The relationship between patients and healthcare providers is a careful balancing act. It requires patients to instill the utmost faith and trust in their practitioners. This revered, yet delicate, bond rests on the notion that physicians are well-trained and educated through an equitable healthcare system. However, a 2016 study by researchers at the University of Virginia exposed the dark side of America’s clinical care, revealing that many medical professionals hold and may use false beliefs about biological differences between Black and white people to pass medical judgments.

These beliefs likely contribute to racial disparities in pain assessment and treatment. For example, 40% of first- and second-year medical students believe in the misconception that “Black people’s skin is thicker than white people’s.” As a result of this myth and others like it—such as the false belief that Black people have less sensitive nerve endings than white people—Black patients are 22% less likely than their white counterparts to receive pain medication.  

This medical fallacy dates back to the early 1800s when physician Dr. Thomas Hamilton conducted horrific experiments on an enslaved man named John Brown in Georgia. Spread by proslavery advocates, these flawed beliefs eventually made their way into medical textbooks in the years that followed. Physicians who studied these texts, like Dr. J. Marion Sims, adopted these misconceptions. Sims went on to justify performing grotesque experiments on enslaved women—cutting their genitals to perfect surgical techniques—based on the spurious belief that Black individuals have a higher tolerance for pain than white individuals.  

Above: Illustration by Robert Thom of Dr. J. Marion Sims and Anarcha, an enslaved woman whom he subjected to 30 experimental surgeries. Image courtesy of Pearson Museum, Southern Illinois University School of Medicine via NPR.

Two centuries later, the American healthcare system would hopefully have rectified these misconceptions in healthcare, especially after the Human Genome Project (HGP) found in 2003 that humans are over 99% genetically identical. This statistic shows humans fail to meet the biological definition of race, which is a population that is genetically distinguishable by having different alleles or allele frequencies. Therefore, no biological rationale exists to distinguish different races in humans. Instead, race is a social construct tied to physical appearance, language, religion, and culture.

Historically, the definition of race depended on state law rather than science. For example, in the state of Alabama during 1910, an individual was defined as Black if they had a single great-grandparent of African ancestry, while in Michigan one needed two great-grandparents to qualify as Black. However, in the modern day, even when refuted by the groundbreaking findings from the HGP, some medical personnel still believe biological differences between races exist. 

Above: Human Genome Project researchers review DNA sequencing data by eye. Autoradiograph developed by Frederick Sanger in 1977. Image courtesy of National Human Genome Research Institute via ScienceNews.

Medical education may have, in part, helped ingrain this belief. While some groups of people with shared ancestry or family history may have specific allele frequencies that could predispose them to certain diseases, medical training and licensing exams have emphasized and oversimplified this concept down to race as the factor for disease predisposition in diagnostic criteria. This portrayal creates the impression of biological differences between races and suggests to future healthcare providers that only particular diseases affect certain races. Likewise, professors often misrepresent race in their discussions, interpretations of race-based data, and assessments of students’ mastery. For example, one 2021 study found after examining more than 880 lectures from 21 courses in one institution's 18th-month preclinical medical curriculum that professors repeatedly connected certain races to particular diseases during lectures. As a result, students were conditioned to acknowledge cystic fibrosis (CF) as a disease solely diagnosable for white patients, which may relegate Black patients to a latent diagnosis or misdiagnosis despite a presentation of CF symptoms. Similarly, researchers found students are trained to view sickle cell disease as affecting only Black people, rather than a disease prevalent in populations at risk for malaria.

Furthermore, the racialization of disease is evident in UWorld’s Step 1 QBank, a popular test prep resource for the U.S. medical licensing exam taken at the end of the second year of medical school. An analysis of this resource found that race was crucial in interpreting correct answers to diagnostic questions. For example, the description "white/Caucasian" appeared in only 7.4% of the questions, while "Native American" was central to 100% of the diagnostic questions. This approach again trains future physicians to associate certain diseases with specific races, inappropriately painting other races as devoid of a disease. By emphasizing a race’s connection to a disease rather than ancestral ties, and failing to discuss social determinants of health that in some cases are linked to socially constructed races—such as socioeconomic status, access to healthy food, and housing quality—the healthcare system is not only providing inadequate education to future healthcare providers but also inadequate care to future patients via delayed diagnosis and treatment. 

Physicians may not even recognize that they are withholding or delaying care for certain patients based on race because medical algorithms often contain inappropriate race-based corrections grounded in biological misconceptions. For instance, the American Heart Association’s heart failure risk algorithm automatically adds points to non-Black patients' scores. As a result, Black patients are mistakenly considered lower risk for heart failure, which can negatively affect their treatment. Indeed, a 2019 study found physicians in a Boston emergency department were less likely to refer Black and Latinx patients presenting with heart failure to cardiology than white patients. Similarly, the Society of Thoracic Surgeons uses a calculator that factors in race and ethnicity to estimate the risk of death and complications during surgery. In many cases, this calculator places minority patients at a higher surgical risk, potentially deterring them from receiving necessary care. Additionally, kidney function equations that estimate glomerular filtration rates report higher values for Black patients, giving a false representation of better kidney function and delaying referral to specialists or transplant services. Unfortunately, these race-based corrections remain widespread in many medical algorithms, and some continue to be used.

Above: Digital illustration of attempts to remove race correction factors from medical algorithms. Image courtesy of Science.

Race-based medicine is deeply embedded in America's healthcare system. While some progress has been made in addressing medical misconceptions about biological differences between races, dispelling the racialization of diseases, and adjusting race corrections in algorithms, much more work remains.