INSIDE WVSMA
Editor ’ s Letter
When Race is Included in Medical Manuscripts
Linda S . Nield , MD
During this past year , the instructions in the manuscript guidelines for the West Virginia Medical Journal have been modified to include a requirement that reads as follows : “ Mention of race : Race is a social construct and must be treated as such in medical publishing . Whenever the race of patients is included in submissions , authors must explain the reasoning for including race and how the race was determined . If race is mentioned unnecessarily and considered as a biological construct in the submission , the submission will be desk rejected or , at minimum , returned for major revisions .” 1
This requirement is in line with the recommendations of the International Committee of Medical Journal Editors . 2 The impetus for this new requirement stems from the need for researchers and authors to ensure that race is being considered as a social construct and not a biological one when the race of a patient is included as a variable in a study . When race is used as a variable , and differences in a study are found along racial lines , it is imperative that the authors theorize why a difference may have occurred . Implying or stating that there may be only a biological or physiologic factor that has not been discovered yet to account for differences is not appropriate , as this reasoning implies that race is a biological construct and the social consequences associated with race , such as racism , are not being considered . A subject ’ s ancestry is a better predictor of a genetic predisposition to disease than one ’ s race . 3
Ortega and colleagues reported that individuals who selfidentify as African American may have widely varying genetic ancestry , 4 so how can a biological conclusion be drawn from race as the sole cause for differences along racial lines ? A substantial number of individuals may not know their full ancestry . Condit et al reported that approximately 9 % of subjects in their study did not know both biological parents and approximately 40 % did not know all four biological grandparents . 5 Although the total number of subjects was small ( N = 99 ), these findings do provide a glimpse into the likely reality that many persons in the United States are not fully knowledgeable about their ancestry / potential genetic backgrounds .
In this final issue of 2022 , Thompson et al mention previously published work that indicates differences in rates of celiac disease along racial and ethnic lines , 6 but it is evident the authors do not assume a sole biological factor as the reason for differences . The other scientific articles do not discuss data along racial or ethnic lines . 7-9
REFERENCES
1 . West Virginia State Medical Association . Manuscript Guidelines . Available at : https :// growthzonesitesprod . azureedge . net / wp-content / uploads / sites / 861 / 2022 / 08 / WVMJ _ 2022 _ Manuscript _ Guidelines . pdf . Accessed on October 31 , 2022 .
2 . International Committee of Medical Journal Editors . Manuscript Preparation and Submission . Available at : https :// www . icmje . org / recommendations / browse / manuscript-preparation / preparing-for-submission . html . Accessed on October 31 , 2022 .
3 . Borrell LN , Elhawary JR , Fuentes-Afflick E et al . Race and genetic ancestry in medicine-a time for reckoning with racism . NEJM . 2021 ; 384:474-480 .
4 . Ortega VE , Kumar R . The effect of ancestry and genetic variation on lung function predictions . What is “ normal ” lung function in diverse human populations ? Curr Allergy Asthma Rep . 2015 ; 15 ( 4 ): 16 .
5 . Condit C , Templeton A , Bates BR , Bevan JL , Harris TM . Attitudinal barriers to delivery of race-targeted pharmacogenomics among informed lay persons . Genet Med . 2003 ; 5 ( 5 ) 385-392 .
6 . Thompson S , Rehman R , Bashir A , Patel P . Characteristics of pediatric celiac disease in southern West Virginia . WVMJ . 2022 ; 118 ( 4 ): 22-27
7 . DeCicco D , Thayer J , Dimachkie . Catatonia associated with buprenorphine-induced toxic leukoencephalopathy . WVMJ . 2022 ; 118 ( 4 ): 28-33
8 . Moore CA , Moise A , Cottrell L , Polak MJ . Incidence of congenital microcephaly is increased with fetal exposure to tobacco , opioids , and cannabis . WVMJ . 2022 ; 118 ( 4 ): 36-40
9 . Balakrishnan B , Hamrick L . Recurrent pneumothorax and a solitary pulmonary nodule : A case report of a rare sequelae of histoplasmosis . WVMJ . 2022 ; 118 ( 4 ): 42-45
6 • www . wvsma . org