Mortality rate for Black babies plummets when they’re delivered by Black doctors
washingtonpost.com
washingtonpost.com
One potentially meaningful point from Table S1A of the supplement: it looks like there are 360k white doctor-black patient observations and 97k black doctor-black patient observations, and the mean length of stay for white doctor-black patient observations is 4.73 days vs. 3.37 days for black doctor-black patient. If I understand these figures, that means that on average white doctors keep black patients 40% longer than black doctors keep black patients.
I don't know what that means for the quality of care. Is keeping patients around good or bad? The Medicaid/Medicare/Self-pay numbers are very similar for the two groups, so it shouldn't be that the black patients going to white doctors are just paying for more care, right? Does it say something about case difficulty?
I know very little about this topic. Hopefully somebody who knows more can chime in. But that gap seems...significant?
[1] https://www.pnas.org/content/pnas/suppl/2020/08/12/191340511...
Some key takeaways:
-They use delivery data from different categories of births, including 'complications occurring during the course of labor and delivery'. Do they account for the conditions in which the babies were born, and then attribute that to the types of doctors handling those deliveries? In other words, do they make a distinction saying emergency white doctors perform worse than emergency black doctors? Because I cannot find that information in the research.
-Since doctor race data isn't codified in Florida's database (where they use the data from), they used web pictures and determine if the doctor is white or black. They narrowed this task down to 4 people who were good at it.
-Black female doctors performed the best, they mention some control of the gender but I do not fully understand how they did it.
-They used a Latino doctor group as well to account for differences, but found that while there is a distinction, it is much smaller than Black-White.
I also don't understand if/how they control for the quality of the hospital. Is there one bad low income hospital with white doctors in a predominantly black area?
I read a study many years ago from a country that valued boy children over girls. Boys -- especially first-born boys -- were more likely to be fed their favorite foods, taken to the doctor the same day instead of "in the morning" and so forth. These were relatively small things, like delaying seeing a doctor by a few hours, and nothing anyone would likely characterize as abuse of the girls, yet the difference could be measured in terms of mortality.
Think about this: You can die of dehydration in as little as two days and you can die of lack of oxygen within minutes.
These are not stats for people of frail health or something. Anyone can die of lack of oxygen within minutes, no matter their current state of health.
Making excuses and saying "But they must have been in a weakened state to begin with or something..." amounts to denial of the racism that we all know is rampant within this country.
It does not study the mortality rate of babies whose mothers had Black obstetricians during their pregnancies.
The researchers did not attempt to identify a cause for this disparity in this study, and noted only that this disparity does not appear to exist for other doctor-patient racial pairings where the mother was not Black.
The point of this study was simply to identify that a disparity exists, so that follow-up research can identify why and hopefully address the disparity in outcomes.
I think that's an important point. I see people already jumping to the conclusion they prefer in other comments, but from what I understand we don't know what is causing the disparity. The paper points that it exists and should be studied more in details. Which is quite important, but it's too early to declare that a specific cause is _the cause_.
Another HNr deleted his comment, but this needs more substance before thrown around. When I was studying sociology I noticed this trend of finding some general stat and the author follows with statements such as is systemic xism.
Most of the times it comes as intellectually weak. Why not researching further, before typing such gross statement. Often it is a non sequitur fallacy, and probably a sort of ecological fallacy too.
Of course, her recipe is not only to train doctors in the particular needs of other races (IDK the validity of this, since I'm not physician nor a biologist) and follow up this people and check them often, but to train doctors on racism and social justice.
In the Internet most of the times you don't know who you're talking to, so just in case I come across as rude, bear in mind, I'm not in or from the US, and I already shared my experience studying sociology.
Racial disparities exist in virtually every important measure of health (and I only say "virtually" because I don't know them all off the top of my head). Genetics plays a part in some, but the root cause of many is the current or lingering effects of racism: families that never accrued much wealth, communities who had much worse professional prospects so education wasn't as valued, "bad" neighborhoods where towns invested less in public transportation or sanitation. A bunch of ways racism shapes communities.
