Quick Read:
- Black History Month begins today with the national theme of Black resistance.
- Race is a social and political construct, not a biological or genetic factor.
- UW Medicine is working to eliminate the harm of race-based medicine on Black and other non-white patients.
Our national observance of Black History Month, which begins today, recognizes the role of Black Resistance in the long fight for justice against racism.
In selecting this theme, the Association for the Study of African American Life and History notes that Black resistance took place in all sectors of American society, including healthcare: “Black medical professionals worked with others to establish nursing schools, hospitals, and clinics in order to provide spaces for Black people to get quality health care, which they often did (and do) not receive at mainstream medical institutions.”
At UW Medicine, we recognize that one of the barriers to quality care in mainstream health systems, including ours, has been the practice of race-based medicine. This notion dates back to the founding of our country and chattel slavery, and it was often used erroneously and maliciously to assert racial superiority of white people.
In the mid-1800s, for instance, Samuel Cartwright, a prominent physician and owner of enslaved persons, conducted a study to compare lung capacity between Black enslaved people and white people. Using the recently invented spirometer, he found a 20% difference and concluded that Black people were born with deficient lungs rather than recognizing how lung health could be affected by the dire living and working conditions of chattel slavery found on Southern plantations.
While this historical example is easy to discredit and dismiss, race correction still exists in the spirometer used today. Often without necessary critique, our medical systems continue to use spirometry and other clinical tools for risk assessment and recommendations that have been adjusted for a person’s race. The following examples illustrate the scope of the problem but do not represent all the tools that currently include a racial bias:
- The formula to interpret a common lab test that uses creatinine levels to assess kidney function, the estimated Glomerular Filtration Rate (eGFR), was modified in 1999 to include a race correction that gave Black patients higher scores than white patients with the same lab results. As a result of this artificially inflated score, Black patients have experienced delays in treatment that allowed their kidney disease to worsen. They have also been less likely to be deemed eligible for kidney transplants than white patients with similar kidney health.
- For many years, our tool for assessing the risk of vaginal birth after cesarean (VBAC) assumed a lower likelihood of success for Black and Latina people based on previous outcomes. What we didn’t know is that these outcomes also correlated with non-racial factors such as marital status and type of insurance. For this reason, the racial component of the tool likely resulted in unnecessary cesarean sections and surgical complications for many people.
- The pulse oximeter is a biomedical fingertip device used to measure oxygen in the blood. While this device is widely used in our hospitals and clinics, a study of patients treated for COVID-19 shows that it is often inaccurate when measuring oxygen levels for patients with darker skin tones and, therefore, it overestimates oxygen levels among those patients compared with light skin patients, who are overwhelmingly white. As a result of this miscalculation, these patients may have been subject to delays in recognizing the severity of their condition or their eligibility for certain therapies.
Call to Action: In recent years, our general understanding of race has changed. We view it now as a political and social construct. As such, it is different from our personal biology, genetics or family history, and it should be excluded from our clinical tools for risk assessment and treatment recommendations.
To the credit of our Department of Laboratory Medicine, Office of Healthcare Equity, and in response to advocacy by our medical students, we were one of the first health systems in the country to change our tests for kidney function when the racial component of the standard formula was called into question. Similarly, we no longer use a person’s race to determine their risk of vaginal birth after cesarean section. However, there are many other clinical algorithms that we use that insert race as a biologic variable. UW Medicine is actively working to develop ways to identify these equations and address them in clinical medicine.
Other solutions will take longer and involve third parties. For instance, while we need to be aware of the bias in pulse oximeter scores and insist on corrections, it will require action by the manufacturers to change their products. As a result, we welcome the current review of pulse oximeters by the Food & Drug Administration.
As we reflect this month on the history of being Black in this country, we encourage you to take a deeper look at your assumptions about race. Thank you, also, for participating in our work to create a future where race-based medicine no longer exists at UW Medicine.
Sincerely,
Timothy H. Dellit, MD
Interim CEO, UW Medicine
Interim Executive Vice President for Medical Affairs and
Interim Dean of the School of Medicine,
University of Washington
Paula L. Houston, EdD
Chief Equity Officer
Office of Healthcare Equity, UW Medicine
Associate Vice President for Medical Affairs
University of Washington
Bessie A. Young, MD
Vice Dean for Equity, Diversity and Inclusion, Office of Healthcare Equity, UW Medicine
Professor of Medicine, Division of Nephrology, Department of Medicine
University of Washington
Edwin G. Lindo
Assistant Dean for Social & Health Justice
Office of Healthcare Equity, UW Medicine
Cynthia Dold
Interim President, UW Medicine Hospitals & Clinics
Interim Vice President for Medical Affairs,
University of Washington
Jacqueline Cabe
Chief Financial Officer, UW Medicine
Vice President for Medical Affairs,
University of Washington
Ruth Mahan
Chief Business Officer, UW Medicine
Chief of Staff, UW Medicine
Vice President for Medical Affairs,
University of Washington
Anneliese Schleyer, MD
Interim Chief Medical Officer, UW Medicine
Interim Vice President for Medical Affairs,
University of Washington
Don Theophilus
Chief Advancement Officer, UW Medicine
Vice President for Medical Affairs,
University of Washington
Cindy Hecker
Chief Executive Officer
UW Medical Center
Sommer Kleweno Walley
Chief Executive Officer
Harborview Medical Center
Jeannine Erickson Grinnell
Chief Executive Officer
Valley Medical Center
Anthony Dorsch
Executive Director
UW Physicians
Debra Gussin
Executive Director, UW Neighborhood Clinics
Associate Vice President, Primary Care and Population Health
UW Medicine
Jeff Richey
Executive Director
Airlift Northwest
