The Untold Racist History of One of Medicine's Biggest Tools
On the morning of June 19, 2020—Juneteenth, now a federal holiday—students in the Internal Medicine Residency Program at the University of California, Davis gathered for weekly rounds. Rachael Lucatorto, the associate program director, opened the session by playing a recording of the Emancipation Proclamation. She then jumpstarted a discussion about racism in medicine.
For Bisrat Woldemichael, then a fourth year medical student at UC Davis and now a resident at Emory University, it was a chance to speak about racism in kidney care, or nephrology. Black Americans experience kidney failure nearly four times as often as White Americans. And yet they are less likely to receive timely referrals to a specialist.
One big problem, Woldemichael remembers pointing out that June morning, was that a common tool for measuring kidney health factored in race. “Racism is very obviously present in a lot of ‘objective’ data in medicine,” she says. Many equations and guidelines adjust for race, and while it is sometimes a convenient proxy, critics say doing so reinforces stereotypes and that alternatives could yield more precise results. For kidney health, the practice could lead to great harm, she says, including death.
Most people have two kidneys—bean-shaped organs about the size of a fist—which, among other things, clean the blood, balance electrolytes, and help form red blood cells. To estimate kidney function, doctors use a standard equation called the eGFR, or estimated glomerular filtration rate. The equation uses the kidneys’ ability to filter a waste product called creatinine to help estimate their health. Plugging the creatinine level into a calculator helps to gauge kidney function, just as a cuff around an upper arm offers an estimate of blood pressure. As kidney function declines, creatinine blood levels rise.
At the time of the UC Davis meeting, the calculator accounted for higher creatinine levels for Black people than other ethnicities. That could have made some Black people’s kidneys appear healthier than they were, delaying life-saving transplants.
https://www.thedailybeast.com/the-campaign-to-purge-racial-bias-from-a-decades-old-medical-tool-used-to-assess-kidney-health?ref=home
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Fascinating. Please read the whole thing before commenting. Thanks.
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