Achieving equity through science and integrity: dismantling race-based medicine

Wright, Joseph L.; Freed, Gary L.; Hendricks-Muñoz, Karen D.; Jarvis, James N.; Maldonado, Yvonne A.; Raphael, Jean L.; Schnadower, David; Sims, Brian; Bogue, Clifford W.; Leonard, Mary B.; Coyne-Beasley, Tamera D.

doi:10.1038/s41390-022-02041-8

Comment
Published: 05 April 2022

Achieving equity through science and integrity: dismantling race-based medicine

Joseph L. Wright^1,2,
Gary L. Freed^3,4,
Karen D. Hendricks-Muñoz⁵,
James N. Jarvis⁶,
Yvonne A. Maldonado^7,8,
Jean L. Raphael⁹,
David Schnadower¹⁰,
Brian Sims¹¹,
Clifford W. Bogue¹²,
Mary B. Leonard^7,13,
Tamera D. Coyne-Beasley^11,14 &
Committee on Diversity, Inclusion and Equity on behalf of the American Pediatric Society

Pediatric Research volume 91, pages 1641–1644 (2022)Cite this article

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This year the American Pediatric Society (APS) awarded the inaugural Dr. David G. Nichols Health Equity Award at the annual meeting of the Pediatric Academic Societies¹. Endowed by the American Board of Pediatrics (ABP) Foundation and administered through the APS, the award recognizes the far-reaching impact of Dr. Nichols’ outstanding contributions to advancing child and adolescent health and well-being, particularly in the domain of equity². During his tenure as President and Chief Executive Officer of the ABP, Dr. Nichols catalyzed collaborative quality improvement networks and fostered partnerships with patients and families to improve health outcomes and address health disparities³. Fittingly, Dr. Nichols was honored as the award’s inaugural recipient. In his address to the assembled body at the APS Presidential Plenary, Dr. Nichols fervently challenged us all to strive toward a 10-year goal of eliminating disparities in the delivery of health care to children and adolescents. A necessary tactic in eliminating health care disparities will require discarding the inappropriate use of race as a proxy for genetic variation in risk adjustment that, for this discussion, we term as race-based medicine. With that charge in mind, we offer this commentary emphasizing the vital importance of science and integrity in unraveling the structural and systemic inequities that have contributed to pervasive disparities in care and outcomes.

Development of clinical algorithms and practice guidelines that drive the delivery of high-quality, safe and equitable clinical care should always be built upon rigorous, evidence-informed processes⁴. Acknowledging that social determinants often contribute to the deleterious health outcomes disproportionately borne by communities of color is a critical operational framework. There has been much discourse around responsible incorporation of the social determinants of health (SDOH) as part of the research backbone upon which guidelines are built and the necessary science and integrity required therein^5,6. Despite the growing scientific acceptance of the false equivalency of race as a proxy for genetic variation, there continue to be numerous examples throughout the twenty-first-century practice of medicine in which the attempted application of race correction or race adjustment factors manifest in differential approaches to disease management⁷. Race is a social construct not a biologic category. Its use as a direct proxy for factors such as genetic ancestry and epigenetics is scientifically flawed⁸. Conflating the limiting phenotype of race assignment with valid measures of SDOH, including the effects of bias and discrimination, illuminate the inequities in care experienced by people of color in the clinical arena. Furthermore, given what we now more completely understand about the physiologic impacts of racism^9,10, it is irresponsible not to incorporate all available evidence-informed armamentarium to most accurately formulate practice guidelines. It is, therefore, incumbent upon the academic community, ascribing to the scientific integrity principles of objectivity, insulation from bias and engendering public trust¹¹ to recognize, dismantle and replace practice guidelines that use race as an independent risk adjusting variable.

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Acknowledgements

We are grateful to Dr David G. Nichols for his review of the manuscript and for his inspiration and untiring leadership.

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Authors and Affiliations

Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
Joseph L. Wright
Department of Health Policy and Management, University of Maryland School of Public Health, College Park, MD, USA
Joseph L. Wright
Department of Pediatrics, University of Michigan School of Medicine, Ann Arbor, MI, USA
Gary L. Freed
Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
Gary L. Freed
Department of Pediatrics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
Karen D. Hendricks-Muñoz
Department of Pediatrics, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA
James N. Jarvis
Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
Yvonne A. Maldonado & Mary B. Leonard
Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, CA, USA
Yvonne A. Maldonado
Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
Jean L. Raphael
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
David Schnadower
Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
Brian Sims & Tamera D. Coyne-Beasley
Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
Clifford W. Bogue
Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
Mary B. Leonard
Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
Tamera D. Coyne-Beasley
Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD, USA
Joseph L. Wright
Department of Health Policy and Management, University of Maryland School of Public Health, College Park, MD, USA
Joseph L. Wright
Department of Pediatrics, University of Michigan School of Medicine, Ann Arbor, MI, USA
Gary L. Freed
Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
Gary L. Freed
Department of Pediatrics, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
Karen D. Hendricks-Muñoz
Department of Pediatrics, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA
James N. Jarvis
Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
Yvonne A. Maldonado & Mary B. Leonard
Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, CA, USA
Yvonne A. Maldonado
Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
Jean L. Raphael
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
David Schnadower
Department of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
Brian Sims & Tamera D. Coyne-Beasley
Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
Clifford W. Bogue
Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
Mary B. Leonard
Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
Tamera D. Coyne-Beasley

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Joseph L. Wright
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Gary L. Freed
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Karen D. Hendricks-Muñoz
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James N. Jarvis
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Jean L. Raphael
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Brian Sims
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Consortia

Committee on Diversity, Inclusion and Equity on behalf of the American Pediatric Society

Joseph L. Wright
, Gary L. Freed
, Karen D. Hendricks-Muñoz
, James N. Jarvis
, Yvonne A. Maldonado
, Jean L. Raphael
, David Schnadower
, Brian Sims
, Clifford W. Bogue
, Mary B. Leonard
& Tamera D. Coyne-Beasley

Contributions

J.L.W. and T.D.C.-B. developed the idea for the manuscript. J.L.W. and T.D.C.-B. engaged the other authors in participating in the writing process. The remaining authors provided critical input into editing and revising of the manuscript.

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Correspondence to Joseph L. Wright.

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Wright, J.L., Freed, G.L., Hendricks-Muñoz, K.D. et al. Achieving equity through science and integrity: dismantling race-based medicine. Pediatr Res 91, 1641–1644 (2022). https://doi.org/10.1038/s41390-022-02041-8

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Received: 10 March 2022
Accepted: 13 March 2022
Published: 05 April 2022
Issue date: June 2022
DOI: https://doi.org/10.1038/s41390-022-02041-8

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Race, Ethnicity, and Mortality Following Major Osteoporotic Fracture: Results from the Women’s Health Initiative Study

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