A paper ominously titled “Structural racism is a mediator of disparities in acute myeloid leukemia outcomes” appeared in the April 7, 2022 edition of the prestigious medical journal, Blood. There are several approaches to putting a title on a medical article. The preferred path is a title that merely describes the study. This one could have been titled, “Mediators of outcome in Acute Myeloid Leukemia.” But that would not have attracted the same attention nor would it have shown the authors’ bias.
They examined the outcome of leukemia in patients from 6 medical centers between 2012 and 2018. They compared the outcomes for Black, White, and Hispanic patients. Black patients had between a 50% greater risk of dying over a 3-year period than White patients. Since Black patients lived in poorer neighborhoods as judged by census information, and since the authors defined racism as living in poor neighborhoods, they concluded that the racism was responsible for the disparate outcomes compared to the White patients. Hence the title.
But whenever one compares the outcomes of two groups of patients with a disease based on their skin color, the question must always be asked whether other characteristics could play an influence. In this case, there were very important differences in the nature of the disease between the two groups. Fifty percent of Black patients developed their leukemia after receiving chemotherapy for a previous malignancy. For White patients, the number was 30%. Moreover, when the genetic characteristics of the leukemic cells were examined, the Black patients had a higher frequency of genetic markers known to result in poor outcomes. This means the authors were comparing two very different groups of patients, beyond the patients’ race.
The authors dismiss the leukemia characteristics as not important, yet they are well known to be important. As Granfeldt Østgård et al wrote in the journal Clinical Oncology in 2015, “we find tAML (post chemotherapy leukemia) to be independently associated with increased risk of death.” The study authors ignore this reality in order to claim racism is the real cause of different outcomes.
Improving the outcomes of Black patients with Leukemia should be based on sound scientific and medical analysis, not unscientific and politicized claims. The real solution is more effective clinical therapeutics applied to each individual patient. Sensationalized studies such as this one do not advance the standard of medical care. All they do is advance a divisive ideology that sees racism in every aspect of American life.
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