Racial disparities persist in patient treatment planning.
The personal identifying factors listed along with the patient’s presenting concerns may perpetuate racism within medical communities. The verbiage continues to be used despite racial bias and disparities within the system that have been made more evident amid the Covid-19 pandemic.
For example, identifying information may read something like, “A 30-year-old African American male presented in the e emergency department with heart palpitations,” and many providers believe race is a vital factor in the clinical decision-making process. However, sometimes this information can reinforce racial biases and prevent patients from receiving standard medical treatments. It’s also important to note that physicians generally place label on the patient rather than asking a patient to self-identify.
On the other hand, patients are usually asked to self-identify in clinical trials. And this has shown that many patients do not self-identify in the same ways as the labels given to them by researchers. A person’s phenotype may not hold important information about their genotype. In fact, a landmark study in the journal Science found that “two people of European descent may be more genetically similar to an Asian person than they are to each other.”
Many people look to the medical community to operate objectively. By using this outdated practice, physicians may be reinforcing the incorrect idea that race differentiation holds scientific value. Estimated glomerular filtration rate (eGFR), for example, and vaginal birth after Cesarean section (VBAC), are both processes that factor race into decision-making. Plugging in a Black or nonwhite/Hispanic into the calculations could prevent them from receiving a kidney transplant or being offered a vaginal birth.
Another example is the prescribing methods of clozapine, an antipsychotic that is under-prescribed to Black Americans. This is due to physician fear of benign ethnic neutropenia (BEN). BEN is a diagnosis that was created some sixty years ago when African Americans were found to have lower neutrophil counts compared to white Americans. Now, Black American patients who would benefit from receiving clozapine are oftentimes either not offered it or decide against it themselves because they’ve been forewarned that they will need blood draws and frequent monitoring. BEN has also affected breast cancer treatment in African American patients by creating bias.
The authors of a recent study published in JAMA Online contend, “Race may well be a surrogate, albeit imperfect, for sociologic constructs. However, the most important sociologic variables (eg, social determinants of health) and, in particular, differential opportunities (eg, good access to and quality of care) fail to associate with sufficient precision when race is used as the placeholder.”
Some organizations and research publications have already made a move to eliminate race as an identifying factor. In Canada, neither the Canadian Medical Association Journal nor the Canadian Journal of Surgery reports race in their case reports. The National Kidney Foundation recently announced that it would no longer be using race as part of its eGFR calculation for kidney transplant necessity.
A viable alternative? Genetic mapping can be used to treat high-risk patients – although, it is a more costly option than phenotyping. However, as civil rights activist Audre Lorde wrote, “The master’s tools will never dismantle the master’s house.” If medical practitioners continue to use tools developed by predominantly white pioneers in the medical profession without questioning them, racial bias and health disparities will likely persist.
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