NEJM Interviews NEJM Interview: Rohan Khazanchi on the gradual but incomplete shift to race-free equations for interpreting pulmonary function tests.
Jul 30, 2025
Rohan Khazanchi, a research affiliate at Harvard's FXB Center for Health and Human Rights, discusses the urgent need to eliminate race-based algorithms in pulmonary function tests. He highlights the historical injustices and inaccuracies stemming from these practices, pointing to cases affecting marginalized workers. Khazanchi advocates for race-neutral guidelines and explores the complexities faced by clinicians in transitioning to equitable patient care. He emphasizes the importance of critical thinking in challenging outdated medical norms for a fairer healthcare system.
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Pulmonary Testing's Racist Origins
- The history of pulmonary function testing dates back to the 1700s and was used to justify slavery.
- Physicians like Samuel Cartwright made biased claims about lung capacity differences by race.
Imprecision in Disability Evaluation
- The Social Security Administration in the 1950s used FEV1 values as proxies for disability claims.
- These measures were imprecise, causing inaccurate evaluations of work capacity.
Legal Challenge to Race Adjustments
- At an asbestos plant in Baltimore in the 1990s, Black workers received lower compensation due to race-adjusted PFT equations.
- A judge initially sided with medical societies but later reversed his view recognizing potential discrimination.
