Racism in Health: the harms of biased medicine

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Olaseni Bello

In January of 2021, I came down with COVID.

Nick Petrić Howe

This is Olaseni Bello.

Olaseni Bello

I was feeling increasingly bad. And my temperature kept spiking, I was trying to break my fever. And they basically gave me something to help with my pneumonia caused by COVID. The problem with that medicine, when I did take it was that it forced me to throw up and lose a lot of water. Now, I was grossly dehydrated. And so now it becomes a slippery slope.

Nick Petrić Howe

Olaseni ended up in the ICU.

Olaseni Bello

It was bad. And when I say bad, when they give you an iPad to communicate with your family, I think you start to understand just how close things are — and I have a lot of gratitude — these near-death experiences change you. I mean they do a lot of things to you.

Nick Petrić Howe

Once he was admitted to the ICU, Olaseni got the treatment he needed and recovered. But his story almost didn’t go this way, in fact he was very nearly not admitted into hospital at all.

Olaseni Bello

Doctor came to sort of give me you know, quick triage. And he looked at me and I think he looked at my physique and was sort of like, “oh, you're fine, you're gonna be fine”, you know.Nick Petrić HoweAs part of the triage, Olaseni’s doctors ran tests including measuring his blood oxygen levels- a key risk factor for COVID. The test used a now somewhat infamous tool called a pulse oximeter, a simple device which clips onto your finger — but Olaseni thinks those readings formed a part of the doctor’s initial decision to send him home.Olaseni Bello

The doctor was like, we're just going to send you home, you know, have you get more rest.

Nick Petrić Howe

But Olaseni was sceptical. And that is because of his skin tone. He had recently seen a social media post which suggested those readings might not be accurate. So, he pushed back.

Olaseni BelloThis reading is probably not accurate and why isn't it? And this is me trying to articulate this through gasps right? Because it doesn't read melanated skin properly. That's not going to give an accurate reading. Because I'm dark.

Nick Petrić Howe

Olaseni is right to be sceptical. The pulse oximeter works by measuring light that is shone through the skin, but melanin in darker skin tones absorbs more light, which can lead to inaccurate readings. And that could put him in a very vulnerable position. Now he doesn’t know exactly what was running through his doctor's head, but in a strained hospital in the middle of the pandemic, he already had his work cut out to convince the staff to admit him, a relatively fit, young man. And an inaccurate reading from a pulse oximeter certainly wouldn’t have helped. But Olaseni stuck to his guns, and ultimately he believes his persistence saved his life.

Olaseni Bello

Internally, I felt that if I went home, I would not survive.

Nick Petrić Howe

Olaseni’s story is not unique. There have been retrospective COVID studies showing that Black, Asian or Hispanic people were around 15% less likely to get treatment when they needed it, due to inaccurate pulse oximeter readings. And with millions being hit by covid that means tens of thousands of people potentially prevented from accessing treatment. And what’s more this isn’t new — these inaccuracies have been known for decades. And yet pulse oximeters are still used in many triage protocols, and oversights like this are still happening.

We should add here, in emergency medicine — under intense life-or-death pressure — quick decisions about who gets treatment and when need to be made, and often there isn’t time to collect all the data a doctor may ideally want to support that decision. But clinicians still do all they can to use as much evidence as possible. And that is why simple readings matter. And doctors rely on a host of tools to help make those decisions. But what if the tools they use are inaccurate, or worse biased?

Olaseni Bello

COVID was outside of my control. And then there are other decision makers, and what information they have, and how they use that. It's also out of your control.

Nick Petrić Howe

And at a time when being Black in the US means you’re about twice as likely to die from COVID than if you were white, more and more researchers are raising the alarm — something much bigger is going on here. And people know it.

In this podcast we are going to explore the myriad ways that people have injected bias and racism into modern medicine. From the tools doctors use, to the textbooks they learn from, even the basic perception of diseases.For Nature, I am Nick Petrić Howe, and this is Racism in Health, a podcast from Nature and Scientific American.

