MINORITY HEALTH: Racism Link in Cardiac Care Overstated
Authors of a "highly publicized" study linking racism and health care published in the February edition of the New England Journal of Medicine came under fire in today's NEJM for overstating a racial disparity in cardiac care, the Dallas Morning News reports. After the press widely reported from the study that "black women were 40% less likely" to be recommended for cardiac catheterization, the White House held meetings, medical curriculums took a look at the data, and there was "talk of congressional hearings and federal legislation." But in today's issue, the authors and the editors of the Journal agree that the "odds ratios" were confusing as reported, and led the media to overstate the disparities. The critique also notes that "the study's results show a potential bias only against black women, not all black patients." In the initial study, 700 doctors were shown videos of actor-patients -- an older and a younger black man, white man, black woman and white woman -- being examined by doctors and presenting the same cardiac symptoms. The doctors in the study were found "significantly less likely to recommend that black women get a test that many doctors consider vital," however, they were not 40% less likely to receive the test, as the media reported (Weiss, Dallas Morning News, 7/22).
In Other Words
Writing in today's NEJM, Mount Sinai Medical Center Drs. Gerard Helft, Stephen Worthley and Sylvie Chokron note that the referral rates were actually very similar across groups -- a 10% difference rather than a 40% difference (NEJM, 7/22 issue). The critics said that in four groups -- 10 white men, 10 black men, 10 white women, 10 black women -- nine out of 10 people in each of the first three groups were recommended for cardiac catherization. But only eight out of 10 black women were recommended for the procedure -- a difference of one (Weiss, Dallas Morning News, 7/22). The authors conceded that "the concept of odds ratios" probably led to confusion, however, they nonetheless hope that the study "will foster a more honest dialogue between physicians and patient and encourage the medical profession to seek ways to eliminate unconscious bias that may influence physicians' clinical decisions" (Shulman et al., NEJM, 7/22 issue). Editors Dr. Gregory Curfman and Dr. Jerome Kassirer also assumed responsibility for the "media's overinterpretation," saying that while "racism and sexism are prevalent in American life, the evidence of racism and sexism in this study was overstated" (NEJM, 7/22). Dr. B. Wine Kong, president of the Association of Black Cardiologists, said that the disparity in treatment for black women cannot be overlooked, no "matter how it is reported." He said, "The issue for me is that there is a difference (in care). Isn't that the point? You cannot presume in America that you will have equal treatment and equal access for the same medical problem" (Dallas Morning News, 7/22).