During his time on dialysis, Cannon reflected on how his race had impacted his medical care. He remembered the words “African American” on his lab report, and how they had influenced his treatment over the years. He thought about the flawed assumptions that had led to Black patients like himself being undertreated and denied transplants. He thought about the years he had spent on the transplant list, waiting for a kidney that may have been delayed because of his race.
But as Cannon waited for a new kidney, the landscape of kidney care was changing. The use of race in clinical algorithms was being questioned and challenged across the country. The fight to remove race adjustments from kidney function equations was gaining momentum, fueled by a new generation of physicians who understood the complexities of race and medicine in ways their predecessors did not.
As Cannon underwent dialysis treatments and waited for a new kidney, the national conversation around race and medicine was evolving. The events of 2020, including the Covid-19 pandemic and the murder of George Floyd, had brought issues of racial injustice to the forefront of public consciousness. In the midst of this national reckoning, the use of race in clinical algorithms became a focal point for change.
Finally, in November 2020, Cannon received the call he had been waiting for. A donor kidney was available, and he underwent a successful transplant surgery. As he recovered, he reflected on the journey that had led him to this moment. He thought about the young medical students who had questioned the use of race in clinical algorithms, and the kidney specialists who had fought to change the system. He thought about the years he had spent on the transplant list, and the impact that race-based medicine had on his care.
Today, Cannon is grateful for his new kidney and the chance to live a healthier life. He hopes that his story will inspire others to question the assumptions and biases that pervade medicine, and to advocate for a more equitable and just healthcare system for all patients.
As he looks to the future, Cannon is optimistic that the changes taking place in kidney care will pave the way for a more inclusive and compassionate approach to medicine. He knows that the fight against embedded bias is far from over, but he is proud to have played a part in the movement for change.
For James Cannon, the journey from questioning race-based clinical algorithms to receiving a life-saving kidney transplant has been a long and difficult one. But it has also been a journey of hope, resilience, and ultimately, healing.
If Six was lucky, he would have had access to a healthcare system that prioritized accurate and equitable assessments of kidney function. The eGFR equation, a method used to estimate kidney function from a simple blood test, has been a topic of controversy within the medical community, particularly in its application to Black patients.
For years, the Cockcroft-Gault formula, the first commonly used equation, did not account for Black patients, leading to concerns about overdiagnosis and potential denial of necessary medications. In 1999, a new calculation that included race was developed, leading to more accurate estimates across all patients. However, as the medical community grappled with the implications of race-based adjustments, debates arose about the necessity of incorporating race into the equation.
When the Mass General Brigham hospital system decided to remove the racial adjustment in June 2020, it sparked widespread concern and debate among nephrologists. The decision led to a divide within the community, with some advocating for evidence-based assessments and others challenging the use of race as a determining factor in kidney function evaluation.
Dr. Winfred Williams, an associate chief of nephrology at Massachusetts General Hospital, acknowledged the complexities of race in medical practice and highlighted the need for a more nuanced approach that considers ancestry and population genetics. Despite resistance to change and a lack of diversity within the field of nephrology, efforts to remove race from the equation continued to gain traction.
Medical students, like Naomi Nkinsi, faced challenges and pushback when advocating for the removal of race from the equation. However, their activism and dedication to equitable healthcare practices have been instrumental in driving change within the medical community.
If Six had been lucky, he would have benefited from a healthcare system that prioritized accuracy, equity, and inclusivity in kidney function assessments. The ongoing discussions and debates surrounding the eGFR equation serve as a reminder of the importance of continuously evaluating and improving medical practices to ensure the best possible outcomes for all patients.
The journey to remove race from kidney algorithms was not an easy one. For many involved, it was one of the hardest times of their lives. The battle to eliminate racial bias in medical assessments faced strong opposition from unexpected quarters, causing rifts within the medical community and leading to intense debates on the best way forward.