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Nick Petrić Howe

The story of the pulse oximeter is not a new one. We often think of technology as neutral, unbiassed, objective. But in reality — well, that just isn’t true. Regardless of how objective a device may appear, humans still create it, and humans are not objective. And as much as scientists try to guard against these biases with statistical practices or study designs. They often don’t succeed. Take clinical trials for example. For decades now many researchers have been trying to increase the diversity of people in these trials.

Otis Brawley

We do need to have diversity in clinical trials for a couple of reasons. And that is that if the population mirrors the US population, you know how well that treatment works.

Nick Petrić Howe

This is Otis Brawley, from Johns Hopkins University and former vice president of the American Cancer Society, who’s been pushing for greater diversity in clinical trials. At its heart, Otis’ basic argument is that when scientists are testing a drug or treatment or a medical tool, they want to make sure it works for the people who are going to use it. So, if it’s being created for people in the US, you want the people enrolled on the trial to be as representative of the US population as possible. If they aren’t, well there’s a real danger of things going wrong.

Otis Brawley

There's even a cancer drug which was approved first in Europe, on a European population. And then later on, when the studies were being done in the United States, it was found that people in the United States had many, many more side effects due to the drug. And it turns out that folate potentiates the drug, folate makes the drugs stronger. And in the United States, we have folate-enriched bread and folate-enriched food that they don't have in Europe. Now that we understand this, the dose of the drug that's recommended in the United States is half the dose recommended in Europe.

Nick Petrić Howe

Clinical trials are vastly overrepresented by people typically defined as white and from urban areas, and that can mean that treatments developed in them may not work for all populations.

For example, it has been reported that the pulse oximeter is mostly calibrated on lighter-skinned individuals, this creates a bias that means that it might not work on populations with darker skin. It’s unclear to what extent manufacturers adjust pulse oximeters to increase accuracy on darker skin tones — much of that information is proprietary — however, we do know that many people with darker skin have been affected by inaccurate measurements.

But underrepresentation in clinical trials is not the only way that biases can enter medical technology — in some other cases, there are much deeper roots.

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Lundy Braun

Race is actually built into the spirometer.

Nick Petrić Howe

This is Lundy Braun. An interdisciplinary researcher who’s gone into huge depth on the history of a device known as the spirometer.

Lundy Braun

Fundamentally it's a medical device that measures the volume in various parameters of lung function. And what I studied primarily, is how the machine itself got racialized.

Nick Petrić Howe

Unlike the pulse oximeter which can give inaccurate readings based on skin tone, the Spirometer requires you to actively input race as a variable.

Lundy Braun

So when you activate it to measure someone's lung function, you have to enter indicator of race

Nick Petrić Howe

Just to pause a second — you might be thinking that something like this would be useful. If there was some kind of correction or calibration applied in Olaseni’s case — maybe he would have had an easier time getting admitted?

But here’s the thing, unlike the pulse oximeter, the spirometer’s readings aren’t impacted by the melanin in a person’s skin. In fact, the colour of someone’s skin is entirely irrelevant to the way the spirometer works, which simply measures volumes of air expelled from the lungs in different contexts. No, the reason the spirometer asks you to input race is to help it interpret the results. Specifically, to “correct” them, based on some pretty dodgy assumptions.

Lundy Braun

So, an actual correction factor wasn't part of the machine itself till 1974 when two researchers proposed a factor based on the study they did with asbestos workers in Louisiana, who were both Black and white. But there was a long, long history prior to that, of conceptualizing Black people's lungs as different and inferior than white people's lungs and that stems as far as I could find to Thomas Jefferson, in his very famous notes on the state of Virginia. And he, he says quite explicitly that the enslaved people's lungs are dysfunctional.

