Analysis: AAP to reassess clinical guidelines to ‘address racism’

by Trinity Cardinal

Lauren Dempsey, MS in Biomedicine and Law, RN, FISM News 


The American Academy of Pediatrics has issued new guidelines for Entrustable Professional Activities (EPAs) in an effort to “address racism” in pediatric medicine. The organization published an article in January 2022 addressing issues they see in both education and practice in the field of pediatrics and six ways to work toward eliminating race-based guidance and subsequent health disparities. 

The organization plans to evaluate all of its current guidance to make sure it is evidence-based and rooted in science.

In this ongoing endeavor, last year the AAP revised a guideline for assessing urinary tract infections (UTI) in black children which stated that black children were at lower risk than white children. Upon review, it was proven that the greatest risk factor for UTIs were prior infection and fevers lasting longer than 48 hours, not race. The organization says that this resulted in fewer black children being tested for the condition.

A growing number of doctors have expressed concern that minority children, specifically black children, were not receiving the care that they needed, leading to the study.  However, some professionals caution that while it is wise to reevaluate, and in some cases issue new guidance, neglecting to appropriately consider a patient’s ethnicity and race could hurt minority children that may be genetically predisposed to certain illnesses.

In a news release today, the AAP announced a call to action, demanding “fundamental changes in the practice of medicine to end long-standing inequities in health care.”

The new policy statement titled “Eliminating Race-Based Medicine,” asserts that “the AAP observes that race is a historically derived social construct that has no place as a biologic proxy. Over the years, the medical field has inaccurately applied race correction or race adjustment factors in its work, resulting in differential approaches to disease management and disparate clinical outcomes.”

However, the question arises, of whether this statement is an over-simplification of the truth? Contributing factors to disparities in healthcare include poverty, environmental factors, and lack of access, as well as individual behaviors, not all of which can be encompassed by racism. 

Also, according to the Cleveland Clinic, ancestry and ethnicity are important determinants of health and are very important to understanding overall health risks and can lead to improved health care. For example, individuals of Ashkenazi Jewish heritage have a higher risk of carrying the BRCA gene mutation than other populations and are also genetically predisposed to Tay-Sachs disease. White people have a higher incidence of cystic fibrosis. African Americans have a higher risk of inheritance for sickle cell anemia and heart disease. Ancestry and ethnicity can also impact how an individual responds to certain medications.

While the AAP is trying to remove race from the discussion in medicine, other medical institutions have moved toward placing a greater emphasis on it.

The University of Bristol Medical School began making changes to its curriculum to focus on teaching clinical signs of disease on various skin tones after students complained that their training didn’t properly equip them to treat minorities, concerned their limited training could place patients’ safety at risk.

Disparities in healthcare exist and need to be seriously addressed by the medical community. It is important for all institutions to self-evaluate for ideologies or practices that may be rooted in prejudice. And yet one might also argue that more considerations, not less, should be made to biological variations specific to race and ethnicity, to offer better, more equitable care.