FASCIST HEGEMONY
Orban seen entrenching right-wing dominance through Hungarian university reform

By Marton Dunai and Anita Komuves 

4/26/2021

© Reuters/BERNADETT SZABO FILE PHOTO: Students in front of the University of Theatre and Film Arts in Budapest

BUDAPEST (Reuters) - Hungary is set to pass legislation on Tuesday setting up foundations to take over the running of universities and cultural institutions in a move critics say extends the ideological imprint of the ruling right-wing government.

Currently, most Hungarian universities are owned by the state but have a large amount of academic autonomy.

The bill, drafted by Prime Minister Viktor Orban's deputy, says they need to be privatised because modern conditions require a "re-thinking of the role of the state" and the foundations will manage institutions more efficiently.

© Reuters/BERNADETT SZABO FILE PHOTO: Hungary's PM Orban in Budapest

Orban's government will appoint boards of trustees to run the foundations, which will control substantial real estate assets and benefit from billions of euros worth of EU funds, while also having considerable influence over universities' everyday life.

The government will endow several of the foundations using its stakes in blue chip companies MOL and drug maker Richter. It will also allocate over 1 trillion forints ($3.3 billion) worth of EU recovery funds for the revamp of universities.

Orban, who came to power in 2010, has tightened his control over much of Hungarian public life, such as the media, education and scientific research, as he seeks to reshape national culture. Orban set out the changes in a speech in 2018 when he envisioned embedding his political system in a new "cultural era".

© Reuters/BERNADETT SZABO FILE PHOTO: Supporters gather in front of the University of Theatre and Film Arts, in Budapest

His government, promoting what it calls Christian, conservative values, has strongly opposed immigration and limited gay adoption and legal recognition of transgender people.

Critics say the new legislation was the next move in extending its ideological influence and power grab.

"This is part of the ideological war that Orban declared two years ago," said Attila Chikan, a professor at the Corvinus economics university in Budapest and a former minister in Orban's first government in 1998.

"They make it no secret: they want to assume intellectual power after political and economic power."

He noted the move came after the government boosted controls over academic research and forced a top liberal school, Central European University, to move to Vienna in 2019.

The bill, to be voted on in parliament on Tuesday, says "the fundamental expectation is that the foundations actively defend the survival and well-being of the nation and the interests of enriching its intellectual treasures."

The foundations running some of the cultural institutions would have patriotic tasks such as "strengthening national identity."

The opposition said with supporters of Orban's ruling Fidesz party, and even government ministers, sitting on the boards, Orban could retain a degree of control over universities beyond the 2022 election and could undermine their autonomy.

Gergely Arato, an MP from opposition party Democratic Coalition said the bill would take away "the property, traditions, community, knowledge" of Hungarian people and give them to government allies controlling the universities.

The government says universities would benefit from the new model. Istvan Stumpf, government commissioner in charge of the changes, declined an interview with Reuters.

In October, students at Hungary's University of Theatre and Film Arts blockaded their school in a row over the imposition of a government-appointed board that protesters said undermined the school's autonomy.

($1 = 300.8700 forints)

(Reporting by Marton Dunai and Anita Komuves; Editing by Toby Chopra)

Opponents force referendum on Swiss same-sex marriage

ZURICH (Reuters) - Swiss voters will get final say on whether same-sex couples can marry after opponents gathered enough signatures to force a binding referendum on a 2020 law allowing them to wed

.

© Reuters/Denis Balibouse FILE PHOTO: A rainbow flag is pictured on a balcony ahead of a referendum on anti-homophobia law in Neuchatel

That legislation also allowed transgender people to change their legal gender with a declaration, in a major change for a country that has lagged other parts of western Europe in gay rights.


The Swiss government certified that opponents had gathered enough support to call a referendum under the nation's system of direct democracy. It will in May set a date for the vote, which could come in September at the earliest, a spokesman said.

Opponents had decried "fake marriages" and said only a man and a woman could wed.

A survey commissioned by a gay advocacy group Pink Cross in 2020 showed more than 80% of Swiss support same-sex marriage, suggesting the law would take effect even if subjected to a referendum.

France legalised same-sex marriages in 2013, Germany followed in 2017 and the U.S. Supreme Court in 2015 ruled that the Constitution provides same-sex couples the right to marry.

(Reporting by Michael Shields and John Miller; Editing by Alexandra Hudson)

THE SURGE IN MIGRATION EL NORTE

More than 27,000 displaced in Colombia violence in 2021

AFP  4.27.2021

More than 27,000 people were displaced during the first quarter of 2021 due to a surge of violence in lawless areas of Colombia, the human rights ombudsman said on Monday.