Nick Petrić Howe

It may seem like a long way to go back, but we need to remember that science is built on what came before it. And that system can lead to ideas becoming cemented in literature when perhaps they shouldn’t.To give you some context here, back when Jefferson made his comments it was the height of the enlightenment. And there was a real trend in science and society at that time for categorisation. For example, famed taxonomist Carl linneaus, was developing his system for classifying species and their relatedness. in which he even categorised humans into into 4 distinct varieties'' based on location and skin colour.Now Jefferson’s comments were not based on studies, they were essentially philosophical musings inspired by the ideals of the enlightenment. But it is important to note that the popular idea that everything could be categorised, even people, presented those that had a vested interest in enforcing social hierarchies — such as Jefferson, who was a slave owner — with an opportunity. In particular, to aid in justifying slavery.

Fast forward to the second half of the 19th century, and these claims would gain supposed empirical backing. Plantation physician Samuel Cartwright used an early spirometer to claim a difference in total lung capacity between groups of people.

Lundy Braun

And he used the most salient category in US society, and that was race. So, you already see the social kind of getting into this machine. And Cartwright drew directly on Thomas Jefforson.

Nick Petrić Howe

Cartwright claimed that Black people had lower lung capacities than white people. Jefferson too had argued that these “differences in pulmonary apparatus” among other alleged physical differences were a powerful obstacle to enslaved peoples’ freedom. Cartwright also famously hypothesised that it was a mental illness which he called drapetomania, that caused enslaved people to desire freedom. It goes without saying that this was bunk.

And yet these ideas quickly proliferated and were used by others to justify slavery using ‘science’. Cartwright’s work with the spirometer, was followed up by an extensive survey of US soldiers carried out by another plantation physician, Benjamin Gould, in which he dedicated a whole chapter to race and lung function, making a similar claim to Cartwright.

Lundy Braun

Benjamin Apthorp Gould sort of gave the perimeter of science to these ideas, that were floating around in US society, pretty explicitly.

Nick Petrić Howe

Now even by the standards of the day, Gould’s work was not thorough — variables such as height, age, sex or occupation were not considered — neither was there any investigation into what could be behind the trend he saw in his data. And yet, his findings, when combined with Cartwright’s and Jefferson’s musings, were enough to cement the concept that Black or African American people had universally ‘weaker’ lungs in the literature. Cement it, for a long, long time.

Lundy Braun

His work looked really like science. And even I've found it cited as late as 2010 in a prominent US journal.

Their racism gets into the science they do, as it does now. Our assumptions, shape the scientific questions we ask, the methods we use the methods we develop, how we interpret it.

Nick Petrić Howe

So where does this leave us? Well, the racial bias of a former president, emboldened by some dubious science, and popularised to help justify slavery, has left a legacy in the literature — and that legacy is built into a machine used in modern-day hospitals. So, let’s look at exactly how this plays out today in the spirometer.

In basic terms, the spirometer works by comparing actual lung volume with expected lung volume. And what is expected is calibrated by various metrics, including height, age, sex etc. And one of those metrics is race. The so-called ‘race-correction’ built into the spirometer assumes that Black people have 10-14% smaller lung capacity than their white counterparts, additionally it is assumed that Asian people have 4-6% smaller lung capacity, again compared to white people. Notably there’s no particular correction for multiracial people.What this means in practice is that a 6-foot-tall Black man, aged 40 who recorded a forced expiratory volume (one of the metrics measured by the spirometer) of 3.5 litres, that man would be considered to have 91% of the predicted lung volume, in the normal range for his age height etc... However, the same 3.5 litre volume if measured in an equivalent white man of the same age and height, would be considered around 78% of the predicted lung volume. Abnormally low, and thus potentially requiring treatment.

Two men, of the same height and age; being treated differently, solely because of the colour of their skin.

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Nick Petrić Howe

A recent study on the spirometer from the US looked at 14,000 readings on Black people over 10 years with and without the race correction. They found that removal of the ‘race-correction’ led to an increase of 20.8% in the diagnosis of any pulmonary defect. That’s a lot of people potentially missing diagnoses. I’ll add that the study has not yet been peer reviewed.

