How journalism can shed light on medicine’s hidden racial bias

By Anil Oza, Freelance Health Journalism Scholarship Recipient

A Friday panel at HJ24 titled "The racial bias hiding in plain sight" tackled the topic of race in clinical algorithms. For decades, researchers and clinicians have introduced so-called "race corrections" in clinical tools used to make health decisions such as placing people on kidney transplant lists, estimating cancer risk, or assessing lung health. These adjustments frequently downplay the health risks of Black, Hispanic and other people of color.

Research in recent years has called into question the practice of using "race-corrected" clinical algorithms to decide a person's course of medical care These algorithms can lead to further health inequities, so journalists should call attention to their use.

"The fact that these practices exist shouldn't come as a surprise. American medicine has been obsessed with race more or less forever," said panelist David Jones, a historian of science at Harvard University. But over the past five years, there has been a debate in medical societies and journals about the use of race correction in algorithms.

That conversation has been catalyzed in part by journalists, Jones said, pointing to New York Times and STAT coverage of a 2020 study he co-authored calling for the reconsideration of race in clinical algorithms. Those stories "helped transform an academic article into a topic of conversation," he said.

From left to right: Usha Lee McFarling, David Jones, Michelle Morse, Sindy Escobar Alvarez, Jyoti Madhusoodanan. Photo by Zachary Linhares

The 2020 study highlighted 13 algorithms that included race correction and thus placed people of color at a disadvantage by delaying dialysis, placing Black and Hispanic women at an unwarranted higher risk of complications following a C-section, and causing other health inequities. Since that publication, Jones said, medical societies have recommended removing race from 11 of the 13 tools. One other is being reviewed. But implementing these race-free versions in clinical practice has proven difficult, he said.

Panelist Michelle Morse, the chief medical officer of New York City's Department of Mental Health & Hygiene, said that part of the challenge is that making such changes requires coordination across institutional leadership as well as pathologists, laboratory teams, electronic medical records, all of the clinicians and department chairs, trainees and medical education. . "This is truly a system transformation and change that needs to happen," she said. "It's not just one flick of a button."

Morse highlighted New York City's efforts to remove race from clinical algorithms, the NYC Coalition to End Racism in Clinical Algorithms, which launched in 2021. The program asked hospitals to remove race from one of three key clinical algorithms using race; measure inequities that may have arisen because of the use of race correction; and to create a plan to engage with patients' whose care was previously harmed or delayed by race-based calculations. The coalition just ended the first phase of its project, and Morse said it encountered three main barriers: inertia from late-career physicians who were used to these equations, the complexity of making large changes in hospital systems, and needing to change medical education.

Panelist Sindy Escobar Alvarez, the program director for the Doris Duke Foundation, discussed efforts to overcome these barriers by funding research that quantifies the harms of race-conscious algorithms and empowers hospital systems trying to change them.

These "race corrected algorithms are both a problem and an opportunity for journalists," said panelist Jyoti Madhusoodanan, a freelance journalist and Civic Science Fellow at the Association for Health Care Journalists. While these algorithms are very opaque, reporting on when they are used, how they use race, and individuals who were directly harmed by them presents an opportunity to cover "a really concrete example of racism" in healthcare, she says.

Anil Oza is a freelance science journalist residing in Sunnyside, N.Y. He is a 2024 recipient of the AHCJ Freelance Health Journalism Scholarship.