On April 14, I put up a post on “Race, ‘Wokeness,’ and Kidney Transplant Shortages,” which was in part a critique of Dr. Stanley Goldfarb’s article on the same subject, published by the City Journal. Dr. Goldfarb has sent me a thoughtful response to my piece, which I am happy to post here, at his request. I will likely put up a rejoinder in a separate post.
Here is Dr. Goldfarb’s response to me:
Dear Professor Somin,
Thank you for the opportunity to respond to your article quoting my piece, “Reparations Come to Medicine” in City Journal. You described my position as favoring a race-based formula for determining kidney function. If the article conveys that idea, I apologize as that is not my position. The previous formulas that required a separate calculation for African Americans have been labeled as racist. That is simply and demonstrably untrue. They were verified in multiple clinical studies with hundreds of patients. As part of the “racial awakening” of the health care enterprise, there was a push to eliminate all race-based algorithms in healthcare. I object to characterizing the older, empirically derived equations as racist as has become a standard trope for activists. It is all part of blaming health care disparities on discriminatory health care treatment and it is a canard. My article sought to make clear that the old formula was absolutely not an indicator of racism.
Adopting new formulae for calculating kidney function is fine if they are accurate and objective. The latest formula using readily available blood chemistries is not more accurate than the old formula and chosen since it produces the desired outcome of lowering the estimation of kidney function in Black patients. Counterintuitively, estimating lower kidney function in Black patients has a benefit: It allows them to enter the kidney transplant waiting list sooner. It is unlikely to increase the number of Black patients receiving a kidney as the actual basis for the disproportionately low number of Black kidney recipients is lack of willingness to pursue this very demanding form of treatment.
I object to the use of the new formula to retroactively alter previous estimates of kidney function and to revise the transplant wait list to reflect the newly calculated values. Using the new formula prospectively will likely have a minimal impact but using it retrospectively will force a to-be-determined number of White and Asian patients to lose their place on the transplant wait list and be forced to wait longer for their transplants. As the formula was knowingly constructed to achieve this result, this retroactive revision is unfair.
Sincerely yours,
Stanley Goldfarb MD
Chairman, Do No Harm
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