ABOUT THE SPEAKER
Dorothy Roberts - Professor, author and social justice advocate
Global scholar, University of Pennsylvania civil rights sociologist and law professor Dorothy Roberts exposes the myths of race-­based medicine.

Why you should listen

Internationally recognized scholar, public intellectual and social justice advocate Dorothy Roberts studies the interplay of gender, race and class in legal issues. She has been a leader in transforming public thinking and policy on reproductive health, child welfare and bioethics.

Professor of Africana Studies, Law & Sociology at the University of Pennsylvania, Dorothy directs the Penn Program on Race, Science and Society. She has authored and co­-edited ten books, including the award-­winning Killing the Black Body and Shattered Bonds. Her latest book is Fatal Invention: How Science, Politics, and Big Business Re­-create Race in the Twenty­-First Century. She received the 2015 Solomon Carter Fuller Award from the American Psychiatric Association for "providing significant benefit for the quality of life for Black people."

More profile about the speaker
Dorothy Roberts | Speaker | TED.com
TEDMED 2015

Dorothy Roberts: The problem with race-based medicine

Dorothy Roberts: O problema da medicina baseada na raza

Filmed:
1,230,390 views

A defensora da xustiza social e experta en Dereito Dorothy Roberts ten unha mensaxe concreta e ben poderosa: a medicina baseada na raza é mala praxe. Mesmo nos nosos días, moitos profesionais da medicina utilizan a raza como atallo; fan importantes escollas sobre cousas como tolerancia á dor baseándose na cor da pel no cando de basearse nas observacións e medicións técnicas. Nesta apaixonante charla, Roberts descóbrenos os vestixios da medicina baseada na raza -- e invítanos a formar parte do seu fin. "É urxente abandonar dunha vez por todas este legado retrógrado", di, "e afirmar a nosa humanidade común poñendo fin ás inxustizas sociais que verdadeiramente nos dividen."
- Professor, author and social justice advocate
Global scholar, University of Pennsylvania civil rights sociologist and law professor Dorothy Roberts exposes the myths of race-­based medicine. Full bio

Double-click the English transcript below to play the video.

