Racial Bias In Western Research

I recently stumbled upon a study that led me down a metaphorical rabbit-hole, drawing me deeper and deeper through information I’d never considered before. The study itself was small, involving just 250 women of childbearing age, and looked specifically at caffeine intake and its effects on the hormone estrogen. I was drawn in because the researchers actually thought to check the effect of a woman’s race on the outcome, which is rare. And as it turns out, race had a pretty big impact on the results.

The study found that caffeine definitely affected a woman’s estrogen level, albeit to a minor degree. The really interesting part, though, was how it broke down by race. The Caucasian women in the study saw their estrogen level drop slightly after ingesting just 200 mg of caffeine a day. Similarly, black women saw their estrogen level drop, although less significantly. But the big news was the Asian women who actually saw their estrogen level rise. The rise in estrogen was not large enough to affect their fertility, but it did attract attention. Researchers tried to control for the racial disparity, by looking at age, diet, exercise, and whether or not the woman smoked, but the results remained unchanged. It made me wonder why Asian women would have such a completely different reaction to caffeine compared with other races. What the heck was so different about Asians?

It turns out that Asian populations do have a considerably different metabolism than the rest of us. For example, while many people of Asian descent remain thin, they have a greater tendency to develop obesity-related complications, like high blood pressure and diabetes. So, even though they are usually slimmer and fitter-looking than the rest of us, their internal organs could be telling an entirely different story.

Researchers cannot yet explain why this happens, but the distribution of body fat is very different depending on your race. Causasian and black people typically accumulate fat in their hips and legs first, and their visceral organs only later, but the opposite appears to be true for Asians. Because fat is so easily stored in their internal organs, even a seemingly slight Asian may already be showing signs of a serious metabolic disorder when looked at from the inside.

It is suspected that this is a genetic adaptation that evolved as a way to protect against starvation. If so, it would have been helpful in centuries past when food scarcity was a more regular occurrence. However, in our modern, calorie-rich environment, it creates problems, and not just because it increases their tendency towards metabolic disorders. It also affects fertility. For Asian women with hormonal imbalances like PCOS tend to develop higher insulin and testosterone levels than other women with PCOS, further complicating the condition. Asian women also seem to be more sensitive to hormone injections in general, responding more quickly and dramatically to any hormone increases.

This brings to mind another common problem among Asians: their inability to properly metabolize alcohol. If you have Asian friends, you may notice that they don’t tend to drink much. This may be partly cultural, but it’s also true that around 30% of Asians lack one of the enzymes needed to properly breakdown alcohol. As a result, they experience facial flushing after just a drink or two, which keeps them from indulging further.

With such a significant difference in their ability to metabolize caffeine, alcohol and hormones, and a known tendency to produce abdominal and visceral fat more quickly than other races, I wonder that Asians aren’t singled out more often in scientific studies. For that matter, what about all the other potential racial differences in health outcomes? For example, it’s well known that sickle cell anemia occurs more frequently in descendants of African populations, and that cystic fibrosis occurs more frequently in descendants of European populations. There are probably many other health problems, not to mention the drugs used to treat them, that work completely differently in select racial groups. Scientific researchers seem to be only slowly awakening to the significance of this.

Of course, race isn’t the only variation among humans. The even more obvious one is sex, and here, we also find big discrepancies. Men and women are known to react to many drugs very differently. For example, it has recently been found that women metabolize sleeping pills much more slowly than men, and as a result, the FDA has reduced the recommended dosage of Ambien for women by half to help prevent overdose. It doesn’t end there. Medical practitioners know that women tend to wake up from anaesthesia faster than men during surgical procedures, and have more severe side effects to other common drugs, like cholesterol-lowering drugs, and even anti-histamines and over-the-counter aspirin. The exception is high blood pressure medication, which actually appears to work better in women than in men.

Yet most research continues to focus on one group only: Caucasian people, and Caucasian men in particular. In most cases, we simply don’t know the true effect of a drug on someone from an Indian or Middle Eastern background, because they’ve never been included in scientific studies. Or, if they were included, their potential reactions were never isolated and observed. The situation is even worse for women, who are typically excluded from drug trials completely because their monthly hormone fluctuations make their reaction to drugs less predictable, and therefore more confusing.

This bias towards Caucasian men in scientific research is a real weakness for Western medicine, and produces a giant blind spot when it comes to treatment. Just think how much more effective Western medicine could be if they considered different racial and sexual reactions in their drug trials and treatment plans. I’ve always thought this was one of the strengths of Chinese medicine, for TCM practitioners have always been taught to consider the particular strengths and weaknesses of each individual when deciding on diagnosis and treatment. It’s never been a one-size-fits-all system the way that Western medicine is, and Western medicine would do well to try to copy this approach. With the advent of individual genetic testing, that time may be coming soon. I would say it’s about time.

