Opinion on change.org petition

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physiogirl2019

physiogirl2019

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www.change.org

Sign the Petition

Demand LCME to mandate teaching race as a social construct in medical schools
www.change.org www.change.org

I want to know fellow med student's opinions on this petition I recently came across.

Personally, I think it's the "I don't see color" argument, but in medical form. How can we ignore a patient's race when that could tell us so much about what they may be predisposed to, health disparities impacting their community, social issues that affect them, etc.? Of course we need to remove the implicit bias that has plagued our profession for decades, but I don't think this is it. Facts shouldn't be ignored. Personalized medicine is important!

Please let me know your opinions! I am curious to know 🙂
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physiogirl2019 said:
www.change.org

Sign the Petition

Demand LCME to mandate teaching race as a social construct in medical schools
www.change.org www.change.org

I want to know fellow med student's opinions on this petition I recently came across.

Personally, I think it's the "I don't see color" argument, but in medical form. How can we ignore a patient's race when that could tell us so much about what they may be predisposed to, health disparities impacting their community, social issues that affect them, etc.? Of course we need to remove the implicit bias that has plagued our profession for decades, but I don't think this is it. Facts shouldn't be ignored. Personalized medicine is important!

Please let me know your opinions! I am curious to know 🙂
Click to expand...
Hmmm I’ve always been curious about if there are any biological / genetic differences between races and what they are. I’ve been taught that race is a social construct and I understand what they’re trying to say and also understand they’re trying to prevent racism by attempting to get rid of any notion that would imply one race might be inferior, but it seems to me that there are at least some biological differences between races given that we can separate the races (for example, skin color is an obvious difference). Of course, there are always exceptions to the general rule and maybe skin color is the only difference.

With that said, it seems like the petition is to bring about the education of race as primarily a socio-political construct, which I have found to be true. However, after centuries of separating races based on the lie of biological differences, races have become “real” in a sense. That is to say, different races have occupied different environments while living in the same spaces due to the socio-political landscape differences. So I agree with you that I wouldn’t go so far as to get rid of race and implement a colorblind approach and there are parts of the petition that seem to do this.
 
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datboi_58 said:
Hmmm I’ve always been curious about if there are any biological / genetic differences between races and what they are. I’ve been taught that race is a social construct and I understand what they’re trying to say and also understand they’re trying to prevent racism by attempting to get rid of anything that would imply one race might be inferior, but it seems to me that there are at least some biological differences between races given that we can separate the races (for example, skin color is an obvious difference). Of course, there are always exceptions to the general rule and maybe skin color is the only difference.

With that said, it seems like the petition is to bring about the education of race as primarily a socio-political construct, which I have found to be true. However, after centuries of separating races based on the lie of biological differences, races have become “real” in a sense. That is to say, different races have occupied different environments while living in the same spaces due to the socio-political landscape differences. So I agree with you that I wouldn’t go so far as to get rid of race and implement a colorblind approach and there are parts of the petition that seem to do this.
Click to expand...
There are some very real clinical differences, the most obvious one being proclivity to developing certain types of skin cancer.
 
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datboi_58 said:
Hmmm I’ve always been curious about if there are any biological / genetic differences between races and what they are. I’ve been taught that race is a social construct and I understand what they’re trying to say and also understand they’re trying to prevent racism by attempting to get rid of any notion that would imply one race might be inferior, but it seems to me that there are at least some biological differences between races given that we can separate the races (for example, skin color is an obvious difference). Of course, there are always exceptions to the general rule and maybe skin color is the only difference.

With that said, it seems like the petition is to bring about the education of race as primarily a socio-political construct, which I have found to be true. However, after centuries of separating races based on the lie of biological differences, races have become “real” in a sense. That is to say, different races have occupied different environments while living in the same spaces due to the socio-political landscape differences. So I agree with you that I wouldn’t go so far as to get rid of race and implement a colorblind approach and there are parts of the petition that seem to do this.
Click to expand...
this sociology bullcrap is gonna get a patient hurt, there are actual prevalence differences in some diseases based on race. No “social construct” lecture changes that
 
datboi_58 said:
Hmmm I’ve always been curious about if there are any biological / genetic differences between races and what they are. I’ve been taught that race is a social construct and I understand what they’re trying to say and also understand they’re trying to prevent racism by attempting to get rid of any notion that would imply one race might be inferior, but it seems to me that there are at least some biological differences between races given that we can separate the races (for example, skin color is an obvious difference). Of course, there are always exceptions to the general rule and maybe skin color is the only difference.