Now we should say that many studies performed since the days of Jefferson and Gould have shown that there is indeed variation in total lung capacity between specific populations. The problem is that the ‘races’ are not the same as populations, and they certainly aren’t very specific. And at any rate, further research has found that much of this variation between races disappears when you simply measure someone’s sitting height, rather than their standing height. As this gives a better indication of the size of their chest.

And this is all before you consider that plenty of other factors can contribute to varying lung capacities that are not inputted into the spirometer. For example, research has shown that in the US, Black, Asian and Hispanic people tend to be exposed to higher levels of damaging air pollution. A similar trend can also be seen in the UK. The fact is that the ‘race-correction’ in the spirometer discriminates between people based on an ill-defined concept with some very questionable history. It is also practically very hard to implement with any real consistency. Even in modern peer reviewed research that include information on race, it’s not very clear how its defined. Here’s Lundy Braun again.

Lundy Braun

I screened 10,000 abstracts, and then ultimately looked in great detail at 226 papers and I found that really a small percentage even try to define race. And I think what, at the very least, what we can take away is our ideas about racial difference, are not based on what we consider scientifically robust studies.

Nick Petrić Howe

In these studies, the question is: how did the researchers determine race? Did they ask their participants? Did they take a look and make a guess? Did they pull from some other data set like a census? We don’t know, and because of that it’s hard to really say who it was that they were comparing.

Joe Graves

Most people are confused about the definitions of race, and they tend to conflate biological conceptions of race with social definitions of race.

Nick Petrić Howe

This is evolutionary biologist Joe Graves from North Carolina Agricultural and Technical State University, who has specifically put race under the microscope. Now the idea that race is ‘biological’ has been debunked for decades, but for the sake of the rest of this episode, it’s maybe worth retreading.

Joe Graves

By the end of the 20th century, we'd come to the consensus that while there is geographically based genetic variation within our species that none of that rises to the level of being able to identify human groups, unambiguously, as biological races. So, if we use modern evolutionary definitions of race, they have to do with two primary criteria, that is: the amount of genetic variation within groups, versus the amount of genetic variation between groups; and the second criterion is whether any group within a species can be considered an evolutionarily distinct lineage. So, going back to the late 1960s studies of human genetic variation demonstrated that there was more genetic variation within so-called races than there was between them. And over the end of the 20th century, using even finer designations of genetic variation. It was shown more and more and more that that was absolutely true. At the same time, in the latter portion of the 20th century, we develop phylogenetic methods to determine whether groups are unique clade. And it turns out that that doesn't work either in anatomically modern humans.

Nick Petrić Howe

When we think about race, we are not thinking about a biological category. We are thinking about a social construct.

And yet, people like Otis, who we heard from earlier, are still campaigning for greater diversity in clinical trials. Well, we should clarify here diversity can mean a lot of things and Otis’ concern is really about representing populations, not specifically races. In fact, if you think just about race rather than populations it could be actively dangerous. Here’s Otis.

Otis Brawley

There's a drug that is used as an anti-seizure drug in the United States very commonly, if you give it to people who live within 100 miles on either side of the Thai Burmese border. 20% of them have a gene in their liver that's different from the rest of the world's population. And they will develop what's called Stevens-Johnson reaction, their mouth will turn red and raw, they will get a fever and the darndest thing, the soles of their feet and palms of their hands start peeling. And so when we talk about race, their race is Asian. But this isn't all Asians, but it's just very concentrated in that area.

Nick Petrić Howe

Population and race are often conflated, which in medicine can be extremely dangerous. But that is not to say that the social construct of race is not an important consideration as well in trials like this. Especially when it comes to how people are treated.

