Small victory

For those of you keeping track, I wrote an editorial about the use of race in calculating renal function which was published in The American Journal of Kidney Disease in 2011. Basically, I pointed out that most African-Americans have mixed African and European ancestry, and using one set of numbers for black patients and another for white patients was problematic every day: which set of numbers should we use for Obama? And would a doctor guess that he was half white?

Recently, I have learned that hospitals are starting to move away from this awkward formulation. I am pleased to be among those who recognized a need for a change: since race is a social construct, and there is no biological binary distinction black/white, it does not make sense to report kidney function in this manner. Below is a copy of a letter sent to the Family and Community Medicine department at San Francisco General Hospital.

Dear FCM SFGH community,

As you may have heard, recently a team of physicians undertook an advocacy effort to abolish race-based eGFR (estimated glomerular filtration rate) by meeting and discussing this issue with the leadership of the SFGH laboratory. We are pleased to report that we were ultimately successful in convincing them to change the laboratory reporting of eGFR to one that does not include a correction factor for race. We recognize that there has not yet been any kind of formal announcement explaining how and why this change occurred and the background context upon which it was grounded, but we understand that a laboratory memo will be forthcoming. In the interim, as the team who advocated for this change, we feel it is important that we share the information that we presented to the lab concerning the reasons necessitating this change. We believe this is a change of utmost importance; one that we hope will be the first of many steps towards eliminating the problematic and structurally oppressive use of race (a social construct with no biological basis) in clinical tools and guidelines. With this change, we hope to spark further discussions on how we can advance health equity for the patients we serve, by focusing not on faulty race-based rhetoric, but instead on examining the effects of structural racism in medicine and its consequences on health. Please see the summary of the information below and feel free to direct any further questions to us. Our team will also be speaking about this advocacy effort at an FCM-sponsored event today, Wednesday 11/13, dedicated to discussing the abolition of biological race in medicine, that we encourage our colleagues to attend.

Sincerely,

FCM Drs. Monica Hahn, Juliana Morris, Stephen Richmond (and Dr. Vanessa Grubbs, from the Division of Nephrology)