Facilitation of Research Networks and Best Practices
Why Race Should Remain a Factor in Clinical Decision Making
When physicians and other clinicians make decisions about how to treat a patient, they should consider all factors—such as health history, test results, demographic, and socioeconomic attributes—that predict a patient’s health risks. They should group patients according to their characteristics to assess the risks they run and then treat patients accordingly. Knowing more about patients allows more accurate predictions of risks and better decision making, IPR economist Charles F. Manski points out in a perspective published in Health Economics. In the last few years, however, researchers have reconsidered the use of race as one of the characteristics in assessments of patients’ risks of disease, and some have argued that race should no longer be included. Manski states that advocates for removing race as a diagnostic consideration have not studied how it would affect the quality of treatment decisions. He subsequently argues that using a “patient-centered perspective” leads to the conclusion that “race-free risk assessment would harm patients of all races.” He identifies and argues against four claims in support of race-free assessment: (1) Race is a social, not biological, concept; (2) race should not be considered if there is no established causal link between race and the illness; (3) using race may perpetuate or worsen race-based health inequities; and (4) many patients are offended by the use of race in risk assessment. He notes that although people may misuse race as a variable in the algorithms employed in risk assessment, race should be included in clinical decisions to give patients the best possible treatment appropriate to them as individuals—unless there is evidence that the social benefit of removing race as a factor in decision making is larger than the harm it causes to patient care. Manski is the Board of Trustees Professor of Economics.