Race-based medicine in the point-of-care clinical resource UpToDate: A systematic content analysis

Cerdeña, Jessica P.; Asabor, Emmanuella Ngozi; Plaisime, Marie V.

doi:10.1016/j.eclinm.2022.101581

Cited by 9 publications

(5 citation statements)

References 43 publications

(61 reference statements)

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“…We concentrated on a narrow subset of the extensive clinical usage of race. Beyond race-based risk calculators, race-based reference ranges for laboratory test results, and race-based guidelines for medications, race is used widely to distinguish among variations in physiological processes, genetics, behavior, and cultural characteristics (29). In the future, we intend to add usages of race outside of calculators and medication guidelines.…”

Section: Discussionmentioning

confidence: 99%

Clinical Algorithms with Race: An Online Database

Visweswaran

Sadhu

Morris

et al. 2023

Preprint

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Some clinical algorithms incorporate a person's race, ethnicity, or both as an input variable or predictor in determining diagnoses, prognoses, treatment plans, or risk assessments. Inappropriate use of race and ethnicity in clinical algorithms at the point of care may exacerbate health disparities and promote harmful practices of race-based medicine. This article describes a comprehensive search of online resources, the scientific literature, and the FDA Drug Label Information that uncovered 39 race-based risk calculators, six laboratory test results with race-based reference ranges, one race-based therapy recommendation, and 15 medications with race-based recommendations. These clinical algorithms based on race are freely accessible through an online database. This resource aims to raise awareness about the use of race-based clinical algorithms and track the progress made toward eradicating the inappropriate use of race. The database will be actively updated to include clinical algorithms based on race that were previously omitted, along with additional characteristics of these algorithms.

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Section: Discussionmentioning

confidence: 99%

Clinical Algorithms with Race: An Online Database

Visweswaran

Sadhu

Morris

et al. 2023

Preprint

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“…The guideline recommends labor induction for White women at 41 weeks of gestation. Clinicians who argued against the recommendation noted that race has been used as a proxy for social and medical factors (43). Again, in this case, there is an implicit presumption that race confers immutable characteristics.…”

Section: Policy Implications and Future Directionsmentioning

confidence: 99%

“…The examples of VBAC and NICE guidelines’ scrutiny of the use of race illustrate a critical need to reexamine the institutionalization of racism in medicine. A recent systematic analysis of UpToDate articles showed that for articles that mention race, biologization of race occurred in 93.3% of the articles, and there were discussions of inherent racial differences without context ( 44 ). Furthermore, 32.7% of the articles racialized biomedical research and clinical practice.…”

Section: Policy Implications and Future Directionsmentioning

confidence: 99%

Reexamining the use of race in medical algorithms: the maternal health calculator debate

Kimani

2024

Front. Public Health

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The concept of race is prevalent in medical, nursing, and public health literature. Clinicians often incorporate race into diagnostics, prognostic tools, and treatment guidelines. An example is the recently heavily debated use of race and ethnicity in the Vaginal Birth After Cesarean (VBAC) calculator. In this case, the critics argued that the use of race in this calculator implied that race confers immutable characteristics that affect the ability of women to give birth vaginally after a c-section. This debate is co-occurring as research continues to highlight the racial disparities in health outcomes, such as high maternal mortality among Black women compared to other racial groups in the United States. As the healthcare system contemplates the necessity of utilizing race—a social and political construct, to monitor health outcomes, it has sparked more questions about incorporating race into clinical algorithms, including pulmonary tests, kidney function tests, pharmacotherapies, and genetic testing. This paper critically examines the argument against the race-based Vaginal Birth After Cesarean (VBAC) calculator, shedding light on its implications. Moreover, it delves into the detrimental effects of normalizing race as a biological variable, which hinders progress in improving health outcomes and equity.

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“…However, while there is increased recognition that race and ethnicity are socially constructed, in practice they continue to be conflated with physiological and even behavioral, cultural, or other social differences in health. For example, in a content analysis of UpToDate, a point-of-care software that aggregates clinical practice guidelines, Cerdeña et al (2022) found that race was consistently biologized or treated as a risk factor for behavioral difference across racial and ethnic groups.…”

Section: Bounded Justice As a Conceptual Framework: Algorithmic (Un)f...mentioning

confidence: 99%

Clinical algorithms, racism, and “fairness” in healthcare: A case of bounded justice

El-Azab,

Nong

2023

Big Data & Society

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To date, attempts to address racially discriminatory clinical algorithms have largely focused on fairness and the development of models that “do no harm.” While the push for fairness is rooted in a desire to avoid or ameliorate health disparities, it generally neglects the role of racism in shaping health outcomes and does little to repair harm to patients. These limitations necessitate reconceptualizing how clinical algorithms should be designed and employed in pursuit of racial justice and health equity. A useful lens for this work is bounded justice, a concept and research analytic proposed by Melissa Creary to guide multidisciplinary health equity interventions. We describe how bounded justice offers a lens for (1) articulating the deep injustices embedded in the datasets, methodologies, and sociotechnical infrastructure underlying design and implementation of clinical algorithms and (2) envisioning how these algorithms can be redesigned to contribute to larger efforts that not only address current inequities, but to redress the historical mistreatment of communities of color by biomedical institutions. Thus, the aim of this article is two-fold. First, we apply the bounded justice analytic to fairness and clinical algorithms by describing structural constraints on health equity efforts such as medical device regulatory frameworks, race-based medicine, and racism in data. We then reimagine how clinical algorithms could function as a reparative technology to support justice and empower patients in the healthcare system.

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Race-based medicine in the point-of-care clinical resource UpToDate: A systematic content analysis

Cited by 9 publications

References 43 publications

Clinical Algorithms with Race: An Online Database

Clinical Algorithms with Race: An Online Database

Reexamining the use of race in medical algorithms: the maternal health calculator debate

Clinical algorithms, racism, and “fairness” in healthcare: A case of bounded justice

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