With that said, it seems like the petition is to bring about the education of race as primarily a socio-political construct, which I have found to be true. However, after centuries of separating races based on the lie of biological differences, races have become “real” in a sense. That is to say, different races have occupied different environments while living in the same spaces due to the socio-political landscape differences. So I agree with you that I wouldn’t go so far as to get rid of race and implement a colorblind approach and there are parts of the petition that seem to do this.
Click to expand...

Of course I agree with removing all false information/biases from our education (implicit bias kills!), but there are biological differences between races. Whether it be small mutations, lacking enzymes, etc., those exist. Also, not to mention social issues that affect different races, which could absolutely affect an individual's health/well-being.

I think the issue is that people think that means there's a "superior" race if we are all "different", which I think is really foolish. Also, again, this is the "I don't see color" argument - how can you completely ignore someone's race when that could tell you so much about them? It's erasing the individual and placing them in a one size fits all box. Each race is affected by different things that are unique to them, and ignoring these differences can only lead to poor health outcomes in my opinion. I just wish "different" wasn't synonymous with "bad".
 
I don't know about you, but UW for step 1 taught me that anytime someone says young African American women with hilar lymphadenopathy it is a guarantee that it is Sarcoidosis. Don't remember many Sarcoidosis questions about white women.
 
Everyone please google race vs. ethnicity. Race is a social construct. Ethnicity is where your ancestors are from, etc. Your ethnic background does predispose you to certain diseases and there are physical differences between ethnicities, albeit minor. Ex. “White” or “Black” are races that tell you almost nothing of medical or biological value. “African descent” or “European descent” may make you more likely to have sickle cell anemia or skin cancer etc. As healthcare providers, we have to be precise with the language we use. You wouldn’t say iliopsoas when you mean the psoas major, so we shouldn’t say race when we mean ethnicity and vice versa.
 
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There are significant proclivities for certain diseases among different ethnicities (e.g. sickle cell in African descent) and race (e.g. adult T-cell leukemia in Japanese people). Race is a social construct but that does not preclude it from being a useful tool. Acknowledging race and ethnicity is crucial to have correct pretest and post-test probabilities.

That being said, race and ethnicity should not be used a value judgement. That lesson should not come from medical school, but life itself.
 
detritus said:
Everyone please google race vs. ethnicity. Race is a social construct. Ethnicity is where your ancestors are from, etc. Your ethnic background does predispose you to certain diseases and there are physical differences between ethnicities, albeit minor. Ex. “White” or “Black” are races that tell you almost nothing of medical or biological value. “African descent” or “European descent” may make you more likely to have sickle cell anemia or skin cancer etc. As healthcare providers, we have to be precise with the language we use. You wouldn’t say iliopsoas when you mean the psoas major, so we shouldn’t say race when we mean ethnicity and vice versa.
Click to expand...
Tell the author of the petition to google it, and then tell them they are wrong about the premise altogether that demographics don’t influence disease prevalence
 
sb247 said:
Tell the author of the petition to google it, and then tell them they are wrong about the premise altogether that demographics don’t influence disease prevalence
Click to expand...
I think the author understands this. They write that race should be taught as a social construct (which it is) and is not based on any biological tenants (which it is not). Ethnicity is useful in medicine in some scenarios, but race is clearly not, unless we’re looking into differences in access, disparities etc. I don’t disagree that it is useful to teach how different ethnicities may be more likely to have certain illnesses for various reasons. That should be taught. It should also be taught that any race based distinctions in medicine are not biologically based and are a result of the meaning placed on physical differences I.e. the social construction of race.
 
peachrings said:
There are significant proclivities for certain diseases among different ethnicities (e.g. sickle cell in African descent) and race (e.g. adult T-cell leukemia in Japanese people). Race is a social construct but that does not preclude it from being a useful tool. Acknowledging race and ethnicity is crucial to have correct pretest and post-test probabilities.

