The Other Box: Why Medicine Should Abandon Race

In The Fatigue of Racism (Book 1), we proved that race is not biologically real—that it was invented, codified, and weaponized to justify centuries of extraction. In The Administrative Construction of the American Citizen (Book 2), we proved that the racial classification system is a bureaucratic construction, built by administrative convenience and maintained by inertia. In The Class Alternative (Book 3), we proved that class-based remedies work better than race-conscious policies.

Now, in Book 4, we enter the hospital, the laboratory, and the clinic.

The Other Box presents the most comprehensive forensic case ever assembled against the use of race in medicine. Drawing on decades of clinical evidence, Caldwell demonstrates that the NIH mandate to collect race data has produced junk science, harmed patients, and delayed the discovery of actual causal mechanisms.

The mandate is not just bad science. It is bad medicine.

The NIH Revitalization Act of 1993 requires that clinical trials include "members of minority groups" and analyze outcomes by race and ethnicity. The mandate was enacted with good intentions—to ensure that historically excluded populations were included in medical research. But good intentions paved a road paved with harm.

The result is not better medicine. It is patient harm.

Caldwell examines the clinical algorithms that have been shown to incorporate race in ways that harm patients:

The eGFR kidney function test included a "race coefficient" for Black patients that delayed diagnosis and treatment. In 2020, the National Kidney Foundation recommended removing race from eGFR.

Pulmonary function tests used "race correction"—reducing the expected value for Black and Asian patients—leading to underdiagnosis of lung disease and denial of workers' compensation. In 2022, the American Thoracic Society recommended removing race correction.

The VBAC calculator included race as a risk factor, making Black and Hispanic women less likely to be offered a trial of labor. In 2021, the American College of Obstetricians and Gynecologists recommended removing race from VBAC calculators.

The NIH Stone Risk Calculator includes race as a variable, though no biological mechanism explains why race would predict stone formation.

The mandate produces junk correlations.

Race is a confounder, not a cause. When you control for income, geography, and healthcare access, the "racial" disparity shrinks or disappears. The NIH mandate requires researchers to collect race data—but it does not require them to collect the confounders that would explain the disparities. The result is a vast literature of "racial disparities" studies that report correlations but cannot identify causes.

The mandate contradicts the AMA.

The American Medical Association formally recognized race as a "social construct" in 2020 and called on physicians and researchers to "recognize the harmful effects of using race as a proxy for biology" and to "develop clinical algorithms that do not rely on race as a variable." The AMA's position is directly at odds with the NIH mandate.

The alternative is precision.

Caldwell presents a comprehensive framework for replacing race with precise variables that actually determine health outcomes:

Ancestry—country or region of origin, more precise than race for genetic variation

Geography—ZIP code, census tract, more precise than race for environmental exposures

Income—the primary driver of health outcomes

Healthcare access—the single largest determinant of health

Direct measurement of discrimination—audit studies, patient surveys, complaint investigations

The NIH's "All of Us" Research Program provides a model.

All of Us collects race data for comparability—but it also collects ancestry, geography, socioeconomic status, discrimination, and environmental exposures. Researchers can use the better variables for analysis and use race only when necessary for historical comparison.

The evidence is clear.

The path is mapped.

The only question is whether we have the will to act.

KEY CHAPTERS

1. The NIH Mandate — How race became a medical variable, and why it was a mistake

2. The Census Race Question in Medicine — Surveillance without science

3. Clinical Algorithms That Use Race — A case study in harm

4. The Junk Correlations Problem — Race as a confounder in clinical research

5. Ancestry, Not Race — A path forward for medical research

6. Repealing the Mandate — Legislative and administrative action

7. Conclusion — The case for abolishing race in medicine

PRAISE FOR THE SERIES

"A forensic masterpiece. Caldwell dismantles the fiction of race with the precision of a surgeon and the moral clarity of a prophet. This is the most important medical book of the decade."

"The Other Box is not just a critique—it's a roadmap. Caldwell shows us not only why the current system is failing patients, but exactly what we need to do to fix it."

"Caldwell's forensic style is bracingly cold, which is exactly what this subject needs. He treats the fiction of race like a fraud case—and he proves, beyond a reasonable doubt, that the Ponzi scheme must be liquidated."

Paperback | Ebook | Audiobook

128 pages | Bibliography | Index

Browse the series

Book 1: The Fatigue of Racism — The Foundational Case

Book 2: The Administrative Construction of the American Citizen — How OMB Directive 15 Manufactured Race

Book 3: The Class Alternative — The Caldwell Model for a Just, Effective, and Colorblind Policy

Book 4: The Other Box — Why Medicine Should Abandon Race

Upcoming

Book 5: Beyond the Pale — How Space Exploration Demonstrates Post-Racial Feasibility

Book 6: The Identity Trap Reversed — Why Both Left and Right Weaponize Race, and Why Abolition Serves All Sides

Book 7: Negative Infinity — The Author's Personal Reckoning