However, pointing out the racism root is only useful for long-term sociological planning. You also need to focus on the immediate causes. Systemic racism is actually a perfect example of this: even if a system becomes "race blind," the effect of past racism means non-white people are at a disadvantage.
I can tell you about public policy that mentions no racism that would change the life of poor black people in the US, allowing them to capitalize themselves easier, and have a better life.
It probably wouldn't be the most trendy, but it works.
That one looked at patients at a walk-in clinic. Patients would be randomly assigned a doctor for their visit. The doctor would diagnose them, treat them, prescribe drugs if needed, and give them instructions on how to care for themselves after they left.
The study found that the patients were significantly more likely to follow the doctor's instructions after they left if the doctor was the same race as the patient.
Note that the doctors were not the patient's regular doctor. These were either patients who did not have a regular doctor, or patients who were going to the clinic because of an urgent condition when their regular doctor was not available. I'm not aware of any studied that looked at whether patients obey their regular doctor more often if the doctor is the same race as the patient.
Here's one I found on an antidepressants impact on covid hospitalizations: https://news.ycombinator.com/item?id=25701446
Far from scientific, but there seems to be a general acceptance of the study in the comments of that article. I cannot say the same of this one. Now obviously the sample size and statistics of the studies are not identical, but it seems to me we're seeing significantly more 'critical thinking' in this thread than that one. I would love to drill into this further and see if this trend holds in further comment threads, but I'm late for a hike.
If there were a covid study that said that Americans was more likely to become sick because they don't care enough about they fellow beings to follow recommendation, even with great sample size and statistics, most would look at such conclusion with skepticism.
My point is, some studies are knee jerkly believed and others are knee jerkly doubted.
If you are saying that HN as a community has commonality in beliefs about what is “generally accepted as true” and “generally accepted as false”, you are basically saying the HN community has shared experiences somewhat unique to that community. You are probably right.
If the community is challenging more findings on bias, they probably have life experiences that suggest such findings are incorrect or that too many such studies themselves have, in the past, been of low-quality, self-serving and/or misleading. Putting the quote marks around social “science” in general. There is also the natural bias for people to want to ignore problems outside of their scope or vision...24 hours in a day and so forth.
If HN is infested with IT professionals who have worked in environments where everyone is a minority of one sort or another and observed or managed the dynamics, their lived experience in ethnic/gender dynamics and opportunities may differ from other groups. If HN skews older, then they also have had the lived experience of both the many successes and many failures of the Civil Rights movement on which to base opinions.
On the specific issue of computer games, there is a dramatic difference in societal and economic impact between Fortnite and the direct personal welfare of tens of millions of people. The latter warrants more due care and attention. There have been a few posts on the psychological harm from gaming, so some balance there.
Those are not just result of experience, but also result of "what you really really want to be true" and "what you really prefer to be false".
The article has studies with authors from the BIG 10 and with Ivy League heritage, but it's the mention of race that causes people to trot out canned and thinly supported reasons of doubt. Here is one of the studies if anyone is interested.
https://1410c6d1-d135-4b4a-a0cf-5e7e63a95a5c.filesusr.com/ug...
In case of these topics, there's a relatively strong publication pressure here.
Also: the raw data is unfortunately not enough without pre-registration. (For obvious reasons.)
"bad faith" is absolutely required in science. Especially in sociology and psychology, unfortunately.
What do you mean? Per the Supplement, their data comes from a pool of ~4k white doctors and ~500 black doctors, with hundreds of thousands of observations/patients. This dataset doesn't seem "so small"?
[1] https://www.pnas.org/content/pnas/suppl/2020/08/12/191340511...
And it goes on and on, even though for hundreds of years, the country and society were tuned to ensure that the black community enjoyed degraded outcomes in all aspects of life.
There are about 4x more white people in America than Black. So it makes perfect sense that you would have 4x as many white patients as Black in the study.
I'm not saying that the study is wrong, just that shocking results like this one need extreme methodological rigor behind them before we start telling everyone that white doctors are killing black babies etc.
Before such a study, when black Americans would have noted that something seemed off, we would have been met with "You need data to back that up, X can't be racist!!!". Now that there is data to back up what we've known, it's "Your p-value is wrong!!!"
