18 | New Scientist | 17 July 2021
Foundation and the American
Society of Nephrology established
a task force in 2020 to “reassess
the inclusion of race in the
estimation of GFR”. Several
medical institutions across
the country, including
Massachusetts General Brigham
and Beth Israel Deaconess
Medical Center in Massachusetts
as well as the University of
Washington School of Medicine,
have abolished the use of race
adjustment in eGFR calculations
over the past four years.
Race-based diagnosis
continues in other areas of
medicine, however. A preliminary
study of about 14,000 lung
function tests, led by Alexander
Moffett at the University of
Pennsylvania, found that removing
racial adjustments from the
interpretation of the tests saw
the number of people correctly
diagnosed with a lung defect
jump from 59.5 to 81.7 per cent.
The results suggest that
adjusting for race in lung function
tests may underestimate the
severity of lung disease in
Black patients, says Moffett.
“We’re assuming that their lung
function should be worse and
using that as a way to approach
the diagnosis,” he says.
The use of race adjustment
in lung function tests can be
traced back to the suggestion
by US physician and slaveholder
Samuel Cartwright in the 1850s
that Black people had lower lung
capacity than white people and
were therefore only healthy
when enslaved. “Everything
we’ve learned about race in
the last 50 years has invalidated
this,” says Moffett.
Joint European Respiratory
Society and American Thoracic
Society (ATS) guidelines
recommend the use of different
lung function test equationsmaternal mortality, because a
successful vaginal birth after
caesarean is associated with
reduced health risks than a repeat
caesarean delivery. In the US,
Black women have higher rates
of caesarean deliveries than white
women and are also more likely
to die from complications related
to pregnancy or childbirth.
Despite many of the
organisations contacted by
New Scientist not taking a stance
on the issue, overall opinions
on racial-adjustments appear to
be shifting. “It seems to be like a
period of reckoning in medicine,”
says Nkinsi. “A lot of it is being
pushed back on, of course,
because people are resistant to
change, but I think we’re moving
down a path where it’s no longer
excusable to have these racist
algorithms,” she says.
Moffett agrees. “A lot of this
movement has been spearheaded
by medical students, who are very
distrustful of race as a concept in
a way that many older clinicians
are not,” he says. “When they’re
taught this in medical school, they
just say, ‘well, that doesn’t make
any sense’, ‘there’s no biological
basis for this’, ‘why are we using
race in these models?’.”
Significant challenges remain,
says Nkinsi, because racism is
so deeply embedded in Western
medicine. “Medicine is very
hierarchical. It’s very much based
on this kind of false meritocracy
where for the longest time white
men were running everything.
You can’t question your superiors,
medical students and younger
physicians are supposed to just
take things as they’re taught,”
she says. “What I’m trying to
tell people is that it’s not just
the algorithms, it’s the entire
system and the way that we
educate doctors that is creating
this problem.” ❚Race is a factor in a
commonly used measure
of kidney functionANAT
OMICAL^ TRA
VE
LOGUE/SCIENCE^ PHOTOLIBRARY14 %
Overestimation of kidney function
using a race-based assessmentNews Insight
depending on a person’s
geographical ancestry. “Ingrained
in lung function interpretation
is the long-standing assumption
that the observed differences
across racial and ethnic
populations is biologically
based,” the ATS told New Scientist.
“There is increasing recognition
that race and ethnicity are
sociopolitical constructs which
are more reflective of the differing
social and environmental
conditions across populations
than representative of true
biologic differences,” said the ATS,
adding that it is “committed to
leading action to address racism
in medicine and eliminate the
misuse of race and ethnicity
in clinical decision making”
and that it has “convened a
workshop to critically evaluate
current guidelines”.Changing times
Moffett thinks race-norming
adjustments should be stopped.
He and his colleagues are currently
developing a “race-free equation”
for interpreting lung function
tests, he says.
There are also ongoing efforts
to develop race-free alternatives
to the most widely used eGFR
equations. And, in the US, the
Vaginal Birth After Cesarean
(VBAC) calculator – a commonly
used medical tool for second
births – was recently updated
to remove a race and
ethnicity adjustment.
Previously, the use of race
and ethnicity adjustments in
the VBAC calculator meant that
women identified as African
American or Hispanic were
systematically assigned a
lower chance of a successful
VBAC than white women.
This may have contributed
to racial-ethnic disparities in“ Race adjustment can be
traced back to the idea
that Black people are only
healthy when enslaved”