At issue is a once widely used test that overestimated how well Black people’s kidneys were functioning, making them look healthier than they really were — all because of an automated formula that calculated results for Black and non-Black patients differently. That race-based equation could delay diagnosis of organ failure and evaluation for a transplant, exacerbating other disparities that already make Black patients more at risk of needing a new kidney but less likely to get one.
A few years ago, the National Kidney Foundation and American Society of Nephrology prodded laboratories to switch to race-free equations in calculating kidney function. Then the U.S. organ transplant network ordered hospitals to use only race-neutral test results in adding new patients to the kidney waiting list.
Dr. Martha Pavlakis (of Boston’s Beth Israel Deaconess Medical Center and former chair of the network’s kidney committee) calls what happened next an attempt at restorative justice: The transplant network gave hospitals a year to uncover which Black kidney candidates could have qualified for a new kidney sooner if not for the race-based test — and adjust their waiting time to make up for it. That lookback continues for each newly listed Black patient to see if they, too, should have been referred sooner.
There is so much racism in healthcare. Really, really awful shit like doctors and nurses actually believing that black people are less pain-sensitive or even literally have thicker skin than white people. People who went to fucking medical school believe this.
https://www.aamc.org/news/how-we-fail-black-patients-pain
The problem is there are significant genetic differences between races that can’t just be painted over and must be taken into account when providing medical care. Redheaded people, for example, need 20% more anesthesia than others. If you don’t take that into account, they could wake up screaming on the operating table.
I’m copying my comment from elsewhere as a jumping off point:
To address your comment about red heads, I’d like to point out that it isn’t the red-headed-ness of a person that creates the effect you’re describing, it is the presence of specific alleles for the creation of pigments that both provide tint to our hair and skin and are also involved in pain/drug metabolic pathways.
Sure, that means that red-heads almost always have the effect you describe, but people with semi-functional or single recessive copies of alleles of the same genes may not have red hair but might have the same pain-pathway dysfunction. These mutations can pop up in individuals of any ethnic background, meaning that it is impossible to rule out the presence of the pain dysfunction based on race, skin, or hair color.
Moreover, in red-heads, individuals may possess mutations in other gene pathways (or epigenetic variation in gene expression regulation) that partially or fully eleviate the effect of the pigment allele mutation. In simple terms, all red heads might have the pain mutation associated with red hair, but some of those individuals might have a separate mutation (that doesn’t change their appearance) that decreases their pain or anesthesia threshold, making the net effect zero. This again means that we can’t be certain of someone’s underlying physiology based on their appearance or race.
source: senior graduate student in epigenetics, gene expression, and with a specific research foci in essentialist beliefs among experts in the biological sciences
Maybe read my link.
Also, this is not about anesthesia, this is about pain management.
(I should preface this with the fact that I only really skimmed the aamc article you linked)
I think we have a serious bias problem in medicine. However, the right answer might be to fund studies that debunk the racist claims pervading the education system, rather than relying solely on stricter policies.
It seems to me that we want individualized medicine. Discounting race, different people may respond differently to various treatments; for example, I have really long tooth roots. Therefore, we should develop tests to identify these differences and tailor treatment accordingly. I understand the fear of research that could possibly establish differences in treatment across racial lines due to historical context. However, I would tentatively suggest that if one truly believes race is an ineffective descriptor for such distinctions, then one should expect that studies would more likely aid than hinder the effort to address racial disparities in medical treatment and outcomes.
Hi hello I am an expert in this
We do have these studies. We have tons of them. At the research level, the essentialist bias of healthcare is well-documented.
Basically, not only do we know that there are very, very few (really, none, when you come right down to it) areas where we can accurately predict a person’s underlying physiology based on their apparent race-- we also know that it is underlying bias (and not biological evidence) that makes some healthcare workers and researchers think otherwise.
In fact, these essentialist biases are documented along other dimensions of identity than race, also. These biases are found whenever healthcare workers treat individuals with different sexes, sexual orientations, gender identities, abilities, and body sizes, too (not an exhaustive list).
You probably aren’t doing it intentionally, but this idea that “we just need more studies” is a common refrain of resistance to change from people who have a vested interest in the biased status quo-- calling for further study is seen as uncontroversial, even if there’s a mountain of evidence already (see: climate denial).
Moreover, it actually misses the point of how epistemologies of biology are constructed. In reality, there are many things we know on the research level that are not efficiently disseminated to the relevant expert populations. The truth is that we don’t really need more studies-- we need to figure out how to get the current best information into the hands of doctors, nurses, and clinical researchers.
Thank you for the information! It was not my intent to echo any such refrain. If you don’t mind, would you point me to some good survey papers which might expand my understanding of the topic? (physiology and human phenotypes?) May not be the right terminology for apparent race but I’ll lean on your expertise to interpret my meaning.
I will do my best! :)
There are a couple different concepts at-play here, and finding a single resource that summarizes everything I mentioned would be quite difficult. Moreover, given the information dissemination problem I mentioned, you’d be hard-pressed to find a non-academic description of this stuff (I.e. written for a non-biological or social researcher audience)…
But, I don’t think that should prevent anyone interested in trying to learn more!
Here’s some papers that discuss some of the issues at play here:
Is the cell really a machine?, discusses some of the issues with relying too much on genetics/molecule scale biology knowledge for determining the emergent nature of traits/phenotypes (with specific respect to the machine model of the cell… This paper is heavy on molecular biology)
Conceptualizations of Race: Essentialism and Constructivism, a sociological overview informed by clinical and biological research discussing constructivist vs essentialist conceptions of race (heavy on sociology)
Addressing Racism in Human Genetics and Genomics Education , reviews several papers specifically addressing the information dissemination problem I mentioned, going back to the “source”, which is education. This paper focuses on studies in undergraduate biology education but others are looking at education in at the k-12 level, also.
If you wanted to do a database search yourself, some keywords I’d use would be: race essentialism, genetic essentialism, (really just “essentialism” would get you somewhere), race in biology education, race in medicine