can distort Earth’s magnetic field.

These so-called solar storms can cause glitches in our power grids and bring down Earth-orbiting satellites. A handful of studies have also hinted that they increase the risk of …

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UK Covid infection rate rising, with more than a million cases in England | Coronavirus

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Coronavirus infections are rising in the UK, figures have revealed, with experts noting the increase is probably down to the more transmissible BA.4 and BA.5 Omicron variants.

The figures from the Office for National Statistics (ONS), based on swabs collected from randomly selected households, reveal that in the week ending 11 June an estimated one in 50 people in the community in England are thought to have had Covid – around 1.13 million people.

The figure is even higher, at one in 45, in both Wales and Northern Ireland, while it was highest in Scotland where, in the week ending 10 June, one in 30 people are thought to have been infected.

While the figures remain below the peak levels of infection seen earlier this year, when around one in 13 people in England had Covid, the findings are a rise on the previous week where one in 70 people in England were thought to be infected. Furthermore, the data reveals increases in all regions of England, except the north-east, and across all age groups.

Experts say that a key factor in the increase is probably the rise of the Covid variants of concern BA.4 and BA.5.

“Infections have increased across all four UK nations, driven by rising numbers of people infected with the BA.4 and BA.5 Omicron variants,” said Kara Steel, senior statistician for the Covid-19 Infection Survey.

While Steel said it remained too early to say if this was the start of another wave, others have warned it may already have begun, with increased mixing and travelling among other factors fuelling a rise in cases.

Among concerns scientists have raised are that BA.4, BA.5 and another variant on the rise, BA.2.12.1, replicate more efficiently in human lung cells than BA.2.

Prof Azra Ghani, an epidemiologist at Imperial College London, said the latest figures were not surprising, and might rise further.

“This increase in infection prevalence is likely due to the growth of the BA.4 and BA.5 Omicron subvariants, which as we have seen elsewhere in Europe, appear to be able to escape immunity generated from previous Omicron subvariants,” she said.

“It is therefore possible that we will continue to see some growth in infection prevalence in the coming weeks and consequently an increase in hospitalisations, although these subvariants do not currently appear to result in any significantly changed severity profile. This does however serve as a reminder that the Covid-19 pandemic is not over.”

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NHS to offer women in England drug that cuts recurrence of breast cancer | Breast cancer

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Thousands of women in England with breast cancer are to benefit from a new pill on the NHS which reduces the risk of the disease coming back.

The National Institute for Health and Care Excellence (Nice) has given the green light to abemaciclib, which cuts the chance of breast cancer returning after a patient has had surgery to remove a tumour.

Trials showed that patients who had the drug with hormone therapy had a more than 30% improved chance of their cancer not coming back after surgery, compared with hormone therapy alone.

“It’s fantastic thousands of women with this type of primary breast cancer will now have an additional treatment option available on the NHS to help further reduce the risk of the disease coming back,” said Delyth Morgan, the chief executive of charity Breast Cancer Now.

“The fear of breast cancer returning or spreading to other parts of their body and becoming incurable can cause considerable anxiety for so many women and their loved ones.

“New effective treatments such as abemaciclib, which can offer more women the chance to further reduce the risk of the disease recurring, are therefore extremely welcome and this is an important step change in the drug options available for this group of patients.”

The twice-a-day pill is suitable for women with hormone receptor-positive, HER2-negative, node-positive early breast cancer at high risk of recurrence who have had surgery. About 4,000 women will benefit initially, Nice said.

Helen Knight, the interim director of medicines evaluation at Nice, said the draft recommendation came less than a month after abemaciclib received its licence.

“The fact that we have been able to produce draft recommendations so quickly is testament to the success of our ambition to support patient access to clinically and cost effective treatments as early as possible,” said Knight. “Until now there have been no targeted treatments for people with this type of breast cancer.

“Abemaciclib with hormone therapy represents a significant improvement in how it is treated because being able to have a targeted treatment earlier after surgery will increase the chance of curing the disease and reduce the likelihood of developing incurable advanced disease.”

Abemaciclib works by targeting and inhibiting proteins in cancer cells which allow the cancer to divide and grow. It normally costs £2,950 for a packet of 56 150mg-tablets, but the manufacturer, Eli Lilly, has agreed an undisclosed discounted price for NHS England.

“Thanks in part to this latest deal struck by NHS England, NHS patients will be able to access another new targeted drug for a common and aggressive form of breast cancer,” said Prof Peter Johnson, the cancer director of NHS England.

“Abemaciclib, when used alongside a hormone therapy, offers a new, doubly targeted, treatment option, helping to increase the chances of beating the cancer for good, as well as meeting the NHS’s commitment to delivering improved cancer care under our long-term plan.”

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