Achieving Equity in Pediatric Clinical Guidance

The last several years have seen increased scholarly attention paid to the use of race in clinical algorithms and practice guidelines.1 Whether it be attempts at race correction, race norming or race adjustment the inappropriate use of race as independent proxy for biologic variables is being vigorously challenged.2 Several organized medicine bodies have issued policy and/or positions declaring opposition to race-based medicine and commitment to critically examining the role of race and racism as structural contributors to outcome disparities.3,4,5 In terms of the investigative underpinnings that support the development of clinical algorithms, in a 2024 study entitled Rethinking the Use of Race in Biomedical Research, the National Academies of Science Medicine and Engineering panel encouraged researchers to "refrain from making unsupported inferences from the analysis, such as relying on race and ethnicity as causal attributes that drive biomedical research outcomes".6 The scientific literature is replete with examples beyond the scope of risk determining algorithms and equations where race is embedded as a variable that can deleteriously influence clinical decision-making.