Overview of Introducing “Intention to Treat: Money and Misdiagnosis”
This episode from KCRW introduces Intention to Treat, a New England Journal of Medicine podcast series examining how race has been built into medical tools and diagnoses. The focus here is on spirometry, a common lung function test that has long used race-corrected equations for Black patients. The episode shows how that practice can underdiagnose lung disease in Black veterans, delay proper treatment, and reduce access to disability benefits they may be owed.
Main Storyline
The episode centers on two Black veterans whose medical care and financial support were affected by race-based lung testing:
- Marcus, a Desert Storm veteran exposed to toxic burn pits, had worsening breathing problems for years. His earlier, race-corrected lung test made his COPD appear milder than it really was.
- After a race-neutral retest, doctors found his lung disease was more severe, which could change both his treatment and his VA disability compensation.
- Richard, a Vietnam veteran, had similar experiences. After being retested with race-neutral methods, he was also found to have more severe lung disease than previously recognized and may qualify for more benefits.
Key Takeaways
Race correction in lung testing can cause real harm
The episode argues that using race as a factor in spirometry has historically led to Black patients being:
- Underdiagnosed
- Undertreated
- Denied access to specialists and medications
- Shortchanged on disability compensation
Medical error has financial consequences
The issue is not only clinical. At the VA, lung function scores help determine:
- Whether a veteran qualifies for disability benefits
- How severe their condition is considered
- How much monthly compensation they receive
A diagnosis that understates disease severity can mean thousands of dollars a year lost.
Black veterans are disproportionately affected
Doctors at the Jesse Brown VA in Chicago, including Dr. Peter Sporn and Dr. Cheryl Connor, saw firsthand that race-neutral testing revealed more lung disease in their mostly Black veteran population. They concluded the old method was unscientific and harmful.
Institutional Conflict and Policy Debate
The episode highlights tension between local VA clinicians and the national VA system:
- The Jesse Brown VA and several Midwest VA hospitals switched to race-neutral testing.
- The VA nationally refused to adopt the change systemwide.
- In 2024, the VA reportedly froze additional hospitals from switching, saying it needed more study and raising concerns that some patients could lose eligibility for lung cancer surgery or benefits.
The doctors interviewed disagree, arguing that continuing to use a race-based equation preserves an inferior and outdated practice.
Broader Implications
The episode places this debate in a wider context of racial bias in medicine:
- The idea that Black bodies are biologically different has been embedded in medical tools for generations.
- Even when the science is weak or debunked, the practice can persist because it is built into systems and policies.
- The episode also notes that federal restrictions on diversity, equity, and inclusion efforts have created a chilling effect on advocacy inside the VA.
Notable Insights
- “If you do not have a proper diagnosis, you do not have access to the proper medications.”
- “It’s not scientific and it’s hurting patients.”
- The most striking insight is that a single diagnostic formula can shape not just treatment, but a veteran’s livelihood and dignity.
Bottom Line
This episode argues that race correction in spirometry is a concrete example of how medicine can misdiagnose Black patients and deepen inequality. For veterans like Marcus and Richard, changing the test to a race-neutral standard could mean better care, more accurate diagnoses, and the disability benefits they may have been denied for years.