A recent Health Affairs piece, Promoting Equity In Clinical Decision Making: Dismantling Race-Based Medicine, examined racial biases in algorithms used in clinical decision-making. The article notes that this topic is of increasing importance as the use of artificial intelligence in healthcare expands. The report found that “[r]eliance on algorithms that use race as a proxy for biological differences leads to inaccurate estimates of clinical risk and contributes to treatment patterns that are inappropriate, unjust, and harmful to minoritized racial and ethnic groups. These patterns have contributed to persistent racial and ethnic disparities in health and health care in the US.” The report proposes shifting from “race-based” medicine to a “race-aware” approach, and presents a roadmap focused on the following four areas:
- Increase the Diversity of Clinical Trial Populations: Racial and ethnic minorities have historically been underrepresented in clinical trials, leading to algorithms not accurately representing broader populations of patients. Diverse groups must be included in clinical trials in order to address this challenge. Data on social determinants of health should also be included. The report notes that “[a]ctive involvement of racial and ethnic minority communities in the design and implementation of clinical trials can help overcome historical mistrust and hesitancy to participate in medical research.”
- Broaden the Focus of Precision Medicine: In contrast to “precision medicine” (which often is narrowly focused on individuals’ genetic characteristics and does not address other critical factors that influence health outcomes), “precision care” considers patients’ multiple morbidities, functional status, values, goals, and preferences, as well as their social and societal contexts.
- Promote Education and Awareness: Increase education about structural racism, discrimination, and inequalities, and how they contribute to health disparities, expand understanding of the complex social, economic, and environmental factors that can influence health outcomes.
- Develop Guidelines and Policies to Enable Culturally Responsive Care: Create public-sector and private-sector guidelines to increase the collection of data on environmental factors, with a focus on “standardized data collection protocols and integration of data on social determinants in electronic health records during routine patient encounters.”
October 19, 2023 – K. Kertesz