How to find stories about changes in race-based algorithms

Doctors use algorithms that include race, or use race-based "normal" values, to make a multitude of health decisions in clinics. Race-based calculators are used to estimate the risks posed by certain surgeries, the need for preventive drugs for heart disease or osteoporosis, or whether a person's lungs or kidneys are functioning normally. Using race in such equations can often worsen existing inequities.

For journalists, knowing when and how calculators are used, as well as efforts to change equations, can yield valuable stories about the interface of research and clinical care, health disparities and more.

What's happening?

Many race-based calculators have been in use for decades. But they entered the limelight in 2020. Following the murders of George Floyd and Breonna Taylor, medical students started to draw attention to the many problems created by racism in health care and medical education. In June 2020, a New England Journal of Medicine publication titled "Hidden in Plain Sight" highlighted the use of race in several equations and the problems it could create.

Now, several specialties are working to review existing algorithms and update them to race-free versions. New studies describing these are quickly emerging and researchers are starting to estimate the impact they could have on patients.

When covering these health advances, journalists can set themselves up for meaty stories by diving into historical context, finding the right sources and trying out algorithms themselves.

Get the backstory

Journalists can spot newsworthy stories in embargoed content, such as when a new paper about a race-free or race-neutral approach lands in their inboxes. Skim through the list of citations to capture the origins and impact of old equations.

Race terms can appear in many ways. Start by getting a sense of whether race and ethnicity are being used to determine treatment guidelines, set a "normal" range for a particular measure of health, or as a mathematical variable that changes a lab value for people who are Black or of other races. Tracking the origins of the problem that's being addressed can reveal whether it was a result of historical racist thinking, studies being conducted in homogenous, small cohorts, or a flawed attempt to capture social drivers of health disparities.

When reporting, look beyond the news and reach out to science historians and ethicists for rich detail.

Find the right sources

Looking at peer-reviewed publications on a race-based calculator can reveal experts who are working on the topic. But journalists should also look to professional societies such as the American Thoracic Society, the American Heart Association, the American Association of Pediatrics, and others that have assembled groups of experts to address the harms of using race in clinical equations.

In addition to talking with clinicians and researchers, journalist Felice Freyer recommends contacting administrators at state or federal programs that process disability payments or other areas where a person's health needs to be measured.

Experts to contact

• JosephWright, M.D., M.P.H., FAAP is chief health equity officer and seniorVice President at the American Academy of Pediatrics. Wright was the lead author on AAP's policy statements about eliminating race-based medicine and is leading an ongoing project on identifying and addressing race-corrected clinical algorithms.
• Nirav R. Bhakta, M.D., Ph.D., is associate professor, critical care specialist and pulmonologist, University of California, San Francisco School of Medicine. Dr. Bhakta co-chairs the American Thoracic Society working group addressing the use of race in tests of lung function.
• David S. Jones, Ph.D. is a psychiatrist and historian of medicine at Harvard Medical School. Jones was the senior author of the 2020 publication "Hiding in Plain Sight."

Finally, for data resources, check out this list of clinical algorithms that use race, together with citations and potential for harm.