Broken promises, broken hearts
August 19, 2005 4:52 AM   Subscribe

The New England Journal of Medicine published several articles this week on remaining, statistically significant gender and racial disparities in the quantity and quality of various medical procedures and care management resources made available to black and white Americans. These disparities may possibly help our understanding of the cause of some of the unexplained differences in mortality rates between populations. "Although the reasons for these differences are unknown, their persistence emphasizes the need for a continued search for explanations so that inequities in clinical care may be eliminated..." (registration req'd)
posted by Rothko (22 comments total)
 
Correlation implies Grant Renewal Application.
posted by srboisvert at 5:22 AM on August 19, 2005


Taking a few WAGs and stereotyping like crazy, I'm guessing if you're white, you're more likely to have better income and/or better health insurance. (Although there are plenty of white folks whose health-care options suck too.)
posted by alumshubby at 5:30 AM on August 19, 2005


Although the reasons for these differences are unknown, their persistence emphasizes the need for a continued search for explanations so that inequities in clinical care may be eliminated..."

And what if "inequities in clinical care" have nothing to do with it?

Race simply cannot be discussed objectively in America. It always ends up as a discussion over institutional racism, inequities in society, and so on and so forth.

Not that such things do not exist and not that such things might very well contribute to disparities in health, but any suggestion that race ALONE is a contributing factor is a dead end. The hostility that the FDA received from progressives when they had the temerity to suggest race-based approval of pharmaceuticals is a case in point. That reaction must have a chilling effect on researchers who want to pursue this line of scientific inquiry. Sure a lot of the opposition was made using scientific arguments, but the goal was clearly to steer researchers away looking at race-based markers.

As srboisvert suggests, you can never be sure when it is science or politics behind these investigations.

Race seems a bit for liberals is like creationism for the religious right: science should not stand in the way of belief. Maybe this is unfair, but race is such an emotionally loaded issue in America that scientists seem forced to tread on egg shells whenever they approach it and that cannot be healthly.
posted by three blind mice at 5:50 AM on August 19, 2005


It's not about punishing white people. And as a white guy who has been beat down by the system I think those correlations are somewhat pointing at something that's not about melatonin levels exactly, but more about allowed freedoms and disallowed freedoms, and the power networks that leave people out in the cold, and create a priveleged class, with a greater right to life than their fellow citizens.
posted by nervousfritz at 6:00 AM on August 19, 2005


but any suggestion that race ALONE is a contributing factor is a dead end

I'm going to tell you a story. Its a true story.

has a MRI discovers that she has an aneurysm. She goes to the hospital her insurance pays 25,000 for an elective procedure to the head of neurosurgeon at that department. He decides that he would rather do another operation in another room and therefore gives the case over to his sixth year neurosurgery resident. His sixth year neurosurgery resident decides for whatever reason to let the second year resident perform the operation. The second year resident uses a permanent clip before testing with a temporary. The flow of blood stops and the woman strokes on the table .She wakes up with an IQ of 70.

Now tell me which world do you prefer one where this is one black woman and her life means nothing to them or that no ordinary citizen's life means anything to them?
P.S. When you think of this hospital think Ivy League.
posted by Rubbstone at 6:21 AM on August 19, 2005


Subtle racism on the part of doctors and other health care professionals.
posted by caddis at 6:34 AM on August 19, 2005


Mod note: edited post to read more clearly, per Rothko's request
posted by jessamyn (staff) at 6:39 AM on August 19, 2005


I agree with caddis on this one, and Rubbstone's story does not surprise me at all.

I'm white and Hispanic, and even so, I've had very bad experiences with callous and downright nasty (to say nothing of irresponsible) treatment... until I decided to seek out Latino doctors only. The difference is like night and day.
posted by reality at 7:08 AM on August 19, 2005


Now tell me which world do you prefer one where this is one black woman and her life means nothing to them or that no ordinary citizen's life means anything to them?

*bzzt* False dichotomy. Try again.
posted by Faint of Butt at 7:28 AM on August 19, 2005


and create a priveleged class, with a greater right to life than their fellow citizens.

Jebus. I just now realized how out of touch I've become with hard left rheotric.
posted by Kwantsar at 7:33 AM on August 19, 2005


The fact that there are race-based differences in both medical care and life expectancy is nothing new. However, it is not nearly as simple as it seems. First of all, differences in insurance and other factors affecting access to health care are responsible for a big part of this difference, not race per se. Also, at least some of the measures cited above are not necessarily better health care, just more expensive health care. To look at just two of the measures cited in the links above, there is a lot of evidence to support the claim that both coronary bypass surgery and cholesterol-lowering drugs are overused in this country and are given to large numbers of people who will see little or no benefit from them. This is why America's per-capita health care expenditures are among the highest in the industrialized world, yet we are at or near the bottom in almost every measure of health (life expectancy, infant mortality, and so on) in the same group of nations. It would take a book to go into the reasons why this is so, and fortunately it has already been written. The articles above are not so much evidence of racism in the practice of medicine but rather evidence that the way medicine is practiced in this country has some fundamental flaws that are not being addressed, such as the fact that the profit motive drives medical care more so than scientific evidence.
posted by TedW at 8:23 AM on August 19, 2005


Addendum: now that I have looked at three blind mice's link, it appears to make my point precisely; I saw nothing in the linked article that sounded like progressive criticism of the FDA; rather, it made the point that the evidence for the use of the drug for which approval was being sought was sketchy at best and was driven by market forces rather than science.
posted by TedW at 8:37 AM on August 19, 2005


Taking a few WAGs and stereotyping like crazy, I'm guessing if you're white, you're more likely to have better income and/or better health insurance. (Although there are plenty of white folks whose health-care options suck too.)

