While medicine is often regarded as an objective field focused on using evidence-based approaches to improve patient outcomes, race-based medicine, in which race is seen as a genetic variable that must be accounted for in the clinical setting, produces discriminatory methods of care that lack objectivity and scientific backing and harm patients. Physicians use race-based medicine to make estimations and adjustments based on self-reported racial identity when testing and diagnosing patients. When examining the origins of race-based medicine it becomes clear that it is rooted in social and cultural biases rather than scientific claims. These practices are implemented in a variety of clinical contexts making erroneous assumptions about the health statuses of patients of color which are both harmful and discriminatory. The harsh reality is that although objective evidence suggests that no basis for race-based medicine exists, physicians continue to incorporate these practices, resulting in poor health outcomes.
It is a common assumption that science and its applications in medicine are rooted in accurate and objective research. However, when it comes to incorporating race into medical care, that expected objectivity is not met. Large-scale genomic studies have shown that 99.9% of the human genome is essentially the same, and the 0.01% of the variation in the human genome is not due to racial differences [6]. Despite the evidence disproving genetic differences between races, medical professionals still accept race as an indicator for a variety of conditions such as reduced lung capacity and an increased risk of stroke [5]. Dr. Dorothy Roberts, a critical race theory scholar, discusses how the spirometer, a device used to measure lung function, has a race setting to correct for presumed lower lung capacities of black patients. She explains that this assumption dates back to a pre-Civil War physician who claimed that African Americans had innately lower lung capacities as a justification for slavery [4]. Further, Noor Chadha et al. along with researchers from the Institute for Healing and Justice in Medicine and the Othering & Belonging Institute connect these discriminatory practices to a longstanding history of racism and eurocentrism in medicine [2]. They link the ideologies behind race-based medicine to the prominence of eugenics in the twentieth century which equated racial difference with genetic variation, with people of color often seen as genetically inferior [2]. Racism has evidently infiltrated science throughout the history of medicine, and it continues as these beliefs perpetuate the conflation of race with genetic variation.
This unfounded conflation of race with genetic variation has contributed to a variety of racially targeted treatments and medical practices. A prominent example of this practice is BiDil, a treatment for chronic heart failure that was approved by the FDA specifically for patients who self-identify as African American [4]. While the trials for BiDil showed a 43% reduction in mortality, it was only tested in African Americans and lacked a comparison group demonstrating the drug is not beneficial for other populations [2]. Further, the MDRD glomerular filtration rate equation is adjusted to produce higher estimations in patients who identify as African American than in white patients with the same creatinine levels due to an assumption that African Americans have more muscle mass [4]. Some laboratories have started making a switch away from GFR calculations that include race, and there is research being done to determine less discriminatory and more accurate methods [3]. However, most laboratories still include race as a factor in their calculations [3]. Although the sources being discussed describe the use of and reasoning behind making medical corrections and assumptions on behalf of race, the rationals remain scientifically unfounded.
The clinical applications of these scientifically unfounded practices and assumptions can lead to deleterious consequences. Discussing BiDil, Dr. Roberts explains the dangers of racially targeted medicine, highlighting their implication that “black people's bodies are so substandard, a drug tested in them is not guaranteed to work in other patients” [4]. Further, there is evidence that these practices produce a variety of negative health outcomes. For example, the idea that African American patients have inherently higher levels of certain compounds, higher risks for renal failure, and even stroke can lead to the delay of lifesaving interventions [5].
Medical anthropologist Dr. Jessica Cerdeña et al. propose raceconscious medicine as a possible alternative that eliminates racial assumptions and instead produces estimations based on social factors that influence health [1]. This approach would improve health outcomes by eliminating incorrect assumptions about genetic variations between races and emphasize the real cause of health disparities which Dr. Roberts cites as social inequality [4]. While Dr. Cerdeña et al.’s proposal seems like a step in the direction of scientifically-backed medical practices, Sandra Soo-Jin Lee, an anthropologist at the Center for Biomedical Ethics at the Stanford University School of Medicine, wisely explains, “I think that science is deeply embedded by the social values and the historical and political environment in which it is conducted” [6, 248]. Therefore the difficulty in adapting to proposals such as the one made by Dr. Cerdeña et al. is likely rooted in clouded judgment caused by a deep history of racial discrimination and assumptions of difference that have infiltrated the medical field. It is likely that further research disproving these outdated methods and a greater sense of social awareness in the medical field is required before a transition to racially conscious medicine is made and for the discriminatory practices of race-based medicine to be overcome.
References:
1) Cerdeña, J. P., Plaisime, M. V., & Tsai, J. (2020). From race-based to race-conscious medicine: How anti-racist uprisings call us to act. The Lancet, 396(10257), 1125-1128. doi:10.1016/s0140-6736(20)32076-6
2) Chadha, N., Lim, B., Kane, M., & Rowland, B. (2020, May 13). Toward the Abolition of Biological Race in Medicine Transforming Clinical Education, Research, and Practice. Retrieved 2021, from https://escholarship.org/content/qt4gt3n0dd/qt4gt3n0dd.pdf? t=qeuxeb&v=lg
3) Diao, J. A., Inker, L. A., Levey, A. S., Tighiouart, H., Powe, N. R., & Manrai, A. K. (2021). In search of a better equation — performance and equity in estimates of kidney function. New England Journal of Medicine, 384(5), 396-399. doi:10.1056/nejmp2028243
4) Roberts, D. (2015). The problem with race-based medicine. Retrieved May 01, 2021, from https://www.ted.com/talks/dorothy_roberts_the_problem_with_race _based_medicine/transcript?language=en
5) Vyas, D. A., Eisenstein, L. G., & Jones, D. S. (2020). Hidden in plain sight — reconsidering the use of race correction in clinical algorithms. New England Journal of Medicine, 383(9), 874-882. doi:10.1056/nejmms2004740
6) Weigmann, K. (2006). Racial medicine: Here to stay? EMBO Reports, 7(3), 246-249. doi:10.1038/sj.embor.7400654