Evidence-Based Medicine? Why Physician Guidelines Are Ending Race-Based Clinical Practices
Insights on health disparity should help close gaps in health, not widen them.
The practice of medicine is constantly transforming. As new real-world evidence emerges, clinical guidelines must be reassessed. These guidelines are essential to advance diagnostic protocols, apply novel treatments and therapies, and deliver improved outcomes for an ever-evolving patient population. Amid rigorous, mounting research on the impact of health disparities, it’s critical to evaluate these clinical guidelines to achieve health equity.
To that end, the American Academy of Pediatrics (AAP) recently pre-published a call to action to eliminate all race-based practice guidelines in pediatric medicine. In their commitment to reevaluate race-based guidelines, the AAP stated that they seek to “end the practice of using race as a proxy for biology or genetics in all education events and literature.” The group urged others to do the same and echoed the intention to move toward race-conscious medicine, which applies the understanding of race as a social construct that influences disease risk and outcomes associated with a patient’s treatment plans.
Racist roots, shaky evidence
Race-based clinical practice guidelines have often been shown to stem from racist assumptions rather than from robust evidence. We now know that broad racial categories — which have been used as crude proxies for clinical assumptions — do not provide accurate biological or genetic information on which medical inferences can be made. Such guidelines run the risk of reinforcing the same disparities they claim to correct, yet there are many places in medicine where they continue to perpetuate an unequal disease burden on people of color.
Chronic Kidney Disease (CKD) is one example. As shown in Komodo’s recent analysis with BLKHLTH, CKD patients face significant disparities in disease diagnosis, staging, and outcomes. As outlined in the AAP’s statement, race-specific guidelines have previously been used in CKD diagnostic staging based on an unsubstantiated theory of differences in muscle mass between Black and White patients. For instance, due to delays in referral to specialty care or transplantation, the resulting treatment differences create disparate outcomes for Black patients with advanced disease. We now know that disease staging is more accurate when race is omitted as a factor. The AAP statement outlines similar issues that have been highlighted in race-based practices for the assessment of UTIs, lung function, atherosclerotic cardiovascular disease, and vaginal birth after cesarean.
Where it matters: using race and ethnicity insights to improve health equity
Race may be a poor proxy for biological or social determinants of health, and it’s possible that in time we will develop and validate variables that do a better job of pointing to differences in health and outcomes. However, as the adage goes, you can’t fix what you can’t measure. Insights about the different healthcare experiences of individuals across diverse racial and ethnic groups help our health system leaders to identify, provide evidence for, and address the racial inequities endemic to the U.S. healthcare system. Race-conscious algorithms, for example, can keep White-preferencing biases in check and improve our understanding of disparities while identifying targeted opportunities to address them. This data helps us improve racial and ethnic diversity and representation in clinical trials, supporting the development of therapeutics that work for more of the population. Solutions that can provide the most comprehensive patient view possible can deepen our capacity for nuance in a way that helps us expose what is obfuscated, track inclusion and equality, and close the gaps.
Komodo Health’s commitment
Actionable insights are key in our collaborative work to end the inequities that overburden patients of color and reform the outdated systems that compound racial health disparities. Komodo Health is committed to identifying gaps in care – and working to close them – by providing the insights and evidence needed to truly understand the divergence in patient experiences. Clinicians, researchers, policymakers, and health agencies continue to need evidence that elucidates the social and systemic factors that drive racial disparities in health. We’re committed to the journey in our mission to reduce the global burden of disease — for everyone.