00:12
15 years ago, I volunteered
to participate in a research study
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Hai 15 anos, fun voluntaria
nunha investigación
00:18
that involved a genetic test.
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que incluía probas xenéticas.
00:20
When I arrived at the clinic to be tested,
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Cando cheguei á clínica,
00:22
I was handed a questionnaire.
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tiven que cubrir un formulario.
00:25
One of the very first questions
asked me to check a box for my race:
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Unha das primeiras preguntas
pedíame marcar a miña orixe étnica:
00:29
White, black, Asian, or Native American.
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caucásica, negra, asiática,
ou nativa americana.
00:33
I wasn't quite sure
how to answer the question.
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Non sabía moi ben como
responder a esa pregunta.
00:37
Was it aimed at measuring the diversity
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O seu obxectivo era medir a diversidade
00:39
of research participants'
social backgrounds?
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de orixes sociais
dos participantes na investigación?
00:43
In that case, I would answer
with my social identity,
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Nese caso, contestaría
segundo a miña identidade social
00:46
and check the box for "black."
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e respondería "negra".
00:49
But what if the researchers
were interested in investigating
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Pero, e se os investigadores estaban
interesados en estudar
00:53
some association between ancestry
and the risk for certain genetic traits?
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a relación entre a xenealoxía e
o risco para certas calidades xenéticas?
00:59
In that case, wouldn't they want to know
something about my ancestry,
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Nese caso, non preferirían coñecer
datos sobre os meus devanceiros,
01:03
which is just as much European as African?
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que son tanto europeos como africanos?
01:07
And how could they make
scientific findings about my genes
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E como poden facer un descubrimento
científico cos meus xenes
01:11
if I put down my social identity
as a black woman?
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se poño a miña identidade social
como muller negra?
01:16
After all, I consider myself
a black woman with a white father
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Considérome unha muller negra
cun pai caucásico
01:21
rather than a white woman
with a black mother
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antes que unha muller caucásica
cunha nai negra
01:25
entirely for social reasons.
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e isto é só por razóns sociais.
01:27
Which racial identity I check
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A identidade racial que podería responder
01:30
has nothing to do with my genes.
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non tería relación cos meus xenes.
01:34
Well, despite the obvious
importance of this question
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En fin, máis alá da importancia
desta pregunta
01:37
to the study's scientific validity,
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para a validez científica do estudo,
01:40
I was told, "Don't worry about it,
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dixéronme, "Non te preocupes por iso,
01:42
just put down however
you identify yourself."
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responde aquilo
co que te identifiques."
01:46
So I check "black,"
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Así que marquei "negra",
01:48
but I had no confidence
in the results of a study
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pero desconfiaba
dos resultados dun estudo
01:52
that treated a critical variable
so unscientifically.
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que trataba de xeito tan pouco científico
unha variable tan relevante.
01:58
That personal experience
with the use of race in genetic testing
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Esta experiencia persoal coa raza
nas probas xenéticas
02:02
got me thinking:
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fíxome pensar:
02:04
Where else in medicine is race used
to make false biological predictions?
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nalgún outro campo da medicina a raza
é a base de presuncións biolóxicas falsas?
02:10
Well, I found out that race runs deeply
throughout all of medical practice.
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Cheguei á conclusión de que a raza
chega até o miolo da práctica médica.
02:17
It shapes physicians' diagnoses,
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Inflúe na diagnose por parte do médico,
nos indicadores, nos tratamentos,
02:20
measurements, treatments,
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02:22
prescriptions,
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nas receitas,
02:24
even the very definition of diseases.
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e mesmo nas definicións de patoloxías.
02:28
And the more I found out,
the more disturbed I became.
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E canto máis investigaba,
peor era a sensación.
02:33
Sociologists like me have long explained
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Os sociólogos temos sostido
02:36
that race is a social construction.
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que a raza é unha construción social.
02:39
When we identify people as black,
white, Asian, Native American, Latina,
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Cando identificamos a alguén como negro,
caucásico, asiático, nativo americano
02:46
we're referring to social groupings
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ou latino, referímonos a grupos sociais
02:49
with made up demarcations
that have changed over time
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con distincións artificiais que foron
mudando ao longo da historia
02:52
and vary around the world.
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e que varían arredor do mundo.
02:55
As a legal scholar, I've also studied
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Como xurista, tamén teño estudado
02:58
how lawmakers, not biologists,
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como o lexislador, e non os biólogos,
03:01
have invented the legal
definitions of races.
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creou as definicións
legais das razas.
03:06
