Racial Segregation in Healthcare?

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When I go to my doctor, I expect him to make decisions that are in the best interest of my health based on objective criteria, such as the signs and symptoms I report and that my body manifests, or the results of my blood work or x-rays. What I don’t expect is for him to make decisions based on the color of my skin. For my part, I don’t decide whether or not to follow my doctor’s recommendations (and I don’t always, frankly) based on the color of his skin. But that thinking may be a vestige of the past if woke activists manage to successfully push their agenda of “racial concordance” between physician and patient.

According to an article in City Journal by Stanley Goldfarb and Alexander Raikin, “racial segregation is returning to healthcare.” Inspired by a 2018 study published in American Economic Review entitled “Does Diversity Matter for Health: Experimental Evidence from Oakland,” Goldfarb and Raikin report that “the medical establishment immediately took up the banner of ‘racial concordance’ between physician and patients” when the above study concluded that black patients were more willing to agree to services toward better health when they were served by black physicians.

The abstract for the study, revised three years ago, reads as follows:

“We study the effect of physician workforce diversity on the demand for preventive care among African-American men. In an experiment in Oakland, California, we randomize black men to black or non-black male medical doctors. We use a two-stage design, measuring decisions before (pre-consultation) and after (post-consultation) meeting their assigned doctor. Subjects select a similar number of preventives in the preconsultation stage, but are much more likely to select every preventive service, particularly invasive services, once meeting with a racially concordant doctor. Our findings suggest black doctors could reduce the black-white male gap in cardiovascular mortality by 19%.”

Goldfarb and Raikin, however, accuse the study of being poorly designed and unable to support its conclusion. Their complaints about the study are that it has no substantial control group, that the authors made unfounded “logical leaps,” and that both the patients and physicians were unrepresentative of the larger groups they were supposed to represent. For instance, the study included 1300 men the authors recruited from barbershops and flea markets. They were more likely to be unemployed, less likely to have graduated from high school, and older than the average age of the black male population. As well, there were only 14 physicians involved, eight non-black and six black.

Despite its poor design, the study was quickly embraced by medical journals and academics, who have quoted the study hundreds of times. Goldfarb and Raikin report that only one academic paper challenged the study, and that paper was later retracted and its author demoted by his employer (the author has filed a lawsuit for violation of his free speech). This raises concerns that these medical journals and even medical schools are more interested in promoting a particular social-cultural agenda than in relying on objective evidence in advancing better practices in healthcare. Goldfarb and Raikin point to a well-known 2011 study of 22,000 patients which concluded that, “Little evidence of clinical benefit resulting from sex or race/ethnicity concordance was found. Greater matching of patients and providers by sex and race/ethnicity is unlikely to mitigate health disparities.”

The fact is, there are not enough black physicians to accommodate “racial concordance,” but if blacks are convinced that they will not receive the best care from white physicians, it may lead to their choosing not to see a doctor at all, and that would further jeopardize the good health of a population that is already less likely to make regular visits to a doctor or to place their trust in the medical establishment. Furthermore, Goldfarb and Raikin contend that the Oakland study has influenced medical education. In an effort to increase the number of black physicians, medical schools are lowering standards for black applicants and students (such as not requiring that they take the MCAT). This results in students accepted who are less qualified, and doctors who are not as well trained. Lower standards may improve diversity in medical schools, but it doesn’t produce better doctors. As well, it also contributes to the “soft bigotry of low expectations.” Rather than finding and supporting those minorities who are qualified and able to excel in medical school, the schools are simply assuming that minorities are not up to the task, so they make it easier for them. Finally, if potential patients, black or white, are concerned that a black physician made it through school because of lower standards, they will be less likely to want to go to that doctor.

Healthcare is neither black nor white. While there is evidence that the health care system does treat white and black patients unequally, the point is to overcome whatever discrepancies there are, not to further balkanize people into a system of black medicine and white medicine, especially when the justification for doing so cannot be supported by quality research. If even medical care falls victim to the subjective priorities of activists rather than the findings of objective assessments, then we are heading toward a precarious future for everyone.

Be Christ for all. Bring Christ to all. See Christ in all.

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