In Prospect

Soundings

The widespread availability of large databases like the one used by the Health Affairs investigators allows studies of the difference between black and white patients’ utilization of procedures and health outcomes. A notorious example, published in the Proceedings of the National Academy of Sciences, used a database from Florida to show that black newborn babies had a greater chance of survival if they were treated by a black pediatrician. A dangerous conclusion might be that patients should seek out physicians matching their own race. If this study is correct, we could be on the path to medical apartheid.

But the study suffers from fatal mistakes. Any study using a large database to assess the cause of death should undertake a chart-level assessment of the circumstances of the patient’s death. A large database is often riddled with errors, as the various entries are made by administrative personnel who are rarely, if ever, trained in health care. It’s a game of telephone: the truth can become hopelessly muddled after multiple rounds. In this paper, the infant mortality data were never checked at the level of the patient’s chart, so it’s impossible to know which doctors actually cared for the patient during any acute event. Moreover, the authors had no way of determining the race of the physician of record besides scanning available photos, and almost 2,000 of the nearly 10,000 doctors in the sample had no photos (they were excluded from the analysis). Finally, it was not clear whether the infants who died had been referred from outlying hospitals to large medical centers because they were already critically ill. If so, the treating physician under whose care the patient died may have received a desperately ill baby with little chance of survival.

These flaws notwithstanding, the study was widely cited in the press as proof of the need for more black physicians. USA Today headlined its story: “Black babies are more likely to survive when cared for by Black doctors, study finds.” The coverage only fed the narrative that racism permeates American medicine.

One could go on dismantling studies like these. But the key finding lacking in any of the studies of racism in medicine is evidence that the countless diversity, equity, and inclusion trainings to which doctors are now subjected would alter patient outcomes. A vast gulf remains between methods of traditional medical research and these alleged remedies. In medical research, cures are proposed and then tested in two populations; if an improvement in outcomes results between the two groups, the therapy may work, and the “null hypothesis” is rejected. But with an antiracist approach to improving medical outcomes for black patients, a cure is proposed, consisting of expensive and time-consuming antiracist training, but the testing step is ignored. One simply must adopt the antiracist cure and implement it widely.

To the extent that medical research exaggerates racism in clinical outcomes, it does a disservice to identifying the real basis for discrepant results. Disparities aren’t always due to discrimination. If a genetic trait is the culprit—for example, increasing susceptibility to chronic kidney