Says Lauren Merz, a hematology fellow at the Dana-Farber Cancer Institute/Mass General Brigham: “Being able to have a grant will allow this to take off. Jones says philanthropy can play a major role in supporting efforts to find better alternatives to algorithms that include race. “If you think race matters because it’s a proxy for experiences of racism, then we should figure out a way to measure experiences of racism.”
“If you think race matters because of ancestry, then we should replace race with measures of ancestry,” he says. But he says that race was included in many algorithms without research proving their efficacy in the first place and that better measures may exist. Some opposition comes from people who believe that including race in algorithms may improve care for patients of color, says Jones from Harvard Medical School, or who are reluctant to change algorithms without further research.
Just one-third of laboratories stopped using one equation for kidney disease following new recommendations, according to a survey released last year. Some medical-society members oppose removing race in clinical equations, Eneanya says, and it can be difficult to get physicians and researchers to adopt alternatives. “Race is a social construct and has no place being embedded in a clinical guideline like this.”Ĭhanging current algorithms will not be without challenge. “Race is not a biologic proxy,” says Joseph Wright, the incoming chief health equity officer for the academy. The American Academy of Pediatrics removed a calculation in 2021 that found Black children faced lower risks of urinary-tract infections than white children.
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Several grantees have already begun to change and update their guidelines. It aims to publish a report in October 2024 with recommendations for using racial and ethnic categories in research. The National Academies of Sciences, Engineering, and Medicine will bring together a group of experts to evaluate the use of race and ethnicity in biomedical research. The Coalition to End Racism in Clinical Algorithms, housed under New York City’s health department, will help local safety-net hospitals such as the Maimonides Medical Center and One Brooklyn Health implement plans to replace medical algorithms with alternatives that aren’t adjusted by race. The organization aims to work with at least 10 hospital systems to evaluate those cells more accurately and to research the impact of medications on people with low counts of neutrophils. The American Society of Hematology will explore how people of African or Middle Eastern ancestry are told incorrectly they have unhealthy levels of neutrophils, a type of white blood cell.
The American Heart Association will bring together members to identify and prioritize algorithms that use race in cardiovascular medicine and will award $1.2 million toward research into those algorithms. The academy will also gather experts to evaluate other algorithms and update its guidelines. The American Academy of Pediatrics will test a revised algorithm for assessing the risk of urinary-tract infections among patients at a children’s hospital. Sindy Escobar Alvarez, program director for medical research at the Doris Duke Charitable Foundation, says the new effort came about because of that advocacy and because limited research has been done on the design and impact of “race-aware” algorithms.įour national medical organizations and one New York City-based coalition will receive grants ranging from $1.36 million to $3.4 million to identify, update, and provide guidelines on medical algorithms that use race and to research how the tools work in hospitals.
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