Otis Brawley

Many of the disparities, especially the disparities that we see by race in the United States, are disparities in quality of treatment. I’m an oncologist so I’ll use oncologic examples. We hear even Black women start talking about ‘Black-breast cancer’, as if it's a different disease, where the majority of the Black-white disparity is because Black women get less than adequate screening as a whole. A black woman is more likely to get less than adequate screening, less than adequate diagnosis, she's more likely to get less than adequate treatment, and even less than adequate survival care. Now, how do we know this? Well, there are certain Black populations that do very well with breast cancer — do just as well as white women. There are certain states even where the Black-white death rate is the same. But in the United States as a whole, Black women have a 40% higher risk of death than white women. You know, maybe maybe the biology of Black women in Massachusetts is different from the biology of Black woman in the rest of the country, or maybe women in Massachusetts are getting adequate care.

Nick Petrić Howe

So, let’s go back to the spirometer. When someone is operating the device, they have to either ask or make a decision about what someone’s race. But two people who socially identify as Black may have far less in common biologically than any other random two people of any race or background. Put simply, the fact that they both identify as Black doesn’t automatically mean they are biologically similar, so why would their lungs be similar?

Lundy Braun

So, what we've been doing is just applying these very superficial, if not seriously problematic, notions of race to scientific studies.

Nick Petrić Howe

Now it’s possible that the focus on race in medicine in some cases is done with the best of intentions. After all, researchers and practitioners see very real disparities between different social groups of people with their own eyes as part of their professional lives, and so they want to make a change. For example, maybe people who are Black in the data have a higher incidence of heart disease. But the real question is do they have a higher incidence of heart disease because they are Black? Or because of other factors? Like access to high-quality diets or care, a well-documented concern amongst marginalised communities.

When race is interpreted as biological, it can pull focus from other variables which might actually be much more relevant.

Direct discrimination is likely a factor here as well. Studies have shown that Black and Hispanic people in the US are less likely to have their care classified as immediate or urgent by clinicians, and less likely to be admitted to the hospital. Black people are more likely to die in the emergency room or hospital too.

The upshot of this is that variation in health outcomes may not be because of race… but they are because of racism.

And yet the use of social classifications of race in medicine continues — it even goes so far as to racialize disease. Here’s Joe Graves again.

Joe Graves

One medical journal reported on a child who was socially defined as African American and who was suffering from cystic fibrosis for eight years without treatment.

Nick Petrić Howe

Cystic fibrosis is a genetic disease that is diagnosed much more commonly in white populations than in Black ones. But it is important to note that this is not because of race. In reality, the most common genetic mutation that causes cystic fibrosis arose in Europe, and as such the disease is much more common amongst people of European descent. And European populations are majority white. But in the US, Black people can trace an average of anything from 16-30% of their heritage back to Europe — owing to atrocities committed during slavery. In other words, Black people with European heritage can be at risk of developing cystic fibrosis, but because of race this risk is dismissed by healthcare professionals.

Joe Graves

Typically, infants are screened for cystic fibrosis, and they start receiving treatment at the infant stage. But because she was socially defined as African American, she never received that screen.

Nick Petrić Howe

A recent study has shown in the US that when infants are described as Black or African American, Native American, or Hispanic, then they tended to be evaluated for cystic fibrosis later than infants characterised as white.

Humans don’t fall into neat boxes, and neither does disease. And yet the racialization of disease continues.

Andrea Deyrup

And this causes a great deal of harm, this idea that certain populations are more prone to certain diseases, and it comes down to sort of biological determinism, and can lead to delay in diagnosis for all individuals.

Nick Petrić Howe

This is Andrea Deyrup from Duke University, a pathologist and medical educator, who focuses on so-called ‘race-based medicine’. And according to her, it comes up, a lot.

Andrea Deyrup

Every single medical student sees it. I do not believe that there is a curriculum being taught that does not use race-based medicine worldwide.

Nick Petrić Howe

And in many of these cases where race and disease are tied together there’s no real reason for it. In fact, it’s often just plain wrong. Take the example of keloids, these are irregular kinds of scars that are often claimed to be more common in people with darker skin. A number that is often thrown around in the literature and on public health websites is that they can occur in up to 16% of people of African descent. But when Andrea tried to track down the origin of that number, she found it was from a pretty unreliable source.