© Luis ROBAYO Despite a 2016 peace accord, Colombia has seen a surge of violence in lawless areas due to a multi-faceted conflict

People have either fled or been chased from their land by threats, murders, forced recruitment by armed gangs, clashes between such gangs, and others pitting them against the armed forces.

It amounts to a 177 percent increase in displacements on the same period in 2020, the ombudsman said.

Colombia thought it had seen the back of more than a half century of armed conflict when in 2016 the Marxist Revolutionary Armed Forces of Colombia (FARC) signed a peace deal with the government to disband and form a political party.

But violence has continued pitting dissident FARC members, other leftist guerrillas from the National Liberation Army (ELN), drug-traffickers, right-wing paramilitaries and the armed forces in a multi-faceted conflict.

Between January 1 and March 31, there were 65 "massive displacement events" compared with just 35 in the same period the previous year, said the ombudsman.

In a statement, the United Nations deplored "the violence carried out against communities, people defending human rights, social and community leaders, as well as ex-combatants of the former FARC, a situation that has worsened in recent weeks."

The UN said seven ex-guerrillas were murdered in an eight-day period recently.

The leftist Comunes party, which was formed after the peace deal, claims that 271 former fighters that signed the accord have been killed.

lv/jss/gma/bc/st

U.S. announces $310 million in humanitarian, food aid to Guatemala, Honduras, El Salvador

WASHINGTON (Reuters) - U.S. Vice President Kamala Harris, in a virtual meeting with Guatemalan President Alejandro Giammattei on Monday, announced an additional $310 million in U.S. government support for humanitarian relief and to address food insecurity in Guatemala, Honduras and El Salvador, the White House said.

© Reuters/EVELYN HOCKSTEIN U.S. Vice President Harris holds videoconference with Guatemala's President Giammattei at the White House in Washington

The two leaders also "agreed to open Migrant Resource Centers in Guatemala to provide services for people seeking lawful pathways of migration as well as those in need of protection, asylum referrals, and refugee resettlement," the White House said.

Gallery: Migrants deported from U.S. find shelter in Mexico (Reuters)















4/25 SLIDES © Reuters

An asylum-seeking migrant child from Central America, who was airlifted from Brownsville to El Paso, Texas, and deported from the U.S. with his mother, is seen inside the El Buen Samaritano shelter in Ciudad Juarez, Mexico April 1, 2021. Young families who crossed the U.S. border seeking a better life find themselves forced to head back south into Mexico. They had hoped President Joe Biden would allow them and their young children to stay in the U.S. until their immigration cases could be heard. Instead, many were promptly deported. REUTERS/Jose Luis Gonzalez

(Reporting by Mohammad Zargham; Editing by Kim Coghill)

#UCPKILLS

Boyle Street supervised drug-use site to stay closed, George Spady site to keep expanded hours

Dustin Cook , Alanna Smith 
4/26/2021

© Provided by Edmonton Journal Erica Schoen is the director of the supervised drug consumption site at Boyle Street Community Services on August 8, 2018.

A supervised consumption site in Edmonton’s downtown will discontinue operations at month’s end, leaving harm reduction advocates worried for the well-being of former clients.

Boyle Street Community Services spokesman Elliott Tanti said the supervised drug-use site has been closed since the fall when the service was redirected to the Tipinawâw shelter at the downtown Edmonton Convention Centre.

But when the shelter closes April 30, the consumption site won’t return to Boyle Street.

Instead, operations at the George Spady Centre across the street have been extended to 24-7 since the fall. The Spady used to run 8 p.m. to 8 a.m. when the Boyle Street site was in operation.

The two sites opened in March 2018 to jointly provide 24-7 access.

A third site at the Boyle McCauley Health Centre opened in November 2018.

Justin Marshall, press secretary to Alberta’s associate minister of mental health and addictions, said there is no reduction in funding for supervised consumption services in the Edmonton Zone despite the changes.

“The previous government decided to place three consumption sites in Chinatown, within very close proximity to other sites,” said Marshall in a statement. “The government is engaged with the Boyle Street society about potentially operating overdose prevention services in an under-serviced area of Edmonton.”
72 Edmonton opioid deaths in two months

But Angela Welz, the Alberta regional director for Moms Stop The Harm, said this could negatively impact former clients of the Boyle Street site.

“It’s disappointing because you are taking away something clients are comfortable with and asking them to go elsewhere,” said Welz. “Change for many of these marginalized people is very difficult, so it’s worrisome.”

She called the change in direction “sheer cruelty” as it could lead to additional overdose deaths, as numbers are already hitting record-high levels in the city.

In the first two months of 2021, 72 people died in Edmonton from opioid overdoses — representing a 157 per cent increase from January and February in 2020. The current rate of drug poisoning deaths in Edmonton sits at 41.1 per 100,000 people in 2021, exceeding the provincial rate of 30.3.

