For centuries, the medical field has utilized race as a factor in diagnosing and treating patients. This practice, known as race-based medicine, has deep roots in the history of healthcare and has significantly influenced the ways in which medical professionals approach patient care. However, recent movements towards equity and inclusivity in medicine are challenging these longstanding practices and promoting more personalized and fair healthcare.

Understanding Race-Based Medicine

Race-based medicine refers to the practice of using a patient’s race as a proxy for genetic, biological, and health-related differences. Historically, this approach was based on the belief that different races had inherently different physiological characteristics. These beliefs influenced everything from medical education to clinical practice, leading to race-specific guidelines for diagnosing and treating various conditions.

One of the most well-known examples is the use of race in determining kidney function. The estimated glomerular filtration rate (eGFR) is a common test for assessing kidney function, and for years, it included a race-based adjustment factor. This adjustment often led to different treatment pathways for Black and non-Black patients, based on the assumption that Black patients naturally had higher muscle mass and, consequently, different creatinine levels.

The Problems with Race-Based Medicine

The primary issue with race-based medicine is that it relies on broad generalizations that can lead to significant disparities in care. Race is a social construct, not a biological one, and using it as a stand-in for genetic differences oversimplifies the complex factors that contribute to health. Moreover, race-based medicine can perpetuate health disparities. For instance, the use of race-adjusted eGFR can delay the diagnosis and treatment of kidney disease in Black patients, potentially leading to worse health outcomes. Similarly, race-based guidelines in other areas, such as hypertension and cardiovascular disease, can result in unequal treatment and exacerbate existing health inequities.

The Shift Towards More Equitable Healthcare

In recent years, there has been a growing recognition of the flaws in race-based medicine and a push towards more equitable healthcare practices. Medical professionals, researchers, and educators are advocating for a shift from race-based to race-conscious medicine. This approach acknowledges the social determinants of health and the impact of systemic racism on health outcomes, without relying on race as a biological determinant.

Several key initiatives are driving this shift:

1. Revising Clinical Guidelines: Organizations and institutions are revisiting clinical guidelines to remove race-based adjustments. For example, in 2021, the American Society of Nephrology and the National Kidney Foundation recommended the elimination of race-based eGFR adjustments.
2. Enhancing Medical Education: Medical schools are incorporating training on the social determinants of health, implicit bias, and the history of race in medicine. This education aims to prepare future healthcare providers to deliver more equitable care. However, it is not enough to just incorporate this training; it must be actively practiced. Schools need to lead by example by ensuring that historically marginalized communities are represented in leadership roles and the student body.
3. Promoting Research Diversity: Researchers are increasingly urged to include diverse populations in clinical research. This effort seeks to ensure that medical research accurately reflects the genetic and environmental diversity of all patients. Additionally, it is essential that researchers themselves come from diverse backgrounds, as this brings varied perspectives and enhances the quality and relevance of research findings. Being open to challenging previous research that erroneously relied on race as a biological entity is crucial for progress.
4. Advocating for Policy Changes: Healthcare organizations are advocating for policies that address health disparities and promote equity. This includes efforts to improve access to care, address social determinants of health, and reduce systemic barriers.

Conclusion

The history of race-based medicine is a testament to the need for ongoing reflection and reform in the healthcare field. By acknowledging the limitations and harms of race-based practices, the medical community can move towards more equitable, personalized, and effective care for all patients. This shift is not just about changing guidelines and practices; it’s about transforming the entire approach to healthcare to be more inclusive and just.

As medical professionals, it is crucial to stay informed and actively participate in these changes. Embracing race-conscious medicine and focusing on the individual rather than broad racial categories will help pave the way for a more equitable healthcare system that truly serves everyone. Through education, representation, and advocacy, we can challenge the status quo and ensure that the future of medicine is one of fairness, inclusivity, and true equality.