The use of race in medicine is based on studies that are often outdated and inaccurate, exacerbating racial disparities rather than addressing their root causes, according to Darshali Vyas, a fellow at Massachusetts General Hospital and Beth Israel Deaconess Medical Center.
"The legacy of this movement is in accelerating a shift away from our first principle of race as genetic or biological, and moving it back toward the first principle of race and the social construct," Vyas said.
Vyas discussed how racial studies have been used to justify the inequitable treatment of minority groups in medicine at a Park Street Corporation Speaker Series lecture on Thursday.
While a student at Harvard Medical School in 2015, Vyas helped start the Racial Justice Coalition, influenced by the rising Black Lives Matter movement.
"We were entering medical school fresh faced and concerned about racial justice and the political movement that was happening outside of our school," Vyas said.
As Vyas transitioned from the classroom to the hospital, said she immediately recognized tools that adjusted their outputs based on a patient's race.
"By embedding race into the basic data and decision-making of healthcare, we started to wonder if the algorithms we're using to propagate race-based medicine may inadvertently direct more attention or more resources to white patients," Vyas said.
One of the most significant examples of this is the estimated glomerular filtration rate (EGFR), measuring kidney function, Vyas said.
"The EGFR algorithm was built this way so that it systematically results in higher EGFR values suggesting better kidney function for anyone identified as black," Vyas said.
According to Vyas, Black people tend to have higher rates and worse outcomes of kidney disease, but the EGFR calculator yields higher results of kidney function for Black patients, potentially causing delayed care and referral to kidney doctors.
In March of 2021, a task force created by the National Kidney Foundation and the American Society of Nephrology released a recommendation to remove race from EGFR. Despite this recommendation, as of 2022, only one-third of national labs no longer used race-reported EGFR.
"It really takes the state advocacy for high hospitals and labs to change their practice," said Vyas.
The Vaginal Birth After a Cesarean (VBAC) calculator helps clinicians decide whether or not it is too risky for a patient to have a VBAC. According to Vyas, it predicted a lower likelihood of success for Black or Hispanic patients, despite vaginal deliveries generally being healthier and easier for patients overall.
According to Vyas, the VBAC calculator's results were validated by a study that showed a correlation between factors like race, marital status, and insurance type and the likelihood of VBAC success.
Her group published their call to reconsider the usage of race in the VBAC tool in 2019, and in 2021, the VBAC calculator was changed to no longer consider race as a determining factor.
"It's powerful to me to see that the same group was able to re-study the tool and concluded that it could remain an accurate and safe way to assess risk without using race," Vyas said.
Vyas shared that the more she looked into the issue, the more she found that race was present in all areas of medicine.
"We decided to study the practice at large to try to understand the rationale behind including race in these tools, and to try to propose a starting framework to challenge and reconsider these practices when we find them," said Vyas.
While race should not be a primary factor in determining medical treatment, Vyas emphasized that the medical field should ignore race or its impacts on patients.
"We strongly believe that we should continue to study racial disparities, trend them over time, and understand how race is affecting our patients," Vyas said.
Race has been embedded in the medical field under the assumption that racial difference is inherent, but, according to Vyas, this is not how these differences should be viewed moving forward.