Medical Concerns and Race

 

A debate is taking place on social media regarding medical concerns and the multiracial community. It is a life and death issue and should not be taken lightly. Some critics have stated that since race is a “social construct,” we are all the same biologically and there are no physical differences. Therefore, they believe, that any medical differences are non-existent and should not be studied further. They believe that the reason for not having racial classifications is that no human medical differences have been found.

Project RACE finds the critics short-sighted and their beliefs dangerous. Perhaps there are physical and/or neurological differences or maybe not. We just do not know, but that is not a reason to cancel medical studies and findings. It is not a reason to prematurely do away with racial categories, although there may be other reasons in other circumstances. We can look mostly at the area of the need for donor increase for life-saving bone marrow and the need for as close to a racial and ethnic match as possible. If there were no physical differences in these areas, why would race and ethnicity be important? Obviously, these include very specific requirements in the medical realm. We simply cannot act as if it doesn’t exist. Bone marrow matching by race and ethnicity is a critical life and death matter.

Tay-Sachs is a disease that affects mostly Jewish people. Sickle Cell Anemia is mainly found in African Americans. There are many more examples. Should we discount race as a factor in medicine? Absolutely not; we should be finding out more. We must take the high road and push for more information to be sought, unlike our critics.

It’s lovely to live in a world where you think there are no racial and/or ethnic differences and perhaps that is true, but the truth is we just don’t know—not enough work has been done. An article appeared in U. S. News and World Report by HealthDay Reporter Maureen Salamon on December 6, 2018 called “Breast Cancer Deadlier for Black Women, Despite Same Treatments, which was revealed by a new trial. They did adjust for lifestyle differences and found that some drugs were metabolized differently by racial groups. The article can be read here:

https://www.usnews.com/news/health-news/articles/2018-12-06/breast-cancer-deadlier-for-black-women-despite-same-treatments

And here is another plea; http://www.fox46charlotte.com/news/4-year-old-alameda-girl-diagnosed-with-rare-genetic-disorder-family-urging-donors-to-join-registry

We need more of these kinds of studies, not fewer. We need to enlarge the pool of multiracial donors for bone marrow, not act as though it’s not a problem. We have a long way to go to save lives. We can’t afford to turn away.

 

 

 

Photo Credit: Depositphotos

Minority Kids and Healthcare

Minority Kids Less Likely to Be Diagnosed, Treated for ADHD: Study

Finding points to possible disparities in care

Minority children are significantly less likely than their white peers to be diagnosed or treated for attention-deficit/hyperactivity disorder (ADHD), new research shows.

The study, which is published online June 24 and in the July print issue of the journal Pediatrics, followed more than 17,000 children across the nation from kindergarten to eighth grade. Researchers regularly asked parents if their children had been diagnosed with ADHD.

Even after taking into account a host of factors that may influence behavior, attention and access to health care, researchers found that Hispanic and Asian children and those of other races were about half as likely to receive a diagnosis as whites. Blacks were about two-thirds less likely to be recognized as having problems with attention or hyperactivity as whites.

In addition, when minority children were diagnosed, they were less likely to receive medication than white kids with ADHD, the investigators found.

The study can’t say, however, whether the differences mean that ADHD is being underdiagnosed in minorities or overdiagnosed in whites. Previous research has raised both possibilities.

A study published in the journal Clinical Psychology Review in 2009, for example, found that despite having more symptoms of distractibility and hyperactivity, black children were diagnosed with ADHD less often than whites.

On the other hand, a study published in April 2012 in the Canadian Medical Association Journal found that the youngest children in their school class were more likely to be diagnosed compared to the oldest children in those grades, suggesting that some doctors and teachers may mistake immaturity for ADHD, leading to overdiagnosis.

One expert suggested that socioeconomic and cultural differences may be at work.

