High-tech wizards may be pushing medicine into a brave new world where important medical decisions rely on supposedly data-driven findings that also may be rooted in an old malignancy: discrimination against black patients.
A new study published in the New England Journal of Medicine warns that race-based tools and formulas, algorithms aimed to assist doctors in speeding up their diagnosis and treatment in such areas as heart disease, cancer, and kidney and maternity care, improperly steer blacks away from therapies commonly given to whites without sound reasons, the New York Times reported:
“The tools are often digital calculators on web sites of medical organizations or — in the case of assessing kidney function — actually built into the tools commercial labs use to calculate normal values of blood tests. They assess risk and potential outcomes based on formulas derived from population studies and modeling that looked for variables associated with different outcomes. ‘These tests are woven into the fabric of medicine,’ said Dr. David Jones, the paper’s senior author, a Harvard historian who also teaches ethics to medical students. ‘Despite mounting evidence that race is not a reliable proxy for genetic difference, the belief that it is has become embedded, sometimes insidiously, within medical practice,’ he wrote.”
Researchers took care to emphasize the potentially negative outcomes for black patients due to the problematic algorithms, and they do not assert discriminatory intent by colleagues. They cite nine instances of concern, the New York Times reported, including with:
- Labs’ routine use of a kidney function calculator that adjusts filtration rates for black patients. They, with the tweaks, end up with slightly better rates than whites, which can be enough to make those with borderline rates ineligible to be on a kidney transplant list.
- An online osteoporosis risk calculator endorsed by the National Osteoporosis Foundation, among others. It calculates fracture risks differently for black and white women. “Black women end up having a score that makes them less likely to be prescribed osteoporosis medication than white women who are similar in other respects.”
- An obstetric calculator based on observational data. It concludes that black women who had a previous cesarean birth are less likely to have a successful vaginal birth in a subsequent pregnancy.
The newspaper digs into the kidney tool, reporting that researchers question the studies on which it bases and puts out its findings. The studies, particularly regarding black patients, were overtaken by later works. The tool needs updating, and this is not easy. Clinicians who have pointed out the flaw have gotten only one major hospital to disregard or use the tool in a different way.
That brings up a sore point in medicine, the experts noted — views and practices, including those based in race, can find too easy acceptance and then they become too deeply entrenched. Medicine, like many institutions these days, finds itself under fire for failing to root out racism.
Christopher D. E. Willoughby, a scholar-in-residence in the Lapidus Center for the Historical Analysis of Transatlantic Slavery at the Schomburg Center for Research in Black Culture in New York, has written in the Washington Post recently on this nightmare:
“The consequences of … medical racism are profound. First, in a 2016 study of medical students at the University of Virginia, many students said they believed that African Americans feel less pain than other patients, which could explain why black patients’ pain often goes under-treated. Second, belief in race-based medicine prevents doctors from searching for social causes of racial health disparities.”
In my practice, I see not only the harms that patients suffer while seeking medical care, but also their struggles to access and afford safe, efficient, and excellent medical care. This has become an ordeal due to the skyrocketing cost, uncertainty, and complexity of therapies and prescription drugs, too many of which turn out to be dangerous drugs.
As patients try to navigate the thicket of medical care now, the last thing they need is to be burdened by old, damaging prejudices. Health care must be a right, not a privilege, and it cannot be better for some over others, especially if important treatment decisions are inappropriately driven by race.
With the rise of data, computing, software, artificial intelligence, and algorithms in so many fields, including medicine, it is crucial that experts keep their humanity at the fore in developing the tools of tomorrow. Our devices, alas, also can reflect our human failings, including cognitive biases — including the extreme of racial prejudice — that mess up our thinking. If these get into complex systems like AI, they can cause real ned, as a researcher at the RAND think tank reported:
“AI systems are often only as intelligent — and as fair— as the data used to train them. They use the patterns in the data they have been fed and apply them consistently to make future decisions. Consider an AI tasked with sorting the best nurses for a hospital to hire. If the AI has been fed historical data —profiles of excellent nurses who have mostly been female — it will tend to judge female candidates to be better fits. Algorithms need to be carefully designed to account for historical biases.”
We’ve got a lot of work to do to ensure fair, equitable health care for all of us — now and into our high-tech, data-rich tomorrow.