Medicine

Medical Care and the Race Card.

By Chris Rangel MD ⋅ April 8, 2002 ⋅  Email this post ⋅  Print this post ⋅ Post a comment

It’s been known for quite a while that inequalities exist in the health of minorities vs. white Americans (Male African-American life expectancy is 7 years less than white Americans) and the causes have been proven to be tightly intertwined with poverty. Low socioeconomic status suffers the ills of poor health care access, lack of health insurance coverage, high rates of violent crime and drug use (as any watcher of “COPS” can attest to), higher stress levels, and generally poorer overall health with higher rates of obesity, smoking, diabetes, high blood pressure, etc. However, last month the publicly funded “Institute of Medicine” announced a “new” study that went one step further. In addition to documenting the above well-known inequalities in health care they came to the stunning conclusion that a person’s skin color plays a role independent of income or any other of the above causes. As they state on the report’s webpage: Minorities tend to receive lower-quality health care than whites do, even when insurance status, income, age and severity of conditions are comparable . . . . Although myriad sources contribute to these disparities, some evidence suggests that bias, prejudice, and stereotyping on the part of health care providers may contribute to differences in care. It’s stunning because National Academy of Sciences via the Institute of Medicine has basically called over 400,000 physicians in this county, racists! This part alone was enough to grab headlines and the national media swallowed it hook-line-and-stinker. Dr. Sydney Smith points out on his web site blogg (medpundit) that the authors apparently went into this study with their minds already made up. All members of the committee had been involved in work on minority inequality in health care with one member’s interests being “stereotyping, prejudice, and discrimination” and another having done research in the area of “racial profiling”! It would seem that to the hammer, everything is a nail.

This was a study of 13 other original studies, two of which did not find evidence of differences based on race alone, and “almost all studies found that adjustment for one or more confounding factors reduced the magnitude of unadjusted racial and ethnic differences in care“- i.e. after they took into account poverty or another real cause of health care inequality, differences based on race alone didn’t appear to be as big as they first were. Differences were most likely to be found in the rates of medication proscribed and bypass surgery done for cardiac disease. Studies of this type that involve complex issues with many different variables are notoriously hard to do. The problem is that they are studying a complex system that involves variables all the way from an individual physician’s decision process to the patient’s prior and overall health status, to patient compliance with medication and follow-up visits, to their access to and ability to pay for medications, to the patient’s home support structures, to doctor-patient relationships, to doctor-family relationships, to cultural and language issues, to physician workload, to etc. etc. etc. What the author’s of this report are trying to claim is that they were able to take into account each and every possible variable that could explain the differences in care and came to the conclusion that skin color alone was the cause. Come on. Keep in mind that these differences though statistically significant were actually small! What this means is that if I saw 50 white patients and 50 socio-economically identical American-American patients in my office I would be likely to place all 50 white patients on a certain heart medication while placing only 45-47 of the 50 African-Americans on the same medication. The study assumes that for some reason, I’m being prejudice to these 3-5 unlucky minorities for no reason other than their skin color. The study does not take into account nor can it control for the complex decision making processes that go into patient care. For example: A medication class called beta-blockers are often prescribed for patients with coronary artery disease to prevent a heart attack but can have harmful effects in patients who happen to also have diabetes and/or asthma and minority populations certainly have higher rates of diabetes and asthma (also independent of socioeconomic status). Therefore, less minority patients are treated with these medications! Speaking of. What the study did not address were the horrible life-styles including obesity, smoking, alcoholism, drug use, violence, poor nutrition, high risk sexual activity, teen pregnancy, poor education and other evils that contribute to the current crisis in the health of certain minorities groups and those living in poverty. Would we not benefit more from studies that look at ways to prevent these health care problems in the first place rather than politically correct, headline-grabbing studies like this one?