How medical science is moving beyond racial essentialism to create more accurate and equitable healthcare
You go to the doctor for a routine check-up. A blood test measures your kidney function. The result comes back with a note: "Calculation adjusted for African American race." For decades, this has been standard practice. But what if this seemingly innocuous adjustment is based on flawed science that perpetuates health disparities instead of solving them? Welcome to one of the most critical and urgent debates in modern medicine: the move to eradicate racial essentialism from its very foundation—the medical curriculum.
Racial essentialism is the erroneous belief that racial categories, which are largely social constructs, reflect fundamental, biological differences between human groups. This outdated thinking has seeped into medical textbooks, diagnostic algorithms, and treatment guidelines, often with harmful consequences.
This article explores how a new generation of medical scientists and educators is challenging the status quo, using rigorous genetics and sociology to build a more accurate and equitable future for healthcare.
For centuries, medicine has used race as a crude proxy for biology. The assumption was that a person's race could tell you something specific about their genetic makeup, disease risk, or even how their body would process drugs. This is racial essentialism in action.
Modern genetics has overwhelmingly shown that there is more genetic variation within any given racial group than there is between different groups. The concept of distinct biological races does not hold up to scientific scrutiny. Race is a powerful social and political identity, but it is a poor predictor of an individual's genetic blueprint.
This is the crucial distinction. Genetic Ancestry refers to the specific geographical origins of your ancestors and the genetic variants you inherited from them. It's a continuous, quantifiable measure. Race, in contrast, is a socially assigned category that can change over time and location. Focusing on ancestry, where relevant, provides precise biological data; relying on race provides blurry, often misleading, assumptions.
Health disparities between different racial groups are very real. However, the evidence points to the root cause being not race itself, but racism—in the form of structural barriers, economic inequality, environmental stressors, and lifelong exposure to discrimination that creates "weathering" effects on the body.
Using race as a biological variable in medicine often leads to both overgeneralization and missed diagnoses, while failing to address the actual social determinants of health disparities.
Perhaps the most famous example of racial essentialism in medicine is the use of race in estimating kidney function via the Glomerular Filtration Rate (GFR). For years, clinical labs used equations that included a "race coefficient," giving a higher GFR estimate for Black patients. The justification was a decades-old study that suggested Black people, on average, had higher muscle mass (a proxy for creatinine, a waste product measured in the test).
A landmark 2020 study led by a consortium of researchers set out to rigorously test the validity of this race-based adjustment.
Researchers gathered a large, diverse group of participants, including both Black and White individuals, with a wide range of kidney function.
For each participant, they collected two key pieces of data:
They then compared the performance of the old, race-adjusted equation against a new, race-free equation. The goal was to see which one more accurately predicted the actual mGFR for all patients, regardless of race.
The key metric was accuracy. Did the equation correctly identify patients with seriously impaired kidney function (a low GFR), or did it miss them?
The results were stark. The race-adjusted equation was systematically overestimating kidney function for many Black patients. This meant that a Black patient and a White patient with the exact same creatinine level and actual kidney function would receive different GFR estimates, with the Black patient's result appearing healthier.
This wasn't just a statistical error; it was a dangerous clinical flaw. By making kidneys look healthier than they were, the race-based equation could delay Black patients' referrals to kidney specialists, their placement on transplant waiting lists, and their eligibility for life-saving interventions.
The study provided the ironclad evidence needed to justify removing race from the GFR calculation nationwide, a change now being adopted by major medical institutions .
Same patient (Creatinine = 1.2 mg/dL, Age = 45, Female)
Disconnect between self-reported race and genetic background
| Participant | Self-Reported Race | Proportion of West African Genetic Ancestry | Likely Impact of Race-Based GFR |
|---|---|---|---|
| A | Black | 85% | Significant overestimation of kidney function |
| B | Black | 15% | Moderate overestimation (inappropriate adjustment) |
| C | White | 2% | No adjustment (accurate for this individual) |
| D | White | <1% | No adjustment (accurate for this individual) |
This table highlights the disconnect between social race and genetic reality. Using a blanket "Black" category inaccurately applies a biological assumption to individuals with vastly different genetic backgrounds.
Moving beyond racial essentialism requires new tools and a new vocabulary. Here are the essential "reagents" for this scientific shift.
Uses panels of genetic markers to estimate an individual's geographical ancestral origins, providing specific biological data instead of broad racial assumptions.
Estimates an individual's genetic predisposition for a disease based on the combined effect of many small genetic variants. More accurate than race-based predictions.
A field that studies the complex interplay between social factors (like racism and socioeconomic status) and gene expression (epigenetics).
Training for healthcare providers to recognize how conditions like housing insecurity, food deserts, and discrimination influence patient health outcomes.
Systematically reviewing algorithms and decision-support tools embedded in Electronic Health Records to identify and remove racially biased logic.
Updating medical education to teach the difference between race and ancestry, and the social determinants of health.
The journey to de-escalate racial essentialism in medicine is not about being "colorblind." It is about seeing race and ethnicity for what they are—powerful social identities with real-world consequences for health, primarily through the mechanisms of racism and inequality—and not as simplistic biological shortcuts.
The removal of the race coefficient from the GFR equation is a monumental first step, but it is just the beginning. The next frontier is to overhaul medical education itself. Future doctors and researchers must be taught to critically evaluate the use of race in medical literature, to understand the difference between ancestry and race, and to address the root causes of health disparities.
By replacing flawed, essentialist assumptions with precise genetics and a robust understanding of societal structures, we can build a medical science that is not only more accurate but also fundamentally more just .
Progress in eliminating race-based medicine
Medicine is undergoing a paradigm shift—from using race as a biological shortcut to implementing precise, individualized care that addresses both genetic factors and social determinants of health. This transition promises not only better healthcare outcomes but also a more equitable system for all.