Modern medicine has developed over the past 2 centuries in societies stratified by race and ethnicity. Race-based medicine analyzes health risks and treatment based on a patient’s race, often assuming that differences in health status are due to biology and genetics. In the United States, there is a history of guidelines using race-based decision-making for a variety of conditions (eg, hypertension, heart failure). These guidelines lead to profound health disparities. Genetic tests reveal precise molecular causes for differences in therapeutic and adverse effects of medications, and certain genetic variants are more common in specific groups of people. At the same time, there is growing evidence on health disparities that shows stratification of social determinants of health by race, ethnicity, income, and geography. Race-based prescribing guidelines and race-correction factors are under review across medicine to ensure that accurate data are used to provide unbiased care and that guidelines are not worsening health disparities. Race-conscious medicine focuses on the understanding that, although racial differences in health status may be influenced by genetics and epigenetics, they are just as likely to be due to racial stratification in access to resources, experiences of bias and discrimination, and social factors correlated with race.
Case 1. JH is a 55-year-old Black man who has had hypertension since he was in his 20s. Today in the office, his blood pressure is 152/96 mm Hg. He reports that his average blood pressure measured at home is 140/90 mm Hg, which does not seem to be affected by diet, exercise, sleep, or medications. He is taking amlodipine 10 mg/day and limiting his salt intake. He did not tolerate diuretics because he works in a warehouse and cannot always go to the restroom when needed or beta blockers because of sexual adverse effects. He used to take lisinopril, which his previous physician discontinued because, according to guidelines, it is not a first-line choice for Black patients without kidney disease or diabetes.
Race-Based Medicine
The evidence base of modern medicine has developed over the past 2 centuries in societies stratified by race and ethnicity.1–3 Social scientists define race as a set of social categories identified by physical characteristics and social status within a hierarchy of social worth and distribution of resources.4
Race-based medicine is the analysis of health risks and determination of treatment based on a patient’s race, often assuming that differences in health status are due to biology and genetics tied to skin color.5 Race-conscious medicine emphasizes that differences in health status by race are just as likely to be due to racial stratification in access to resources, experiences of bias and discrimination, and social factors correlated with race.6
Social determinants of health (eg, wealth, working conditions, environment, access to healthy food) are influenced by economic mechanisms, government programs, and other systems that are unequal among individuals and communities.7 Health surveys in Victorian England showed the consequences on the health of the poor in the stark terms of life expectancy—poor people lived into their teens and 20s, whereas the overall population lived 40 to 50 years or more.8–11
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