One of the key figures in the push to maintain the status quo was Neil Powe, a Black professor of medicine at the University of California, San Francisco. Powe, who advocated for equity in kidney care, believed that removing race from the equation too quickly and in disorganized ways could do more harm than good. He argued that the race-based equation accounted for differences in kidney function seen in Black populations and produced more accurate results for all patients. Despite his intentions, Powe’s stance surprised and disappointed many who were fighting to eliminate racial bias in healthcare.
The decision to remove race from the equation at UCSF clinical lab in October 2019 sparked a larger debate within the medical community. Some believed that keeping race in the equation improved accuracy, while others argued that race had been handled inaccurately from the start. The clash of opinions resulted in heated discussions in news articles, editorials, and medical journals, with both sides passionately defending their positions.
Amidst the controversy, Amaka Eneanya, a nephrologist and chief transformation officer at Emory Healthcare, emerged as a leading voice in the fight to remove race from kidney algorithms. Eneanya had been advocating for change since co-writing an op-ed in 2019, highlighting the harmful effects of using race to assess kidney function. Despite facing resistance from senior colleagues and experiencing bias in the publication process, she continued to push for reform, determined to make a difference.
In August 2020, the National Kidney Foundation and American Society of Nephrology formed a task force to examine the issue. Led by Powe and Cynthia Delgado, the task force spent months gathering input from experts and patients, evaluating different approaches, and engaging in intense debates. In September 2021, the panel unanimously recommended transitioning to a new equation that did not involve race adjustment and increasing the use of a race-free measure of kidney function.
Behind the scenes, the process was fraught with acrimony, politics, and attempts to silence dissenting voices. Eneanya, a member of the task force, faced bullying and dismissal as she raised concerns about race. Despite the challenges, she persevered, driven by the belief that change was necessary to ensure equity in healthcare.
The journey to remove race from kidney algorithms was a challenging and emotionally draining experience for all involved. It highlighted the complexities of addressing racial bias in medicine and the importance of standing firm in the face of opposition. While the road ahead may be difficult, the dedication and determination of those fighting for change offer hope for a more equitable future in healthcare. The debate surrounding the use of race in kidney function estimation has been a contentious one, with different factions within the medical community taking strong and often conflicting stances. The issue has sparked heated discussions, with some members of task forces supporting the removal of race from the equation, while others fear the repercussions of going against senior nephrologists.
One task force member, who supported Dr. Eneanya’s account but chose to remain anonymous, highlighted the power dynamics at play within medicine. The fear of career reprisals and concerns about having papers reviewed or grants funded led some members to support Eneanya only privately.
The debate over the use of race in the equation has exposed deep divisions within the medical community. Those advocating for the removal of race argue that their intentions were unfairly characterized as harmful to Black people. On the other hand, proponents of keeping race in the equation argue that their concerns were not about accuracy but rather about the ethical implications of using race in medical decision-making.
Lesley Inker, who played a role in developing the original equation, emphasized the importance of considering individual patients’ access to important drugs. She expressed concerns that some patients could be harmed at an individual level if race continued to be a factor in the equation.
Task force co-chair Delgado, who grappled with her own racial identity, acknowledged the conflicting voices within the task force but stressed the importance of finding common ground. The task force ultimately recognized the dual importance of clinical accuracy and equity, leading to a shift in their approach.
The work of Inker in developing a new equation without using race as a factor played a crucial role in the ongoing discussions. While the new equation may not be as accurate as the original, it was deemed more equitable and distributed inaccuracies among different racial groups more fairly.
Despite the progress made in revising the kidney function estimation equation, there are still challenges ahead. Some within the medical community have been slow to adopt the new recommendations, and there is a recognition that changing one equation will not solve racial disparities in kidney disease.
The process of revising the equation has not been without its controversies. Some activists and young physicians who initially spoke out against the use of race feel marginalized and overlooked in the official narratives surrounding the change. The historical credit for the change has largely gone to established physicians who ran the task force, leaving out the voices of those who took risks by advocating for change.
