Intention to Treat

What happens when medicine gets race wrong? In a new 8-week series, The Race Equation confronts harmful assumptions about race in clinical medicine, why they endure, and what it will take to change. ​
​Follow “Intention to Treat” on Apple Podcasts or wherever you get your podcasts. 

Many clinical algorithms, including the eGFR test for kidney function, have actually had race baked into them and produce different results for Black patients. Most of us assume these algorithms are based on science, but what if the science is wrong?
A full transcript of this episode is available at https://www.nejm.org/doi/full/10.1056/NEJMp2601974.

The history of race-based correction of lung-capacity measures can be traced to a pre–Civil War belief among slave owners that slaves had naturally inferior lung capacity. Despite work to show that race-corrected spirometers mask lung-disease severity in Black patients, the majority of U.S. hospitals still use them.
A full transcript of this episode is available at https://www.nejm.org/doi/full/10.1056/NEJMp2601975.

Many Black veterans live below the poverty line, often struggling to manage their illnesses. As V.A. hospitals began to stop using race-corrected interpretation of Black patients’ spirometer readings, there was an epiphany: the race correction wasn’t just harming the health of Black patients, it was also hurting them financially.
A full transcript of this episode is available at https://www.nejm.org/doi/full/10.1056/NEJMp2601976.

The story of the pulse oximeter demonstrates that sometimes consideration of race is critical to diagnosis and treatment — as came starkly into light during the Covid-19 pandemic.
A full transcript of this episode is available at https://www.nejm.org/doi/full/10.1056/NEJMp2601977.

How did a drug for congestive heart failure get approved and marketed for Black people only?
 
A full transcript of this episode is available at https://www.nejm.org/doi/full/10.1056/NEJMp2601978.

We now know that humans are more than 99.9% genetically alike. So why does medicine still link certain diseases to race? And what do genetics actually tell us about race, ancestry, and disease?
A full transcript of this episode is available at https://www.nejm.org/doi/full/10.1056/NEJMp2601980.

The use of race in medicine is harming patients. What is being done to move away from these practices and to change a culture of medicine based on the false premise that race is biological?
A full transcript of this episode is available at https://www.nejm.org/doi/full/10.1056/NEJMp2601981.

The ripple effects of U.S. anti-DEI policies extend far beyond individual labs: scientific discovery is slowing, early‑career investigators are reconsidering their futures, and the pipeline of medical school applicants is shifting in real time.
A full transcript of this episode is available at https://www.nejm.org/doi/full/10.1056/NEJMp2601982.