Naomi Tweyo Nkinsi (left) and James Diao (right), both 2021 Paul & Daisy Soros Fellows.
As our nation’s society continues its reckoning with the historic legacy of systematic racism and white supremacy, Paul & Daisy Soros Fellows James Diao and Naomi Tweyo Nkinsi are on the front lines of a growing movement to promote racial justice in the field of medicine.
The two 2021 Fellows have been central players in a multifaceted effort to reevaluate and end the use of race in kidney disease diagnosis, and their work recently paid off in a big way: In late September of 2021, a task force sponsored by the National Kidney Foundation and the American Society of Nephrology published a report that encourages the use of an equation which disregards race as a variable for measuring kidney function.
This new approach is designed to replace a commonly used equation that does factor in a patient’s racial identity, which introduced a degree of racial bias against Black and Brown patients when testing for kidney disease. As a result of the task force’s recommendation, America’s medical community is taking a necessary step in the right direction.
For James, whose research as a Harvard University medical student examined how race factored into the clinical process surrounding kidney disease and how clinicians could develop new race-neutral approaches to diagnoses, the task force recommendations represent the potential for data to further racial justice efforts in medicine. James was a lead author in two research studies —published in JAMA and the New England Journal of Medicine in December 2020 and January 2021, respectively— that influenced the direction of the task force.
“Our approach was to generate data, review the literature, and outline a roadmap for moving forward with race-free equations,” James says while referring to how he and his co-researchers approached their work. We’re chatting approximately a week after the task force announcement, and James is keen to acknowledge that his research is in part an outgrowth of advocacy efforts that question why race was initially included in kidney diagnosis to begin with. He also shares the importance of advocacy efforts and metric-driven equity campaigns to work together—in essence, there should never be what he considers to be “a false dichotomy” established between these two interconnected pathways to change in medicine.
Naomi is also aware of how advocacy and equity can go together, particularly when it comes to dismantling systemic and institutionalized racism in medicine, not only in clinical spaces but in academic spaces as well.
As a first-year medical student at the University of Washington, Naomi initially questioned the inclusion of race as a variable in the equation for testing for kidney function when she learned about it in class. At first, she encountered a degree of push-back from her peers and even from some professors and administrators on UW’s campus. In 2020, she spearheaded an advocacy campaign on her campus, which led to the University of Washington being one of the first medical communities in the country to reevaluate and later drop its usage of race in kidney disease diagnosis, before becoming a spokesperson for this effort nationwide.
Naomi, who’s taken a year off from medical school to pursue a master’s degree in public health, understands the bigger picture when it comes to race and medicine in America, including the prevalence of information the community has falsely considered as “fact” for way too long. “If you look at the science behind it [the facts], and the works that are cited, a lot of it goes back to trying to justify slavery and white supremacy in the United States.”
When interviewing Naomi, her voice is filled with resilience. Although she mentions the emotional toll these efforts have taken on her psyche, she carries intuition well beyond her years when it comes to promoting change in medicine. She also notes that, “a lot of activism requires risks in [many] ways. Finding allies, operating in groups, and protecting yourself so that you don’t hinder your own progress.”
She and James made sure to mention the many pioneers, including Dorothy Roberts, who’ve led efforts to promote racial justice in medicine. While they continue moving forward in their careers, James and Naomi have one giant thing in common: as emerging scholars and experts, they represent the best in their chosen profession. ∎