Distinguishing between diseased and healthy states in medicine has immense consequences because it influences treatment, insurance coverage, employment, and disability.
This is yet another example of the contagion of woke infecting the realm of science and academic inquiry. It’s long since set up shop in the quads of some of our august institutions (quite literally, in some cases in recent memory) and it’s no surprise that its reach has extended to erstwhile flagship academic journals like NEJM. I hope one consequence of the beatdown in yesterday’s election will be an awakening such that people will start extricating their craniums from their rectums.
Obviously, “race” makes a difference. There are inherent biologic variations based on one’s ethnic/genetic heritage, the fact of which is altogether indifferent to various idiotic social frameworks du jour. Different “races” will have different “normal range” of FEV1, just as they do of waist circumference. Or that biologic men and women will have different “normal ranges” for LV mass index. No amount of kvetching about “equity” will change such biologic realities.
And they ignored the multiple studies that suggest the real difference is an difference in body proportions. Statistically blacks have a longer leg length relative to torso length. Current methods use standing height, but several papers indicate that using seated height resolves the differences. Instead of advocating for better measurement, they push a political agenda that will move more influence and power to further their own interests.
Some heretics would claim that the doctor can make a clinical diagnosis of disease based on the consideration of all the factors that matter for each individual patient and ignore the collectivistic categorization so favored by the "public health" people (who have their own agenda and biases). Once again, the main source of the problem is the participation of third parties in medical care.
Appreciate this article, learned a lot, adds a valuable perspective. We need more practicing docs involved in peer review / public health conversations.
The idea that "we must draw the line somewhere" is not only false, but a disservice. Dichotomizing diagnostic tests is problematic, especially when we can use continuous likelihood ratios and ROC curves. There's some good literature on this by Arthur Evans: https://link.springer.com/article/10.1007/s11606-023-08177-5
This is yet another example of the contagion of woke infecting the realm of science and academic inquiry. It’s long since set up shop in the quads of some of our august institutions (quite literally, in some cases in recent memory) and it’s no surprise that its reach has extended to erstwhile flagship academic journals like NEJM. I hope one consequence of the beatdown in yesterday’s election will be an awakening such that people will start extricating their craniums from their rectums.
Obviously, “race” makes a difference. There are inherent biologic variations based on one’s ethnic/genetic heritage, the fact of which is altogether indifferent to various idiotic social frameworks du jour. Different “races” will have different “normal range” of FEV1, just as they do of waist circumference. Or that biologic men and women will have different “normal ranges” for LV mass index. No amount of kvetching about “equity” will change such biologic realities.
And they ignored the multiple studies that suggest the real difference is an difference in body proportions. Statistically blacks have a longer leg length relative to torso length. Current methods use standing height, but several papers indicate that using seated height resolves the differences. Instead of advocating for better measurement, they push a political agenda that will move more influence and power to further their own interests.
Disability, like race, is also a social construct.
Not only is means testing needed for environmental exposure, it is needed for who and in what social context seeks disability.
Some heretics would claim that the doctor can make a clinical diagnosis of disease based on the consideration of all the factors that matter for each individual patient and ignore the collectivistic categorization so favored by the "public health" people (who have their own agenda and biases). Once again, the main source of the problem is the participation of third parties in medical care.
Appreciate this article, learned a lot, adds a valuable perspective. We need more practicing docs involved in peer review / public health conversations.
Modern medicine is plagued by the one-size-fits-all mentality you see in 90% of its execution.
The idea that "we must draw the line somewhere" is not only false, but a disservice. Dichotomizing diagnostic tests is problematic, especially when we can use continuous likelihood ratios and ROC curves. There's some good literature on this by Arthur Evans: https://link.springer.com/article/10.1007/s11606-023-08177-5