By: Leah Savage
In an age of anti-racism that often looks like doctors being encouraged to interrogate implicit biases they may harbor, a more insidious beast undermines efforts towards equity in healthcare: ascriptions of race as biological in biomedical research and consequential medical guidelines.
Part one of the text, “the cracked biomedical foundation of race-specific hypertension guidelines,” dives deeply into the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) study comparing thiazide-type diuretics to calcium channel blockers and angiotensin-converting-enzyme inhibitors (ACEIs), highlighting the structural critiques of its racialized findings and also its influence in widely-used hypertension guidelines. The rationale for the acceptance and persistence of ALLHAT is covered in part two of this essay, “historically situating race-based hypertension guidelines and their influences.” Indeed, the acceptance of ALLHAT and its poor study design and analysis is not surprising upon consideration of 1) the scientific paradigm during which it was conceptualized, the inclusion-and-difference paradigm and 2) its demonstration of the inefficacy of ACE inhibitors for Black patients, which fit neatly in with folk ideas about racial difference stemming from the slavery hypertension hypothesis. Finally, part three of this essay, “an analysis of the persistence of racialized medicine, and a better model,” reimagines the field of medicine. The paper culminates with advocacy for the abolition of race correction in medicine and offers practical changes to install in medicine the notion of biocritical inquiry, which allows for the parsing out of the specific social determinants of disparities in hypertension.comments powered by Disqus