Racial Discrimination in Medicine: A Critical Analysis
Race-based medical practices are a sensitive and complex topic within the American healthcare system, where scientific foundations intertwine with social and historical influences. In this article, we examine a serious issue known as “race calibration,” a practice that modifies medical test results based on race, meaning that patients from different backgrounds may receive varying assessments for the same symptoms. We will look at the perspective of Dr. Malika Fair, a physician and new mother of African descent, who serves as the senior director of equity and social responsibility at the Association of American Medical Colleges. Dr. Fair expresses her concerns about how this type of assessment can affect the health of her patients, citing the example of “UTICalc,” a tool used to assess the risk of urinary tract infections in children. The article will also discuss how “race calibration” is utilized in professional sports such as the National Football League, and how this controversial discussion has prompted a rethinking of the broader implications of these practices in medicine. Join us in exploring a vital issue regarding the balance between healthcare and discrimination and its ramifications for various racial groups.
Health Insurance Practices and Racial Discrimination
Health insurance practices constitute a sensitive topic in American society, where various issues are addressed, including racial discrimination manifesting in how healthcare is provided to minorities, especially African Americans. Although the healthcare system aims to provide care equally to all patients, there are techniques and medical tools used to promote what is known as “race-based outcome modification.” The term “racial outcome modification” refers to the way medical test results are adjusted based on a patient’s race, which may diminish the chances of minority patients receiving appropriate care from doctors. This type of discrimination can significantly impact diagnosis and treatment, leading to poor health outcomes and contributing to the exacerbation of health disparities between races.
Dr. Malika Fair’s experience as an African American physician exemplifies issues of inequality in healthcare. Fair focuses on how race influences risk assessment in children, where some medical calculators, such as UTICalc, utilize race-related information to determine infection rates. These practices cast a shadow on how healthcare is delivered to Black children, highlighting an important issue that requires deep re-evaluation and reflection from the medical community.
Health Effects Resulting from Sports-Related Injuries in the NFL
The impact of mental and physical health issues stemming from sports-related injuries extends beyond players to encompass the entire community. The case of the National Football League (NFL) provides a clear example of how trauma affects players’ health. Since 2013, the league has announced it will compensate players suffering from brain damage resulting from repeated injuries during play. Despite the compensations, there seems to be an approach that still discriminates against Black players in their neurological evaluations. When cognitive assessments are conducted, white players retain a baseline that Black players cannot achieve, meaning their chances of proving neurological harm are diminished. This issue is not just a legal matter; it also reflects major headlines regarding health disparities faced by Black NFL players.
Attorneys representing affected players assert that the cognitive assessment methodology employs a framework that makes it difficult for many Black players to prove they were impacted by those injuries. This raises ethical issues regarding the use of race as a criterion in medical assessments, leading to unfair outcomes that mirror systemic biases. Ultimately, the idea is to reassess how these evaluations are conducted and even eliminate the racial disparities that contribute to discrimination.
Techniques
Medical Tools Used in Assessing Racial Risk
The practice of adjusting outcomes based on race extends beyond brain assessments in sports, touching on various areas of medicine such as kidney care, cardiology, oncology, and many other specialties. For example, the use of risk assessment tools in cardiology results in different evaluations based on race, with Black patients receiving lower scores deducted from their results, which may lead to their exclusion from life-saving treatment options. This dynamic opens the floor for discussions about the impact of current practices on healthcare and overall patient outcomes, as it is deemed unfair and does not reflect the true requirements of patient needs.
Moreover, medical tools often overlook other factors such as socio-economic status, making the impact of healthcare disparities more evident. Recognizing these issues helps foster a dialogue about the need to revamp how physicians think about their medical outcomes. Pressure from doctors and health advocates is one of the key factors that may lead to positive changes in how race is utilized in clinical assessments.
Public Health and Inequality in Care Delivery
Public health and inequality in healthcare delivery are interrelated issues that require widespread attention. It is important to understand that social and historical factors play a significant role in how healthcare impacts certain groups. Developing health policies that account for racial disparities can help raise awareness and build trust within marginalized communities. There is an urgent need to document gaps and provide educational programs aimed at changing the perception of race in medical fields.
A significant group of doctors and researchers are striving to enhance awareness around these issues, as seen with Dr. Malia Fair, who calls for a reevaluation of how race is used in medical decision-making. Both clinical practice and the infrastructure of the healthcare system present specific challenges, but these can be overcome through initiatives aimed at achieving health equity and ensuring equitable care for all.
Analysis of Race-Based Assessment Algorithms in Healthcare
Algorithms used in healthcare are a common tool for estimating health risks and making decisions. However, some of these algorithms incorporate race-based adjustments, raising many questions about their effectiveness and impact on patient health outcomes. One study conducted by Dr. Jones highlights the lack of sufficient knowledge about the proportion of medical decisions influenced by racial factors. Dr. Jones notes the need to carefully consider these tools, particularly those dating back to the 1990s, which still influence treatment recommendations today.
For example, an analysis of coronary artery bypass surgery shows that patients with Black skin have a higher risk of dying after surgery compared to White patients. But here, Dr. Jones questions the biological basis for these disparities. Is there a compelling biological reason that makes Black patients more susceptible to risks? The indicators suggest that the disparities may result from social and economic factors, such as lack of access to quality healthcare, rather than biological factors.
Risk assessment tools should be based on accurate and confirmed facts, rather than race-based assumptions. Dr. Jones emphasizes the importance of treating all patients equally, except in cases where strong reasons justify different actions. This emphasis on equal treatment raises questions about the extent to which social and economic factors impact health outcomes.
