{"id":61230,"date":"2021-08-12T22:14:18","date_gmt":"2021-08-12T22:14:18","guid":{"rendered":"http:\/\/www.mixedracestudies.org\/?p=61230"},"modified":"2021-08-12T23:42:39","modified_gmt":"2021-08-12T23:42:39","slug":"hidden-in-plain-sight-reconsidering-the-use-of-race-correction-in-clinical-algorithms","status":"publish","type":"post","link":"https:\/\/mixedracestudies.org\/wp\/?p=61230","title":{"rendered":"Hidden in Plain Sight \u2014 Reconsidering the Use of Race Correction in Clinical Algorithms"},"content":{"rendered":"

Hidden in Plain Sight \u2014 Reconsidering the Use of Race Correction in Clinical Algorithms<\/strong><\/em><\/a><\/p>\n

The New England Journal of Medicine<\/a>
\nVolume 2020, Number 383
\npages 874-882
\n2020-08-27 (published on 2020-06-17, at NEJM.org<\/a>.)
\nDOI: 10.1056\/NEJMms2004740<\/a><\/p>\n

Darshali A. Vyas, M.D.<\/strong><\/a>, Resident Physician
\nDepartment of Medicine, Massachusetts General Hospital, Boston, Massachusetts<\/em>
\nDepartment of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts<\/em>
\nHarvard University, Cambridge, Massachusetts<\/em><\/p>\n

Leo G. Eisenstein, M.D.<\/strong><\/a>, Resident Physician
\nNew York University Langone Medical Center, New York, New York<\/em><\/p>\n

David S. Jones, M.D., Ph.D.<\/strong><\/a>, A. Bernard Ackerman Professor of the Culture of Medicine
\nDepartment of Medicine, Massachusetts General Hospital, Boston, Massachusetts<\/em>
\nDepartment of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts<\/em><\/p>\n

Physicians still lack consensus on the meaning of race. When the Journal took up the topic in 2003 with a debate about the role of race in medicine, one side argued that racial and ethnic categories reflected underlying population genetics and could be clinically useful.1<\/sup><\/a> Others held that any small benefit was outweighed by potential harms that arose from the long, rotten history of racism in medicine.2<\/sup><\/a> Weighing the two sides, the accompanying Perspective article concluded that though the concept of race was \u201cfraught with sensitivities and fueled by past abuses and the potential for future abuses,\u201d race-based medicine still had potential: \u201cit seems unwise to abandon the practice of recording race when we have barely begun to understand the architecture of the human genome.\u201d3<\/sup><\/a><\/p>\n

The next year, a randomized trial showed that a combination of hydralazine and isosorbide dinitrate<\/a> reduced mortality due to heart failure among patients who identified themselves as black. The Food and Drug Administration<\/a> granted a race-specific indication for that product, BiDil<\/a>, in 2005.4<\/sup><\/a> Even though BiDil\u2019s ultimate commercial failure cast doubt on race-based medicine, it did not lay the approach to rest. Prominent geneticists have repeatedly called on physicians to take race seriously,5<\/a>,6<\/a><\/sup> while distinguished social scientists vehemently contest these calls.7<\/a>,8<\/a><\/sup><\/p>\n

Our understanding of race and human genetics has advanced considerably since 2003, yet these insights have not led to clear guidelines on the use of race in medicine. The result is ongoing conflict between the latest insights from population genetics and the clinical implementation of race. For example, despite mounting evidence that race is not a reliable proxy for genetic difference, the belief that it is has become embedded, sometimes insidiously, within medical practice. One subtle insertion of race into medicine involves diagnostic algorithms and practice guidelines that adjust or \u201ccorrect\u201d their outputs on the basis of a patient\u2019s race or ethnicity<\/a>. Physicians use these algorithms to individualize risk assessment and guide clinical decisions. By embedding race into the basic data and decisions of health care, these algorithms propagate race-based medicine. Many of these race-adjusted algorithms guide decisions in ways that may direct more attention or resources to white patients than to members of racial and ethnic minorities…<\/p>\n

Read the entire in PDF<\/a> or HTML<\/a> format.<\/p>\n","protected":false},"excerpt":{"rendered":"

Our understanding of race and human genetics has advanced considerably since 2003, yet these insights have not led to clear guidelines on the use of race in medicine. The result is ongoing conflict between the latest insights from population genetics and the clinical implementation of race.<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[12,2039,8,394],"tags":[31717,31718,1264,31719,3277,31716,8621],"class_list":["post-61230","post","type-post","status-publish","format-standard","hentry","category-articles","category-health-medicine","category-media-archive","category-socialscience","tag-darshali-a-vyas","tag-darshali-vyas","tag-david-s-jones","tag-leo-g-eisenstein","tag-new-england-journal-of-medicine","tag-race-based-medicine","tag-the-new-england-journal-of-medicine"],"_links":{"self":[{"href":"https:\/\/mixedracestudies.org\/wp\/index.php?rest_route=\/wp\/v2\/posts\/61230","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/mixedracestudies.org\/wp\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/mixedracestudies.org\/wp\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/mixedracestudies.org\/wp\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/mixedracestudies.org\/wp\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=61230"}],"version-history":[{"count":2,"href":"https:\/\/mixedracestudies.org\/wp\/index.php?rest_route=\/wp\/v2\/posts\/61230\/revisions"}],"predecessor-version":[{"id":61242,"href":"https:\/\/mixedracestudies.org\/wp\/index.php?rest_route=\/wp\/v2\/posts\/61230\/revisions\/61242"}],"wp:attachment":[{"href":"https:\/\/mixedracestudies.org\/wp\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=61230"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/mixedracestudies.org\/wp\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=61230"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/mixedracestudies.org\/wp\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=61230"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}