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July 29, 2020

Black Kidney Function Matters: Use or Misuse of Race?

Author Affiliations
  • 1Priscilla Chan and Mark Zuckerberg San Francisco General Hospital, University of California, San Francisco
JAMA. Published online July 29, 2020. doi:10.1001/jama.2020.13378

Racial discrimination has been a lightning rod for passionate discourse and social action in the US for decades, if not centuries. The recent killings of African Americans by law enforcement has amplified the discourse. Health care has not been immune to such tragedies, with past experimentation without informed consent and segregation in health care facilities. These were systemically ingrained, institutional practices without ethical or evidentiary footing. Race was an identifying characteristic used to implement practices that resulted in consequences for health and well-being. The use of race in algorithms for clinical care, including for kidney disease, has generated and now even more so is generating discourse and action about current-day, systemic discrimination in health care.

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    3 Comments for this article
    Charles Hubbert, MD | Self
    I think we could do just as well without the concept and practice of race, but it is politically important presently, and it stimulates more "research" and "scientific" papers (RCTs?). Fortunately I was never smart enough to understand eGFR anyway, so I went into psychiatry. So be it.
    Antonio Amoroso, MD | University of Turin - Italy
    I think the term "Race" should be avoided. It is better to define population variability by a patient's continent origin. Instead of race I think it is more correct to utilize words such as "geographical origin" or "ethnicity."
    Race as a Social Construct
    Paloma Carcamo, MD |
    It's important to remember that a designation of "race", even when self-determined, does not necessarily correlate with a set of clinical characteristics. While it may be useful to collect information on race or ethnicity to look at, for instance, health disparities or social determinants, it may be counterproductive to use in clinical contexts. Making clinical judgments based on a patient's race may mean making assumptions about their physiology that are likely not true, as race is a socially and not genetically defined construct.