The Incredible Resilience Of women

The halls are quiet, and virtually empty as we enter the nursing home, but every once in awhile, a nurse slips in and out of room. She must be doing the rounds this afternoon, quickly checking in on all the patients to make sure they’re alright. Though we’ve never met, she greets us with a smile and a quick “hello” as we pass.

When we turn the corner and enter my mother’s room, we are not surprised to find her in her usual spot – sitting in her wheelchair by her desk, working on a craft of some sort. Though she looks pitiably uncomfortable, with a back now permanently bent from osteoporosis, and fingers stiffened and uncooperative with Parkinson’s Disease, she works happily, with a patient deliberation that never ceases to amaze me.

For the last 22 years, my mother has been battling Parkinson’s disease, a large enough expanse of time that she is now one of the longest survivors of the disease in Canada. She was only 60 when she was diagnosed, after falling off a ladder while washing windows. Since she was otherwise completely healthy, her diagnosis came as a bit of a shock to all of us, and plunged her into a bout of denial for a few years. As I’ve watched her gracefully navigate this challenging condition over the years, I’ve wondered if her longevity hinges on those two basic facts: her relative youth when diagnosed, and her lack of other health problems. Then again, a new study published last January suggests there may be something more to it than that.

After analyzing historical information from seven different populations over a period of 150 years, researchers In Denmark and Germany have found that women have a distinct survival advantage over men. At first glance, this information may not sound surprising at all ; we’ve long known that women tend to outlive men. But that’s during normal circumstances. In this study, they were looking at abnormal conditions of crisis, particularly during periods of starvation, disease, and slavery. Their study included data from the Irish potato famine (1845-1849), the measles epidemics in Iceland (1846 and 1882), and plantation slaves in Trinidad (at the beginning of the 19th century). Here, once again, it was found that women tend to outlive men.

The reason this is so noteworthy is because times of crisis also tend to be times when women are neglected. Historically, parents have been more willing to seek treatment for sick little boys when there is an epidemic, but not so much for sick little girls. When food is scarce, it’s the little boys who are fed first, and the girls get the leftovers, if there are any. So, why is it that a girl’s chance of survival is still higher despite these significant disadvantages?

Researchers point to biology, and to the hormone estrogen in particular. Estrogen is known to have protective effects on the immune system, while testosterone is more of an immunity suppressor. There are also the well-known protective effects on the heart that estrogen provides. Testosterone, on the other hand, tends to lead men into trouble, making them more reckless, with a greater chance of accidental or violent death. It also makes them more likely to smoke, drink, and take psychoactive drugs. Then, there is also the fact that girls have two X chromosomes, whereas boys have only one. In this case, if there is any damage to one of a girl’s X chromosomes, the other can fill in the gaps. But boys have just one X and one Y, and therefore no back-up in the case of bad genetic mutation.

There may be even more to it than that. In another study published earlier this year from researchers at Lehigh University and Queen’s University in Belfast, it was found that women also tend to make better leaders during times of crisis. Because when everything falls apart, people tend to get angry and point fingers of blame, which can disintegrate feelings of social cohesion and lead to failure. In addition to their biology, women also have relational strengths, which help them manage other’s emotions, defuse tensions, reappraise the situation more positively, and redirect negative attention elsewhere. This allows groups to establish or repair trust, which is crucial for maintaining group solidarity during a challenging event, and makes survival more likely. Women are also generally seen as more trustworthy, and so are better able to maintain feelings of goodwill between groups, and obtain necessary resources from others.

Damien Mander, a trainer for park rangers in the Phundundu Wildlife Area in Zimbabwe has taken note of these advantages and put them to good use. Because of rampant trophy hunting, rangers of African game parks must essentially act as combat soldiers, and Mander has spent the last ten years looking for good prospective hires. Over the years, he has learned that women can make better rangers than men. For one, they are less susceptible to bribery from poachers. They are also more adept at de-escalating violent situations, making attempts at conciliation before using their weapons. They are also more likely to bring their income back to their families instead of spending it on themselves, which is of greater economic benefit to the region.

And as it turns out, they’re also tougher. A former special forces soldier from Australia, Mander has trained countless recruits, both male and female, subjecting them to days of nonstop exercises to see how well they perform while wet, cold, hungry and tired. Of the 37 female potential recruits he recently trained for the park ranger program, only three quit, and 16 were eventually hired. Meanwhile, after a similar course for 189 men, almost all of them quit after the very first day. Only three remained to continue the program. It’s this particular brand of female resilience that I’m referring to, this incredible endurance that so many of the women I know possess which inspires me.