That being said, race and ethnicity should not be used a value judgement. That lesson should not come from medical school, but life itself.
Click to expand...
Forgive my potential ignorance, but isn't calling someone an African-American explicitly pointing out that they are of African descent and so have increased sickle cell risk, require different GFR calculations, and so on?
 
detritus said:
Everyone please google race vs. ethnicity. Race is a social construct. Ethnicity is where your ancestors are from, etc. Your ethnic background does predispose you to certain diseases and there are physical differences between ethnicities, albeit minor. Ex. “White” or “Black” are races that tell you almost nothing of medical or biological value. “African descent” or “European descent” may make you more likely to have sickle cell anemia or skin cancer etc. As healthcare providers, we have to be precise with the language we use. You wouldn’t say iliopsoas when you mean the psoas major, so we shouldn’t say race when we mean ethnicity and vice versa.
Click to expand...
Would you not assert that “Black American” is a different ethnicity than “White American” considering that while they occupied the same physical space, the two races lives in different worlds? Or is ~350 years too evolutionary insignificant to be considered under the definition of “ethnicity”?
 
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datboi_58 said:
Would you not assert that “Black American” is a different ethnicity than “White American” considering that while they occupied the same physical space, the two races lives in different worlds? Or is ~350 years too evolutionary insignificant to be considered under the definition of “ethnicity”?
Click to expand...
350 years? From what preclinicals taught me, being black in America comes with the same hereditary problems/risks as being black in Africa. Your chances of diseases like sickle cell don’t dramatically change as a black person because you have “American” at the end of your ethnic calling. If anything it’s the “American” part at the end that could be gotten rid of from a medical standpoint since that has more to do with the social aspects of life
 
detritus said:
Everyone please google race vs. ethnicity. Race is a social construct. Ethnicity is where your ancestors are from, etc. Your ethnic background does predispose you to certain diseases and there are physical differences between ethnicities, albeit minor. Ex. “White” or “Black” are races that tell you almost nothing of medical or biological value. “African descent” or “European descent” may make you more likely to have sickle cell anemia or skin cancer etc. As healthcare providers, we have to be precise with the language we use. You wouldn’t say iliopsoas when you mean the psoas major, so we shouldn’t say race when we mean ethnicity and vice versa.
Click to expand...

Right except that race does matter in medicine insofar as prevalence and incidence of disease goes. African males in Africa have an extremely low rate of colorectal cancer, but African American males are one of the two groups with the highest incidence. That is one example of many. So no, they aren’t useless. There are actual differences based on race whether the idea is a construct or not. When there are no social or health disparities that create these differences, then we can feel free to ignore them. But until then you’re not doing your patients any service by ignoring their race.

Edit: apparently my phone autocorrects “social” to “socks.”
 
Matthew9Thirtyfive said:
Right except that race does matter in medicine insofar as prevalence and incidence of disease goes. African males in Africa have an extremely low rate of colorectal cancer, but African American males are one of the two groups with the highest incidence. That is one example of many. So no, they aren’t useless. There are actual differences based on race whether the idea is a construct or not. When there are no social or health disparities that create these differences, then we can feel free to ignore them. But until then you’re not doing your patients any service by ignoring their race.

Edit: apparently my phone autocorrects “social” to “socks.”
Click to expand...

Right. It's important to take into consideration the nuances of culture and life style between them. Things like diet will certainly influence medical outcomes. It can be useful when well applied, aware of any bias but taking the useful information it provides.
 
physiogirl2019 said:
www.change.org

Sign the Petition

Demand LCME to mandate teaching race as a social construct in medical schools
www.change.org www.change.org

I want to know fellow med student's opinions on this petition I recently came across.

Personally, I think it's the "I don't see color" argument, but in medical form. How can we ignore a patient's race when that could tell us so much about what they may be predisposed to, health disparities impacting their community, social issues that affect them, etc.? Of course we need to remove the implicit bias that has plagued our profession for decades, but I don't think this is it. Facts shouldn't be ignored. Personalized medicine is important!

Please let me know your opinions! I am curious to know 🙂
Click to expand...
How do you know that they don't do this already????
 
MLNS said:
I can’t tell if you’re serious. I made a general non-personal observation. That dude literally quoted me to attempt to belittle me.

You’re better than this.
Click to expand...

I'd be hard pressed to say calling an entire generation "misguided" and "brainwashed" is a "non-personal" observation. They simply chastised you for doing so, hardly belittling.
 
