Doctors often use mathematical equations to calculate a person’s lung function, risk of kidney disease and other aspects of health. The answers help determine what treatment to select, whether to place a person on a transplant list, and even whether they’re eligible for disability benefits or certain jobs.
But many of these equations adjust the math based on a person’s race, often downplaying health risks in Black people and other people of color.
STAT National Science Correspondent Usha Lee McFarling’s reporting on these equations and broader issues of race in medicine recently earned her the 2024 Bernard Lo, MD Award in Bioethics. McFarling spoke with AHCJ about her coverage of race corrected algorithms. This interview has been edited for length and clarity.
When did you first learn about this topic and what got you interested?
I first learned about this in part because of an article at STAT by the amazing Sharon Begley. I started reporting on this myself when the Kidney Foundation and Society for Nephrology made their official recommendation to change the eGFR equation to remove race.
This topic feels like a microcosm of so many issues in medicine: power, evolution of thinking, science and AI, in that these algorithms are gobbled up by programs that use AI to guide decision making. I think this has huge repercussions, but it also just really sheds light into how medicine functions.
There’s been pushback on efforts to remove race from equations. What have you learned about this through your reporting?
It’s fascinating because there are really good arguments on both sides.
With lung function, for example, there’s research that says if you use the new test that takes out race, it looks like lung function is poorer for black patients than it was with the old equation. As a result, they might not get the most aggressive lung cancer surgery treatments and, therefore, not survive lung cancer.
I think the main tension in both the kidney and lung function equations is that people who are upset that race was used want to get it removed right away because it’s wrong. Other people are like, okay, we agree this is wrong, we would never think about race that way now. We’re all much more sophisticated, but we don’t want to do this quickly and potentially harm patients. There’s a tension between “change it now” and “no, we need a year.”
It’s partly a generational problem. These sloppy studies that treated race as biological or made assumptions that all black people have a lot of muscle mass — why were these not questioned? How did this stuff get published?
At the time, I think people were just not thinking about race as we are now. This is a direct repercussion of the lack of diversity in medicine and medical publishing.
How do you feel covering this topic as a person of color?
I feel like it does affect my health because I’m mixed race. And actually, both the kidney tests and the lung tests are far less accurate for Asians. I focus more on Black health disparities because they’re so large, but the disparities really do exist for so many ethnic and racial groups, many because they just weren’t even included in the studies back in the ʼ90s.
I think white reporters need to be reporting on this, too. There’s not enough people of color or mixed race to do this work.
What advice do you have to journalists starting to cover this topic?
When the kidney function equation was being discussed, some hospitals were changing it, and some weren’t. Look at your own local hospital and the lab managers there. Was there someone pushing for it? How did it change where you are? Or has it not changed yet?
It’s a little harder with lung function tests. That’s not just adopting a new equation. The algorithms are actually in the software on devices, and software is not free to update as anyone that uses MS Word knows. Another interesting story might be to look at the safety net hospitals in your area. Can they even afford to do these updates?
What patients think is another piece. It’s very possible that many black people who have higher stages of kidney disease are not being treated but don’t know it. A lot of people need to see where they stand with the new equations and whether they need more aggressive treatment. Those public service stories are important too. They literally could save lives.