How Medicine's Dangerous Assumption Harms Patients
When a doctor calculates your kidney function, estimates your heart disease risk, or interprets your breathing tests, you might assume these medical assessments are based on objective science. Yet for decades, many clinical tools have adjusted their results based on one controversial factor: your race. These adjustments appear in calculators for kidney function, cardiovascular risk, vaginal birth after cesarean section, and even osteoporosis screening 1 . The underlying assumption? That race reflects meaningful biological differences that should influence medical diagnosis and treatment.
The American Academy of Family Physicians states unequivocally that race "does not have a biologic definition, but rather a political and social one that is fluid and independent of science" 1 .
A growing movement in medicine is challenging these practices, revealing that race is a social construct being misused as a biological one. This distinction matters because when medicine treats race as biology, it can lead to misdiagnosis, delayed treatment, and perpetuation of health disparities that harm already marginalized communities.
Modern genetic research has consistently demonstrated that there is more genetic variation within racial groups than between them 1 . The Human Genome Project found no genetic evidence supporting distinct racial groups 9 .
The problem lies in confusing correlation with causation. While health disparities between racial groups are very real, the causes are primarily social and environmental rather than genetic.
The spirometer, a device for measuring lung capacity, was adapted in the mid-19th century by Samuel Cartwright, a plantation physician who used it to compare lung function between enslaved Black Americans and free White Americans 2 .
Cartwright incorrectly interpreted the 20% lower average lung function he observed in Black individuals as evidence of biological inferiority rather than considering social and environmental factors 2 .
Visualization showing greater genetic variation within populations than between them
"Race-based approaches to medicine reinforce a system that assumes biologic causes of health inequities, which can lead us to ignore the social determinants of health that are the true drivers for racial disparities in health outcomes" 1 .
| Clinical Area | Race-Based Adjustment | Consequence | Affected Population |
|---|---|---|---|
| Kidney Function | Race-based eGFR equations assign higher kidney function to Black patients 1 | Underdiagnosis of chronic kidney disease, delayed specialist referral, reduced transplant eligibility 1 2 | Black patients |
| Cardiovascular Risk | ASCVD calculator assigns higher risk to Black patients independent of health factors 1 | Potentially excessive preventive treatments without evidence-based justification 1 | Black patients |
| Vaginal Birth After C-Section | Predicts lower success rate for Black patients 1 | Discouragement from attempting vaginal birth, leading to unnecessary surgeries 1 | Black patients |
| Osteoporosis | FRAX tool assigns lower fracture risk to non-White women 1 | Reduced screening and treatment, higher disability and mortality after fractures 1 | Black women |
One of the most well-documented examples of harmful race-based medicine involves estimated glomerular filtration rate (eGFR) equations, which measure kidney function. These equations traditionally included a "race correction factor" that assigned approximately 16% higher kidney function to Black patients with the same creatinine levels as non-Black patients 2 .
This adjustment had dangerous consequences. By artificially inflating kidney function values for Black patients, the race-based equation made them appear healthier than they were, delaying diagnosis of chronic kidney disease and referral to nephrologists 1 . It also affected eligibility for kidney transplants, as patients must reach a certain level of kidney failure to qualify for waiting lists 2 .
Higher kidney function assigned to Black patients with race-based eGFR
Comparison of kidney function assessment with and without race correction
Recent research provides compelling evidence that removing race corrections improves diagnostic accuracy. A study published in JAMA Network Open compared two approaches to detecting asthma symptoms in children: the Global Lung Initiative's 2012 equation that adjusted for race, and a new race-neutral equation 3 .
The researchers analyzed data from children with asthma or asthma symptoms, comparing how each equation classified lung function impairment. The results were striking: the race-neutral equation identified two to four times as many Black children with reduced lung function compared to the race-based equation 3 .
| Metric | Race-Based Equation | Race-Neutral Equation | Improvement |
|---|---|---|---|
| Detection of reduced lung function in Black children | Baseline | 2-4 times more cases identified | Significant improvement in early detection |
| Identification of children needing intervention | Limited detection | Enhanced detection | More timely treatment |
| Potential to reduce disparities | Perpetuates underdiagnosis | Addresses diagnostic gaps | Moves toward equity |
Asthma disproportionately affects Black children in the United States, with higher rates of emergency department visits and hospitalizations. If diagnostic tools are systematically underestimating disease severity in this population, it could contribute to these disparities. The race-neutral approach enabled earlier detection of impaired lung function, potentially allowing for interventions that might prevent asthma exacerbations and improve long-term outcomes 3 .
Comparison of asthma detection rates using race-based vs. race-neutral equations
The alternative to race-based medicine isn't ignoring race altogether—it's practicing race-conscious medicine that recognizes race as a social construct with real health consequences, while rejecting it as a biological category 9 . This approach investigates and addresses the true drivers of health disparities: structural racism, social determinants of health, and environmental factors.
Race-conscious medicine acknowledges that racial health disparities are real while correctly attributing them to unequal social conditions rather than innate biological differences. It focuses on understanding how racism, not race, affects health outcomes 9 .
Organizations like the American Thoracic Society and European Respiratory Society have endorsed race-neutral equations for pulmonary function testing 2 .
Medical journals are increasingly requiring researchers to justify their use of race and ethnicity variables 3 .
Electronic health record systems are working to integrate race-neutral clinical calculators, though implementation varies across systems 3 .
Research institutions are developing new guidelines for appropriate use of race and ethnicity in biomedical research .
Race shouldn't be used as a proxy for your genetics or health predispositions 3 .
You have the right to ask why race is being considered in your diagnosis or treatment plan.
Many race-based adjustments are being removed from clinical practice, but change takes time.
Your neighborhood, stress, diet, and healthcare access significantly influence health outcomes.
The fallacies and dangers of race-based medicine represent both a scientific and ethical imperative for change. By confusing social constructs with biology, medicine has perpetuated harmful stereotypes and worsened health disparities. The legacy of these practices—from spirometry to kidney function estimation—reveals how easily bias can be embedded in seemingly objective tools.
The good news is that medicine is reckoning with this legacy. The shift toward race-conscious medicine that addresses true drivers of health disparities represents a more scientifically accurate and ethically sound path forward.
This transformation requires changes at every level—from medical education and research practices to clinical algorithms and electronic health records. But the goal is clear: a medical system that sees patients as individuals with unique biological, social, and environmental influences on their health, rather than representatives of racial categories with presumed biological differences. Such a system wouldn't be colorblind, but would finally see all its patients clearly.