“I don’t know what else we can say as advocates and families who have lost a loved one to overdose and to the drug toxicity issues,” said Welz. “This is just another stab in the heart.”

Welz said the UCP isn’t listening to pleas from families who have lost loved ones to overdoses and calls from frontline workers when it comes to tackling the overdose crisis.

She said government should be bolstering harm reduction services and exploring safe supply programs.

“This is a very big blow to Edmonton,” said Welz. “It’s just very, very unfortunate because it is so important for that community hub in that neighbourhood. We need more supervised consumption sites, not less.”

Tanti said he isn’t certain there won’t be an impact with one less site but said “a lot has been done to mitigate the impact” as there is still 24-7 care.

He confirmed Boyle Street is working closely with the government to explore the potential for additional overdose prevention sites in parts of the city where they are needed.

Anti-lockdown protest aftermath: How do Peterborough residents feel?

Duration: 02:16 
4/27/2021

After the largest anti-lockdown protest yet on Saturday, Global News asked Peterborough residents what they think of the weekly demonstrations. Officials of the city's Downtown Business Improvement Area are concerned with the growing divide between those who support the protests and those who do not. Sam Houpt has the story...

WHO ELSE SHOWS UP BUT FOR SOME REASON GLOBAL FAILS TO MENTION HIM; MAXIME BERNIER LIBERTARIAN WHITE NATIONALIST
FORMER CONSERVATIVE LEADERSHIP CANDIDATE WHO FORMED HIS OWN TRUMP LIKE PEOPLES PARTY LAST ELECTION
AND OF COURSE HE IS NOT WEARING A MASK

UK
Shift workers treated in hospital three times more likely to have Covid – study

Shift workers treated in hospital are up to three times more likely to test positive for coronavirus than other hospitalised patients, a study has found.

Shift work was defined in the study as working outside the hours of 9am to 5pm, and it is estimated that around 25% of the UK’s workforce engages in some form of such work.

Using data from UK Biobank, the world’s largest biomedical database, researchers from the University of Manchester, Oxford, and the West Indies found that even after taking account of known coronavirus risk factors, such as age, ethnicity and deprivation, shift work increased the likelihood of testing positive for coronavirus in patients treated in hospital. The nature of the shift work or the occupation of those undertaking the shift work did not seem to affect the association.© Photograph: Anthony Harvey/Rex/Shutterstock Patients arrive at the emergency department at the Royal London hospital in Whitechapel.

Over half a million people were enrolled in the UK Biobank, and of these, 6,442 were tested for Covid-19 in hospital, resulting in 498 positive tests between March and August 2020. The shift workers were 2.5 to 3 times more likely to test positive with coronavirus than non-shift workers.

Dr John Blaikley, one of the lead researchers, said that although the study “shows quite a strong association between shift working and being hospitalised for Covid-19, even after controlling for existing Covid-19 risk factors”, further studies looking into the issue, especially in ethnic minority communities, were needed because the UK Biobank did not fully reflect the diversity of the UK.

He added that although it was difficult to explain the exact cause of this association, it could be speculated that possible causes might include reduced social distancing at work and how shift work may impact on the body clock of workers, with the body clock controlling immune response according to time of day.

Dr Hannah Durrington, the other lead researcher, said it was of “paramount importance” that the health and working conditions for shift workers were improved. “We do believe it should be possible to substantially mitigate these risks through good hand-washing, use of face protection, appropriate spacing and vaccination,” she added.

The study is further testament to the disparities that exist in relation to coronavirus and different kinds of work. Earlier this month, research from the Trades Union Congress found that workers on zero-hours contracts and other insecure jobs were twice as likely to have died of Covid-19 compared with those in other professions.

© Photograph: Paul Ellis/AP The GMB union said Boris Johnson’s reported comments that he would rather see ‘bodies piled high’ than approve a third lockdown ‘shows why a public inquiry is needed now’.The Trades Union Congress is calling for an immediate public inquiry into the handling of the Covid pandemic, insisting it should examine whether workers were kept safe enough after about 15,000 people of working age died from Covid in England and WalThe GMB union said the prime minister’s reported comments that he would rather see “bodies piled high” than approve a third lockdown “shows why a public inquiry is needed now”. It said its members “deserve to know why they were put in harm’s way unnecessarily and if the PM think it’s OK for them to die”.The unions want Downing Street to announce a start date and consult the public about its scope. Men working in processing plants, security, care and restaurant work were most at risk of dying from Covid, according to figures up to the end of last year, while for women it was machine operators and care workers.No 10 told bereaved families earlier this month the government did not have time for an inquiry and would not for months to come. It has said there will be “an independent inquiry at the appropriate time”.Calls for an immediate inquiry are gathering momentum. The TUC’s affiliated unions represent 5.5 million workers and its intervention follows similar demands for an inquiry from the archbishop of Canterbury, Labour, government scientific advisers and thousands of the bereaved, who have voiced outrage at Johnson’s alleged comments.They include Lobby Akinnola, whose father Olufemi, 60, was a care worker in Leamington Spa who died a year ago. He was visiting different clients’ homes improvising PPE from a winter scarf and gloves.“If we had locked down a week earlier, how many people could have been saved?” said Akinnola, adding that he was “disgusted” by reports the prime minister said “let the bodies pile high”.“My dad was on the threshold of life and death, but fell on the wrong side. Throughout this pandemic we have relied on frontline workers, but the government didn’t seem to support them.”The TUC has set five priorities for an inquiry: workplace infection control, including financial support to self-isolate; the impact of a decade of spending cuts on the capacity of public services; Covid’s unequal impact on workers, particularly ethnic minorities and people in insecure jobs; the impact of employment support packages such as furlough; and government procurement and its effect on supplies of PPE.