MLNS said:
I called them misguided? Please show me where I said that. Facts matter. Even in a safe space

No worries though, bud. Resident out. You guys enjoy your totalitarian mindset. God fobid you ever see a patient with a different viewpoint than yourself.
Click to expand...

1591916316604.png


Are you okay? Disagreement =/= totalitarian mindset.
 
VA Hopeful Dr said:
Forgive my potential ignorance, but isn't calling someone an African-American explicitly pointing out that they are of African descent and so have increased sickle cell risk, require different GFR calculations, and so on?
Click to expand...

Yes, and I think that this is beneficial if the differences are significant and different races/ethnicities have different pretest probabilities. I think detritus is talking about differentiating race and ethnicity. Race is a social construct, but it does lead to differences in epidemiology, response to medications, etc and should be taught as such. Using race serves to refine medical decision-making.
 
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thumbz said:
.

View attachment 309705

I guess certain ethnicties responding better to certain medications is all just a social construct too. Perhaps we should stop treating gender/sex differently too, just get a PSA and a mammogram on everyone! [/sarcasm]
Click to expand...

I would venture to say this differential response to hypertension medications is based on race, not ethnicity. Native Africans have a lower prevalence of hypertension than black Americans, and stands to reason that response to thiazides may be different as well. This is not unreasonable if you assume a founder's effect scenario with the slave trade and the Middle Passage.

 
Matthew9Thirtyfive said:
Right except that race does matter in medicine insofar as prevalence and incidence of disease goes. African males in Africa have an extremely low rate of colorectal cancer, but African American males are one of the two groups with the highest incidence. That is one example of many. So no, they aren’t useless. There are actual differences based on race whether the idea is a construct or not. When there are no social or health disparities that create these differences, then we can feel free to ignore them. But until then you’re not doing your patients any service by ignoring their race.

Edit: apparently my phone autocorrects “social” to “socks.”
Click to expand...
Yeah I agree but that doesn’t go against what the petition is saying. The social construction of race isn’t irrelevant to medicine, it affects health for sure. I mentioned in another post that when looking at epidemiological data, race is relevant and should be looked at because of disparities like African American men getting colon cancer at a higher rate. The petition is calling for the teaching of race as a social construct. African Americans have higher rates of colon cancer because of SES, diet, etc. all of which are social phenomena that are built over decades and decades, if not centuries. Without that caveat, that same fact may be misconstrued to imply African Americans are genetically predisposed to higher rates of colon cancer which is factually incorrect as you pointed out. No 300 years is not enough time to develop meaningful genetic differences between populations of humans for the poster above.
 
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detritus said:
Yeah I agree but that doesn’t go against what the petition is saying. The social construction of race isn’t irrelevant to medicine, it affects health for sure. I mentioned in another post that when looking at epidemiological data, race is relevant and should be looked at because of disparities like African American men getting colon cancer at a higher rate. The petition is calling for the teaching of race as a social construct. African Americans have higher rates of colon cancer because of SES, diet, etc. all of which are social phenomena that are built over decades and decades, if not centuries. Without that caveat, that same fact may be misconstrued to imply African Americans are genetically predisposed to higher rates of colon cancer which is factually incorrect as you pointed out. No 300 years is not enough time to develop meaningful genetic differences between populations of humans for the poster above.
Click to expand...

I wasn’t responding to the petition, I was responding to this:


detritus said:
Ex. “White” or “Black” are races that tell you almost nothing of medical or biological value. “African descent” or “European descent” may make you more likely to have sickle cell anemia or skin cancer etc
Click to expand...

Which isn’t true.
 
Epigenetic traits have some heritability, and lifestyle is an important modifier of epigenetic gene modification. So I don't think the "300 years is too short a time period to be genetically meaningful" is true.

This whole argument is embarrassing and distracting for the proponents. There are more meaningful arguments to be made that can tangibly improve the provision of care for the disadvantaged. All the above petition accomplishes is increase the national prevalence of eye rolling.
 
Iz_FtB said:
Epigenetic traits have some heritability, and lifestyle is an important modifier of epigenetic gene modification. So I don't think the "300 years is too short a time period to be genetically meaningful" is true.

This whole argument is embarrassing and distracting for the proponents. There are more meaningful arguments to be made that can tangibly improve the provision of care for the disadvantaged. All the above petition accomplishes is increase the national prevalence of eye rolling.
Click to expand...
What do you suggest?
 
