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If you want to talk about public health today, you won’t be able to circumvent the issue of COVID-19. It’s a disease that has ravaged its way through our nation, states, and local communities. It has exposed some of the unfortunate shortcomings nestled throughout our three trillion-dollar healthcare system.


Hidden in Plain Sight – Reconsidering the Use of Race Corrections in Clinical Algorithms is a recent paper published in The New England Journal of Medicine (NEJM). In wake of the recent unrest, this paper brings about a relevant critique on the health systems rooted in years of old-fashioned tradition. From cardiology to urology, caesarian sections to kidney failure, this paper covers a multitude of fields and standard procedures that have been subject to unintentional racial bias.


With the recent events stemming from injustice, my work at Families USA has taken on what people in the health policy/equity fields call “a racial equity lens.” The grant deliverables we push out, the webinars we host, and the letters we write all factor in racial equity in some way, shape, or form. This NEJM paper is proof that this new way of critical analysis is reaching beyond the world of politics. Papers like this challenge us to critically think about what we accept as the norm. This paper is a representation of the things I think about every day through my work with Families USA.


Vyas et al. argue that unconscious and implicit bias has spread itself through all of medicine. Often times, diagnostic algorithms and guidelines use race to “correct” or “adjust” for physiological differences in different individuals of different races. The author poses the question: “is there really a difference?”


I do not wish to push any agenda or beliefs onto you. If interested, I recommend taking a look into the paper to generate your own thoughts about this issue. For now, I’ll hone into the example of the kidney transplant. Estimated glomerular filtration rate (eGFR) is a number used to directly evaluate kidney function. Using the amount of creatinine (a waste product produced by muscle) in the blood, age, weight, and some other factors, a calculation can be run to output eGFR. A higher eGFR is great, a low eGFR means your kidney isn’t filtering out as much waste as it should. You might require a new kidney. Well, that’s empirical data and numbers, so where’s the controversy?


The gold standard used to calculate eGFR is an equation that raises the final eGFR value by a factor of 1.210 if the patient is Black. That’s where the divisive issue lies. By increasing the eGFR value of a black patient, it seems that an eGFR calculation of a White patient and Black patient with similar kidney functions will result in higher eGFR to the Black patient. Even though they both had the same kidney functions, that difference could result in different treatment options. Sounds absurd, right?


Proponents of this 1.210 factor increase say removing this adjustment would unnecessarily over treat Black patients in a healthcare system where we are already billing our patients for way too much. The opposition say there is no substantial evidence for this difference in eGFR, they claim that the need to adjust for race is unnecessary: the claim that Black people inherently have higher levels of creatinine in the blood is inaccurate.


Hopefully, you can see why this is an issue. On one hand, we have a system that is seemingly imbued with systemic racism to its core. On the other hand, these diagnostic tests seemingly account for physiological differences, attempting to create an objective measure in good faith. However, sometimes the best intentions can have the worst consequences. I’m not well-versed enough to take a stance on this issue. I am not yet a medical professional, and I have not read all the literature surrounding this issue, but I do know one thing.


In my future medical training and career, I will always look at the data, I will hear both sides, and I will strive to make the most moral and equitable decision possible.


Should we immediately overhaul these criteria? Maybe not. Should we critically analyze the issue that surround it? Most definitely. The people that are against diagnostic race-adjustments care about their patients. The people who championed the race-adjustments do as well. We all have the same goal, let’s not forget that. We all want to heal. At the end of the day, that’s what being a physician is all about.