I was watching Grey’s Anatomy the other night when an implicit bias crept into the story. One patient was a black woman in need of a kidney transplant. She explained to her new doctor that she did not qualify for a transplant because her algorithm used to determine qualification for a transplant was too low.
As the new doctor explained to his patient (and to the television audience), the algorithm is racially biased against black people. According to an article in Nature (Is racially-biased algorithm delaying health care for one million Black people) published in December 2020, in the late 1990s, researchers introduced a correction factor
… to take into account that, on average, Black people in the United States tend to have higher blood levels of a molecule called creatinine than do white people- despite having similar kidney function. Creatinine levels are a marker of how well a person’s kidneys filter waste from the body. Doctors feed the measurement, along with other information, into algorithms that calculate a person’s estimated glomerular filtration rate (eGFR) to evaluate kidney function. High creatinine levels lead to a lower eGFR, which is a sign of kidney disease; the correction inserts a multiplier of about 1.2 when calculating the eGFR of Black people, potentially making their kidneys seem healthier than they actually are. (Id)
Another article published in JAMA noted that this multiplier “… systematically raises the eGFR by 16% for Black individuals… conferring an estimate of better kidney function for Black individuals ….” (Id.) The authors conducted several studies of patients using the algorithm with and without the correction factor and found that when the Black race correction factor or multiplier was removed, Black individuals qualified to be on the transplant list approximately 1.9 years earlier, and the referral to nephrology occurred 3.6 years earlier. (Id. at Systemic Kidney Transplant Inequities for Black Individuals: Examining the contribution of Racialized Kidney Function Estimating Equations by L. Ebony Boulware, MD, MPH; Tanjala S. Purnell, MPH; Dinushika Mohottige, MD, MPH)
Of course, the doctor on Grey’s Anatomy used much simpler language in explaining this to his patient and in confronting his colleague- the nephrologist- who was responsible for placing patients on the list. And obviously, the doctor used a lot more drama than any article in JAMA or Nature conveys. (This was, after all, a TV drama.)
As is true in TV Land, the show ended with the black patient getting on the transplant list. The doctor’s advocacy with this colleague – the nephrologist- succeeded.
But as a student of implicit bias, the point is not lost: implicit bias exists everywhere. Those who created the multiplier may have had good intentions- creating the multiplier to correct a perceived discrepancy or imbalance- to equalize the alleged differences among the different races. But unwittingly, they tipped the scales the other way- making the situation a lot more inequitable and with deadly consequences!
So the moral- in trying to correct one imbalance, we must be careful not to create another motivated by an implicit bias. When trying to “equalize “a situation, we may end up making it a lot more unequal due to our implicit biases.
… Just something to think about.
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