A Clinical Pharmacology and Therapeutics Teacher's Guide to Race-Based Medicine, Inclusivity, and Diversity.

Michiel J Bakkum, Petra Verdonk, Elias G Thomas, Floor van Rosse, Michael Okorie, Paraskevi Papaioannidou, Robert Likic, Emilio J Sanz, Thierry Christiaens, João N Costa, Lorena Dima, Fabrizio de Ponti, Jeroen van Smeden, Michiel A van Agtmael, Milan C Richir, Jelle Tichelaar

Journal: Clinical pharmacology and therapeutics 2023;113(3):600-606

PMID: 36325997

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Abstract

The relationship between race and biology is complex. In contemporary medical science, race is a social construct that is measured via self-identification of study participants. But even though race has no biological essence, it is often used as variable in medical guidelines (e.g., treatment recommendations specific for Black people with hypertension). Such recommendations are based on clinical trials in which there was a significant correlation between self-identified race and actual, but often unmeasured, health-related factors such as (pharmaco)genetics, diet, sun exposure, etc. Many teachers are insufficiently aware of this complexity. In their classes, they (unintentionally) portray self-reported race as having a biological essence. This may cause students to see people of shared race as biologically or genetically homogeneous, and believe that race-based recommendations are true for all individuals (rather than reflecting the average of a heterogeneous group). This medicalizes race and reinforces already existing healthcare disparities. Moreover, students may fail to learn that the relation between race and health is easily biased by factors such as socioeconomic status, racism, ancestry, and environment and that this limits the generalizability of race-based recommendations. We observed that the clinical case vignettes that we use in our teaching contain many stereotypes and biases, and do not generally reflect the diversity of actual patients. This guide, written by clinical pharmacology and therapeutics teachers, aims to help our colleagues and teachers in other health professions to reflect on and improve our teaching on race-based medical guidelines and to make our clinical case vignettes more inclusive and diverse.

Address: Department of Internal Medicine, Section Pharmacotherapy, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.; Research and Expertise Centre in Pharmacotherapy Education, Amsterdam, The Netherlands.; Department of Ethics, Law and Humanities, Amsterdam Public Health Research Institute, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, The Netherlands.; Department of Internal Medicine, Geriatrics Section, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.; Erasmus Medical Centre, University Medical Center Rotterdam, Hospital Pharmacy, Rotterdam, The Netherlands.; Clinical Pharmacology and Medical Education, Department of Medical Education, Brighton and Sussex Medical School, Brighton, UK.; European Association for Clinical Pharmacology and Therapeutics Education Working Group, Athens, Greece.; Department of Pharmacology, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.; Unit of Clinical Pharmacology, University of Zagreb School of Medicine and Clinical Hospital Centre Zagreb, Zagreb, Croatia.; Universidad de La Laguna, School of Health Sciences, Tenerife, Spain and Hospital Universitario de Canarias, La Laguna, Tenerife, Spain.; Section Clinical Pharmacology, Heymans Institute of Pharmacology Ghent University, Ghent, Belgium.; Laboratory of Clinical Pharmacology and Therapeutics, Faculty of Medicine, University of Lisbon, Lisbon, Portugal.; Department of Fundamental Disciplines and Clinical Prevention, Faculty of Medicine, Transilvania University of Brașov, Brașov, Romania.; Department of Medical and Surgical Sciences, Pharmacology Unit, Alma Mater Studiorum, University of Bologna, Bologna, Italy.; Division of Education, Centre for Human Drug Research, Leiden, The Netherlands.; Leiden University Medical Center, Leiden, The Netherlands.

DOI: 10.1002/cpt.2786

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MeSH Terms: Humans, Pharmacology, Clinical, Racism, Students, Social Class, Learning