The medical journey of Vanessa Apea, a busy medical student, serves as a poignant example of the impact of race-based clinical algorithms in medicine. When Apea visited the doctor due to feeling unwell, she was told she had neutropenia, a low white blood cell count that can indicate leukemia. However, a second doctor, who shared Apea’s Black heritage, recognized that she actually had a normal condition common in people of African or Middle Eastern descent. This misdiagnosis highlights how norms and algorithms based on white male physiology can lead to unnecessary health scares and treatments for individuals from different racial backgrounds.
The historical context of race adjustments in clinical algorithms sheds light on the misconceptions surrounding race and biology in medicine. Terms like “benign ethnic neutropenia” have been used to describe lower blood counts in individuals of African descent, perpetuating the idea that certain racial groups have abnormal medical conditions. However, advancements in genomic sequencing have debunked the notion that race is a biological determinant, emphasizing the need to move away from using race in medical diagnostics.
Hematologist Lauren Merz and her colleagues have proposed a new term, Duffy-null associated neutrophil count (DANC), to describe the genetic variant that leads to low white blood cell counts in certain populations. This variant, which is more prevalent in individuals with African or Middle Eastern ancestry, does not pose a health risk but has led to unnecessary follow-up procedures and anxiety due to a lack of routine testing for the variant.
The reluctance to conduct simple tests for the Duffy null variant has resulted in patients undergoing extensive workups and procedures, causing undue stress and financial strain. Moreover, the reliance on outdated norms based on white populations has led to disparities in treatment eligibility and participation in clinical trials for individuals with low white blood cell counts.
Merz’s advocacy for updating reference norms for neutrophil counts based on Duffy status aims to minimize unnecessary testing and ensure equitable care for all patients. By challenging the status quo in hematology and oncology, she is striving to address the systemic biases that have marginalized patients of different racial backgrounds and perpetuated health disparities.
As a physician and HIV specialist, Apea emphasizes the importance of not pathologizing normal variations in health based on race. She underscores the need for inclusivity and sensitivity in medical practice to prevent individuals from feeling “othered” or stigmatized due to their racial background. Through ongoing efforts to raise awareness and implement changes in medical protocols, healthcare professionals like Merz and Apea are paving the way for a more equitable and inclusive healthcare system.