Doctors still don’t know if one or both problems may be driving the rates of lower diagnoses in minorities seen in the current study, said Dr. Tanya Froehlich, a pediatrician at Cincinnati Children’s Hospital in Ohio.

“It does seem to be clear that there are some cultural differences at work, and also probably some differences in access to health care and access to health care information,” said Froehlich, who was not involved in the research.

For example, the study noted that children without health insurance were less likely to be diagnosed with ADHD than children who had coverage. Kids from lower-income families were also less likely to be diagnosed.

Yet, children with older mothers, who tend to be more highly educated, and those with parents who spoke to doctors in English were more likely to be diagnosed with the condition. Both those factors are signs that access to health care and awareness of the problem may also be playing a role.

Several risk factors for ADHD occur more often in minority children than in whites. Those include a lower household income, less educated parents and low birth weight.

“What that suggests in our study is that there are children who are likely deserving of a diagnosis, but who aren’t receiving a diagnosis, which raises the question of a lack of treatment,” said study author Paul Morgan, director of the educational risk initiative at Pennsylvania State University in University Park, Pa.

The consequences of ADHD can be serious if the condition is left untreated.

“We know that people with ADHD have higher rates of failing a grade in school, lower academic achievement, lower achievement in their jobs, higher rates of incarceration, higher rates of substance abuse, more problems with relationships, and higher rates of depression and anxiety,” Froehlich said. “It is extensive.”

There’s some evidence that treatment, either with behavioral therapies or medication, can improve the outlook for affected children.

“Definitely, we want all kids to be treated and to have the best chance possible for success in life,” Froehlich said. “So if people truly have ADHD and they’re not identified, that’s going to hold them back.”

Source: Health Day/Brenda Goodman

Cell Therapy for Leukemia

Cell Therapy Shows Promise for Acute Type of Leukemia

A treatment that genetically alters a patient’s own immune cells to fight cancer has, for the first time, produced remissions in adults with an acute leukemia that is usually lethal, researchers are reporting.In one patient who was severely ill, all traces of leukemia vanished in eight days.

“We had hoped, but couldn’t have predicted that the response would be so profound and rapid,” said Dr. Renier J. Brentjens, the first author of a new study of the therapy and a specialist in leukemia at Memorial Sloan-Kettering Cancer Center.

