Conflating Race and Genetics Among Newborns With Neonatal Abstinence Syndrome

Words matter

“…According to Drs Clark and French, the manuscript "perpetuates racism by offering genetics as an explanation for racial treatment differences among newborns with NOWS". 2 The conflation of race and biology is common in the literature and significant because it can result in "misdiagnoses and underdiagnoses". 2 The risk of differential treatment is not restricted to neonates with NOWS; in a recent study of children with appendicitis, black children received less treatment for pain, which suggests, according to the authors, "a different threshold for treatment".…”

“…2 The conflation of race and biology is common in the literature and significant because it can result in "misdiagnoses and underdiagnoses". 2 The risk of differential treatment is not restricted to neonates with NOWS; in a recent study of children with appendicitis, black children received less treatment for pain, which suggests, according to the authors, "a different threshold for treatment". 4 While standardization and validation testing of scoring tools will not single-handedly eliminate the risk of provider bias in clinical assessment, such efforts are important and must be a priority.…”

“…A recent commentary published in JAMA Pediatrics reported a major concern regarding the analysis and interpretation of race as a study variable. 2 Drs Clark and French’s commentary, “Conflating race and genetics among newborns with neonatal abstinence syndrome,” highlighted two articles on neonatal opioid withdrawal syndrome (NOWS) and described the implications of the conflation of race and genetics. Based on an analysis of two papers, one published in the Journal of Perinatology and another published in Pediatric Research , Drs Clark and French highlighted an important methodologic issue in clinical research: the distinction between treatment that newborns received to treat NOWS and the treatment that newborns required to treat NOWS.…”

“…According to Drs Clark and French, the manuscript “perpetuates racism by offering genetics as an explanation for racial treatment differences among newborns with NOWS”. 2 …”

“… 6 As highlighted by Drs Clark and French, authors frequently consider genetic factors in the context of racial or ethnic differences in health outcomes but a conceptual framework that attributes outcomes to genetics may perpetuate racism. 2 For example, if structural or systems-level factors are associated with the outcome of interest but not included in the study, attributing causality to race or ethnicity would be incorrect and potentially harmful. 7 Similarly, if racism is the cause or a contributor to health outcomes, attributing differences in outcomes to genetic factors, rather than racism, is conceptually wrong, harmful, and may divert attention from underlying social causes.…”