And it's not just the view
of social scientists.
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E non é só a visión dos
científicos sociais.
03:10
You remember when the map
of the human genome
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Recordades a presentación pública
do mapa do xenoma humano
03:12
was unveiled at a White House
ceremony in June 2000?
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celebrada na Casa Branca en xuño de 2000?
03:17
President Bill Clinton famously declared,
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O presidente Bill Clinton declarou:
03:20
"I believe one of the great truths
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"Creo que unha das grandes verdades
03:22
to emerge from this triumphant expedition
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que xorden desta exitosa empresa
03:26
inside the human genome
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dentro do xenoma humano
03:27
is that in genetic terms,
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é que en termos xenéticos,
03:29
human beings, regardless of race,
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os seres humanos, sen importar a súa raza,
03:32
are more than 99.9 percent the same."
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son iguais, ao 99,9%."
03:36
And he might have added
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Mais debeu engadir
03:38
that that less than one percent
of genetic difference
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que ese menos do 1% de diferenza xenética
03:42
doesn't fall into racial boxes.
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non ten relación coa raza.
03:45
Francis Collins, who led
the Human Genome Project
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Francis Collins, que dirixiu
o Proxecto Xenoma Humano
e é hoxe o director dos NIH
(Institutos Nacionais de Saúde),
03:49
and now heads NIH,
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03:50
echoed President Clinton.
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recolleu as verbas do presidente Clinton.
03:52
"I am happy that today,
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"Hoxe estou feliz,
03:54
the only race we're talking about
is the human race."
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pois a única raza da que estamos a falar
é a raza humana."
04:00
Doctors are supposed to practice
evidence-based medicine,
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Suponse que os médicos practican
unha medicina baseada nas probas,
04:04
and they're increasingly called
to join the genomic revolution.
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e que cada vez máis se unen
a esta revolución xenómica.
04:08
But their habit of treating patients
by race lags far behind.
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Pero resístense a mudar o hábito de tratar
aos doentes en función da súa raza.
04:14
Take the estimate
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Tomemos como exemplo
04:15
of glomerular filtration rate, or GFR.
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a taxa de filtración glomerular (GFR).
04:18
Doctors routinely interpret GFR,
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Normalmente os médicos interpretan a GFR,
04:22
this important indicator
of kidney function, by race.
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este importante indicador da función
renal, segundo a raza.
04:27
As you can see in this lab test,
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Como podedes ver neste test,
04:31
the exact same creatinine level,
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cos mesmos niveis de creatinina,
04:36
the concentration
in the blood of the patient,
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de concentración en sangue
do paciente,
04:40
automatically produces
a different GFR estimate
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producen automaticamente
un GFR estimado diferente
04:45
depending on whether or not
the patient is African-American.
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en función de se o doente
é ou non afroamericano.
04:51
Why?
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Por que?
04:53
I've been told it's based on an assumption
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Disque isto se basea na presunción
04:56
that African-Americans
have more muscle mass
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de que os afroamericanos
teñen maior masa muscular
04:59
than people of other races.
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que persoas doutras razas.
05:02
But what sense does it make
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Pero que sentido ten
05:04
for a doctor to automatically assume
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que o médico asuma de xeito automático
05:08
I have more muscle mass
than that female bodybuilder?
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que teño máis masa corporal
que unha culturista?
05:12
Wouldn't it be far more accurate
and evidence-based
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Non sería moitísimo máis preciso
e acorde cos datos
05:16
to determine the muscle mass
of individual patients
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determinar a masa muscular
de cada doente
05:20
just by looking at them?
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só botándolles unha ollada?
05:24
Well, doctors tell me
they're using race as a shortcut.
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Os médicos coméntanme que utilizan
a raza coma un atallo.
05:27
It's a crude but convenient proxy
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É un indicador rudimentario,
pero útil
05:30
for more important factors,
like muscle mass,
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para outros factores relevantes,
coma a masa muscular,
05:33
enzyme level, genetic traits
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nivel enzimático ou trazos xenéticos
05:36
they just don't have time to look for.
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que realmente non teñen
tempo de comprobar.
05:39
But race is a bad proxy.
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Pero a raza é un mal indicador.
05:42
In many cases, race adds
no relevant information at all.
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As máis das veces, a raza non engade
información útil.
05:46
It's just a distraction.
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É só un distractor.
05:49
But race also tends to overwhelm
the clinical measures.
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Pero a raza tamén tende a solapar
indicadores clínicos.
05:55
It blinds doctors to patients' symptoms,
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Nubra a vista do médico sobre
os síntomas do doente,
05:59
family illnesses,
