ABSTRACT
"Be not the first by whom the new are tried, Nor yet the last to lay the old aside." Pope aimed his coupiet (1) at literary criticism in the 18th century, but it makes sense for medicine in the 20th century. Be not the first to recommend to patients a new treatment with value not established by a rigorous clinical trial. Be not the last to discard antique habits of practice. An example of this second fault is the subject of the "Perspective" essay by Caldwell and Popenoe (2) in this issue. For years, medical students have been taught, with good reason, to systematically record every fact ascertainable from a patient, no matter its final relevance or irrelevance to deducing the diagnosis or selecting treatment. To show their thoroughness in history taking and physical examination, they have generally been expected to trot out all of these details when presenting cases. Among these details has often been a term for the patient's "race." Hence, a case presentation would typically open with a description like "This 69-year-old black male came to the clinic with a chief complaint of ...." As Caldwell and Popenoe point out, what is the listener to make of the statement, as in this example, of "black"? What value does such "racial" designation have for diagnostic analysis in most cases? In rare instances, it might be a clue to the genetic determinant of a disease, as with sickle cell anemia, but even in such cases, far more convincing markers than skin color for genetically determined diseases are now likely to be available. Perhaps more frequently, a "racial" term might be a clue to some nongenetic risk factor for a disease. In such cases, specific inquiries into potential risk factors are much more likely to be fruitful. Caldwell and Popenoe emphasize this point by recommending that simplistic "racial" terms such as "black" and "white" be dropped and that more attention be paid to detailed history taking that can yield "invaluable information" on "ethnic background and possible risks for certain diseases" and "potentially important cultural information."