Andrea Deyrup

It actually came from a report of a dermatologic meeting in Strasbourg in 1931. And in it, someone stood up and spoke and said that he'd been in the Belgian Congo, and he'd looked at 1205 Congolese adult mine workers and found that 16% of them had keloids. So one thing that’s challenging with that is you cannot take something from a single population, and extrapolate that to an entire continent and people who are descended from people from that continent. We know there's more genetic variation in Africa than anywhere else.

Nick Petrić Howe

But this sort of information then gets passed on to medical students who then take it to practice in the real world. They are the ones who go on to make diagnostic decisions. Decisions that may be based on faulty assumptions.

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Nick Petrić Howe

Two separate systematic reviews have found that healthcare professionals in the US showed some amount of racial bias — with higher amounts of bias correlating with lower quality of care.

Joel Bervell

I think no one wants to think that they are biased. But unfortunately, by human nature, we all are biased.

Nick Petrić Howe

This is Joel Bervell, a medical student at Washington State University and medical mythbuster on social media. As one of the few Black students at his medical school, he became all too aware of biases in teaching of medicine, and it isn’t always just about racializing disease.

Joel Bervell

I was sitting inside my classroom, we're talking about cyanosis, which is when the skin turns blue. But I kept looking at myself and saying, my skin's not going to turn blue. What would happen to me?

Nick Petrić Howe

I should point out here that Joel was not thinking that cyanosis would be more or less prevalent in Black or white people, he just wondered how the symptoms would manifest differently on people with different skin tones.

Joel Bervell

And I remember thinking, Should I raise my hand and ask this question? Or should I just kind of sit here and look it up on my own? But I ended up rose, I rose my hand and asked the doctor at the time that I was lecturing. What does it look like in someone like me, in a Black patient? And he had a response, he said, you can look at someone's mucous membranes, you can look at their eyes, you can look at their skin pallor, there's a lot of different places you can look. But after class, one of my friends came up to me and she said, “thank you so much for asking that question. I never would have thought to even think about what does cyanosis look like in a Black patient”.

Nick Petrić Howe

The point here is that this wasn’t an unknown. Joel’s teacher was able to answer his question. But, in that class Joel and his peers were only taught about how cyanosis manifests in patients with light skin. Had Joel not asked the question, it may have never occurred to the rest of the cohort of future doctors in that room that there might be different symptoms to look for. And the same is true for many other conditions of the skin. And that is a big knowledge gap for some future doctors.

In many medical textbooks, skin conditions are only shown on lighter skin, unless it’s a condition claimed to be associated specifically with darker skin. So, doctors may not know how to properly diagnose someone, as they’re not used to seeing how a disease would manifest for them. For example, in basal cell carcinoma — a type of skin cancer — on light skin it looks very different from on dark skin. It’s described as ‘pearly’ for light skin, whereas on dark skin it looks much more similar to a melanoma. But these conditions require different treatments.

According to Joe Graves, even the way that medical students are examined in the USA is contributing to the problem.

Joe Graves

So, the way our board exams exist now, individuals are there by socially-defined race, specifically associated with the disease. So, you know, most of the questions, they'll use a person's social definition. And if it's a person of European descent or who we call white in the United States, they're there just as a descriptor. ‘A white man is in an automobile accident.’ Whereas, if a person is African American, or American Indian, or Latino, they're, they're associated with a specific disease. And so, again, this reinforces the stereotype that there are race specific diseases when in fact, there are not.

Nick Petrić Howe

These race-based questions are something that struck Joel during his medical training as well.

Joel Bervell

If you see that there's a black patient in your question stem, it automatically primes you to think about things like sarcoidosis, or Sickle Cell disease. It's not only black patients that can get sickle cell disease. The reason why people get things like sickle cell disease is because of their ancestry. Sickle cell trait can actually have some protection over malaria. So, people that were in malaria-endemic areas have a gene that is more likely to get you Sickle Cell disease. But that includes way more than just Black individuals. Yet for some reason, we don't talk about it like that in medicine.

