The practice of medicine and medical science is characterized as being beneficent with the ultimate goal of promoting health and healing. However, medicine is not immune to the systemic inequalities that pervade our society.
The history behind black men's poor health outcomes, and what we can do to close the gap
The history of medicine and health care in the United States is embedded in racism and other forms of structural violence; dating back to crude medical experimentation done to Black slaves against their will to the manifestations of racial disparities in Covid-19 outcomes.
Racial health disparities are a major concern and race-based corrections are still widely used across the health care industry. However, there is no meaningful correlation between race and biological difference so the way we talk about racial health disparities—and possible solutions—is fundamentally flawed.
Current standards operate under outdated and racist assumptions that non-White people are biologically different from White people. Using race alone as a scapegoat for health disparities detracts from systemic and societal causes for differences in health outcomes.
Today, numerous equations used in medicine use race-based corrections and clinical reference values are adjusted for race, even though science has recognized that race is a social construct and a poor proxy for human genetic variation (Table 1).
The use of race in clinical decision-making is a controversial point in U.S. medical practice and education. There are consequences to utilizing race-based corrections and in doing so, pathologizing race.
Race-based corrections pervade numerous therapeutic areas of medicine, but race-based correction is not a scientific way to capture the lived experiences of structural racism and its manifestations. Race-based care might drive health inequities by propagating racialized assumptions about health status and reducing quality of care for patients of color.
Race-conscious care considers racism as a social risk factor for illness rather than race as a biological risk factor for illness. Using racial identification in medicine is problematic because differences related to genetic ancestry are not captured by a person's self-reported racial identity, an issue that only becomes more complex as mixture between populations continues.
Institutional and organizational level changes and recommendations are enabling health systems to move from race-based to race-conscious medical practice. Some examples of organizational changes made include:
While some argue that politics should be "kept out of the doctor's office," the misrepresentation of race in clinical medicine and medical education has political and social implications. Health care practitioners should commit to culturally competent care and leverage their expertise and cultural capital to advocate for race-conscious policies in their place of work.
Health systems and hospitals should issue guidance around race-based corrections across their institutions and work proactively to investigate race-based corrections and make recommendations for race-conscious medicine.
Precision medicine paints a patient-centered future of personalized medical diagnostics and clinical decision-making that takes into account individual differences in genes, environments and lifestyles. Data is the foundation of precision medicine, but current data collection practices are heavily tied to race-identification, potentially furthering racial bias. Ensuring that precision medicine combats racial inequities requires:
Early successes of precision medicine research have identified opportunities to improve imprecise prescribing practices of ACE inhibitors for Black patients. However, the translation of genomic data into clinical care is very complex and necessitates investment across the health care industry. With the nation's current focus on health equity, now is the time to act and enable race-conscious medicine.
'Put simply, people of color receive less care—and often worse care—than white Americans,' Austin Frakt, an associate professor at Boston University's School of Public Health writes for the New York Times' 'The Upshot,' drawing attention to a history of patient consent violations that has fueled black patients' distrust in the system.
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