The impact of racism on medicine has frequently been the subject of headlines over the past few years, particularly during the COVID-19 pandemic, when federal regulators pushed for more inclusive enrollment in the vaccine trials, and societal calls to action to address systemic and structural racism became loud and clear.
As medical communications professionals, what can we do to help promote racial and ethnic diversity in medicine?
1. Follow updated guidelines on the reporting of race and ethnicity in medical and science journals
When we create content for our clients, the AMA Manual of Style: A Guide for Authors and Editors serves as the cornerstone for our deliverables. In 2021, the AMA Manual of Style published updated guidance on reporting race and ethnicity, specifically in the 11.12.3 Race and Ethnicity subsection. This guidance is freely available on the JAMA website, in the AMA Manual Style, and in the JAMA Network journals’ Instructions for Authors. It specifies that the language and terminology used in medical journals must be clear, precise, and accurate to ensure equity, fairness, and consistency in reporting of race and ethnicity.
Topics addressed in the guidance include how to report demographic information in research articles, use of racial and ethnic collective terms, capitalization, adjectives, geographic origin and regionalization considerations, and abbreviations. Specific examples are included to ensure appropriate implementation.
It is important to acknowledge that this reporting should also be accompanied by other sociodemographic factors and social determinants, including concerns about racism, disparities, and inequities, and how these intersect with race and ethnicity.
2. Promote transparency and accountability with our clients to ensure adequate representation
While our clients bear the majority of the responsibility in ensuring that the right research questions are being asked, the appropriate populations are being engaged and considered in study design, the study participants are being recruited and retained, and the appropriate analysis and reporting of results are occurring, we can ensure that all of these research findings and the steps in the process are communicated clearly and appropriately.
Medical journals often serve as the final checkpoint in releasing scientific findings to the public that influence clinical practice and advance human health. Recognizing this important role, the New England Journal of Medicine announced the requirement of a supplementary table for research articles to encourage authors to ensure more diversity, inclusion, and equity in their study populations. By implementing these standards in publication practices and adhering to these guidelines with our clients, we can pave the way for more inclusive research.
Our organizations themselves can also facilitate a more diverse and inclusive environment through our own hiring and recruitment processes to ensure that we employ individuals across all backgrounds.
3. Provide education on the role of race and ethnicity in medicine and clinical practice, including the use of race correction algorithms
Although race is a social, not biological, construct, it nonetheless may factor into medical decisions and patient outcomes. Race correction refers to the inclusion of a patient’s race in scientific algorithms and practice guidelines. According to the New England Journal of Medicine, the use of such algorithms risks embedding race into the data used to inform treatment decisions, which further propagates race-based medicine and could amplify race-based medical inequities. Such algorithms are used in nephrology, cardiology, obstetrics, urology, endocrinology, pulmonology, and oncology.
Specifically in the case of nephrology, the Modification of Diet in Renal Disease (MDRD) Study equation used for calculating the estimated glomerular filtration rate (eGFR), a common measure of kidney function used to monitor the development and treatment of kidney disease, includes race correction. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), this equation calculates an eGFR value higher by a factor of 1.212 if the patient identifies as Black. The use of such an algorithm can impact the treatments and interventions for which patients may be eligible.
Although the MDRD Study equation currently listed on the NIDDK website includes the race correction factor, the NIDDK also noted that recommended eGFR equations will be changing. In response to criticism of this algorithm, the National Kidney Foundation and American Society of Nephrology formed a task force to clarify and resolve the problem and ultimately recommended alternative methods for assessing kidney function. In 2021, the task force released a report proposing a new race correction-free approach to diagnosing kidney disease.
4. Cultivate awareness of the problems associated with race in medicine
Classifying patients into a single racial group does not capture the full complexity of patients’ ethnicity and ancestry. For example, if a patient is perceived as or self-identifies as Black but also has another ethnicity, diseases more common in the other ethnicity may be overlooked. Furthermore, not all patients who identify as Black have the same ancestry; for example, multiracial Americans may not have the same ancestry as recent African or Caribbean immigrants.
Additional challenges are associated with classifying patients who identify as Asian. In administrative documentation, health systems, and electronic health records data, Asian people are often misclassified as “other” or “missing,” which means basic demographic data may not be reliable, generalizable, or predictive of health outcomes in this population. Some experts have pointed out that the category “Asian” is too broad, as it includes people from many different populations. Efforts are being made to promote more granularity in how patients self-report their race and ethnicity in healthcare, including allowing patients to select more than one race and ethnicity and provide further information about which racial and ethnic categories they think best apply to themselves.
We can each do our part to promote equity and increase diversity. If we each take steps to raise awareness among our colleagues in medical communications about the historic and ongoing racial and ethnic disparities in healthcare, our colleagues, in turn, will be better equipped to raise awareness among their own clients. Let’s make a difference!