Nick Petrić Howe

These sorts of biases in medical teaching, as well as biases in medical equipment and tech are something that Joel spends a lot of his time now mythbusting.Joel in TikTok Clip

What does racial bias in medicine look like? This is a pulse oximeter. It measures your blood oxygen…

Nick Petrić Howe

This is a TikTok that Joel posted back in December of 2020.

Joel in TikTok Clip

…it doesn’t treat all skin colour equally, because of differences in how the skin absorbs light. Black patients…

Nick Petrić Howe

This was the social media post that Olaseni, who we met at the start of this episode, saw. And he says that it was the video that empowered him to advocate for himself with his doctors. He credits it with saving his life.

Joel in TikTok Clip

…understanding racial bias in medicine can help save lives.

Nick Petrić Howe

So how is any of this going to change? Well, Joel is on TikTok trying to raise awareness with his peers, he also runs a mentorship programme and has even spoken at the WHO, American Medical Association, even the White House to help stop the spread of misinformation. At the same time, academics like, Joe Graves and Andrea Deyrup have been trying to combat the racialisation of disease too. But it’s been an uphill battle. Here’s Andrea again.

Andrea Deyrup

So, one argument that I heard was, well, you know, they're going to see this, you know, they're going to hear people say this disease is two times more common in African Americans than, you know, European Americans when they go to the wards. It's a canonical fact. Right? This fact has been discussed so much that when they go on the wards someone's going to tell them this. So even if we spare them in the preclinical years, once they're on the wards, they're going to hear it. And I'm like, but how is that an argument? You know, they're going to hear a falsehood on the on the wards? Shouldn't we prepare them for that by explaining it?

Nick Petrić Howe

Andrea and Joe have been working to remove references to race-based medicine from medical textbooks to better prepare students for what they will find in clinics and on wards. Joe also wants more teaching for medical students and practitioners about what race is, and what it isn’t, giving them a better grounding in biological anthropology.

There is a lot that’s changing, and researchers are continuing to expose inequities every day. But this is just the first step.

In a world, a culture, a system that has racism baked right in — built on centuries of agendas and hearsay — we need those in power to keep investigating and seeking change, challenging received wisdom wherever they see discrepancies. After all, science is supposed to question itself. And given that racism is entrenched in modern science, that questioning is more important than ever. And it is clear that until we change the way we think about how we teach medicine, how we diagnose conditions, how we treat and conceptualise disease, and how we talk about race and health. The same disparities are going to keep happening. Again, and again.

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Olaseni Bello

I was in this situation where I reflected on how misinformation, lack of information and bias combined, or assumptions can lead to false diagnosis. And at least in my situation, I had the knowledge, and I had the ability of a friend to take me to the hospital, and a family member to call in. Those things in combination saved my life.

In the midst of COVID, people would say ‘we want the world to be back the way it was’. Now, I submit that hopefully COVID does not take us back to the way the world was. What I mean by that is, there's so many layers of inequity and bias. COVID of course brought many of those things to light, but it doesn’t mean it erased it, doesn’t mean those things don’t still exist.

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Nick Petrić Howe

This has been racism in health, a podcast from Nature and Scientific American.

This episode was produced and narrated by me, Nick Petric Howe. With reporting by me and Tulika Bose. Sound design was by Jeff Delviscio, with editing help from Noah Baker and Chrissy Yates.We would also like to thank guest editor Melissa Nobles, who has provided invaluable advice and guidance in the production of the podcast.

If you want to read more about racism in science, Nature has a special issue of content which you can check out. We will put a link in the show notes. And to read more about the topics discussed in this episode, we will add a list of the studies we have referenced in the shownotes too.

I’ve been Nick Petrić Howe. Thanks for listening.

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