Race-Based Medicine

Introduction

Race-based medicine is rooted in the belief that racial categories reflect biological differences. This belief has shaped diagnoses, treatments and medical education but in itself rooted in scientific racism.

Race is a social classification, not a biological one, yet it continues to appear in clinical decisions today. Modern genetics and anthropology both make it clear that trace has no real biological basis, and when medicine treats race as genetic, it often leads to bad science and unfair treatment.

Race and Medicine

The use of race in medicine today continues the legacy of eugenics and racial pseudoscience. Racial categories were invented to justify colonial hierarchies and were later affirmed into scientific language as if they reflected a natural difference.

However, current research has found no genetic basis for medical decision-making based on race and concluded that continued use of racial adjustment in medicine reinforces bias rather than improving care (National Library of Medicine, 2023). Despite this, race is still used as a medical explanation, even through environmental and social inequities (like poverty, discrimination, and access to care) better explain health differences between populations (Macias-Konstantopoulos, 2023).

Built-In Bias

Race-based medical guidelines are one of the clearest examples of how racism becomes disguised as objective science. For decades, the eGFR (estimated glomerular filtration rate) equation used to measure kidney function included a “race correction” that assumed Black patients naturally had higher muscle mass (National Library of Medicine, 2023). This often led to delayed referrals and transplants for Black patients.

In the same way, lung function tests used in respiratory medicine still include a “race correction” that assumes Black and Asian patients naturally have lower lung capacity. This practice no longer has any scientific basis, and we realize now it comes from racist beliefs that were once used to defend slavery (Macias-Konstantopoulos, 2023).

Race bias also appears in obstetrics. Until recently, the VBAC calculator (used to determine if a person could safely deliver vaginally after a previous C-section) automatically lowered success scores for Black and Hispanic patients (National Library of Medicine, 2023). The calculator had no biological justification or race-asked adjustments, yet it influenced thousands of medical decisions. These tool show that medicine is not race-neutral, and racial bias can be built into clinical software, protocols, and “evidence-based” practice.

Canada’s Reality

Canada is often perceived as less racist than the U.S., but race-based medical harm exists here as well. Systemic racism in Canadian healthcare disproportionately affects Indigenous and Black communities (Canadian Human Rights Commission, 2023).

In the case of Brian Sinclair, an Indigenous man who died after being ignored for 34 hours in a Winnipeg ER, racial bias directly led to a preventable death (Allan & Smylie, 2015). These outcomes are not genetic but structural, caused by unequal access to quality care and racist assumptions about patients.

Race-based medicine continues the logic of eugenics by presenting inequality as natural instead of historical and systemic.

Discussion Question

If race isn’t biological, why do you think it’s still used in medical decisions today?

References

Allan, B., & Smylie, J. (2015). First Peoples, second class treatment: The role of racism in the health and well-being of Indigenous peoples in Canada. Wellesley Institute. https:// www.cfpc.ca/CFPC/media/Resources/Indigenous-Health/SystemicRacism_ENG.pdf

Canadian Human Rights Commission. (2023). Discussion paper on systemic racism. https://www.chrc-ccdp.gc.ca/resources/publications/discussion-paper-systemic-racism

Macias-Konstantopoulos, W. L., Collins, K. A., Diaz, R., Duber, H. C., Edwards, C. D., Hsu, A. P., Ranney, M. L., Riviello, R. J., Wettstein, Z. S., & Sachs, C. J. (2023). Race, Healthcare, and Health Disparities: A Critical Review and Recommendations for Advancing Health Equity. The Western Journal of Emergency Medicine, 24(5), 906–918. https://doi.org/10.5811/westjem.58408

National Library of Medicine. (2023). History of race-based clinical algorithms and their impact on achieving health equity. In R. M. Martinez, R. Taffe, & J. Alper (Eds.), Examining the history, consequences, and effects of race-based clinical algorithms on health equity: Proceedings of a workshop (Chapter 2). National Academies Press. https://www.ncbi.nlm.nih.gov/books/NBK600053/