The Foundations
Biology and Race in Health Risk Assessment
Racial classification is often linked to biological foundations, but it is emphasized that this classification is a social construct and not biological. A key challenge lies in how physicians understand the role that race plays in health. For example, previous research highlights that Black men are more prone to prostate cancer. This contributes to researchers recommending earlier screening compared to White men, necessitating a careful and balanced approach to risk assessment.
There are other examples illustrating this idea, such as breast cancer screenings where recent research suggests that screenings should start at an earlier age for Black women. This evidence shows that genetic and hereditary knowledge may play a role in understanding risks, but it requires in-depth and broad scientific analysis. It is evident that using race as a classification may be misleading if not supported by clear and measurable evidence.
Studies linking race to health indicators represent a significant challenge for scientists and physicians. When social and environmental factors are overlooked, opportunities to improve healthcare can be missed. Researchers in this field challenge the notion that race can be an accurate measure of health conditions, calling for further studies to identify truly influential factors.
Negative Impacts of Racial Adjustments on Healthcare
Some health assessment methods include racial adjustment criteria, such as the estimated glomerular filtration rate (eGFR) test. This algorithm is based on possibly inaccurate assumptions, such as higher creatinine levels in Black patients. The result is that patients who may be eligible for placement on the kidney transplant list could be excluded based on adjustments made by physicians based on race.
Research has shown that using racial adjustments in computing eGFR outcomes may delay treatment for years for Black patients. This treatment gap is an unfair practice, leading to severe deterioration in the health of these patients. Dr. Anyanya points out that this raises an important question about the basis on which these criteria are founded.
If that is the case, how can doctors work to improve care for Black patients without relying on race-based adjustments? Standards should be based on the individual needs of patients and actual health indicators, not on unproven assumptions.
It is imperative for healthcare workers to emphasize the importance of recognizing health disparities without resorting to race-based discrimination. Physicians need more comprehensive assessment tools that take into account the complete circumstances of patients, including social and economic factors, to ensure the provision of fair and effective healthcare.
Conclusions on Addressing Race in Healthcare
Discussions about using race as a criterion for health risk assessment reveal that this issue is complex and urgent. The focus should be on providing evidence-based healthcare, which includes studying the social and economic factors affecting health. Physicians and researchers agree on the futility of relying on race-based assessments inaccurately.
Practitioners should emphasize the importance of thoroughly analyzing data and gathering comprehensive health information about their patients rather than relying on potentially harmful classifications. Both doctors and researchers must play their roles in promoting improvements in how health risks are assessed without resorting to racial divisions.
If recommendations are based on strong biological indicators, the role of race in risk assessment must be reviewed. Delivering healthcare to individuals and determining their health risks needs to rely on accurate and beneficial data aligned with fundamental human values. This ensures the implementation of all necessary standards to improve health outcomes for various groups in society without bias.
Impact
Race and Medical Standards
The medical standards based on race entail serious issues related to health equity, as research shows that many clinical tests take race into account when assessing patient health. For example, the estimated glomerular filtration rate test, which evaluates kidney functions, is used differently based on race. If the result is below 30, patients from certain racial backgrounds may be denied essential medications like Metformin, jeopardizing their health. These practices reflect outdated and historical perceptions of differences among races and pose significant risks to the health of patients from racial minorities. It is deeply concerning that tests and clinical tools are used to exclude patients based on their race, exacerbating health disparities among different communities.
Assessment Systems and Racial Bias
Tools like the STONE score, developed to determine a patient’s likelihood of developing kidney stones, have shown the impact of racial bias on treatment decisions. Research indicates that some physicians may make different clinical decisions based on race-related test results, raising ethical questions regarding the use of these criteria. For instance, if a white child receives a positive diagnosis based on test results while a child from a different racial background is denied, this represents a violation of the principle of justice. This can lead to serious negative health effects for patients requiring medical care, highlighting the urgent need to reconsider the methods employed in this context.
Moving Towards Reforms in Addressing Race
There are increasing calls for change in medical education systems and clinical practices, with new physicians advocating for the abandonment of race-based standards. Notably, some educational institutions like the University of Washington and the University of California San Francisco have ceased using race as a factor in evaluating certain diseases, reflecting a genuine effort toward a more equitable health system. However, there is concern that abolishing all race-related systems without studying their impact may lead to the loss of potentially important information needed to understand health disparities stemming from racism. Thus, it is crucial to seek a balance between eliminating racial biases and understanding how they affect health outcomes.
Chronic Stress and the Impact of Racism on Health
Racism is not simply a social issue; it has tangible effects on individual health. Stress resulting from discrimination and chronic racism is considered a significant factor in physical and mental health problems, from increased blood pressure to harmful behaviors such as alcohol and drug abuse. A report published in 2019 noted that these daily stressors could lead to increased rates of depression and anxiety, underscoring the importance of exploring the complex relationships between racism and public health. By understanding this relationship, more effective interventions can be developed to help address health gaps affecting racial minorities.
Hope for a Fairer Health Future
There is a sense of transformation and high hopes that modern medicine can overcome race-based barriers, especially with technological advancements and increased awareness of health equity. Physicians like Dr. Jones suggest that there is a need to invest in understanding human diversity in a way that enhances the accuracy of tests and diagnoses without relying on outdated biases. Additionally, experts emphasize the importance of direct communication with doctors about how their practices affect patient care based on race. Patients should be able to ask questions about how race influences their treatment decisions, ultimately embodying the principle of shared decision-making that ensures their safety and health.
Link
Source: https://www.healthcentral.com/article/health-disparities-race-norming
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