In a major shift toward health equity, Boston Medical Center has adopted race-neutral reference equations for pulmonary function testing (PFT), a move that challenges decades of race-based medical norms. As reported by Ruth Jessen Hickman, MD, and Ellen Strenger in The Cardiology Advisor, this transition reflects growing concern that race-specific equations “codify race and contribute to health disparities by norming differences in lung function.”
Historically, PFTs assumed Black individuals had inherently lower lung function than White individuals. This belief, rooted in 19th-century scientific racism, persisted into modern clinical practice. “Differences in lung function reflected the social conditions experienced by Black Americans,” noted W.E.B. DuBois, countering the notion of biological inferiority.
The American Thoracic Society now recommends race-neutral equations, citing evidence that race-based adjustments may mask disease and delay diagnosis. Dr. Aaron Baugh of UCSF explained, “I would rather have to explain to a patient about a falsely abnormal result than have a patient who really had disease that I didn’t catch.”
Race-neutral equations increase sensitivity for Black patients, potentially improving early detection. While some worry about reduced specificity, Dr. Meredith McCormack of Johns Hopkins emphasized the importance of context: “We should really dig in and pay more attention to additional ways of assessing.”
Boston Medical Center’s roadmap included software updates, staff education, and physician engagement. “No clinicians voiced a desire to maintain race-specific reference equations,” reported Dr. Amos Wu and colleagues.
See: “Race-Neutral Pulmonary Function Testing: The Long Journey Toward Health Equity” (October 10, 2025)
