Mixed Race Studies

Very Little Is Keeping Doctors From Using Racist Health Formulas

Wired
2021-10-08

Jyoti Madhusoodanan

Photo-Illustration: Sam Whitney; Getty Images

If nothing in medicine changes, it’s just a matter of time before yet another race-based risk calculator harms people of color.

RECENTLY, TWO LEADING medical associations recommended ending a decades-old practice among doctors: using race as one of the variables to estimate how well a person’s kidneys filter waste out of their bodies. Before, clinicians would look at the levels of a certain chemical in blood, then multiply it by a factor of approximately 1.15 if their patient was Black. Using race to estimate kidney function contributes to delays in dialysis, kidney transplants, and other life-saving care for people of color, especially Black patients.

To make the recent decision, 14 experts spent approximately a year evaluating dozens of alternative options, interviewing patients, and weighing the impact of keeping race in the equation. Their final recommendation ensures the corrected kidney equation is equally precise for everyone, regardless of race.

Yet other risk equations that include race are still being used—including ones that have been used to deny former NFL players’ payouts in a concussion settlement, ones that might contribute to underdiagnosing breast cancer in Black women, and ones that have miscalculated the lung function of Black and Asian patients. Ending the use of race-based multipliers in these and dozens of other calculators will take more than a task force in one medical specialty. It’ll need researchers to not just believe, but act on the knowledge that race is not biology, and for the biomedical research enterprise to implement clearer standards for how these calculators are used. Otherwise, it’s just a matter of time before another tool that wrongly uses race to make decisions about patients’ bodies trickles into clinical care…

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Abolish race correction

The Lancet
Volume 397, Issue 10268 (2021-01-02)
pages 17-18
DOI: 10.1016/S0140-6736(20)32716-1

Dorothy E. Roberts, George A. Weiss University Professor of Law and Sociology; Raymond Pace and Sadie Tanner Mossell Alexander Professor of Civil Rights
University of Pennsylvania, Philadelphia, Pennsylvania

Several years ago my daughter sent me an alarming text. She copied the results of her routine blood work and wrote, “Look at eGFR!”. Under the estimated glomerular filtration rate (eGFR) were listed two numbers—one for non-African Americans and a higher one for African Americans. I was floored. Did this automatic adjustment mean the doctor interpreted my daughter’s eGFR differently based simply on her racial identity? The test’s categories themselves made no biological sense. “African American”, like all racialised populations, is a socially constructed grouping. In the USA, individuals with any amount of discernible African ancestry fit the definition—irrespective of the rest of their ancestral backgrounds. Although my daughter and I identify solely as Black, my mother was a Black Jamaican and my father was the son of white Welsh and German immigrants to the USA. The eGFR disregarded the fabricated nature of the racial distinction it made in calculating kidney function.

I later learned that eGFR race “correction” stems from study findings that participants who self-reported as Black, on average, released more creatinine than white participants for a given kidney function, which historically was attributed to Black people’s assumed higher muscle mass. Recent studies have challenged the muscle-mass hypothesis, but the upward adjustment for all Black patients remains embedded in eGFR calculations. Whatever the flawed rationale, there must be a better way to measure kidney function accurately than by using race—a social classification whose delineations change across time, geography, and political priorities.

Yet misguided ideas about race continue to feature in medicine. I was also dismayed when data on COVID-19 cases and deaths revealed staggering—and strikingly similar—racial disparities in the USA and the UK. As of Dec 10, 2020, the age-adjusted US mortality rates for COVID-19 for Black, Latinx, and Indigenous people were more than 2·7 times higher than for white people. The greater COVID-19 burden on these populations is not surprising: it stems from structural racism that impaired their health before the pandemic—eg, disproportionate exposure to unhealthy food, environmental toxins, shoddy housing, inadequate health care, and stress from racial discrimination—and forced them into risky front-line jobs with greater exposure to infection. Yet some researchers speculated that these unequal outcomes might be caused by Black people’s innate susceptibility—potentially resuscitating the same false racial concepts that underlie race correction.

My 2011 book, Fatal Invention: How Science, Politics, and Big Business Re-create Race in the Twenty-first Century, challenged the resurgence of biological concepts of race in genomics, biomedical research, and biotechnologies. As I wrote: “the delusion that race is a biological inheritance rather than a political relationship leads plenty of intelligent people to make the most ludicrous statements about Black biological traits”. Since then, I have warned dozens of audiences about the dangerous persistence of this racial ideology. Yet I have encountered resistance from many doctors, who tend to defend their use of race by saying it’s only part of a nuanced evaluation of many factors meant to produce more accurate diagnoses and therapies. But the eGFR race correction isn’t nuanced at all—it’s an automatic, across-the-board adjustment. It asserts that Black people, as a race, are biologically distinguishable from all others…

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