Race-based medicine uses a patient’s self-identified or perceived racial category in medical diagnosis, treatment, and risk assessment. This approach, long-standing in healthcare, assumes inherent biological differences among racial groups influence disease susceptibility and treatment response. It remains a subject of considerable debate due to its complex implications for patient care and health outcomes.
Historical Origins of Race in Medicine
The roots of incorporating race into medical practice are deeply entwined with social and political ideologies, not biological discoveries. During the 18th and 19th centuries, theories emerged to categorize human populations based on physical traits, often to justify existing social hierarchies like slavery. These early concepts embedded race into medical thinking as a biological reality, despite lacking scientific basis.
Physicians developed pseudoscientific theories, such as Samuel Cartwright’s “drapetomania,” which pathologized enslaved people’s desire for freedom. These unsubstantiated beliefs about anatomical and physiological differences were taught in medical schools and propagated through literature. This established race as a biological marker, influencing diagnostic and treatment approaches for centuries. Enslaved individuals and Native Americans were also used as subjects for medical experimentation, often without consent or anesthesia. This practice further solidified the idea of inherent biological distinctions and contributed to foundational biases within American medicine.
Current Applications and Clinical Algorithms
Race continues to be factored into various contemporary medical applications and clinical algorithms, influencing diagnosis, treatment, and risk assessment.
Kidney Function (eGFR)
The estimated glomerular filtration rate (eGFR) calculation, used to assess kidney function, historically included a “race correction” factor. This adjusted results higher for Black patients, assuming greater muscle mass and higher creatinine levels. This adjustment could overestimate kidney function, potentially delaying chronic kidney disease (CKD) diagnosis and referrals for specialized care, including transplants.
Cardiology (BiDil)
The drug BiDil received controversial FDA approval in 2005 specifically for self-identified Black patients with heart failure. Although its active ingredients were used for heart failure regardless of race, the company sought a race-specific indication for patent protection. Critics argued this perpetuated the misleading idea of biological differences linked to race, despite a lack of evidence it worked differently in other populations.
Pulmonology (Spirometry)
Race adjustments are also seen in spirometry, a test measuring lung capacity. Reference values for lung function are often adjusted downwards by 10-15% for Black patients and 4-6% for Asian patients compared to White patients. These corrections, often automatic, can misinterpret lung health, potentially masking impairment and delaying treatment for conditions like asthma.
Obstetrics (VBAC)
Race is employed in risk calculators, such as for predicting vaginal birth after cesarean (VBAC) success. The original VBAC calculator included race and ethnicity, typically assigning Black and Hispanic women a lower probability of successful VBAC. This could lead to clinicians discouraging VBACs for these groups, potentially increasing repeat cesarean deliveries and their associated risks.
The Scientific Debate on Race and Genetics
The core scientific debate centers on whether race serves as a valid proxy for underlying genetic differences. The overwhelming scientific consensus is that race is a social construct, not a biological or genetic category with clear boundaries. Human genetic variation is continuous and clinal, changing gradually across geographic space, rather than occurring in discrete, racially defined clusters. More genetic variation exists within socially defined racial groups than between them, underscoring the lack of a biological basis for race.
While race is not a biological category, genetic ancestry is a measurable biological parameter reflecting an individual’s recent geographic origins. Genetic variations influencing disease risk or drug response can be more common in populations with shared ancestral backgrounds due to historical migration and environmental adaptations. For instance, the sickle cell trait, offering protection against malaria, is more prevalent in people whose ancestors originated from malaria-endemic regions like parts of Africa, the Mediterranean, India, and Latin America. This distribution links to ancestral environment, not a singular “race.”
Conflating race with genetic ancestry can lead to misinterpretations and flawed medical decisions. Relying on broad racial labels as shortcuts for genetic information overlooks the vast diversity within racial groups and inaccurately assumes genetic homogeneity. For example, Black individuals may have varying proportions of African and European genetic ancestry, influencing disease susceptibility or treatment response. The shift towards understanding specific genetic markers and ancestral populations, rather than broad racial classifications, offers a more precise approach to identifying health risks. This distinction acknowledges that while some genetic differences exist at a population level due to shared ancestry, these do not align with socially constructed categories of race. Therefore, using race as a proxy for genetics in medicine is considered misleading and scientifically inaccurate.
Impact on Health Equity and Patient Care
The continued use of race-based medicine can perpetuate health disparities, undermining efforts toward health equity. When medical algorithms and practices treat race as a biological determinant, they risk stereotyping patients and leading to misdiagnosis or inequitable treatment. This can delay diagnoses and prevent timely intervention.
Such practices also erode trust between patients from marginalized communities and the healthcare system. Patients may feel their individual needs are overlooked in favor of broad, often inaccurate, racial assumptions, leading to reluctance in seeking or adhering to care. This exacerbates disparities influenced by historical and ongoing systemic racism.
Focusing on race as a biological shortcut can distract from the more significant impacts of social determinants of health (SDOH). Factors like access to nutritious food, safe housing, quality education, environmental exposures, and chronic stress play a substantial role in health outcomes, often disproportionately affecting racialized groups. Attributing health differences to “race” rather than these underlying social and environmental conditions obscures the true drivers of health inequities and hinders effective interventions.
Moving Toward Precision Health
Recognizing the limitations and harms of race-based medicine, a growing movement within the medical community advocates for precision health approaches. Precision medicine focuses on an individual’s unique genetic makeup, environmental exposures, lifestyle, and social circumstances to tailor diagnosis and treatment. This approach moves beyond broad racial categories to consider specific, actionable biological and non-biological factors.
Instead of relying on race as a proxy, precision health incorporates direct markers of risk and a comprehensive understanding of social determinants of health. This involves collecting diverse genomic data and integrating information on factors like neighborhood conditions, access to transportation, and socioeconomic status into clinical decision-making. Healthcare providers can then develop personalized and effective treatment plans addressing the true complexities of a patient’s health.
Many medical organizations are actively working to remove race from clinical algorithms and guidelines, replacing them with more accurate and equitable parameters. This shift represents a commitment to dismantling historical biases and fostering individualized, evidence-based care for all patients.