Notley calls for Alberta to offer 10 days of paid work leave to stop workplace spread of COVID-19

Lisa Johnson

EDMONTON JOURNAL

4/26/2021

© Provided by Edmonton Journal On Monday April 26, 2021 in Edmonton Alberta NDP Leader Rachel Notley, right, and NDP labour critic Christina Gray laid out a proposal for paid sick leave to slow the spread of the COVID pandemic, protect Alberta workers, and speed up Alberta's economic recovery.


The Opposition NDP is calling for the Alberta government to provide 10 days of paid leave for isolating workers to curb workplace spread of COVID-19.

Leader Rachel Notley said Monday the Alberta government should cover employers sending the wage support directly to workers as part of their paycheques, leaving the details of how the province might be reimbursed through the federal government’s recovery sickness benefit until later.

Notley said with variants of concern spreading faster in the workplace, the support would help get transmission rates down and bring the pandemic and public health restrictions to an end faster.

“What we need to do is bring (transmission) down and we can’t do that if people go to work with symptoms, or if they go to work while they’re waiting five days to get a test, or if they go to work because they can’t afford to stay home and not get paid while isolating,” said Notley.

“There’s a good reason to do it, and it’s long overdue,” said Notley, calling on the government to work again with the opposition as it did in passing legislation last week to guarantee three hours of paid sick leave to get workers vaccinated.

Notley also encouraged the government to consult with employers to reach a cost sharing agreement that recognizes that some large employers have increased their profits throughout the pandemic, while many small businesses struggle to survive.

Joseph Dow, press secretary to Labour Minister Jason Copping, said in a statement the Alberta government is concerned by the third-wave surge in cases across the province, but did not say whether Copping is considering any measure to fill in the gaps of the federal program.

Dow encouraged residents to take advantage of existing COVID-19 supports including those of the federal government, and the province’s isolation hotel program that offers up to $625 in financial support .

The NDP’s call comes as paid sick leave makes headlines across the country, especially in Ontario. Premier Doug Ford refused to implement paid sick leave until the public outcry prompted a pledge last week that a provincial program would fill in the gaps left by the federal sick pay program.

On Monday, Ford’s government shut down a bill proposed by a Liberal MPP that would guarantee 10 paid sick days.

As of Sunday , Alberta’s per capita rate of active COVID-19 cases, at 455 per 100,000, far exceeds Ontario’s, which is at 279 per 100,000 people. Ontario’s COVID-19 Science Advisory Table has called for paid sick leave to curb workplace spread.

The federal program offers $450 after taxes per week for up to a maximum of four weeks if they tested positive or are self-isolating due to COVID-19.

Notley pointed out that is less than a full-time minimum wage paycheque in Alberta, and it can take weeks to get the cash to eligible workers.

“Many families simply cannot afford to wait weeks without an income while they try to navigate the federal government’s application process,” said Notley.

Notley said the wages would be far less than the cost of occupied ICU beds and continued damage to the economy.

“We must weigh the cost of this program against the cost of thousands more Albertans falling sick, hundreds more in the hospital and ICU and the broader economic damage that occurs as a result of a longer third wave,” said Notley.

Beginning March last year, all Albertan employees who are in quarantine due to COVID-19 are eligible for 14 days of unpaid, job-protected leave.

 cbc.ca

Mandating paid sick days is 'not the expectation, it's the ask," says federal labour minister

Duration: 01:52

Federal Minister of Labour Filomena Tassi tells Vassy Kapelos on Power & Politics that her government is only asking provinces to mandate paid sick days.

Paid sick days would be 'game changer': grocery store worker

Duration: 05:40

 

Toronto Grocery store worker Rechev Browne says many of his colleagues who have been working throughout the pandemic can't afford to stay home, even when they feel sick.

