February 2022

Abstract 1: Aspirin Use to Prevent Preeclampsia

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John Michael B. -

Thank you for your ongoing informative and epistemological analysis of ongoing papers in the medical literature. It is always a pleasure to listen to. However, I would take issue with a couple of remarks that you made which are not evidence-based and in fact cater to misinformation.
You did state that race is a social political construct. While there are social interpretations to racial expression, for example President Obama had a black father and a white mother but we considered him the first black president. However, the primary driver of racial differences is evolutionary biology. We know that as the populations of humans migrated northward, they changed genetically in order to have translucent skin to absorb vitamin D and developed anatomic changes to adapt to the cold weather. These phenotypic changes with a result of genetic response to natural selection. There is nothing wrong about this it does not imply any specific superiority. It is not surprising than that there might be genetic differences in the expression of disease. In fact, we know there is.
It is an important distinction because we know there are differences between races in terms of their responses to medication and in terms of their expression of different diseases and so this is hardly a social clinical construct but more of a biologic one. You then went on to assume that the differences in preeclampsia rates were related to structural racism. (That certainly is an ill-defined and nonscientific concept but seems to be a derivative of the concept of systemic racism which is often used as a cudgel more than a rational argument.) You did this in the absence of any evidence that other factors were not at play. Certainly, we know that preeclampsia does occur in people in lower socioeconomic classes more frequently. It also occurs much more frequently in young mothers. You also did not look at the African experience in which there is more or less the same prevalence of preeclampsia in African woman as there are in American blacks. I would have a hard time believing the structural racism in Zanzibar and South Africa. As an aside, I am sure that interventionalists would point out that this may be of post-colonial phenomenon causation but that is always their default position in the absence of evidence.
You may posit that the difference in preeclampsia within races is the result of racism, but you really have no proof that it does not just a result of biologic racial differences. Yet you took deposition without question and that is concerning because it is more of an emotional response as opposed to a evidence-based one.
This is a marked departure from her usual hard-core analysis of papers and sweeping statements. I think you should reconsider this. To really determine if there are differences based on racism as opposed to biologic differences you would need to analyze different cohorts of patients. We are at a time when emphasis has been placed on race as the most preeminent characteristic of any individual. I think this has led many to believe that all differences are the result of our racism as opposed to the actual medical biologic characteristics which are unique and singular to anyone race. It was quite disappointing to see that you have bought into this without bringing your usual thorough analysis to the conclusion that was drawn in the paper.

Prevalence and risk factors associated with severe pre-eclampsia among postpartum women in Zanzibar: a cross-sectional study
• Mwashamba M. Machano &
• Angelina A. Joho
BMC Public Health volume 20, Article number: 1347 (2020)

Steven B. -

Hello, thank you for listening and your comment. I understand that you will probably not agree with me that race as a social construct in our country is more important than biologic differences. Historical injustices have lead to health disparities that continue to this day. Zip code is more important than genetic code in the United States. I have noted your feedback.

John Michael B. -

I do agree that social inequities can be based on historic features and there is no doubt that slavery has had a sequi-generational effect.

However, to broadly conclude that all racial patho-physiologic differences are based on social -political influence is not well supported by fact.

We do know that there are racial differences in the response to medications and in the expression of disease. It is a bit of a leap to suggest that of differences in rates of preeclampsia are solely based on a racist systemic inequity when in fact it may be related to biologic differences. Certainly when we look at other cohorts of patients in other countries and in other circumstances it does not support your conclusion. Seeing everything through the myopic lens of racism and racial inequity is a disturbing but prevalent bias.
It lacks scientific rigor and introduces a priori bias. . I say this knowing full well that the scientific method has been the subject of scrutiny for being a racist process. Yet it is the best way we have of finding and pursuing truth. Much like Churchill said about democracy, it is the worse process except for all the rest.

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