April 4, 2023
Class of 2023: Medical students challenge the 'Things We Do for No Reason'
Fourth-year medical students Sarah Beaverson and Victoria Ngo are advocating for the abolition of biological race in medicine by challenging the use of race adjustment calculators.
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The Journal of Hospital Medicine’s “Things We Do for No Reason” (TWDFNR) series invites current physicians and students of medicine to research and discuss ongoing clinical practices which, upon further review, may provide little value to patient care.
Sarah Beaverson and Victoria Ngo, two fourth-year students at the Virginia Commonwealth University School of Medicine, recently published an article in the journal on the use of race adjustments in calculating lung function in Black patients and the resulting health disparities. Though the journal typically focuses on outdated diagnostic and treatment methods, Beaverson and Ngo sought to highlight the intersection within social justice and medicine that causes harm to specific patient populations.
Race adjustments are commonly used medical algorithms that use a patient’s race to help calculate biological function and potential pre-existing medical conditions. But health care providers and researchers are questioning their validity.
“People in historical and sociological fields have understood for some time that race has no biological basis,” Ngo said. “It is socially constructed.”
“I was shocked these were still included.”
Beaverson and Ngo have researched multiple race adjustments, including the pulmonary function testing (PFT) calculation used to measure lung function. When race adjustments are implemented for both Black and white patients, the calculator automatically attributes a lower standard of lung function within the Black patient, solely on the basis of race. Both students found this troubling, and Ngo noted that research has shown that “two people of the same race may have wildly different biological makeups than two people of different races.”
“I was shocked these were still included and frequently used. There wasn’t any scientific evidence to support this claim,” Beaverson said.
So, she and Ngo co-wrote the article recommending the removal of the race factor in calculating PTFs, and with the support of Patrick Nana-Sinkam, M.D.; Matthew Schefft, D.O.; Meera Pahuja, M.D.; and Alan Dow, M.D., submitted it to the Journal of Hospital Medicine’s TWDFNR series.
“We wanted to get this information out past VCU and to a broader audience,” Beaverson said.
Abolishing biological race in medicine
Beaverson and Ngo’s article explains how the acceptance of race adjustment factors used for PFTs are specifically harmful to Black patients. Since race adjustments view race through a biological lens, it ignores the social, environmental and individualized genetic factors of individual patients. This leads to an underdiagnosis of pulmonary disease in Black patients and narrowing their access to effective treatments.
“As doctors and future doctors, basing our health care decisions on race makes zero sense,” Schefft said. “What we need to be doing is impacting those social and moral determinants of health. Sarah and Victoria are bringing a cleansing light to a topic that impacts both the livelihoods of individual patients and the community as a whole.”
Health systems across the country still include race adjustments in medical calculators, and Beaverson and Ngo want to empower physicians and medical students to challenge practices that have no basis in biology. Their article promotes practicing race-conscious medicine, which purposefully acknowledges systemic and institutional racism's effect on patients, as a means of moving towards the abolition of these practices.
“All of our co-authors for the article were very supportive in helping us develop our work and empowering us as students,” said Beaverson.
One step at a time
Beaverson and Ngo first learned about race adjustments in their second semester as medical students during a webinar hosted by the Institute for Healing and Justice in Medicine. Co-founded by medical students and family physicians, the institute aims to create “a new medicine that is centered on healing, community and justice,” and advocates for the removal of biological race in medicine.
Inspired by the institute's activism, Beaverson and Ngo worked alongside faculty and physicians in the Division of Nephrology encouraging the Department of Internal Medicine to remove race adjustments from the glomerular filtration rate (eGFR) equation, which is used to evaluate kidney function.
In 2021, after the National Kidney Foundation released a report outlining a race-free approach to diagnosing kidney disease, VCU Health Systems launched its new electronic health records system, and the race adjustment calculator for the eGFR equation had been removed.
VCU Health Systems have also removed race adjustments for the vaginal birth after cesarean calculator, which calculates how probable a successful vaginal birth would be after cesarean section, and for pediatric urinary tract infection tests for babies arriving to the hospital with a fever.
Progress and beyond
Both Beaverson and Ngo are pursuing family medicine, a field where they can continue to advocate for individualized and equitable health care for entire communities.
“The compassion and care Sarah and Victoria have for community health will make them phenomenal doctors in the field of family medicine,” Schefft said.
For Beaverson, she understands the impact research and writing can have on both social and medical issues and wants to continue using them as forms of advocacy.
“Sometimes when I’m discouraged by a system that is a lot bigger than me, I know that change can occur on an individual level,” she said. “If only one person reads my article and reflects on their own practices, then that can be really powerful.”
Ngo hopes the conversation she and Beaverson have brought to the TWDFNR series can help the medical field progress beyond its traditional and biologically inaccurate understanding of race.
“It has been a complicated journey forward, but in raising awareness and getting the backing of a well-respected journal, we're hoping to be a drop in a changing tide,” Ngo said.
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