January 26, 2024

Taskforce works to end racialized differences in medical education and practice

The Wayne State University School of Medicine’s End Race-Based Medicine Taskforce is working to dispel and extinguish the misguided belief that individual races are biologically distinct groups determined by genes, and terminate medical practices and research that adhere to that concept.

Co-created by Ijeoma Nnodim Opara, M.D., assistant professor of Internal Medicine and Pediatrics, and Latonya Riddle-Jones, M.D., M.P.H., assistant professor of Internal Medicine and Pediatrics, the taskforce includes representation from institutional leadership, students, residents, faculty, and community members and leaders, including those from the School of Medicine, Wayne Health, the Detroit Medical Center, the Barbara Ann Karmanos Cancer Institute, the Detroit Health Department and the Michigan State Medical Society.

"Race-based medicine is the practice of medicine – and other forms of health care – grounded in racial essentialism, which is the false belief that races are biologically distinct groups determined by genes," Dr. Opara said. "It is a key component of structural and systemic racism in medicine and has perpetuated multiple generations of harm to Black, as well as other minoritized and structurally excluded communities."

The group has delineated three primary goals to accomplish within its two-year mission:

• Discontinue and “de-adopt” race-based medicine, including "race correction" in practice, teaching and research.

• Lead the adoption and institutionalization of racism-conscious medicine in practice, education, policy and research, and provide support for clinicians and health care workers.

• Organize stakeholder community roundtables and symposia on ending race-based medicine.

The taskforce is supported by Dean Wael Sakr, M.D.; the Michigan State Medical Society Taskforce to Advance Health Equity; the School of Medicine’s Office of Inclusion, Diversity, Equity and Access; the Health Equity and Justice in Medicine initiative at the School of Medicine and the Detroit Medical Center; and the WSU Department of Internal Medicine.

“The work of this taskforce is critical to health care in our city, our state and our nation, and lives in the very soul of our Wayne State University School of Medicine and our mission,” Dean Sakr said. “The promise of equitable health care for all people is deeply embedded in the mission and values of the university and its health science schools. We need to lead the way in this effort.”

The task force, Dr. Opara said, will consider its work successful by the measurement of several factors, including:

Removal of racialized reporting from electronic health records in areas such as Glomerular Filtration Rate, or eGFR, a test in renal function.

The discontinuation of the "race corrective" function of pulmonary function tests.

The discontinuation of inputting race as a risk factor in the atherosclerotic cardiovascular disease calculator.

The discontinuation of relying upon race as a reason for offering different medical treatments.

“We will conduct regular practice and teaching audits to track the frequency of practice and teaching of these domains of race-based medicine, and when we are at zero, we will know our mission is completed,” Dr. Opara said.

One impetus for the taskforce lies in the publication of a paper calling for the end of race-based medicine.

In 2021, Dr. Opara, Dr. Riddle Jones and Nakia Allen, M.D., FAAP, clinical associate professor of Pediatrics, published an article in which they called upon the medical and scientific communities to confront and end a legacy of scientific racism in research, medical education, clinical practice and health policies by “de-pathologizing and humanizing” American Black bodies.

In “Modern Day Drapetomania: Calling Out Scientific Racism,” published in the Journal of General Medicine, the physicians noted that racism in medicine has “deep historical roots in white supremacy and anti-Blackness, particularly the pathologizing of Black bodies through pseudoscientific claims of the biological significance of the sociopolitical construct that is ‘race,’ which is often incorrectly conflated with ‘genetic ancestry.’” Those roots, they wrote, developed branches that continue to reach into medical science and medicine to this day, particularly in the ways science frames racial health disparities as a result of biological differences among racial categories.

“Racism, not race, is the vector of disease and health disparities. Racist policies, such as redlining and the ‘war on drugs’ and ‘war on crime,’ inform systems of housing, education, criminal justice, health and the economy, and determine a community’s exposure to the social and environmental factors that drive health disparities through direct effects, chronic toxic stress and epigenetic mechanisms,” the physicians wrote. “This is the contemporary version of pathologizing Blackness and normal responses to chronic intergenerational trauma, oppression and exploitation. It reinforces the bogus theory of supposed Black inferiority. It is the modern Drapetomania.”

Now recognized as pseudoscience nonsense, Drapetomania was first concocted by Dr. Samuel Cartwright in 1851 to pathologize runaway enslaved Blacks. He claimed that enslaved Blacks had inherently smaller brains and blood vessels that accounted for “indolence” and “barbarism.” His prescribed “cure” and prophylactic treatment for the faux condition was “whipping the devil out of them.” The nonsensical condition remained in some medical texts into the early 1900s, and was used – along with other false claims – to support racist perceptions and attitudes toward Black Americans. Some of those perceptions continue in medicine, despite the fact that in 2003 the Human Genome Project showed race has no genetic basis and human beings are 99.9% identical genetically.

“The belief that differences in disease outcomes are due to genetic differences between racialized groups still plagues contemporary medicine and science, and unfortunately continues to be funded, published, taught and practiced,” they state. “The use of race to measure human biological differences stubbornly persists and, consequently, these structures and systems are absolved of responsibility, reinforced and perpetuated.”

To eliminate scientific racism, the physicians called for identifying and excising it from clinical algorithms and medical decision-making equations; expunging it from the publication process through anti-racist peer review and editorship; transforming medical, health care professions, and scientific education in both clinical and social sciences from undergraduate studies through faculty development and curricular revision; and advocacy among academic partnerships with patients, marginalized communities and policymakers that prioritize social and structural determinants of health to positively impact health outcomes.

“Our oath as clinicians is to first do no harm,” Dr. Riddle-Jones said. “When we practice race-based medicine, knowingly or unknowingly, we are performing harm on our beloved patients and communities. The time to end race-based medicine is past due. The time is now.”

A number of national and international regulatory agencies, including the National Institutes of Health, the U.S. Centers for Disease Control and Prevention, the Accreditation Council for Graduate Medical Education, the Association of American Medical Colleges, the American Medical Association, the National Kidney Foundation and the American Academy of Pediatrics have called for an end to race-based medical practices and many have published updated guidelines reflecting this change. More importantly, Dr. Opara said, medical students, trainees, patients and communities are demanding this change.

“Many clinicians are already on board for the change,” she added. “They just need support and guidance to de-adopt these established practices and adopt better ones.”

Dr. Opara said that it is important to note that the taskforce is not advocating for “color-blind” medicine or science as there are notable differences in health outcomes among racialized groups. Instead, “we are advocating for critical racism-conscious medicine, science, research, policy, education and practice that understands that the reason and context for those differences are as a result of racism and other inequitable and unjust systemic/structural factors and not as a result of mythical inherent biological differences. … Research that appropriately categorizes populations and explains the basis of population categorization and how they account for racialized differences decoupled from biology is what is called for. Eliminating iatrogenic (health care-induced) disparities in order to actualize health equity is what is urgently called for.”

For more information, contact Dr. Opara at innodim@wayne.edu or Dr. Riddle-Jones at lriddle@med.wayne.edu. A presentation on the task force is available at https://www.youtube.com/live/G8QYtRhlZAM?feature=share

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