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enfermidades familiares,
06:02
their history, their own illnesses
they might have --
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a súa historia clínica, mesmo as
enfermidades que podería contraer...
06:06
all more evidence-based
than the patient's race.
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todos eles con maior base empírica
que a raza do doente.
06:11
Race can't substitute
for these important clinical measures
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A raza non pode substituír
estas importantes variables clínicas
06:16
without sacrificing patient well-being.
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sen que isto supoña un sacrificio do
benestar do doente.
06:21
Doctors also tell me
race is just one of many factors
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Os médicos tamén din que a raza
é só un dos moitos elementos
06:25
they take into account,
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que teñen en consideración,
06:27
but there are numerous medical tests,
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mais hai moitos test médicos,
06:29
like the GFR,
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coma o GFR,
06:30
that use race categorically
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que usan a raza sistematicamente
06:34
to treat black, white,
Asian patients differently
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para tratar doentes negros, caucásicos,
e asiáticos de xeito diferente
06:38
just because of their race.
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só por causa da súa raza.
06:41
Race medicine also leaves
patients of color especially vulnerable
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A medicina baseada na raza fai vulnerables
aos doentes de cor
06:47
to harmful biases and stereotypes.
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a ideas preconcibidas e estereotipos.
06:50
Black and Latino patients
are twice as likely
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Os doentes negros e latinos teñen o dobre
de posibilidades
06:53
to receive no pain medication as whites
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de non recibir analxesia, en relación
aos doentes caucásicos,
06:57
for the same painful long bone fractures
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para a mesma dor, provocada por unha
fractura de óso longo
07:02
because of stereotypes
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e isto por mor de estereotipos
07:04
that black and brown people
feel less pain,
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que indican que as persoas de cor
senten menos dor,
07:08
exaggerate their pain,
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esaxeran a súa dor,
07:10
and are predisposed to drug addiction.
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e teñen predisposición á adicción
a medicamentos.
07:14
The Food and Drug Administration has even
approved a race-specific medicine.
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A Axencia Americana de Alimentación
e Drogas (FDA) aprobou un medicamento
07:20
It's a pill called BiDil
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para unha raza concreta.
É a píldora BiDil
07:22
to treat heart failure in self-identified
African-American patients.
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para o tratamento de episodios cardíacos
en doentes afroamericanos.
07:27
A cardiologist developed this drug
without regard to race or genetics,
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Un cardiólogo desenvolveu este medicamento
sen importar a raza ou os xenes,
07:33
but it became convenient
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pero volveuse oportuno
07:36
for commercial reasons
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por motivos económicos
07:38
to market the drug to black patients.
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venderlles este medicamento a doentes negros.
07:42
The FDA then allowed
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A FDA permitiulle
07:44
the company, the drug company,
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á empresa farmacéutica
07:47
to test the efficacy in a clinical trial
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probar a eficacia nun ensaio clínico
07:51
that only included
African-American subjects.
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que só incluía suxeitos afroamericanos.
07:56
It speculated
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A súa hipótese
07:58
that race stood in as a proxy
for some unknown genetic factor
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era que a raza podía suplir
algún factor xenético descoñecido
08:04
that affects heart disease
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que afecta á patoloxía cardíaca
08:07
or response to drugs.
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ou á resposta aos medicamentos.
08:11
But think about
the dangerous message it sent,
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Pero pensade na perigosa mensaxe
que isto enviaba,
08:15
that black people's bodies
are so substandard,
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que os corpos da xente negra
son tan deficientes,
08:19
a drug tested in them
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que unha substancia ensaiada neles
08:21
is not guaranteed
to work in other patients.
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non ten eficacia garantida
noutros pacientes.
08:26
In the end, the drug company's
marketing scheme failed.
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Á fin, o planeamento comercial
da compañía farmacéutica fallou.
08:30
For one thing, black patients
were understandably wary
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Por un lado, é comprensible que
os doentes negros receasen
08:34
of using a drug just for black people.
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de usar un medicamento
só para xente negra.
08:38
One elderly black woman stood up
in a community meeting and shouted,
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Unha anciá negra levantouse
nunha xuntanza comunitaria e berrou:
"Dádeme o mesmo que a xente
caucásica está a tomar!"
08:42
"Give me what the white
people are taking!"
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08:44
(Laughter)
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(Risas)
E se estes medicamentos
en función da raza vos sorprenden
08:47
And if you find race-specific
medicine surprising,
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08:52
wait until you learn
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agardade a que vos conte
08:54
that many doctors in the United States
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que moitos médicos nos Estados unidos
08:57
still use an updated version