 Health minister announces details of COVID-19 vaccination rollouts at meat-packing facilities in Alberta

Duration: 01:17 

Alberta Health Minister Tyler Shandro offers details of the province's rollout of the COVID-19 vaccine to meat-packing plants.

Narcity

​Costco Canada Gave Staff A Permanent Pandemic Raise & Now Some Cashiers Make $60K A Year

 AND THAT'S A GOOD THING

Duration: 01:00 

While other stores offered short-term pay increases to frontline employees during the COVID-19 pandemic, Costco Canada has decided to make their pandemic pay raise permanent.

COSTCO IS UNIONIZED THE AGREEMENT WAS NEGOTIATED BETWEEN MANAGEMENT AND UFCW. THE OTHER GROCERS ARE EITHER WITH 

A FAKE UNION OR NON UNION

BONUSES ARE ONE TIME PAY A RAISE IS A RAISE

Race correction in medicine: A fight brewing in America's hospitals

By Jacque Smith and Cassie Spodak, CNN

 Video by Athena Jones, Jessi Esparza and Natalia V. Osipova, CNN
4/26/2021

When she first learned about race correction, Naomi Nkinsi was one of five Black medical students in her class at the University of Washington.

© CNN A web page on UKidney.com illustrates how the eGFR formula uses race to calculate kidney function.

Nkinsi remembers the professor talking about an equation doctors use to measure kidney function. The professor said eGFR equations adjust for several variables, including the patient's age, sex and race. When it comes to race, doctors have only two options: Black or "Other."

© Jeff Roberson/Associated Press

Nkinsi was dumbfounded.

"It was really shocking to me," says Nkinsi, now a third-year medical and masters of public health student, "to come into school and see that not only is there interpersonal racism between patients and physicians ... there's actually racism built into the very algorithms that we use."

© CNN Naomi Nkinsi is a third-year medical and masters of public health student at the University of Washington in Seattle. She has been advocating for the removal of race correction in medicine.

At the heart of a controversy brewing in America's hospitals is a simple belief, medical students say: Math shouldn't be racist. Patients like Nichole Jefferson agree:

The argument over race correction has raised questions about the scientific data doctors rely on to treat people of color. It's attracted the attention of Congress and led to a big lawsuit against the NFL.

What happens next could affect how millions of Americans are treated.


Medicine has never been immune to racism

Carolyn Roberts, a historian of medicine and science at Yale University, says slavery and the American medical system were in a codependent relationship for much of the 19th century and well into the 20th.

"They relied on one another to thrive," Roberts says.

© Getty Images

It was common to test experimental treatments first on Black people so they could be given to White people once proven safe. But when the goal was justifying slavery, doctors published articles alleging substantive physical differences between White and Black bodies — like Dr. Samuel Cartwright's claim in 1851 that Black people have weaker lungs, which is why grueling work in the fields was essential (his words) to their progress.

© Gabe Ramirez/CNN Dr. Neil Powe says by simply removing race from the eGFR equations, "You're taking the data on African Americans, and you're throwing it in the trash."

The effects of Cartwright's falsehood, and others like it, linger today.

In 2016, researchers asked White medical students and residents about 15 alleged differences between Black and White bodies. Forty percent of first-year medical students and 25% of residents said they believed Black people have thicker skin, and 7% of all students and residents surveyed said Black people have less sensitive nerve endings. The doctors-in-training who believed these myths — and they are myths — were less likely to prescribe adequate pain medication to Black patients.

© Richard Heathcote/Getty Images North America/Getty Images

To fight this kind of bias, hospitals urge doctors to rely on objective measures of health. Scientific equations tell physicians everything from how well your kidneys are working to whether or not you should have a natural birth after a C-section. They predict your risk of dying during heart surgery, evaluate brain damage and measure your lung capacity.

But what if these equations are also racially biased?

Race correction is the use of a patient's race in a scientific equation that can influence how they are treated. In other words, some diagnostic algorithms and risk predictor tools adjust or "correct" their results based on a person's race.

© Science & Society Picture Library/Getty Images Dr. Samuel Cartwright developed his own version of a tool called the spirometer. Doctors still use spirometers today, and most include a race correction for Black patients to account for their supposedly shallower breaths.

The New England Journal of Medicine article "Hidden in Plain Sight" includes a partial list of 13 medical equations that use race correction. Take the Vaginal Birth After Cesarean calculator, for example. Doctors use this calculator to predict the likelihood of a successful vaginal delivery after a prior C-section. If you are Black or Hispanic, your score is adjusted to show a lower chance of success. That means your doctor is more likely to encourage another C-section, which could put you at risk for blood loss, infection and a longer recovery period.


Cartwright, the racist doctor from the 1800s, also developed his own version of a tool called the spirometer to measure lung capacity. Doctors still use spirometers today, and most include a race correction for Black patients to account for their supposedly shallower breaths.

