User:Dthagan/new sandbox

Race and health in the United States

Race-based diagnoses (under 4.3 Inequalities in healthcare)
BiDil is a drug used to treat congestive heart failure in African Americans, but the Food and Drug Administration rejected any application of the medication since their clinical trials did not demonstrate any efficacy for other racial populations. BiDil’s manufacturer, NitroMed, completed a clinical trial that solely enrolled African Americans. They found a decrease in mortality for this exclusive group and in 2005, the FDA approved the drug’s usage exclusively for black patients. It is still in use with the same racial stipulation today, sixteen years later. BiDil's place in medicine today represents that specific races can be treated differently in clinical settings, which can result in one racial group being given a specialized treatment while another group can suffer or benefit from an alternate treatment.

One study recorded in Science magazine found that a specific algorithm, which determines what patients need further care, favors additional medical attention towards white people over black people, based on average health costs that are incurred by these races. The same researchers, though, that using health costs as a proxy for health needs is an unfortunate form of bias, as black patients face disproportionate poverty levels in the United States and are forced to spend less on healthcare than white patients. This bias caused the algorithm to conclude that black patients are generally healthier than white patients and therefore, it concluded that black patients do not need extra care in such instances. If black patients are believed to have less clinical need for a medical condition, this could be a step backwards from medical equity.

Estimated glomerular filtration rate (eGFR) is a scored measurement of a patient’s kidney function; a higher score is a better score. According to a 2020 study, researchers found that the equation for eGFR reports a higher score for black patients by a factor of 1.210. When an individual receives this higher score, perceived better kidney condition is then relayed to healthcare providers, which creates issues: black people with poor kidney function but an inaccurately higher score than the baseline may encounter roadblocks when they should receive referrals to nephrologists or even kidney transplants.

Similarly, the vaginal birth after Cesarean section (VBAC) calculator is used to estimate the probability that a patient will successfully complete a vaginal birth if they have already had a C-section birth. There are again correction factors based on race that have been integral to this calculator; African Americans’ results are multiplied by a factor of 0.671. When an African American or Hispanic individual is given bias-containing results that suggest that their next vaginal birth could go poorly, clinicians may sway them away from trials of labor. A white individual in the exact same situation will receive a different score and may subsequently deliver their child via a different procedure. The VBAC calculator, which factored certain risks for childbirth based on the patient’s race, is now being altered by the Maternal-Fetal Medicine Units Network to omit race and ethnicity in the interest of ignoring such "socially constructed variables."