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seguen a usar unha versión actualizada
09:00
of a diagnostic tool
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dunha ferramenta diagnóstica
09:02
that was developed by a physician
during the slavery era,
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que foi desenvolvida por un médico
durante o tempo da escravitude,
09:06
a diagnostic tool that is tightly linked
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unha ferramenta que está
intimamente ligada
09:09
to justifications for slavery.
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ás xustificacións da propia escravitude.
09:13
Dr. Samuel Cartwright graduated
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O Dr. Samuel Cartwright licenciouse
09:16
from the University
of Pennsylvania Medical School.
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na Facultade de Medicina
da Universidade de Pennsylvania.
09:19
He practiced in the Deep South
before the Civil War,
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Exerceu no Sur profundo
antes da Guerra Civil,
09:23
and he was a well-known expert
on what was then called "Negro medicine."
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e era un recoñecido experto no que
daquela se chamaba "medicina de negros".
09:28
He promoted the racial concept of disease,
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Promoveu o concepto racial de enfermidade,
09:31
that people of different races
suffer from different diseases
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de que xente de razas diferentes
sofre patoloxías diferentes
09:35
and experience
common diseases differently.
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e pasa por enfermidades comúns
de xeito diferente.
09:39
Cartwright argued in the 1850s
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Cartwright defendía polo 1850
09:43
that slavery was beneficial
for black people
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que a escravitude era beneficiosa
para a xente negra
09:47
for medical reasons.
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por razóns médicas.
09:49
He claimed that because black people
have lower lung capacity than whites,
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Argumentaba que dado que a xente negra
ten menor capacidade pulmonar,
09:54
forced labor was good for them.
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o traballo forzado era bo para eles.
09:57
He wrote in a medical journal,
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Escribiu nunha revista científica,
10:00
"It is the red vital blood
sent to the brain
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"O sangue vermello
que chega ao cerebro
10:03
that liberates their minds
when under the white man's control,
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libera as súas mentes cando se atopan
baixo o control do home branco,
10:07
and it is the want of sufficiency
of red vital blood
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e é a falla dunha cantidade axeitada
deste sangue vermello
10:11
that chains their minds to ignorance
and barbarism when in freedom."
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o que ata as súas mentes á ignorancia
e á barbarie cando están en liberdade."
10:17
To support this theory,
Cartwright helped to perfect
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Para apoiar esta teoría,
Cartwright axudou a perfeccionar
10:20
a medical device for measuring breathing
called the spirometer
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un dispositivo médico para medir
a respiración chamado "espirómetro"
10:26
to show the presumed deficiency
in black people's lungs.
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para demostrar a deficiencia
nos pulmóns da xente negra.
10:31
Today, doctors still
uphold Cartwright's claim
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Hoxe, os médicos seguen
a apoiar a afirmación de Cartwright
10:37
the black people as a race
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de que a raza negra
10:40
have lower lung capacity
than white people.
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ten menor capacidade pulmonar
que a xente caucásica.
10:44
Some even use a modern day spirometer
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Algúns mesmo usan un moderno espirómetro
10:48
that actually has a button labeled "race"
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que mesmo ten un botón
rotulado "raza"
10:52
so the machine adjusts the measurement
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para que a máquina poida axustar as medidas
10:55
for each patient
according to his or her race.
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para cada doente, de acordo coa súa raza.
10:59
It's a well-known function
called "correcting for race."
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É unha función moi coñecida
que se chama "corrección por raza".
11:05
The problem with race medicine
extends far beyond misdiagnosing patients.
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O problema coa medicina baseada na raza
vai máis alá da mala diagnose dos doentes.
11:11
Its focus on innate
racial differences in disease
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Facer fincapé en diferenzas raciais
innatas na enfermidade
11:16
diverts attention and resources
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distrae a atención e os recursos
11:19
from the social determinants
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dos determinantes sociais
11:21
that cause appalling
racial gaps in health:
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que causan graves diferenzas
raciais en cuestións de saúde:
11:25
lack of access
to high-quality medical care;
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déficits no acceso a medicina
de alta calidade;
11:29
food deserts in poor neighborhoods;
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escaseza de alimentos
en barrios pobres;
11:33
exposure to environmental toxins;
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exposición a tóxicos ambientais;
11:37
high rates of incarceration;
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elevadas porcentaxes de poboación reclusa
11:39
and experiencing the stress
of racial discrimination.
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e a vivencia do estrés derivado
da discriminación racial.
11:45
You see, race is not a biological category
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Veredes, a raza
non é unha categoría biolóxica
11:48
that naturally produces
these health disparities
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que produza, sen outro factor,
esas diferenzas de saúde
11:52
because of genetic difference.
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por mor de diferenzas xenéticas.
11:55
Race is a social category
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A raza é unha categoría social
