By Luisa N. Borrell, Jennifer R. Elhawary, Elena Fuentes-Afflick, et al., New England Journal of Medicine, February 4, 2020
In the United States, race, ancestry, genetics, and medicine are inextricably linked in a complex and fraught history. Medicine is replete with examples of racial injustice inflicted by the use of race and ethnicity as biologic constructs to engender hierarchical discrimination. Race and ethnicity are dynamic, shaped by geographic, cultural, and sociopolitical forces; they can influence people’s socioeconomic position and lead to disproportionately high morbidity and mortality for racial and ethnic minorities by sustaining inequitable access to resources, including health care.1
Nevertheless, we believe that it is inappropriate to simply abandon the use of race and ethnicity in biomedical research and clinical practice, since these variables capture important epidemiologic information, including social determinants of health such as racism and discrimination, socioeconomic position, and environmental exposures. Eliminating the use of race/ethnicity, or implementing a race/ethnicity-blind approach, could enable inequitable health care systems to persist and exacerbate racial/ethnic inequities in health outcomes. Complementing the use of race/ethnicity with data on genetic ancestry, genotypes, or biomarkers might be useful, but risks and benefits should be analyzed carefully for specific clinical applications.
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