The treatment is experimental, has been used in only a small number of patients and did not work in all of them. But experts consider it a highly promising approach for a variety of malignancies, including other blood cancers and tumors in organs like the prostate gland.
The new study, in five adults with acute leukemia in whom chemotherapy had failed, was published Wednesday in the journal Science Translational Medicine.
The treatment is similar to one that pulled a 7-year-old girl, Emma Whitehead, from death’s door into remission nearly a year ago, and that has had astounding success in several adults with chronic leukemia in whom chemotherapy had failed. The treatment regimen that saved Emma and those adults was developed at the University of Pennsylvania. Related studies have also been done at the National Cancer Institute.
But this cell-therapy approach had not been tried before in adults with the disease that Emma had, acute lymphoblastic leukemia. This type of blood cancer is worse in adults than in children, with a cure rate in adults of only about 40 percent, compared with 80 percent to 90 percent in children. The disease is not common. Each year in the United States, it affects about 2,400 people older than 20, and 3,600 younger. Though there are fewer cases in adults, there are more deaths: about 1,170 adults die each year compared with 270 deaths in people under 20.
In adults, this type of leukemia is a “devastating, galloping disease,” said Dr. Michel Sadelain, the senior author of the new study and director of the Center for Cell Engineering and the Gene Transfer and Gene Expression Laboratory at Memorial Sloan-Kettering Cancer Center in Manhattan.
Patients like the ones in the study, who relapse after chemotherapy, usually have only a few months left, Dr. Sadelain said. But now, three of the five have been in remission for 5 to 24 months. Two others died: one was in remission but died from a blood clot, and the other relapsed. The survivors have gone on to have bone-marrow transplants. Their prognosis is good, but relapse is still possible, and only time will tell.
Experts not connected with the study said it was an important advance in an emerging field. Dr. Carl June of the University of Pennsylvania, who led the team that treated Emma and the other patients, said, “This is the first report showing some real, clinically beneficial activity in adult acute lymphoblastic leukemia.” He said his team was also starting to test its version of the cell therapy on patients with the disease.
Dr. Richard M. Stone, the program director for adult leukemia at the Dana-Farber Cancer Institute in Boston, called the research exciting and said he hoped to begin collaborating with the team at Sloan-Kettering. He has already sent them a patient.
The treatment uses patients’ own T-cells, a type of white blood cell that normally fights viruses and cancer. The patient’s blood is run through a machine that extracts T-cells and returns the rest of the blood to the body. Researchers then do some genetic engineering: they use a disabled virus as a “vector” to carry new genetic material into the T cells, which reprograms them to recognize and kill any cell that carries a particular protein on its surface.
The protein, called CD19, is found on B-cells, which are part of the immune system. This target was chosen because the patients had a type of leukemia that affects B-cells, so the goal was to train the patients’ T-cells to destroy B-cells. Healthy B-cells — which make antibodiesto fight infection — would be killed along with cancerous ones, but that side effect was treatable.
“We’re creating living drugs,” Dr. Sadelain said. “It’s an exciting story that’s just beginning.”
One of the sickest patients in the study was David Aponte, 58, who works on a sound crew for ABC News. In November 2011, what he thought was a bad case of tennis elbow turned out to be leukemia. He braced himself for a long, grueling regimen of chemotherapy.
His oncologist, Dr. Brentjens, suggested that before starting the drugs, Mr. Aponte might want to have some of his T-cells removed and stored (chemotherapy would deplete them). That way, if he relapsed, he might be able to enter a study using the cells. Mr. Aponte agreed.
At first, the chemotherapy worked, but by the summer of 2012, while he was still being treated, tests showed that the disease was back. “After everything I had gone through, the chemo, losing hair, the sickness, it was absolutely devastating,” Mr. Aponte recalled.
He joined the T-cell study. For a few days, nothing seemed to be happening. Then, his temperature began to rise. He has no memory of what took place during the next week or so, but the journal article — where he is Patient 5 — reports that his fever spiked to 105 degrees. He was in the throes of a “cytokine storm,” meaning that the T-cells, in a furious battle with the cancer, were churning out enormous amounts of hormones called cytokines. Besides fever, the hormonal rush can make a patient’s blood pressure plummet and his heart rate shoot up. Mr. Aponte was taken to intensive care and treated with steroids to quell the reaction.
Eight days later, his leukemia was gone. Even the doctors were shocked, Dr. Brentjens said. They repeated the lab tests just to make sure there was no mistake.
Once he was in remission, Mr. Aponte had a bone-marrow transplant, as did three of the other patients in the study. Another had medical problems that made a transplant impossible, and it was he who relapsed and died. The researchers think he may have relapsed because the steroids he needed to treat the cytokine storm may have wiped out the T-cells before they could do their job.
For the other patients, it is not known whether the transplants were really needed; in theory, the T-cells alone might have produced a long-term remission or even a cure. Patients treated at the University of Pennsylvania were not given transplants, and most have stayed in remission. But the technique used there involves a different viral vector and different genetic programming from the one at Sloan-Kettering.
In any case, Dr. Brentjens said, the T-cells are still experimental, whereas transplants are the standard of care in acute leukemia because they have been shown to give many patients the best odds of survival. So the transplants were done for ethical reasons. The study is continuing, and as more patients are treated, answers may emerge as to whether the T-cells alone will be enough for some patients.
Mr. Aponte, who had the transplant in December, is still recovering, and trying to gain back some of the 40 pounds he lost while he was ill. But he hopes to return to work soon.
Source: The New York Times