Understanding Race Norming in Medical Treatment
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Chapter 1: The Controversy Begins
The conversation ignited with a seemingly innocent tweet from the British National Health Service (NHS) requesting blood donations. The phrasing, however, sparked outrage online. The NHS's call for "Black blood" led to a torrent of criticism, with many asserting that race is a social construct that does not determine blood type. The backlash was fierce, and the NHS faced potential fallout from this misstep.
In response, the NHS clarified their position, stating, "Everyone's blood IS NOT the same, so you can stop calling us racist." While their explanation was logical, it’s understandable why people reacted so strongly. After all, blood appears uniform in color and texture, yet the reality is far more nuanced.
Blood is not as homogenous as it seems. Each person's blood comprises trillions of red blood cells adorned with unique proteins and sugars. These sugars categorize blood into types A, B, AB, or O, and further distinctions can arise based on the presence of the Rhesus (Rh) antigen. Delving deeper reveals that over 300 antigens can trigger immune responses, complicating the matching process between donors and recipients.
Thus, blood banks categorize blood by race to expedite matching. For instance, Black individuals are significantly more likely to possess a rare blood subtype associated with sickle cell disease.
However, the implications of race in medicine extend beyond blood donation. The practice known as “race norming” or “race correction” raises significant concerns. In this approach, physicians incorporate a patient’s race into treatment algorithms, inadvertently skewing care based on racial assumptions.
For example, if a patient arrives at the emergency room with chest pain, cardiologists may apply a predictive tool called the Get with the Guidelines®–Heart Failure Risk Score. In this case, being classified as “nonblack” results in a three-point deduction from the score, potentially trivializing the urgency of the situation.
This issue is not isolated to cardiology; it permeates various medical fields. When assessing kidney function through the Estimated Glomerular Filtration Rate (eGFR), Black patients are often given inflated values that suggest a lower risk of kidney failure, based on the assumption that they possess higher serum creatinine levels. This assumption stems from dubious theories about muscle mass, perpetuating harmful stereotypes rather than reflecting medical accuracy.
Section 1.1: The Myth of Muscle Mass
The notion that Black individuals are inherently more muscular than their white counterparts is not only scientifically unfounded but also reinforces damaging stereotypes. A study revealed that people often perceive Black individuals as more muscular, even when the actual muscle mass is identical. This skewed perception could lead to dangerous assumptions in medical settings.
Section 1.2: Consequences of Race Norming
The most glaring instance of race norming arose from a class-action lawsuit against the NFL. For years, the league employed race-based evaluations in concussion settlements, which resulted in Black players receiving lower compensation due to a lower assessed risk for cognitive impairment. Following legal action, the NFL was compelled to amend its assessment processes, highlighting the dire need for change in medical evaluations as well.
Chapter 2: The Historical Context
The roots of racial discrimination in medicine extend deep into history. During WWII, blood banks were segregated, labeling blood types based on race. This misguided approach was not scientifically driven. Historical figures like Dr. Samuel Cartwright and Thomas Jefferson propagated harmful beliefs regarding racial inferiority, reinforcing the notion that physical differences dictated medical treatment.
As a response to growing awareness, many medical professionals are now challenging the validity of race as a criterion for treatment. With DNA studies revealing that 99.9% of human DNA is identical, the reliance on race is increasingly viewed as outdated and scientifically inaccurate.
No matter the historical context, the pressing question remains: does race or the biases it entails dictate a patient's medical care?
Chapter 3: Moving Towards Precision Medicine
The future of healthcare lies in precision medicine, which aims to customize treatment based on an individual’s genetic, environmental, and lifestyle factors. However, the inclusion of race in these calculations can lead to significant oversights, particularly for patients of mixed heritage. The traditional approach of categorizing patients based solely on racial identity is not only limiting but can also compromise the quality of care received.
Fortunately, some progress is being made. The VBAC calculator, which previously incorporated race to predict the likelihood of a successful vaginal birth, has removed race from its metrics after advocacy from healthcare professionals. This change should serve as a model for other medical fields, including cardiology and surgery.
Ultimately, patients must advocate for themselves and seek healthcare providers who prioritize individual circumstances over statistical norms. While blood may be uniquely different, equitable medical care should be a universal standard.