Commentary

Vanderbilt University Medical Center Department of Radiology Kicks Off Its DEI Week With “Emerging Models of Health Equity” Claiming Racism is the Cause of Disease

  • By Do No Harm Staff
  • November 1, 2023
  • Vanderbilt University

Leave it to Vanderbilt University Medical Center (VUMC) to find a way to infuse racism and health equity into every aspect of medicine. The Department of Radiology’s joint effort with the VUMC Office of Diversity and Inclusion this week demonstrates just how far they are willing go with its mission of “achieving health equity.”

The 2023 Vanderbilt Radiology Diversity, Equity, and Inclusion (DEI) Week event kicked on October 23 with a Grand Rounds session by Dr. Ruth Carlos titled “The Biology of Discrimination: Social Genomics and Health Equity.” The stated objectives for this presentation are quite a mouthful:

1. Review emerging models of health equity that link social exposure risk to cancer outcomes 

2. Assess developing evidence for inflammation as a potential pathway for biological effects of social exposure on cancer outcomes  

3. Explore potential effects of social risk on physiologic and epigenetic alteration through a social genomics framework. 

In her presentation, Dr. Carlos, a professor of radiology at the University of Michigan, spoke on “the heritability of social trauma.” This was a typical discussion about how the “social determinants of health” – which physicians have no ability to address or change – are at the root of every health problem in certain groups of patients. She demonstrated this concept in a graphic model. But take note of one thing: She places “race/ethnicity” as the starting point for the model:

Figure 1. Model depicting “the heritability of social trauma” by Dr. Ruth Carlos at VUMC (October 23, 2023).

Dr. Carlos stated, “I’m sure you’re asking, ‘why is a radiologist studying this’?”

Great question. The answer appears in her additional assertions regarding the origin of disease.

Dr. Carlos presented her theory about “social genomics.” In a nutshell, racial discrimination has an effect in the brain that creates a “potential mechanism for embodiment of racism-related disease.”  

Figure 2. Slide from “The Biology of Discrimination: Social Genomics and Health Equity,” presented at VUMC on October 23, 2023.

In conclusion, Dr. Carlos thanked the attendees “for allowing me to push the envelope today.” In response to a question regarding “the ‘biologicization’ of race” and physicians “trying to get away” from that, she said that physicians don’t always think there is racism in medicine because there isn’t “a lab test” that shows it. She also pointed out that Blue Cross Blue Shield of Massachusetts (BCBS) “has signed a deal” with four healthcare organizations to track equity measures and outcome rather than services delivered.

Figure 3. From “Championing Health Equity” at BCBS Massachusetts.

As Dr. Carlos put it, “If you align incentives, you will get the results you want.”

Do No Harm rejects the assumption that financial incentives to physicians and healthcare facilities for approaching their patients as members of a group instead of as individuals will result in better care. And, Dr. Carlos’s declarations of the presence of racism in every corner of radiology and the healthcare industry does not affirm her theory that “social genomics equals equitable evidence-based care.” The Vanderbilt University Medical Center Department of Radiology must stop sponsoring events that perpetuate messages that promote division instead of caring for patients according to their individual clinical needs.