Turns out, second-year medical student Carina Seah wryly told CNN, math is as racist as the people who make it.


Race isn't based on biology

The biggest problem with using race in medicine? Race isn't a biological category. It's a social one.

"It's based on this idea that human beings are naturally divided into these big groups called races," says Dorothy Roberts, a professor of law and sociology at the University of Pennsylvania, who has made challenging race correction in medicine her life's work. "But that's not what race is. Race is a completely invented social category. The very idea that human beings are divided into races is a made-up idea."

Ancestry is biological. Where we come from — or more accurately, who we come from — impacts our DNA. But a patient's skin color isn't always an accurate reflection of their ancestry.

Look at Tiger Woods, Roberts says. Woods coined the term "Cablinasian" to describe his mix of Caucasian, Black, American Indian and Asian ancestries. But to many Americans, he's Black.

"You can be half Black and half White in this country and you are Black," says Seah, who is getting her medical degree and a PhD in genetics and genomics at the Icahn School of Medicine at Mount Sinai in New York. "You can be a quarter Black in this country — if you have dark skin, you are Black."

So it can be misleading, Seah says, even dangerous, for doctors to judge a patient's ancestry by glancing at their skin. A patient with a White mother and Black father could have a genetic mutation that typically presents in patients of European ancestry, Seah says, but a doctor may not think to test for it if they only see Black skin.

Video: Can a formula be racist? She says one put her health at risk (CNN)

"You have to ask, how Black is Black enough?" Nkinsi asks. And there's another problem, she says, with using a social construct like race in medicine. "It also puts the blame on the patient, and it puts the blame on the race itself. Like being Black is inherently the cause of these diseases."

An overdue reckoning

After she learned about the eGFR equation in 2018, Nkinsi began asking questions about race correction. She wasn't alone — on social media she found other students struggling with the use of race in medicine. In the spring of 2020, following a first-year physiology lecture, Seah joined the conversation. But the medical profession is nothing if not hierarchical; Nkinsi and Seah say students are encouraged to defer to doctors who have been practicing for decades.

Then on May 25, 2020, George Floyd was killed by police in Minneapolis.

His death and the growing momentum around Black Lives Matter helped ignite what Dr. Darshali A. Vyas calls an "overdue reckoning" in the medical community around race and race correction. A few institutions had already taken steps to remove race from the eGFR equation. Students across the country demanded more, and hospitals began to listen.

Four days after Floyd's death, the University of Washington announced it was removing race correction from the eGFR equation. In June, the Boston-based hospital system Mass General Brigham where Vyas is a second-year Internal Medicine resident followed suit. Seah and a fellow student at Mount Sinai, Paloma Orozco Scott, started an online petition and collected over 1600 signatures asking their hospital to do the same.

Studies show removing race from the eGFR equation will change how patients at those hospitals are treated. Researchers from Brigham and Women's Hospital and Penn Medicine estimated up to one in every three Black patients with kidney disease would have been reclassified if the race multiplier wasn't applied in earlier calculations, with a quarter going from stage 3 to stage 4 CKD (Chronic Kidney Disease).

That reclassification is good and bad, says Dr. Neil Powe, chief of medicine at Zuckerberg San Francisco General Hospital. Black patients newly diagnosed with kidney disease will be able to see specialists who can devise better treatment plans. And more patients will be placed on kidney transplant lists.

On the flip side, Powe says, more African Americans diagnosed with kidney disease means fewer who are eligible to donate kidneys, when there's already a shortage. And a kidney disease diagnosis can change everything from a patient's diabetes medication to their life insurance costs.

Powe worries simply eliminating race from these equations is a knee-jerk response — one that may exacerbate health disparities instead of solve them. For too long, Powe says, doctors had to fight for diversity in medical studies.

The most recent eGFR equation, known as the CKD-EPI equation, was developed using data pooled from 26 studies, which included almost 3,000 patients who self-identified as Black. Researchers found the equation they were developing was more accurate for Black patients when it was adjusted by a factor of about 1.2. They didn't determine exactly what was causing the difference in Black patients, but their conclusion is supported by other research that links Black race and African ancestry with higher levels of creatinine, a waste product filtered by the kidneys.

Put simply: In the eGFR equation, researchers used race as a substitute for an unknown factor because they think that factor is more common in people of African descent.

Last August, Vyas co-authored the "Hidden in Plain Sight" article about race correction. Vyas says most of the equations she wrote about were developed in a similar way to the eGFR formula: Researchers found Black people were more or less likely to have certain outcomes and decided race was worth including in the final equation, often without knowing the real cause of the link.

"When you go back to the original studies that validated (these equations), a lot of them did not provide any sort of rationale for why they include race, which I think is appalling." That's what's most concerning, Vyas says -- "how willing we are to believe that race is relevant in these ways."

