Race in Medicine: Letting 'Health Justice' Get in the Way of a Good Algorithm

Our discussion centered on the complexities of using race in medical diagnostics and treatment algorithms. I expressed concern about how race is often overused in clinical algorithms, explicitly citing the example of creatinine clearance in kidney function tests. Historically, race has been factored into these tests in ways that disadvantage Black patients. The same misuse of race appears in pulmonary function tests, where it has resulted in inappropriate treatments for Black patients.

While acknowledging the flaws in these approaches, I argued for a more nuanced perspective. I emphasized that race, though a poor indicator of biological differences due to the genetic similarities among humans, can still serve as a marker for social disadvantages or lived experiences. However, I called for a re-evaluation of race in medicine, advocating for changes where race is misapplied while warning against eliminating it in cases where it might still provide clinical benefits.

Physicians should treat guidelines and algorithms as flexible tools rather than rigid rules, focusing on the unique needs of their patients. Ultimately, the key to effective care lies in the one-on-one interactions between doctor and patient.

Dr. Pho's original podcast, which includes video, can be found here.

You can hear the entire conversation here:

The original article is here, along with a deeper dive into the “lumpers and the separators.”