Lawmakers Call for the Removal of Racial Bias in Healthcare Algorithms

Four lawmakers sent a stern warning to the U.S. Department of Health and Human Services today, asking the government agency to investigate racial bias in healthcare algorithms and how they affect patient care. Advocates and industry experts have warned that the machines that use algorithms could worsen health disparities among African Americans if they use race as a determining factor for care.

Healthcare algorithms use vast quantities of data to make complex decisions in a matter of seconds. They are designed to simplify the diagnosis process by assisting doctors in their assessment of the patient. However, if these systems contain the wrong data or doctors use them in the wrong way, it could put certain patients, particularly those of color, at a disadvantage.

This comes in the middle of the coronavirus pandemic, which has disproportionately affected Latinx and African Americans. Find out why these algorithms are getting so much attention from Washington.

A Lawsuit from the NFL

It all started in the courts.

In August of this year, a group of black former NFL players sued the league, claiming they used racially biased algorithms when assigning compensation to players after they suffered from head injuries in the field.

We’ve long known that the sport can lead to serious brain damage, so the league started financially compensating players for the toll the game is taking on their bodies. The suit says the algorithms are inherently biased by assuming that white players have higher cognitive abilities. This lowers the threshold for white players seeking financial compensation, while black players say they have to work harder to prove they have suffered a head injury.

The NFL quickly responded to the lawsuit, calling it “misguided.” However, these players were able to get the attention of Democratic lawmakers and providers across the healthcare industry.

Democratic Lawmakers Push for Equality

U.S. Senators Cory Booker (D-New Jersey), Elizabeth Warren (D-Massachusetts), Ron Wyden (D-Oregon), and House Representative Barbara Lee (D-California) all signed a letter today asking HHS to investigate these algorithms, warning such miscalculations could cause doctors to make decisions that worsen health outcomes for people of color.

In an email, Elizabeth Warren writes, “In order to reduce health disparities among communities of color and promote anti-racist health policy, we need to research the impact of structural racism on the health of communities of color, including the use of race-based algorithms.”

The letter was sent to the Agency for Healthcare Research and Quality, a division of HHS that researches emerging technology and its effect on the industry. The group will investigate the algorithms in question, how they are being used on the ground, and what, if any, harm they may be causing to patients. The group will also look for ways this technology can be improved.

How Algorithms Affect Patient Care

Facilities and health networks are investing in algorithms as a way of improving patient outcomes and reducing costs. The system may recommend additional care for some patients, so providers can make decisions quickly as they try to do more with less. The main focus of these complaints is that the system seems to prioritize white patients over those of color. Multiple algorithms seem to think that white people need specialized care more than black people.

A 2019 study shows how a major U.S. hospital was using an algorithm that let white patients skip over black patients in line for specialized care programs, including those for complex chronic conditions, such as diabetes, kidney disease, and heart disease. This prompted senators Booker and Wyden to write to the Federal Trade Commission and Centers for Medicare and Medicaid Services.

Since then, the tool has been replaced with an alternative that doesn’t use race. It has also been abandoned by some major U.S. hospitals, including Massachusetts General and University of California San Francisco.

The most recent letter highlights six algorithms that may discriminate against patients of color; however, similar reports list up to 12 programs that may contribute to health disparities, and experts say there are more waiting to be discovered.

One is a program known as eGFR, which recommends additional care for those at risk of kidney disease. Nwamaka Eneanya, an assistant professor at the University of Pennsylvania who studies the tool, says the data shows black patients need to get sicker than white patients before they can access specialist care. She believes these programs shouldn’t use race as a determining factor. “We need to be more responsible and stop putting social constructs into these tools.”

Eneanya is also a member of a special task force at the American Society of Nephrology and National Kidney Foundation. She says organizations need to investigate these tools and come up with reasonable solutions to counter these trends.

The more we draw attention to these issues, the more providers and lawmakers will investigate any potential harm these algorithms may cause. Advocates say the next step is to quantify the damage that’s already been done, so we can correct these issues before they get worse.