Vyas is clear she isn't calling for race-blind medicine. Physicians cannot ignore structural racism, she says, and the impact it has on patients' health.

Powe has been studying the racial disparities in kidney disease for more than 30 years. He can spout the statistics easily: Black people are three times more likely to suffer from kidney failure, and make up more than 35% of patients on dialysis in the US. The eGFR equation, he says, did not cause these disparities — they existed long before the formula.

"We want to cure disparities, let's go after the things that really matter, some of which may be racist," he says. "But to put all our stock and think that the equation is causing this is just wrong because it didn't create those."

In discussions about removing race correction, Powe likes to pose a question: Instead of normalizing to the "Other" group in the eGFR equation, as many of these hospitals are doing, why don't we give everyone the value assigned to Black people? By ignoring the differences researchers saw, he says, "You're taking the data on African Americans, and you're throwing it in the trash."

Powe is co-chair of a joint task force set up by the National Kidney Foundation and the American Society of Nephrology to look at the use of race in eGFR equations. The leaders of both organizations have publicly stated race should not be included in equations used to estimate kidney function. On April 9, the task force released an interim report that outlined the challenges in identifying and implementing a new equation that's representative of all groups. The group is expected to issue its final recommendations for hospitals this summer.


The multi-million dollar lawsuit

Race correction is used to assess the kidneys and the lungs. What about the brain?

In 2013, the NFL settled a class-action lawsuit brought by thousands of former players and their families that accused the league of concealing what it knew about the dangers of concussions. The NFL agreed to pay $765 million, without admitting fault, to fund medical exams and compensate players for concussion-related health issues, among other things. Then in 2020, two retired players sued the NFL for allegedly discriminating against Black players who submitted claims in that settlement.

The players, Najeh Davenport and Kevin Henry, said the NFL race-corrected their neurological exams, which prevented them from being compensated.

According to court documents, former NFL players being evaluated for neurocognitive impairment were assumed to have started with worse cognitive function if they were Black. So if a Black player and a White player received the exact same scores on a battery of thinking and memory tests, the Black player would appear to have suffered less impairment. And therefore, the lawsuit stated, would be less likely to qualify for a payout.

Race correction is common in neuropsychology using something called Heaton norms, says Katherine Possin, an associate professor at the University of California San Francisco. Heaton norms are essentially benchmark average scores on cognitive tests.

Here's how it works: To measure the impact of a concussion (or multiple concussions over time), doctors compare how well the patient's brain works now to how well it worked before.

"The best way to get that baseline was to test you 10 years ago, but that's not something we obviously have for many people," Possin says. So doctors estimate your "before" abilities using an average score from a group of healthy individuals, and adjust that score for demographic factors known to affect brain function, like your age.

Heaton norms adjust for race, Possin says, because race has been linked in studies to lower cognitive scores. To be clear, that's not because of any biological differences in Black and White brains, she says; it's because of social factors like education and poverty that can impact cognitive development. And this is where the big problem lies.

In early March, a judge in Pennsylvania dismissed the players' lawsuit and ordered a mediator to address concerns about how race correction was being used. In a statement to CNN, the NFL said there is no merit to the players' claim of discrimination, but it is committed to helping find alternative testing techniques that do not employ race-based norms.

The NFL case, Possin wrote in JAMA, has "exposed a major weakness in the field of neuropsychology: the use of race-adjusted norms as a crude proxy for lifelong social experience."

This happens in nearly every field of medicine. Race is not only used as a poor substitute for genetics and ancestry, it's used as a substitute for access to health care, or lifestyle factors like diet and exercise, socioeconomic status and education. It's no secret that racial disparities exist in all of these. But there's a danger in using race to talk about them, Yale historian Carolyn Roberts says.

We know, for example, that Black Americans have been disproportionally affected by Covid-19. But it's not because Black bodies respond differently to the virus. It's because, as Dr. Anthony Fauci has noted, a disproportionate number of Black people have jobs that put them at higher risk and have less access to quality health care. "What are we making scientific and biological when it actually isn't?" Roberts asks.

Vyas says using race as a proxy for these disparities in clinical algorithms can also create a vicious cycle.

"There's a risk there, we argue, of simply building these into the system and almost accepting them as fact instead of focusing on really addressing the root causes," Vyas says. "If we systematize these existing disparities ... we risk ensuring that these trends will simply continue."


Change on the horizon

Nearly everyone on both sides of the race correction controversy agrees that race isn't an accurate, biological measure. Yet doctors and researchers continue to use it as a substitute. Math shouldn't be racist, Nkinsi says, and it shouldn't be lazy.

"We're saying that we know that this race-based medicine is wrong, but we're going to keep doing it because we simply don't have the will or the imagination or the creativity to think of something better," Nkinsi says. "That is a slap in the face."