If it is indeed the case, then it is a horrible thing that should be researched more, and dealt with.
If not, publishing it is just racist and divisive.
https://1410c6d1-d135-4b4a-a0cf-5e7e63a95a5c.filesusr.com/ug...
We aren't yelling that, though, and you're the first one to say it here. This fear of being accused of racism is intense; as if acknowledging that black people are actually treated worse by our society is actually more harmful than the loss of life that black people experience.
This is a preliminary study, and yes, it deserves a followup. If you're saying that preliminary studies should always be kept under wraps and not discussed, that's weird and anti-science. There are a couple of well-understood phenomena that can explain this. The first is unconscious bias -- it's been shown time and time again, across the board with various population differences, and could easily explain this. Second, bad training data -- if a doctor hasn't been trained with black patients, and pictures of black people with various ailments, then they might not recognize symptoms as readily (insert analogy to facial recognition). Also, a large proportion of black people in the US speak a different dialect than their white counterparts -- the way folks describe their symptoms differs between dialects -- so if a white doctor can't understand what their black patient is saying, they're operating on less information than a white doctor treating a white patient would be. Finally, a matter of trust -- psychosomatics are real -- black women know their history, and might not trust a white doctor as well as a black doctor, and that can impact outcomes. Rebuilding that trust will take generations of trustworthy, good faith efforts to correct the wrongs of the past.
> Preprints are preliminary reports of work that have not been certified by peer review. They should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
It's annoying when news websites report on research that isn't reviewed. It's been happening at an increasing rate over the last few years because these news websites are so hungry for advertising revenue. It undermines the public's trust in science. It threatens our ability to do research openly and inclusively.
This is not shocking. It's well known that Blacks don't live as long as Whites in the US and have generally poorer outcomes for all metrics -- health, economic status, etc. That's old news and common knowledge.
It's also old news and common knowledge that the difference is quite substantial. It's not a small difference at all.
Blacks are last hired, first fired.
There is a history of laws being written to explicitly and intentionally exclude them and not all those laws have been expunged from the books.
Redlining and similar practices are well documented.
I don't know how anyone can suggest that poverty is the root cause of poor outcomes for Blacks and is wholly unrelated to their skin color and deny that skin color has any connection as a root cause when we know for a fact it does. We know for a fact that there is a long history in this country of Blacks being actively and intentionally denied access to the same things as Whites in this country because of the color of their skin.
Sounds like you don’t have much exposure to large companies these days. If anything it’s the opposite.
You’re incorrect that there are any racist laws remaining that might influence hiring, unless you are referring to govern contracts, in which minority owned businesses are given preference.
It is silly to introduce historical artifacts as though they are the situation today.
https://www.cbsnews.com/news/black-professionals-hold-only-3...
A close examination of wealth in the U.S. finds evidence of staggering racial disparities. At $171,000, the net worth of a typical white family is nearly ten times greater than that of a Black family ($17,150) in 2016.
https://www.brookings.edu/blog/up-front/2020/02/27/examining...
There are still laws on the books that were written expressly to exclude Blacks.
https://wset.com/features/special-reports/racists-laws-are-s...
If hiring practices have changed at big companies in recent years, it doesn't mean Blacks have achieved equality yet by any stretch of the imagination.
As for laws on the books, you found a historical artifact that has no legal effect, which the article you linked explains. It’s a reminder of a racist past, yes. These reminders will always exist in our society, and while it makes sense to continue to scrub them from legal documents over time, it’s not a good faith argument to cite such a thing as though it has any legal effect today.
To be intellectually honest, you should also be upset that virginia makes it illegal for unwed couples to live together. It’s also illegal to kill a sasquatch in Washington. In Kansas, it’s illegal to put ice cream on cherry pie.
To falsely say that blacks are hired last and fired first in America is not only preposterous, but extremely counterproductive to the outcome you’re presumably looking for. This is just inventing bogus reasons for Americans to feel hostile towards each other, and discouraging more people from even trying.
That isn't anything I said.
I don’t know why you insist on being so adamant about how hiring works.
