The best comedians can help us understand complicated social issues. In 2014 Amber Ruffin made history as the first Black woman to join the writer’s room of a major late-night TV show when she began working on Late Night with Seth Meyers. Today, she hosts The Amber Ruffin Show on NBC, where her regular “How Did We Get Here” segments have analyzed complex, historically rooted topics digestible for a popular audience—with the added benefit of Ruffin’s whimsical and pointed wit.
On March 18, 2022, Ruffin’s topic was medical racism. Specifically, what medicine and medical research call “race correction.” Most Americans haven’t heard of this common practice, but it has affected the quality of the health care provided to many millions of us for generations.
As Ruffin correctly summarized it, “race correction” involves the adjustment of medical calculations based on the race of the patient. This might sound innocuous, but for Black Americans, it can be disastrous.
Errors built on racism
While professionals use race correction in calculations involving many parts of the body, Ruffin used our pandemic-fueled familiarity with respiratory conditions to explain. She and her writers did a lot of research, uncovering how, for generations, doctors have assumed that Black patients have a smaller lung capacity than white patients.
Enter Dr. Samuel Cartwright, who in the mid-19th century dedicated himself to investigating the “diseases and peculiarities” of Black people. It was Cartwright who invented and popularized insulting and ridiculous medical conditions such as drapetomania, the “mental illness” that caused enslaved people to try to escape from servitude. This disease, wrote Cartwright in 1851, was unknown to physicians but well within the knowledge of “our planters and overseers.”
Another “disease” conjured up by Cartwright explained the “laziness” of enslaved people. The major symptom of this condition was lesions on the back. As Ruffin told her audience through gritted teeth, “I wonder how they got there.”
Cartwright also set out to measure the difference in lung capacity between Black and white individuals. He used the spirometer, a breathing measurement device invented in the 1840s by British surgeon John Hutchinson. Today’s spirometer is a relatively simple device: a patient breathes into a tube, and the air pressure lifts a ball up into the tube’s chamber. This device can also be used by patients recovering from conditions such as pneumonia to keep their lungs healthy.
Cartwright decided that people of color had a lower lung capacity than white people. This incorrect idea persists to this day, causing numerous physicians to make a “race correction” in their use of the spirometer, due to the allegedly 10 percent to 15 percent less effective lung power of Black patients.
The real causes
Hard data to back up the assumption that race influences lung capacity is scanty. What we can be sure of is that structural racism influences where a person lives and the quality of health care they have access to, with Black Americans often living in more highly polluted and less well-resourced areas.
Medical journal The Lancet published an entire article on this topic, asking whether “race-adjustment” of spirometer readings only serves to increase racial disparities in COVID recovery rates.
Most likely, the article said, the fact that people of color suffer COVID infection rates at three times those of whites and a death rate as much as twice as high is due to structural inequalities. The authors predicted that long-term tests of post-COVID lung function will reveal similar disparities. Used extensively to measure lung function during COVID recovery, spirometer reading outputs come with automatic “race corrections” that often go unnoticed by the physicians using them.
As Ruffin summed it up, there’s little evidence showing that race affects lung health but abundant data showing that “racism could.” If a doctor believes a lower-than-normal lung capacity in a Black patient doesn’t signal a problem, that doctor may not order potentially life-saving diagnostics and treatment for severe respiratory illnesses. As Ruffin put it, “all those small decisions add up.”
Short-changing women of color
The comedian-educator also called attention to the fact that the use of the VBAC score, which attempts to help doctors determine a woman’s chances of successful vaginal birth after a previous cesarian section, has led to unnecessary C-sections for numerous Black and Latina women.
Until new research in 2021 prompted doctors to drop race as a component, protocols automatically had them assign a higher VBAC risk score to Black and Latina women. This often led to the automatic ordering of C-sections for these women, even though C-section births substantially increase the risk of maternal health complications and death.
The research that brought about the change found that the higher risk scores for women of color had originally been based not on race or genetics, but on findings that single parenthood and lack of insurance were additional risk factors contraindicating vaginal birth. Somehow, “uninsured single mother” was fed into the algorithm, and the interpretation was “Black or Latina.”
Correcting heartless calculations
Heart failure risk score is another in this long list of “race corrections.” Physicians use this calculation to determine the level of risk of death in patients prior to hospital admission, with higher scores indicating greater risk. This protocol gives white patients what amounts to a “golden ticket” into the hospital. Being “non-black” automatically confers an additional three points. Black and Latino patients, regardless of other health concerns, frequently receive lower scores and are thus less likely to obtain needed hospital care.
When a popular comedian can educate the public about an issue like medical racism, it’s all for the good. It’s now up to us to make some changes.