Race-based medicine in the point-of-care clinical resource UpToDate: A systematic content analysis

Jessica P. Cerdeña, Emmanuella Ngozi Asabor, Marie V. Plaisime, Rachel R. Hardeman

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Race-based practices in medical education and clinical care may exacerbate health inequities. Misguided use of race in popular point-of-care clinical decision-making tools like UpToDate® may promote harmful practices of race-based medicine. This article investigates the nature of mentions of Black/African American race in UpToDate®. Methods: We conducted a systematic content analysis of UpToDate® articles mentioning Black or African American race to assess for biological interpretations of racial categories. Following a simple text search for the terms “Black” and “African American” in UpToDate® on January 24 and March 19, 2020, respectively, removal of duplicates yielded an analytical sample of 208 documents. We adopted a deductive coding approach and systematically applied 16 a priori codes to all documents, refining the codebook to achieve a final inter-rater reliability of 0.91. We then developed these codes into two themes: (1) biologization of race and (2) racialized research and practice. Findings: Biologization of race occurred nearly universally across all documents (93.3%), with discussions of inherent physiological differences between racial groups and presentation of epidemiologic disparities without context emerging most frequently. Sixty-eight documents (32.7%) included codes related to racialized biomedical research and clinical practice, including references to racialized patterns of behavior and cultural practices, insufficient data on Black populations, research limiting study to a specific racial group, and race-based clinical practices guidelines. Interpretation: Our findings suggest that UpToDate® articles often inappropriately link Black race to genetics or clinical phenotype—without considering socio-structural variables or the health effects of structural racism—thus perpetuating a false narrative that race is inherently biological. UpToDate® articles may also promote unequal treatment by recommending race-based clinical practices. Such racial essentialism risks exacerbating racialized health inequities. Funding: The study is supported by the Health Policy Research Scholars Program, Robert Wood Johnson Foundation, Medical Scientist Training Program, National Institutes of Health, the National Science Foundation, the JPB Foundation, the Minnesota Population, the Eunice Kennedy Shriver National Institute for Child Health and Human Development (NICHD), and the Center for Antiracism Research for Health Equity at the University of Minnesota.

Original languageEnglish (US)
Article number101581
JournalEClinicalMedicine
Volume52
DOIs
StatePublished - Oct 2022

Bibliographical note

Funding Information:
JPC, ENA, and MVP are supported by the Health Policy Research Scholars Program, Robert Wood Johnson Foundation. JPC and ENA are supported by the Medical Scientist Training Program, National Institutes of Health (NIH; grant T32GM136651). MVP is supported by the National Science Foundation (No. 2105430) and the JPB Foundation. RRH acknowledges support from the Minnesota Population Center (P2C HD041023) funded through a grant from the Eunice Kennedy Shriver National Institute for Child Health and Human Development (NICHD) and the Center for Antiracism Research for Health Equity at the University of Minnesota.

Funding Information:
E.N.A. acknowledges support from the Robert Wood Johnson Foundation, and the National Institutes of Health; and support for attending meetings/travel from the Robert Wood Johnson Foundation. J.P.C. acknowledges support from the Robert Wood Johnson Foundation, and the National Institutes of Health. M.V.P. acknowledges support from the Robert Wood Johnson Foundation, the National Science Foundation, and the JPB Foundation; and support for attending meetings/travel from the National Science Foundation, and the JPB Foundation. R.R.H. acknowledges support from the Robert Wood Johnson Foundation, and the National Institutes of Health; and support for attending meetings/travel from the Robert Wood Johnson Foundation.

Publisher Copyright:
© 2022 The Authors

Keywords

  • Black/African American
  • Clinical decision-making
  • Point-of-care
  • Racism
  • UptoDate

PubMed: MeSH publication types

  • Journal Article

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