That's not what I'm doing. You latched onto that as a thing to argue with me about in a way that ignores everything else I say and is a tactic that looks very bad faith. It looks like it is hand waving off known widespread racial bias in the name of "this one detail you said is inaccurate."
It's like attacking someone over a misplaced comma to imply they are stupid without bothering to engage anything they have said.
What I originally said is just that this is not shocking and talked about generally known statistics and you are latching onto "This woman knows nothing about hiring and I am going to dog her to the ends of the earth about that while pretending it is a good faith argument and overlook how shitty and racist it looks to deal with her in this fashion."
This is a routine thing that whenever racism, sexism and similar come up, someone wants to go to town and nitpick something in a way that looks extremely dismissive of the very existence of the problem because they want to argue they aren't guilty of something. Some people have an expression for that along the lines of "moves to innocence" -- in other words, it is vastly more important to most White people to insist "I'm not a racist and I don't do that and that's not how hiring works" than to actually talk about how racism does work and how to remedy it. Defending their own claimed innocence is their highest priority rather than working on understanding how racism persists and what needs to be done to remedy it.
"Last hired and first fired" was very much a known and standard thing for a lot of years and you have not provided any citations and I haven't gone looking because this style of arguing is so bad faith I don't want to engage it by agreeing that I need to "prove" that long-known practice remains true.
There can be lots of ways that still happens without any hiring managers intentionally discriminating against Blacks. There are lots of ways that someone can be effectively removed from the pipeline before it gets to the point of applying for a particular job which is one of the things that contributes to people fighting over the few qualified candidates who do apply and have certain traits.
But "Last hired, first fired" is not and has never been exclusively about "Hiring managers are just racist assholes who look for bullshit reasons to not hire Blacks."
It's an observation about general trends that result in worse unemployment for Blacks. Some ways that can play out without any hiring manager being blatantly racist and intentionally wanting to exclude Blacks:
1. It's harder to get a job with a criminal record and you are more likely to have a criminal record if you are Black.
2. It's harder to get a job if your criminal record is for certain kinds of crimes and Blacks are more likely to be convicted and do hard time rather than get probation for the same thing.
3. It's harder to get a job if you have less education and education costs money and Blacks tend to have less of that than others.
4. It's harder to get a job if your education is from a less prestigious institution and the prestigious institutions cost more money.
5. Certain classes of jobs may be cut at a big company to save money because they are deemed "less essential" and those classes of jobs may be typically held by Blacks while the "essential" jobs are typically held by Whites.
At my corporate job during a recession, they cut janitorial service to save money. They stopped having all trash removed daily and had it removed every other day.
Janitorial jobs and cleaning jobs are very often held by people of color.
You don't have to be a racist piece of shit to go "Oh, the company is not doing well. We need to make some cuts. Um...let's have the trash taken out less." You can do that for completely good reasons that aren't inherently racist and it can still result in higher rates of unemployment for some groups than others.
I don't really want to argue this further. I cannot believe I am being given so much grief over this as if no one on the planet has heard that "racism is alive and well in the US of A."
It is not just racism/sexism but, seriously, white people are not oppressed.
Or could it be that black doctors are just overall better?
Assuming it's harder for a black person to become a doctor, it could stand to reason that those that do are among the very best. (Or skews that way statistically)
Second: what percentage of obgyns are black? Could Simpson’s paradox be at play?
> Simpson's paradox, which also goes by several other names, is a phenomenon in probability and statistics, in which a trend appears in several different groups of data but disappears or reverses when these groups are combined.
Didn't see anything adjusting for the success rates between the groups of black vs white doctors in general. Are these differences present?
I’ve seen also some calls to the need of training more Black doctors to address inequalities in the healthcare due to racial biases. Should this also be extended to other races or ethnicities? (e.g Iranians, Vietnamese, Latinx, Greeks) Should we maintain a ratio of doctors according to race percentages? What should we do with those ethnicities that are over represented in medicine, should we curtail them? What do we do with mixed race patients?
I suspect this is a confounder (selection bias for where black doctors work?) being paraded as some racial finding.