11:57
that has staggering
biological consequences,
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de brutais consecuencias biolóxicas,
12:01
but because of the impact
of social inequality on people's health.
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pero por mor do impacto tamén
da inxustiza social na saúde da xente.
12:07
Yet race medicine pretends
the answer to these gaps in health
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A medicina racial quere facernos crer
que a resposta a estas carencias
12:11
can be found in a race-specific pill.
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pode atoparse nunha pílula especial.
12:14
It's much easier and more lucrative
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É moito máis sinxelo e rendíbel
12:17
to market a technological fix
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vender unha solución tecnolóxica
12:20
for these gaps in health
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para eses déficits en saúde
12:22
than to deal with the structural
inequities that produce them.
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que lidar coas inxustizas sistémicas
que son a súa base.
12:29
The reason I'm so passionate
about ending race medicine
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A miña vehemencia para eliminar
a medicina baseada na raza
12:34
isn't just because it's bad medicine.
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non só nace de que sexa mala medicina.
12:37
I'm also on this mission
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Tamén estou nesta loita
12:39
because the way doctors practice medicine
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porque o xeito en que moitos médicos
exercen o seu labor
12:42
continues to promote
a false and toxic view of humanity.
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continúa dando vida a unha
visión errada e tóxica da humanidade.
12:48
Despite the many visionary breakthroughs
in medicine we've been learning about,
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Malia os enormes descubrimentos médicos
dos que estamos sendo testemuñas,
12:54
there's a failure of imagination
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seguimos ante unha falla de imaxinación
12:57
when it comes to race.
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no que respecta á raza.
13:00
Would you imagine with me, just a moment:
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Imaxinade comigo, será só un minutiño:
13:04
What would happen if doctors
stopped treating patients by race?
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Que pasaría se os médicos
deixasen de tratar doentes pola raza?
13:12
Suppose they rejected
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Supoñamos que rexeitan
13:14
an 18th-century classification system
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un sistema de clasificación do s.XVIII
13:18
and incorporated instead
the most advanced knowledge
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e incorporan no seu lugar
o máis moderno coñecemento
13:22
of human genetic diversity and unity,
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da diversidade xenética humana,
13:25
that human beings cannot be categorized
into biological races?
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que nos di que os seres humanos non
se poden clasificar en razas biolóxicas.
13:32
What if, instead of using race
as a crude proxy
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Que pasaría se, no lugar de usar a raza
como pobre substituto
13:37
for some more important factor,
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dalgún outro factor máis importante,
13:39
doctors actually investigated
and addressed that more important factor?
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os médicos investigaran e atenderan
a ese outro factor directamente?
13:46
What if doctors joined the forefront
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Que pasaría se os médicos
fosen a vangarda
13:49
of a movement to end
the structural inequities
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dun movemento para liquidar
as inxustizas sistémicas
13:53
caused by racism,
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provocadas polo racismo,
13:55
not by genetic difference?
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e non por diferenzas xenéticas?
14:01
Race medicine is bad medicine,
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A medicina baseada na raza
é mala praxe,
14:05
it's poor science
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é unha ciencia de baixa calidade
14:07
and it's a false
interpretation of humanity.
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e é unha errónea concepción da humanidade.
14:11
It is more urgent than ever
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Hoxe é máis imperioso que nunca
14:14
to finally abandon this backward legacy
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abandonar esta retrógrada visión
14:18
and to affirm our common humanity
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e afirmar o que nos une como humanidade
14:22
by ending the social inequalities
that truly divide us.
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poñendo fin dunha vez por todas
ás inxustizas sociais que nos dividen
14:28
Thank you.
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Moitas grazas.
14:29
(Applause)
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(Aplausos)
14:31
Thank you. Thanks.
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Grazas. Moitísimas grazas.
14:34
Thank you.
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Grazas.

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ABOUT THE SPEAKER
Dorothy Roberts - Professor, author and social justice advocate
Global scholar, University of Pennsylvania civil rights sociologist and law professor Dorothy Roberts exposes the myths of race-­based medicine.

Why you should listen

Internationally recognized scholar, public intellectual and social justice advocate Dorothy Roberts studies the interplay of gender, race and class in legal issues. She has been a leader in transforming public thinking and policy on reproductive health, child welfare and bioethics.

Professor of Africana Studies, Law & Sociology at the University of Pennsylvania, Dorothy directs the Penn Program on Race, Science and Society. She has authored and co­-edited ten books, including the award-­winning Killing the Black Body and Shattered Bonds. Her latest book is Fatal Invention: How Science, Politics, and Big Business Re­-create Race in the Twenty­-First Century. She received the 2015 Solomon Carter Fuller Award from the American Psychiatric Association for "providing significant benefit for the quality of life for Black people."

More profile about the speaker
Dorothy Roberts | Speaker | TED.com