Modern medicine has developed over the past 2 centuries in societies stratified by race and ethnicity. Race-based medicine analyzes health risks and treatment based on a patient’s race, often assuming that differences in health status are due to biology and genetics. In the United States, there is a history of guidelines using race-based decision-making for a variety of conditions (eg, hypertension, heart failure). These guidelines lead to profound health disparities. Genetic tests reveal precise molecular causes for differences in therapeutic and adverse effects of medications, and certain genetic variants are more common in specific groups of people. At the same time, there is growing evidence on health disparities that shows stratification of social determinants of health by race, ethnicity, income, and geography. Race-based prescribing guidelines and race-correction factors are under review across medicine to ensure that accurate data are used to provide unbiased care and that guidelines are not worsening health disparities. Race-conscious medicine focuses on the understanding that, although racial differences in health status may be influenced by genetics and epigenetics, they are just as likely to be due to racial stratification in access to resources, experiences of bias and discrimination, and social factors correlated with race.

Case 1. JH is a 55-year-old Black man who has had hypertension since he was in his 20s. Today in the office, his blood pressure is 152/96 mm Hg. He reports that his average blood pressure measured at home is 140/90 mm Hg, which does not seem to be affected by diet, exercise, sleep, or medications. He is taking amlodipine 10 mg/day and limiting his salt intake. He did not tolerate diuretics because he works in a warehouse and cannot always go to the restroom when needed or beta blockers because of sexual adverse effects. He used to take lisinopril, which his previous physician discontinued because, according to guidelines, it is not a first-line choice for Black patients without kidney disease or diabetes.