Clinical algorithms that use race to guide patient care are under scrutiny as the medical community grapples with embedded bias in healthcare. A STAT investigation reveals that these race-based tools, used on millions of patients annually, are deeply rooted in medical practice and proving difficult to change.
The controversy came to a head after the murder of George Floyd in 2020, sparking a racial justice movement that reached into medicine. Clinicians and researchers began questioning the ethical implications of considering people of different races as biologically different in medical decision-making.
One example is the urinary tract infection (UTI) risk calculator used in pediatrics. For years, the tool subtracted points for Black children, potentially leading to missed diagnoses and long-term kidney damage in Black girls. Dr. Alexandra Epee-Bounya, a pediatrician at Boston Children’s Hospital, challenged this practice, leading to the removal of race from several algorithms at her institution.
While some medical societies have taken steps to revise their guidelines, progress is inconsistent across specialties. The American Academy of Pediatrics retired its race-based UTI guideline, but other societies resist change, arguing that race remains a powerful predictor of disease risk.
The debate highlights a broader struggle in healthcare to reassess scientific and ethical assumptions about race. As medicine seeks to balance predictive accuracy with racial justice, the path forward remains unclear. Without strong leadership and funding, advocates worry that the momentum for change may stall, leaving patients vulnerable to the harmful effects of biased algorithms.
“Doctors use problematic race-based algorithms to guide care every day. Why are they so hard to change?”
Published: September 3, 2024
URL: https://www.statnews.com/2024/09/03/embedded-bias-investigation-health-equity-clinical-algorithms
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Clip source: Embedded Bias: STAT investigates use of race in clinical algorithms
Race-Based Medical Algorithms Face Scrutiny, Slow Reform
Efforts to remove race from medical decision-making tools are stalling despite recognition of potential harm to patients of color. A STAT investigation found that race-based algorithms, used by doctors to guide care decisions for millions of patients annually, remain widespread in medicine. While some progress has been made in revising a handful of national calculators, many tools that may disadvantage minority patients have yet to be changed or reexamined.
The issue gained prominence after George Floyd’s murder in 2020, sparking calls to eliminate clinical tools perpetuating bias. Examples include a kidney health calculator that delayed transplants for Black patients and UTI guidelines that may have led to missed infections in Black girls. However, reform efforts now face headwinds, including pu
shback from some specialties reluctant to remove race from predictive tools.
Leadership and accountability for addressing embedded biases are lacking. Much of the work is being driven by medical trainees through grassroots efforts. While the Biden administration has issued rules prohibiting discrimination through clinical decision support tools, advocates are skeptical of their impact. Medical societies and researchers are grappling with how to revise algorithms without compromising predictive accuracy.
Some specialties have successfully updated tools by identifying non-racial factors that can replace race in calculations. However, the scale of the problem is daunting, with researchers identifying at least 40 algorithms still using race adjustments at one institution alone. Health equity advocates are calling for more leadership, funding and a coordinated national approach to make meaningful progress in rooting out racial bias from clinical tools across medicine.
See “Doctors use problematic race-based algorithms to guide care every day. Why are they so hard to change?” (September 3, 2024)