As the medical community grapples with the implications of removing race from the equation, the debate continues. Activists argue that the evidence supports their stance, while some established physicians maintain that the younger generation went about advocating for change in the wrong way.
Ultimately, the revision of the kidney function estimation equation serves as a reminder of the complexities and challenges inherent in addressing racial disparities in medicine. The ongoing discussions and debates highlight the importance of listening to all voices and finding common ground in the pursuit of equity and accuracy in medical decision-making. Enenaya, who now serves as chief transformation officer for Emory Healthcare, recently opened up about falling out of love. This revelation came as a surprise to many, considering her successful career and seemingly happy personal life.
On a different note, in May, Powe and his task force co-chair Delgado were recognized for their work on removing race from kidney assessments. They were placed on Time’s list of the 100 most prestigious people in medicine, showcasing their dedication to addressing racial disparities in healthcare.
The issue of racial disparities in kidney transplants is a significant one, with Black Americans being disproportionately affected. Despite being four times more likely to have end-stage kidney disease, they are less likely to receive the optimal treatment of a kidney transplant. This disparity is due in part to the systemic underestimation of kidney disease severity for many Black patients, stemming from the racial adjustment in the kidney function equation.
In response to this issue, the Organ Procurement and Transplant Network mandated the use of a race-free calculation for all hospitals in its transplant network. This decision was a significant step towards addressing the racial disparities in access to transplants and providing redress for Black patients who had been affected by the race-based equation.
For individuals like La’Tonzia Adams, who lost her father to severe kidney disease that went undiagnosed for years, the change came too late. However, she now works tirelessly to ensure that race-free kidney assessments become the norm, hoping to prevent similar tragedies in the future.
Despite the challenges faced by individuals like Adams, there have been success stories following the implementation of the race-free calculation. Patients like Jazmin Evans, who received a kidney transplant after years on dialysis, have benefited from the correction in the system and received life-saving treatment.
However, not everyone has had an easy journey. Individuals like Cannon have faced obstacles in accessing the care they need, with lab reports labeled as African American being scrubbed from patient records. This practice has hindered their ability to qualify for transplant waitlists, highlighting the ongoing challenges in addressing racial disparities in healthcare.
Despite these challenges, the transplant network has made significant progress in addressing racial disparities in kidney transplants. More than 16,000 Black patients have received a waiting-time modification, leading to nearly 4,000 of them receiving new kidneys. This progress has been met with emotion and gratitude from those who have been personally impacted by the change.
Overall, the shift towards race-free assessments in kidney transplants represents a crucial step towards achieving health equity for all patients. As individuals like Eneanya tear up at the sight of these numbers, it is clear that there is still work to be done, but progress is being made in the right direction. If you’re looking for a new way to stay fit and healthy, consider adding Pilates to your workout routine. Pilates is a form of exercise that focuses on body awareness, core strength, flexibility, and overall muscle tone. It is a low-impact workout that can benefit people of all fitness levels.
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Artificial intelligence (AI) has become an integral part of our daily lives, revolutionizing the way we work, communicate, shop, and even make decisions. From virtual assistants like Siri and Alexa to self-driving cars and personalized recommendations on streaming platforms, AI is everywhere.
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While AI has the potential to improve our lives in countless ways, it also raises ethical and societal concerns. Issues like data privacy, algorithmic bias, and job displacement are hotly debated topics in the AI community. As AI becomes more integrated into our daily lives, it is essential to address these challenges and ensure that the technology is used responsibly and ethically.
In conclusion, the rise of artificial intelligence has transformed the way we live, work, and interact with the world around us. From healthcare to retail to transportation, AI is reshaping industries and pushing the boundaries of what is possible. As we continue to harness the power of AI, it is crucial to strike a balance between innovation and responsibility to ensure that the technology benefits society as a whole.