Women may not have the muscular strength and power of men, but we more than make up for it in other ways. We just don’t quit. Despite being discriminated against, harassed, and neglected, we just keep showing up and finishing whatever jobs we start. Men may rage, burn out, and walk away, but women trudge onward, building solidarity and support wherever we can, collecting other stragglers, and bringing them with us as we go.

And so, I often find myself moved when I visit my mother. For, despite the weakness of her fingers, and her growing lack of co-ordination, she soldiers on with a smile on her face. She glues lace around supportive cards for the nursing home staff, she cuts out colourful hearts and tapes them to her wall, and she greets all visitors with a big hug, despite whatever pain or discomfort she may be in. Like women everywhere, my mother is a survivor. In fact, she’s more than a survivor, she’s simply incredible.

A Sudden Case of Blindness

Shock. Devastation. “It’s been a nightmare,” the woman said.

So says the mother of a 17 year old boy from Bristol, England, who has now become blind. The boy’s blindness occurred, not due to accident or trauma, but because of his diet. A diet of mostly white flour products, and junk food. And it is this fact that has caused his sudden blindness to be so shocking.

In developing countries, where children often don’t receive the required amount of nutrients for optimum growth, blindness is unhappily much more common, and hence, less surprising. But in the rich, developed world, it is virtually unheard of, and this is why this unique case of blindness has made headlines.

As most parents know, there is a period in the life of virtually every child, where they suddenly become extremely picky eaters. Babies that once happily ate pureed carrots and finely chopped, steamed beans suddenly refuse to eat anything but Premium Plus crackers and the occasional hot dog. It can throw parents into a panic. Mealtimes become battlegrounds. Many tears are shed, on both sides. In most cases, the crisis dissipates as the child grows and re-learns his appreciation for various fruits and vegetables, and finally, the parents can begin to relax again.

But in this particular case, the boy never outgrew his aversion to the nutrient-dense foods presented to him. His diet remained one primarily of starches: French fries, potato chips, the occasional slice of white bread. For protein, he ate ham and sometimes sausages. Only rarely did he eat any fruits or vegetables.

Now, before you start to blame her, I want to assure you that his mother tried her best to help him. She made attempts to expand his diet, but since he suffers from a relatively unknown eating disorder called ARFID, or “avoidant/restrictive food intake disorder”, he continually struggled to eat foods with certain textures. Other ARFID sufferers may eventually start to avoid food entirely, preferring not to eat at all.

If the only eating disorders you’ve previously heard of are anorexia nervosa, or bulimia, it is important to know that ARFID is different. With ARFID, there isn’t any concern about body size or shape behind the lack of interest in food. In fact, many ARFID sufferers know that their eating disorder causes them to be too thin, and they try to cover this up by wearing multiple layers of clothing. For reasons that will vary, there is just no desire to eat, or there is concern about the eating process in general. Most cases of ARFID are among children who also struggle with other learning disorders, like autism, ADHD, or excessive anxiety, which is why counselling is so important.

In the case of this particular boy, it was recommended that he receive counselling to help with the psychological component of the illness. They also made sure to supplement with various vitamins and minerals, and gave him occasional B12 injections to make up for the lack of variety in his diet. Although they tried their best, repeated visits to the doctor for fatigue and anemia meant they knew they were failing to improve their son’s situation, but even so, the blindness still came as a shock.

It turns out that the optic nerves that carry sensory information to the eyes can become irreversably damaged in children if they are not supplied with important nutrients like folic acid and B vitamins. Without these nutrients, toxic metabolic by-products can build up within the nerve cells, eventually killing them. If the right nutrients are provided in time, the nerves can be repaired. But in this boy’s case, there was already too much damage done. In addition to clinical blindness, he also suffers from some hearing loss, as well as reduced bone density. He was found to be deficient in vitamin B12, along with low levels of copper, selenium and vitamin D.

I am not writing about this boy to encourage shaming, either of the boy, or his parents. But his case does serve as a reminder of how important a balanced diet is for optimum health. Living in the calorie-rich Western world, we rarely have to worry about a lack of access to food. But it is important to remember that quality is more important than quantity. The foods we are exposed to, and which we then tend to eat, are calorie dense, yet nutrient deficient. To offset this, try to incorporate a wider variety of foods into your diet, including whole grains rather than white flour products. Especially try to eat an increased amount of fruits and vegetables, ideally filling half of your plate at each meal.

Let the sad plight of this boy be a reminder that high blood pressure, high cholesterol and high blood sugar aren’t the only health problems we are trying to avoid. Our sight, our hearing, and the strength of our bones need protection too.