You are either with us or against us, eh?

This isn't anything more than preliminary research establishing a pattern. If you didn't catch the reference I was implying that Correlation does not equal Causation and that this is really only a research proposal level explanation. Everything of substance to this question is yet to be determined.

The only WAG I will make about you is that your political passion burns blindingly bright.
posted by srboisvert at 8:42 AM on August 19, 2005


Cultural differences in diet and habits contribute strongly to healthcare outcomes, as do biological / genetic differences, and differential access to healthcare, etc. But it's pretty clear that there is some institutional racism also at play, and it's important that major journals continue to publish disparities research like this to monitor our progress on this front. See also the Institute of Medicine report from 1999.
posted by mert at 8:49 AM on August 19, 2005


Correlation implies Grant Renewal Application.
posted by srboisvert at 8:22 AM EST on August 19 [!]


I hear this most often in my department from someone who likes to play devil's advocate, criticizing ecological and environmental studies as callous grasps at cold, hard research cash. Whenever I press him on this, he never comes up with any evidence for this comment...
posted by Rothko at 10:02 AM on August 19, 2005


For those focusing on the access to health care and biocultural influences at recovery, take a look at the Ashish et al. (second linked) article:

We examined data for men and women enrolled in Medicare from 1992 through 2001.... in 1992, the rates of receipt for all the procedures examined were higher among white patients than among black patients.

I could be wrong, not being an American resident, but everyone enrolled in Medicare should have equal access to the operations that it covers, so the study seems to control for access. By looking at whether or not there are differences in the rate that people receive the operations by race they also control for biocultural differences in operative success and healing.

Not specifically related, but perhaps of interest to people who are interested in Rothko's links: A really good discussion (from a non-medical perspective) of the intertwining of race, policy, and medicine (specifically reproduction) is Killing the Black Body by Dorothy Roberts.
posted by carmen at 10:38 AM on August 19, 2005


evidence for this comment...

What kind of evidence is required to support that correlational studies are only preliminary and require further research before any conclusion should be drawn?

Help me here because to me it seems logical rather than empirical.
posted by srboisvert at 10:41 AM on August 19, 2005


What kind of evidence is required to support that correlational studies are only preliminary and require further research before any conclusion should be drawn?

It's not a big deal, I was just poking a little fun at you. But to be fair, you weren't arguing that, though.

Help me here because to me it seems logical rather than empirical.

You're asserting that statistical studies are published for the sole purpose of winning future funding. I've seen no effect study that backs up that claim, but I often see this argument used as a foil against, say, global warming studies. So whenever I hear this argument, it makes me suspicious.

For what it's worth, I know that labs live on the grants they get, and so winning funding is important, but knowing research scientists as I do, I doubt that writing a paper is done solely for the purpose of getting that next grant, and nothing else.
posted by Rothko at 11:14 AM on August 19, 2005


*bzzt* False dichotomy. Try again.
Maybe I'm missing the other options what are they?

I can guess maybe your suggesting this is just one bad doctor. I think that his being the director of the neurosurgery department at one of the "best"(top ten in US news and world reports) neurosurgery departments in the country suggests the problem is more insitutional than you want to belive. The residents behavior is irrelevant, they should have never been in that position. Or perhaps you don't think the diretor was grossly negligent in which case your simply wrong.
Clearly you think I'm being illogical it would be a help to me if you could point out what my other options should have been.
posted by Rubbstone at 11:33 AM on August 19, 2005


Clearly you think I'm being illogical it would be a help to me if you could point out what my other options should have been.

Um, yeah. I'm not defending the actions of the doctor or the resident. What happened was dreadful. I'm simply attacking your rhetorical method. You said:

Now tell me which world do you prefer one where this is one black woman and her life means nothing to them or that no ordinary citizen's life means anything to them?

In other words, you gave us two, and only two, choices:

one where this is one black woman and her life means nothing to them

or

no ordinary citizen's life means anything to them

That's what's called a false dichotomy, because you reduced the situation to two options when there are clearly others that are possible and preferable. I would like a world where every person, regardless of race, background or economic standing, gets the best medical care that technology can provide. It can certainly be argued that this is unlikely, but it's still an option. Ergo, your dichotomy is, as I said, false.
posted by Faint of Butt at 1:33 PM on August 19, 2005


. I would like a world where every person, regardless of race, background or economic standing, gets the best medical care that technology can provide.

I think this whole problem goes back to english. My antecedent for my question was the hospital staff in the story. I am not discussing medicine as a whole. I'm discussing individuals and ascribing motivations to them for their past actions. Therefore your option is irrelevant.

Just to let you know mister logician blanket assertions without any evidentiary support are questionable. In the case of a false dichotomy you have to give me another option in order to support your assertion. Until then....

The dichotomy stands.
posted by Rubbstone at 3:32 PM on August 19, 2005


I'm discussing individuals and ascribing motivations to them for their past actions. Therefore your option is irrelevant.

Upon review of your comment and your profile, I realize that I misunderstood you, and apologize for my harshness. Your hypothetical proposition was unclear.
posted by Faint of Butt at 4:32 PM on August 19, 2005


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