Maybe it took someone new to medicine to see it. When Darshali Vyas, a second-year medical student at Harvard at the time, encountered a calculator commonly used by obstetricians to counsel women on whether they should attempt a vaginal birth after cesarean (VBAC), she couldn’t fathom why it included race. She started looking at the evidence and found, to her dismay, that the rationale for why Black women shouldn’t attempt VBAC traced back to slavery-era thinking that the pelvises of Black women were suited for physical labor, not childbirth. Her paper on the subject was published in 2019.
Later, in what little free time she had as an intern, she documented two dozen more commonly used race-based calculators. A paper about 13 of them was published in the New England Journal of Medicine in 2020, sparking concern the calculators contributed to health disparities — and action. Twelve of those tools have since been revised. Vyas’ paper prompted congressional hearings and has since become one of the most cited on the issue.
As for Vyas, after serving as chief resident at Massachusetts General Hospital last year, she remains extremely busy — continuing to critique areas in clinical medicine where race is used improperly, giving talks about her findings at the National Academies of Science, Engineering, and Medicine, and other venues, and finishing her fellowship training in pulmonary and critical care medicine.
—Usha Lee McFarling