Matthew9Thirtyfive said:
I wasn’t responding to the petition, I was responding to this:




Which isn’t true.
Click to expand...
So whether a patient is black or white should change the treatment paradigm of a physician? I already made the caveat for population wide studies looking at specific disparities. Which part is untrue?
 
detritus said:
So whether a patient is black or white should change the treatment paradigm of a physician? I already made the caveat for population wide studies looking at specific disparities. Which part is untrue?
Click to expand...
It changes the prevalence of disease states so it is relevant if you want to give good care, the OP seens to want to remove that knowledge from medical training
 
sb247 said:
It changes the prevalence of disease states so it is relevant if you want to give good care, the OP seens to want to remove that knowledge from medical training
Click to expand...
Yeah I already said that disease prevalence and other public health measures should be maintained. I don’t think the underlying argument of the petition is remove the information. There may be differences, but the underlying cause of *MOST* of those differences should be taught as sociological in nature if we really want to chip away at those disparities. Aside from providers’ own personal biases (which everybody has, even URM physicians), the way we teach medicine leaves out why we are where we are today, leaving many providers to think it’s a genetics thing which biology tells us it’s not.
This stuff really isn’t controversial in public health departments or sociology departments. They teach race as a social construct and adequately explain most disparities using social determinants. Again ethnicity matters to some diseases that may be endemic to certain parts of the world, but race ≠ ethnicity even though the two are correlated. Anyway I don’t think we really disagree on this issue. If we ignore the straw man arguments that try to simplify what the petition is saying, the only point of disagreement I have seen is some on here don’t think race is a social construct. I can’t convince anybody on SDN so if they disagree with that, they can do their own research or not, up to them.
 
detritus said:
Yeah I already said that disease prevalence and other public health measures should be maintained. I don’t think the underlying argument of the petition is remove the information. There may be differences, but the underlying cause of *MOST* of those differences should be taught as sociological in nature if we really want to chip away at those disparities. Aside from providers’ own personal biases (which everybody has, even URM physicians), the way we teach medicine leaves out why we are where we are today, leaving many providers to think it’s a genetics thing which biology tells us it’s not.
This stuff really isn’t controversial in public health departments or sociology departments. They teach race as a social construct and adequately explain most disparities using social determinants. Again ethnicity matters to some diseases that may be endemic to certain parts of the world, but race ≠ ethnicity even though the two are correlated. Anyway I don’t think we really disagree on this issue. If we ignore the straw man arguments that try to simplify what the petition is saying, the only point of disagreement I have seen is some on here don’t think race is a social construct. I can’t convince anybody on SDN so if they disagree with that, they can do their own research or not, up to them.
Click to expand...
I disagree with your interpretation of the petition
 
I think that one big issue with teaching race-based medicine is that while an individual's race may be somewhat predictive for certain clinical outcomes (due to social factors, racism, shared environmental exposure, etc), we have much more robust predictors for these same clinical features.

For example, a poster above referenced rates of skin cancer. While race may be a crude metric to analyze skin cancer risk, ancestry (along with other environmental features like sun exposure, germline genetic risk alleles, etc) is a better metric because this accurately reflects the person's genetic make-up/genetic predisposition that can affect their skin cancer risk as opposed to race-based social groups that we lump patients into based on appearance/our social conditions.

I think another great example is the discussion of GFR that they mention in the petition. Historically, race is used as a shortcut because of observed differences among races in metrics like BP, BMI, etc. Why not just accurately measure the values for each individual and use one consistent formula that creates a robust estimate of a patient's GFR instead of using shortcuts that actually lead to worse patient care? We have the technology, data, and infrastructure to do so!

This is also a great TED talk if you haven't seen it!
 
Iz_FtB said:
Epigenetic traits have some heritability, and lifestyle is an important modifier of epigenetic gene modification. So I don't think the "300 years is too short a time period to be genetically meaningful" is true.

This whole argument is embarrassing and distracting for the proponents. There are more meaningful arguments to be made that can tangibly improve the provision of care for the disadvantaged. All the above petition accomplishes is increase the national prevalence of eye rolling.
Click to expand...
 
I think the issue is that race is an imperfect proxy to heredity. Not only that but race-based medicine can confuse students and even doctors that SOME diseases that impact race disproportionality is just "genetic" but based on SDOH.

