How scientists are subtracting race from medical risk calculators

How scientists are subtracting race from medical risk calculators

Science Magazine

Jyoti Madhusoodanan
Portland, Oregon

Anuj Shrestha

To pediatrician Nader Shaikh, the rhythm of treating babies running high fevers is familiar. After ruling out the obvious colds and other common viruses, he must often thread a catheter into a months-old baby to draw a urine sample and check for a urinary tract infection (UTI). “You have to hold the baby down, the baby’s crying, the mother is usually crying too,” says Shaikh, who works at the University of Pittsburgh. “It’s traumatic.”

UTIs, although relatively rare in children under age 2, carry a high risk of kidney damage in this group if left untreated. Often, the only symptom is a high fever. But high fevers can also signal a brain or blood infection, or a dozen other illnesses that can be diagnosed without a urine sample. To help clinicians avoid the unnecessary pain and expense of catheterizing a shrieking infant, Shaikh and his colleagues developed an equation that gauges a child’s risk of a UTI based on age, fever, circumcision status, gender, and other factors—including whether the child is Black or white. Race is part of the equation because previous studies found that—for reasons that aren’t clear—UTIs are far less common in Black children than in white ones.

The UTI algorithm is only one of several risk calculators that factor in race, which doctors routinely use to make decisions about patients’ care. Some help them decide what tests to perform next or which patients to refer to a specialist. Others help gauge a patient’s lung health, their ability to donate a liver or kidney, or which diabetes medicines they need.

In the past few years, however, U.S. doctors and students reckoning with racism in medicine have questioned the use of algorithms that include race as a variable. Their efforts gained momentum thanks to the Black Lives Matter movement. In August 2020, a commentary published in The New England Journal of Medicine (NEJM) highlighted the use of race in calculators as a problem “hidden in plain sight.” It’s widely agreed that race is a classification system designed by humans that lacks a genetic basis, says Darshali Vyas, a medical resident at Massachusetts General Hospital and co-author on the paper. “There’s a tension between that [understanding] and how we see race being used … as an input variable in these equations,” Vyas says. “Many times, there’s an assumption that race is relevant in a biological sense.”…

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