Mass General Brigham Physicians Call for Elimination of Harmful Language in Clinical Medicine

Continued Use of Diagnoses like “Red Man Syndrome” Undermine Health Equity

Female doctor with patient in hospital room

In a new perspective published in the New England Journal of Medicine, physicians from Mass General Brigham and Johns Hopkins Medicine say it is time to eliminate the use of racist and harmful terms such as “Red Man Syndrome” and encourage improvements in drug-allergy documentation that recognize the diversity of patient populations.

The article focuses on terminology used to describe a drug reaction to Vancomycin, the most commonly used antibiotic in U.S. hospitals. As many as half of patients who receive Vancomycin have this reaction and yet since 1959, the symptoms have been widely referred to by clinicians as “Red Man Syndrome.” 

Similar to “redskin,” which was recently removed as the name of Washington DC’s NFL team after many years of protest, “Red Man” calls up historical narratives that endorse and reinforce discrimination against American Indians and Indigenous peoples say the study’s authors. 

“We can move beyond “Red Man Syndrome” just as we have changed problematic references to avoid Nazi associations and have confronted race ‘corrections’ in clinical practice,” says Kimberly Blumenthal, MD, MSc the study’s senior author, who is an allergy specialist and researcher at Massachusetts General Hospital. “Additionally, the current use of this term causes inequities beyond its original racist implications. It is centered around the reaction of a white male and perpetuates biases and racial norms that may undermine prompt and equitable diagnoses and treatment for patients of color.”  

This was demonstrated in a prior research study that demonstrated that “Red Man Syndrome” documentation was more likely for males (odds ratio, 1.30; 95% CI, 1.17-1.44) and less likely for blacks (odds ratio, 0.59; 95% CI, 0.47-0.75). Santiago Alvarez‑Arango, MD, allergy specialist and Clinical Pharmacology Fellow at Johns Hopkins School of Medicine, was the first author of both that prior study and this perspective. 

Alvarez‑Arango, in addition to co-authors, S. Michelle Ogunwole, MD, General Internal Medicine Fellow at Johns Hopkins School of Medicine, Thomas D. Sequist, MD, MPH, Chief Patient Experience and Equity Officer for Mass General Brigham, Caitlin M. Burk, MD, Allergy and Immunology Fellow at Massachusetts General Hospital and Kimberly G. Blumenthal, MD, MSc Co-Director of the Clinical Epidemiology Program within the Division of Rheumatology, Allergy, and Immunology and the Mongan Institute at Massachusetts General Hospital say that it is time to rename the reaction using a gender- and race- conscious approach that reinforces, rather than undermines health equity. They propose five critical steps to achieving this goal:

  • Physicians need to stop teaching “Red Man Syndrome” and using it in clinical practice. The authors recommend using the term “vancomycin infusion reaction” for this reaction moving forward and “infusion reaction” for other nonallergic reactions that occur during drug infusions. 
  • Clinicians can combat racial and ethnic bias by providing and broadening dermatologic findings and images from drug allergies in diverse patients. Availability of more diverse images of dermatologic findings can help prevent cognitive biases, which lead clinicians to estimate disease probability based on comparisons to available images.
  • Hospitals and health systems should institute multidisciplinary training on best practices for drug-allergy documentation.
  • Allergy specialists can help improve antibiotic-allergy documentation, clarify drug-allergy diagnoses, and optimize antibiotic choices.
  • Finally, race-based reporting of clinical research examining racial differences needs to be challenged. Researchers should acknowledge that race is a social construct and explore how racism, rather than race, contributes to racial inequities.

The authors state, “Implementing these recommendations would mean not only striking racist terminology from our professional vocabulary, but also improving the diagnosis and documentation of all allergic drug reactions for greater clinical precision and patient safety. It would move us one step closer to a safe, just, and equitable health care system.”

The elimination of harmful terminology like “Red Man Syndrome” is consistent with Mass General Brigham’s “United Against Racism” strategic initiative, a commitment to eliminate the many impacts that racism has on patients and employees within the Mass General Brigham system. The system-wide plan includes specific timelines and metrics to measure improvement in leadership, employees and culture; patient care; and community health and policy advocacy. 

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Mass General Brigham is an integrated academic healthcare system, uniting great minds in medicine to make life-changing impact for patients in our communities and people around the world. Mass General Brigham connects a full continuum of care across a system of academic medical centers, community and specialty hospitals, a health insurance plan, physician networks, community health centers, home care, and long-term care services. Mass General Brigham is a non-profit organization that is committed to patient care, research, teaching, and service to the community. In addition, Mass General Brigham is one of the nation’s leading biomedical research organizations and a principal teaching affiliate of Harvard Medical School. For more information, please visit massgeneralbrigham.org.