Last week, House Ways and Means Chairman Richard E. Neal followed up a series of letters to medical leaders with an open Request for Information about “the misuse of race within clinical care.”
We told you about the series of letters in this post.
Apparently, Chairman Neal received so many responses from health professionals that he hadn’t originally written to that he broadened the scope of his inquiry.
Now he’s asking you for input, if you are an individual or in an organization that has “interest in or experience working with clinical algorithms.” He’s looking for short responses (less than 3 pages).
The deadline is October 16, 2020.
Here’s some more details.
The problem
The letters sent to the professional societies earlier this month “describe how racism has influenced the use of race in medicine, science, and research, and call for a new path forward where medicine considers race as a tool to measure racism, not biological differences.”
The recent Request for Information provides some more background information: “Unfortunately, race has been misinterpreted and misused in clinical care and clinical algorithms to the harm of communities of color.”
Citing that “there is great interest in addressing the misuse of race within clinical care across the health industry,” Chairman Neal also provides a hard-hitting, un-fancy summary.
From the Fact Sheet “Racism and clinical algorithms: Moving toward racial equity in health care“
The approach
In the RFI, the focus is sharpened to address clinical algorithms, specifically:
“Therefore, in an effort to solicit input and recommendations more broadly on this important issue, I am inviting other organizations and individuals that have interest in or experience working with clinical algorithms to provide comment by October 16, 2020”
The RFI also offers some helpful clarification on clinical algorithms and their connection to race:
“What are clinical algorithms and how do they (mis)use race?
• Clinical algorithms are frameworks that use research and data to guide clinical assessment and decision-making. Examples include calculating kidney function, estimating risks of giving birth, and calculating lung function.
• For too long, racism has impacted medical research and data collection/interpretation. Racial differences in outcomes are too often misinterpreted as biological differences instead of the result of social and structural forces.
• Inaccurate beliefs about biological differences between races misdirected the creation and use of clinical algorithms.”
As I see it, these algorithms constitute durable, often-invisible structures where biases can hide and be normalized. That makes them important structures to interrogate–which is exactly what’s happening.
Here’s the ask
The RFI specifies three questions:
1. To what extent is it necessary that health and health related organizations address the misuse of race and ethnicity in clinical algorithms and research? What role should patients and communities play?
2. What have been the most effective strategies that you or your organization have used to correct the misuse of race and ethnicity in clinical algorithms and research, if any? What
have been the challenges and barriers to advancing those strategies?
3. What strategies would you propose to build consensus and widely used guidelines that could be adopted broadly across the clinical and research community to end the misuse of race and ethnicity in clinical algorithms and research?
These are good questions to start with–and a move in the right direction. I especially appreciate the inclusion of patients and communities, and hope there is meaningful follow-through.
For more information, including the email address where responses are to be sent, here is the RFI one more time.
And if you’re in a position to respond, please do.
