The past three decades of genetic research have clearly established that racial categories have no basis in biology, that there is more genetic variation within races than between them, and that race is not at all a proxy for the complexities of ancestry and genetics. Actually, race is a social construct that uses physical characteristics such as skin color, hair texture, and other phenotypical traits to categorize and rank human beings, and which in the U.S. and much of the western world was invented to rationalize and facilitate settler colonialism, indigenous genocide, chattel slavery, and white supremacy. As a pervasive and oppressive social category, race is often strongly correlated with individual and group health outcomes and inequities because of how certain racial/ethnic groups are treated within socio-political structures, but not because race itself has any basis in biology or genetics. (For more on this topic, see our module “Racism not Race as a Cause of Health Inequities”)
Despite strong scientific consensus about the social construction of race, American medical education, clinical practice, and research methodologies continue to employ race as a biological concept and scientific variable with disastrous consequences for patients and communities. In this module, we provide resources that discuss some of the many diagnostic calculators that still treat race as a causal, biologic variable, for everything from kidney function, urinary tract infections, and head injury, to vaginal delivery. The development of these calculators often used health outcomes related to structural racism as causes rooted in biological race, and many of these tools date back to pseudoscientific practitioners of “slave medicine” who helped establish American medical institutions, particularly in sexual and reproductive health. (For more on this, see our module “Captive Patients: Gynecology, Slavery, and the Rise of American Medicine”) The module also includes resources for you to examine the use of racial categories in your own institutions and to take action for change.
This module is part of RHEDI’s Justice & SRH Unit, which focuses on Reproductive Justice in sexual and reproductive health.The module can be used for self-study or as part of group didactic sessions. Learners have the opportunity to discuss the material with their peers in RHEDI’s Curriculum Discussion Forum, to share their responses anonymously, and to submit their answers to their instructor. The module is also available on the RHEcourse learning management system.
Bonzo Reddick. Fallacies and Dangers of Practicing Race-Based Medicine. Am Fam Physician. 2021 Aug 1;104(2):122-123. PMID: 34383449.
Noor Chadha, Bernadette Lim, Madeleine Kane, & Brenly Rowland, “Section 3.0–3.4: Race-Based Medicine in Diagnosis and Treatment,” Toward the Abolition of Biological Race in Medicine. 2020. UC Berkeley: Othering & Belonging Institute.
Jessica Cerdeña, Marie Plaisime, & Jennifer Tsai. From race-based to race-conscious medicine: how anti-racist uprisings call us to act. Lancet. 2020 Oct 10;396(10257):1125-1128. doi: 10.1016/S0140-6736(20)32076-6. PMID: 33038972; PMCID: PMC7544456.
Darshali Vyas et al. Challenging the Use of Race in the Vaginal Birth after Cesarean Section Calculator. Womens Health Issues. 2019 May-Jun;29(3):201-204. doi: 10.1016/j.whi.2019.04.007. Epub 2019 May 6. PMID: 31072754.
James Diao et al. In Search of a Better Equation – Performance and Equity in Estimates of Kidney Function. N Engl J Med. 2021 Feb 4;384(5):396-399. doi: 10.1056/NEJMp2028243. Epub 2021 Jan 6. PMID: 33406354; PMCID: PMC8084706.
Jennifer Tsai. Jordan Crowley Would Be in Line for a Kidney-if He Were Deemed White Enough. Slate. 27 June 2021.
Hamza Shaban. How Racism Creeps Into Medicine. The Atlantic. 29 Aug 2014.
Hannah Knight et al. Challenging racism in the use of health data. Lancet Digit Health. 2021 Mar;3(3):e144-e146. doi: 10.1016/S2589-7500(21)00019-4. Epub 2021 Feb 3. PMID: 33549513.
Lundy Braun, Anne Fausto-Sterling, Duana Fullwiley, Evelynn Hammonds, et al. Racial categories in medical practice: how useful are they? PLoS Med. 2007 Sep;4(9):e271. doi: 10.1371/journal.pmed.0040271. PMID: 17896853; PMCID: PMC1989738.
The problem with race-based medicine, Dorothy Roberts, TED
Allegories on race and racism, Camara Jones, TEDxEmory
Is Being Black Really More Dangerous Than Smoking? Dr. Bonzo Reddick, Montefiore/Einstein
Dorothy Roberts (12:08–30:07)
Darshali Vyas (31:22–49:32)
Jennifer Tsai (50:56–1:109)
Reproducing racism (Part 4), Reveal. May 2020.
Reporter Julia Simon takes a look at a commonly used calculator that may be leading Black and Latina women to C-sections they don’t need.
[segment: 17:38–37:15]
Addressing Anti-Black Racism in Medicine, The Curbsiders, Utibe Essien MD, MPH.
Dr. Essien provides insights into ways that racism impacts work in the clinical and academic settings and offers approaches for addressing anti-Black racism in these settings.
[segment: 14:11–49:50]
Reflection questions:
1. Why has the scientific community determined that race is not a legitimate biological or scientific variable, but is instead a social and political construct? (Please identify 2–3 reasons.)
2. What are some of the key differences between race-based and race-conscious medicine? Why is it important that race-conscious medicine does not ignore race as an important factor for health? (Please identify 2–3 differences.)
3. What are some of the fallacies and unscientific assumptions that led to the inclusion of race in the eGFR calculator? How does this harm Black patients in particular?
Submit your reflections directly to your instructor or share at: https://rhedicommunities.org/discuss
Diagnostic Calculators and the Invention of Race
Unit Learning Objectives:
1. Learn how contemporary U.S. institutions (including medicine) have roots in genocide, colonialism, slavery, and white supremacy
2. Examine the roots of U.S medical research and clinical practice in white supremacist experimentation and violence
3. Understand the racist structures that perpetuate and sustain contemporary health inequities
Diagnostic Calculators and the Invention of Race
Module Learning Objectives:
1. Explain the scientific consensus that race is not a biological variable or a proxy for genetics or ancestry
2. Discuss the invention of race as a socio-political category designed to rank, oppress, and exploit human beings based on phenotypic characteristics
3. Describe how frequently used diagnostic calculators rely on falsely biological conceptions of race, often providing misleading, inaccurate, or even harmful clinical recommendations
4. Identify differences between race-based and race-conscious medicine, and how diagnostic calculators may be revised to account for the distinction
