Taking Color out of Medicine
If you strip every human on the planet of their skin, leaving their bones and organs behind, could you tell who is black, brown or white? It’s an impossible task, yet today doctors around the world use race, or skin color, as a tool in diagnosing and treating some diseases. That’s why one University of Minnesota Medical School resident is working to eliminate race from medical teaching and practice.
Ebiere Okah, MD, a third-year resident in the Department of Family Medicine and Community Health, first heard the concept of race-based medicine from Dorothy Roberts, JD, a lawyer and professor at the University of Pennsylvania, when Roberts spoke at the Physicians for National Health Program (PNHP) conference in 2014. Dr. Okah’s advocacy grew while studying as a medical student at Icahn School of Medicine where her peers began challenging the use of race as a risk factor for disease.
“I did not come up with the concept that medical providers should stop using race-based medicine. Many people, especially social scientists, have clearly expressed that race is a social construct without underlying biological basis,” Dr. Okah said. “In this country, blackness was constructed for the maximum exploitation of people of African descent. It is an overly inclusive category with the underlying notion that people with any African blood could not be categorized as white, a pure race.”
Dr. Okah explained that there were laws defining race in different states. In Virginia, for example, a black person who has eight grandparents, with just one of them having African descent, would by law be considered a black person.
“And it carries on to today,” Dr. Okah said. “There are many white women with biological black children. Yet, somehow, it is almost impossible for a black woman to bear white children.”
This knowledge inspired Dr. Okah to dig a little deeper into the effects of race-based medicine. Six months into her residency, Dr. Okah applied for the Larry Green Scholar Fellowship, which landed her a spot at the Robert Graham Center, a policy institute focused on family medicine and primary care research, to conduct a study on black race and hypertension in June 2019.
She also participated in the Medical School’s Health Equity Leadership and Mentoring Program, where she learned from others engaged in health disparities work. With the mentorship of Janet Thomas PhD, LP, Andrea Westby, MD, and Brooke Cunningham, MD, PhD, she is currently studying the use of race in medical decision-making by family medicine providers in Minnesota, which was supported by a grant from the Minnesota Academy of Family Physicians (MAFP).
“I surveyed physicians who are members of the MAFP. They were asked several questions about their use of race when treating patients and also about color-blindness and racial awareness,” Dr. Okah said. “We are currently analyzing this data.”
According to The Health Care Blog, while more minority races do suffer from diabetes, hypertension and heart disease compared to white individuals, the cause may not be genetics (or race) but rather the social determinants of health, including lack of access to healthcare, homelessness and underfunded schools.
Dr. Okah says that’s why providing care based on race is a disservice to patients. She used the example of how doctors use black race to determine kidney function. GFR, or glomerular filtration rate, helps doctors determine if a patient’s kidneys require attention. When providing the assessment, doctors must select whether someone is black or non-black.
“GFR is a way of assessing renal function with a higher score implying better function. However, the score is based on race, and an individual who is identified as black will have a higher GFR than an individual who is classified as non-black,” Dr. Okah explained. “Therefore, being classified as a black person means that your kidney function has to deteriorate to a worse level than a non-black person, before you are given the same type of care.”
Dr. Okah believes doctors should assess patient care based on one score, regardless of race. For the past year, her and a group of leaders passionate on the topic proposed that message through resolutions to the MAFP and the American Academy of Family Physicians (AAFP). In March 2019, she, along with two other residents, introduced a resolution on race-based medicine that they presented at the Resident’s Congress at the AAFP national conference. It failed.
“My faculty mentor, Dr. Westby, suggested that we revise the resolution and submit it to the MAFP House of Delegates. There, she gave testimony in support of the resolution, and it passed at the state level. A similar resolution also passed in New York,” Dr. Okah said. “Because the resolutions passed at the state level, they were then discussed at the Congress of Delegates, which is the annual policy-making meeting of the AAFP.”
During this meeting, they determine whether or not resolutions will become policy of the national organization, and in September 2019, their resolution was referred.
“There are three options for any resolution; it can be rejected, accepted or referred to the board,” Dr. Okah said. “Our resolution was referred to the board, meaning that the AAFP leadership will devote the year to researching the topic more and determining its feasibility. I would have loved it if it were accepted, but I am happy that it wasn’t rejected. It’s a complicated topic, and this will take time.”
Dr. Okah will be a part of that research moving forward. After her residency ends in June, she will join a research fellowship at the University of North Carolina to study how race is used in medical decision-making, primarily as a risk factor for cardiovascular disease.