Shortly after Vyas' article published in The New England Journal of Medicine, the House Ways and Means Committee sent letters to several professional medical societies requesting information on the misuse of race in clinical algorithms. In response to the lawmakers' request, the Agency for Healthcare Research and Quality is also gathering information on the use of race-based algorithms in medicine. Recently, a note appeared on the Maternal Fetal Medicine Units Network's website for the Vaginal Birth After Cesarean equation — a new calculator that doesn't include race and ethnicity is being developed.

Dorothy Roberts is excited to see change on the horizon. But she's also a bit frustrated. The harm caused by race correction is something she's been trying to tell doctors about for years.

"I've taught so many audiences about the meaning of race and the history of racism in America and the audiences I get the most resistance from are doctors," Roberts says. "They're offended that there would be any suggestion that what they do is racist."

Nkinsi and Seah both encountered opposition from colleagues in their fight to change the eGFR equation. Several doctors interviewed for this story argued the change in a race-corrected scores is so small, it wouldn't change clinical decisions.

If that's the case, Vyas wonders, why include race at all?

"It all comes from the desire for one to dominate another group and justify it," says Roberts. "In the past, it was slavery, but the same kinds of justifications work today to explain away all the continued racial inequality that we see in America... It is mass incarceration. It's huge gaps in health. It's huge differences in income and wealth."

It's easier, she says, to believe these are innate biological differences than to address the structural racism that caused them

Unsafe bedding still causes 3 out of 4 unexpected infant deaths, CDC finds

IN MEDIEVAL TIMES IT WAS THE SWADLING 

THAT SMOTHERED BABIES

Erika Edwards 19 hrs 

A majority of unexpected deaths among young babies still involve soft bedding, despite decades of safe-sleep messaging targeting new parents, a study from the Centers for Disease Control and Prevention found.

© Provided by NBC News

The research, published Tuesday in the journal Pediatrics, finds that blankets, pillows, crib bumpers, stuffed animals and sleep surfaces other than cribs remain leading causes of accidental suffocation among babies 4 months old and younger.

The study analyzed data from 4,929 cases of sudden unexpected infant death, or SUID, from 2011 to 2017. Soft bedding was associated with 72 percent of the cases. Very young infants are unable to move away from suffocation hazards that impair their ability to breathe.

SUID is the sudden unexpected death of a baby under age 1. It includes SIDS, or sudden infant death syndrome, as well as accidental suffocation in sleep environments.

"We're also talking about infants being placed on surfaces other than a bassinet or crib — a couch, a recliner or an adult bed," said the study's author, Sharyn Parks, senior epidemiologist at the CDC's Division of Reproductive Health. "We're seeing babies who are dying in all of those circumstances."

Just 1 percent of the deaths analyzed were confirmed as having been unexplained without any soft bedding or other unsafe sleep surfaces. Factors for the other 27 percent couldn't be determined because of insufficient information.

If possible, keep the baby's crib in the caregiver's bedroom for at least six months, preferably until the baby is 1 year old.

SUID cases declined rapidly in the mid-1990s, thanks to a massive public health campaign called "Back to Sleep," which encouraged new parents to put newborns on their backs to sleep, rather than on their stomachs.

When the campaign began in 1994, nearly 4,700 babies had died of sudden unexpected death the previous year. By 2010, the number of such deaths had been cut in half, according to the American Academy of Pediatrics.

Since then, the gains have stalled. The CDC now reports that up to 3,500 babies die of SUID every year in the U.S.

"We have not been able to engage our families effectively," said Dr. Sunah Hwang, an associate professor of pediatrics at the University of Colorado School of Medicine and a neonatologist at Children's Hospital Colorado. Hwang was not part of the CDC study.

She suggested that the time to talk with parents about safe sleep practices should be before a baby is born. "We've got to be having this conversation early in the prenatal period. We have to start asking families: 'What is your sleep plan? What sort of cribs or pack-n-plays are you considering?'

"Too often, we think it's a conversation for after the baby's born," Hwang said. "At that time, it's too late."

What's more, the conversations may need to be tailored to certain groups with higher rates of SUID.

"We consistently see the highest rates among American Indian and Alaskan Native populations, followed fairly closely by the African American population," Parks said. "We definitely want to figure out ways to better reach those populations and provide support."

The American Academy of Pediatrics recommends that infants go to sleep on their backs on firm, flat surfaces that are free of any pillows, blankets, toys and crib bumpers, which are soft padding attachments to the perimeters of babies' beds.

Studies have also shown that the use of pacifiers can reduce the risk for sudden infant death. Pacifiers should not be attached to clothing or toys, experts say.

"Also, if possible, keep the baby's crib in the caregiver's bedroom for at least six months, preferably until the baby is 1 year old," Parks said.

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