If we really want to get away from race-based medicine we probably need to rely more on genetics or markers/correlates proximal to genes of interest since that's what we are really after. I doubt this is practical though.

I think reevaluating the race-based medicine we have and understanding if it's accurate based on current literature is important (like anything in medicine.)
 
Yhwach said:
I think the issue is that race is an imperfect proxy to heredity. Not only that but race-based medicine can confuse students and even doctors that SOME diseases that impact race disproportionality is just "genetic" but based on SDOH.

If we really want to get away from race-based medicine we probably need to rely more on genetics or markers/correlates proximal to genes of interest since that's what we are really after. I doubt this is practical though.

I think reevaluating the race-based medicine we have and understanding if it's accurate based on current literature is important (like anything in medicine.)
Click to expand...
There are certain issues I do have with race-based medicine. i.e. GFR calculations showing AA as higher values. This makes me mad, especially considering the high rates of ESRD. And these artifically elevated GFR values compared to others may prevent certain members of the black population from getting kidney transplants on time. University of Washington just eliminated the use of "race-based" GFR, which I agree with and support. I don't understand how they even came up for the equation for "African American GFR."

On the other hands - there are certain things that do have to do with race/genetics. For example, there is a certain medication I should not be given because no one from my ethnic group can tolerate it and results in severe adverse effects. A doctor prescribed me it once, and I had "all the rare" symptoms associated with it and got really sick. But then again...this has a lot to do with heredity. Maybe not so much as race.
 
wispyfairy said:
There are certain issues I do have with race-based medicine. i.e. GFR calculations showing AA as higher values. This makes me mad, especially considering the high rates of ESRD. And these artifically elevated GFR values compared to others may prevent certain members of the black population from getting kidney transplants on time. University of Washington just eliminated the use of "race-based" GFR, which I agree with and support. I don't understand how they even came up for the equation for "African American GFR."

On the other hands - there are certain things that do have to do with race/genetics. For example, there is a certain medication I should not be given because no one from my ethnic group can tolerate it and results in severe adverse effects. A doctor prescribed me it once, and I had "all the rare" symptoms associated with it and got really sick. But then again...this has a lot to do with heredity. Maybe not so much as race.
Click to expand...
So let me get this straight. You don't understand how they came up with the AA GFR calculation (and why its different from everyone else), but you're still against it?

Did it ever occur to you that there is a different calculation for a reason?
 
The actual changes demanded by this petition are pretty minor and reasonable. Whenever educational materials say stuff like "African-Americans have higher rates of focal segmental glomerulosclerosis," they want them to specify whether it's due to genetic, social, and/or unknown reasons, e.g. "Some alleles in people of African descent may confer increased susceptibility to FSGS."

The inflammatory wording of this petition, and all of its BS virtue signalling in it, is another story.
 
finn_ said:
This is also a great TED talk if you haven't seen it!
Click to expand...

Except what she fails to explain since she is not a scientist or physician is that there actually are GFR differences between races.
 
finn_ said:

UW Medicine to exclude race from calculation of eGFR (measure of kidney function) | Department of Medicine | University of Washington

medicine.uw.edu medicine.uw.edu
Click to expand...

I am aware of that news release. And there has been backlash.

jamanetwork.com

Estimation of Glomerular Filtration Rate With vs Without Including Patient Race

This cross-sectional study evaluates the use of race in estimating glomerular filtration rate and whether height and weight could substitute for race using pooled data from 10 studies of people with and without chronic kidney disease.
jamanetwork.com jamanetwork.com
 
wispyfairy said:
There are certain issues I do have with race-based medicine. i.e. GFR calculations showing AA as higher values. This makes me mad, especially considering the high rates of ESRD. And these artifically elevated GFR values compared to others may prevent certain members of the black population from getting kidney transplants on time. University of Washington just eliminated the use of "race-based" GFR, which I agree with and support. I don't understand how they even came up for the equation for "African American GFR."

On the other hands - there are certain things that do have to do with race/genetics. For example, there is a certain medication I should not be given because no one from my ethnic group can tolerate it and results in severe adverse effects. A doctor prescribed me it once, and I had "all the rare" symptoms associated with it and got really sick. But then again...this has a lot to do with heredity. Maybe not so much as race.
Click to expand...
You should learn more about gfr before you get too upset about this one
 
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