Table.

Examples of race-based medicine, the potential harm to patients, and race-conscious alternatives

	How race is used	Rationale for race-based management	Potential harm	Race-conscious approach
eGFR6	eGFR for Black patients is multiplied by 1·16–1·21 the eGFR for White patients, depending on the equation used	Black patients are presumed to have higher muscle mass and creatinine generation rate than patients of other races	Black patients might experience delayed dialysis and transplant referral8, 9	Use eGFR equations that do not adjust for race (eg, CKD-EPI Cystatin C).10
BMI risk for diabetes7	Asian patients considered at risk for diabetes at BMI ≥23 vs 25 for patients of other races	Asian patients are presumed to develop more visceral than peripheral adiposity than patients of other races at similar BMI levels, increasing risk for insulin resistance7	Asian patients screened for diabetes despite absence of other risk factors might experience increased stigma and distrust of medical providers11	Screen patients with lower BMIs on the basis of indications of increased body fat (eg, body roundness,12 body fat percentage), not based on race
FRAX13	Probability of fracture is adjusted according to geography or minority status, or both	Different geographical and ethnic minority populations are presumed to have varied relative risks for fracture on the basis of epidemiological data	Some populations, including Black women, might be less likely to be screened for osteoporosis than other populations14	Screen patients for osteoporosis on the basis of clinical risk criteria, rather than race; counteract existing biases that place Black patients at risk because of racial essentialist beliefs about variation in bone density15
PFT16	Reference values for pulmonary function are adjusted for race and ethnicity	Racial and ethnic minority groups are presumed to have varied lung function on the basis of epidemiological data	Black patients might experience increased difficulty obtaining disability support for pulmonary disease17	Use unadjusted measures of lung function for all patients; counteract existing biases that harm Black patients because of racial essentialist beliefs about variation in lung capacity18
JNC 8 Hypertension Guidelines19	Treatment algorithm provides alternate pathways for Black and non-Black patients	ACE-inhibitor use associated with higher risk of stroke and poorer control of blood pressure in Black patients than in patients of other races	Black patients might be less likely to achieve hypertension control and require multiple antihypertensive agents20	Consider all antihypertensive options for blood pressure control in Black patients; adjust as needed to achieve goals and manage adverse effects
Paediatric UTI diagnosis21	White race in girls and non-Black race in boys are considered independent risk factors for UTI	Study of febrile children in the emergency department found highest prevalence of UTI among White girls and non-Black boys22	Experimental data suggests that these guidelines could affect management of UTI by race23	Treat UTI in children on the basis of clinical presentation, regardless of race
ASCVD risk estimation	Race-specific equations included to estimate ASCVD risk	ASCVD events higher for Black patients than patients of other races with otherwise equivalent risk burden24	Black patients might experience more adverse effects from recommended statin therapy, including persistent muscle damage25	Recommend preventive therapy on the basis of clinical metrics and comorbidities; consider pathways by which structural racism might increase cardiovascular risk among Black patients and promote resources to reduce racial stress and trauma26
Eltrombopag dosing	East Asian patients receive half the starting dose compared with non-east Asian patients	Limited pharmacokinetic studies suggest reduced metabolism of eltrombopag in patients of East Asian descent27	Some East Asian patients might receive inappropriate dosing28	Initiate same starting dose for all patients, regardless of race, and adjust as needed on the basis of platelet response

Examples of race-based medicine were chosen to represent multiple racial groups (eg, White, Black, Asian) and domains in which race is essentialised as biological (eg, pharmacokinetics, bone density, lung capacity). ACE=angiotensin-converting enzyme. ASCVD=atherosclerotic cardiovascular disease. BMI=body-mass index. CKD-EPI=Chronic Kidney Disease Epidemiologic Collaboration equation. eGFR=estimated glomerular filtration rate. FRAX=fracture risk assessment score. JNC 8=Eighth Joint National Committee. PFT=pulmonary function test. UTI=urinary tract infection.