Study: African Americans Are More Burdened by Atopic Dermatitis Severity mdmag.com/medical-news/s… the conclusions of this study are deeply problematic and show the authors don't quite understand how to think about race.
A thread 👇🏾👇🏾👇🏾
A thread 👇🏾👇🏾👇🏾
The first flag for me was this statement: 
I was unaware that there is a paucity of safe and effective treatments for African Americans with atopic dermatitis. 🤔
I'll take this statement at face value and move on...
What the authors did seems simple enough, compare the skin of African-American patients with atopic dermatitis to skin of European Americans with atopic dermatitis to see if there are differences in molecular expression patterns.
The problem is that the authors are using race which is a SOCIAL construct and infusing it with molecular biology. ---> article here annallergy.org/article/S1081-…
If you are going to make a biological claim about race then you should explain how you defined it in your paper. Here is how it was defined:
"Investigator confirmed" Really??? How does an investigator confirm race? What if it conflicted with that the patient thought? Was there a paper bag test? Just the ole' eyeball test? The one drop rule?
Again race is a social construct and an external marker of a lot of other variables e.g. where you live, environmental exposures, SES, access to health care, etc. which should be accounted for in any analysis.
This is particularly true if this is central to your findings!!!
Do the author try to account for it? Nope.
Do the author try to account for it? Nope.
The environment plays an important role in the natural history of atopic dermatitis. --> ncbi.nlm.nih.gov/pmc/articles/P… Likely WAY more than your melanin concentration.
It is possible the difference between AA and EA were related to access to care or some other external factor which was not accounted for and drove differences in molecular profiles of the skin.
Again all of this should be addressed as a CRITICAL limitation in the discussion but it wasn't.
The authors instead double down on the findings insinuating that race = biology and characterize AA skin as "unbalanced" and having "more inflammation." You know, dark skin has a lot of pathology, duh!!!
This is all based on the molecular profile of ONLY 24 African Americans (15 with atopic dermatitis)!!!!
Friendly reminder: There is more genetic variation between two black people than there is between a black person and a white person.
Friendly reminder: There is more genetic variation between two black people than there is between a black person and a white person.
If the MAIN point of your study is to BIOLOGIZE a social construct, then you should do a better job of defining the biology of race. If not, then you should explicitly spell out why you didn't and how that could affect your results.
Unfortunately, neither was done but what is being perpetuated is the narrative that disparate clinical outcomes are the fault of race genetics/biology and all we need is "personalized medicine" and another molecular target!!!
This view of race and medicine is not only short sighted but it distracts and absolves us from grappling with how structural problems in society are far stronger causes of disparities than genetics.
A pill and personalized medicine WILL NOT eliminate racial disparities in medicine. Period.
Despite what the authors say, their study has too many weaknesses to make the conclusions they arrive at concerning race and atopic dermatitis.
/End rant.
/End rant.
