Here’s another read for you, this time from Bari Weiss’s Substack column. Weiss seems to have been farming out the writing part of her site to others (Katie Herzog in this case) and concentrating on podcasting, a genre I don’t listen to. Herzog’s piece, below, discusses the kind of wokeness in medicine that is either potentially injurious to people or makes doctors keep their mouths shut when they shouldn’t.
Click on the screenshot to read:
Herzog readily avers that there are inequities in medicine, many stemming from racism in the past that has led Hispanics and blacks to be unable to afford good medical care or to be shunted to ineffective adyts of the system. These have to be addressed.
But the object of the current fracas is what’s seen as “ongoing systemic racism” in medicine. This, claims Herzog, has led to doctors being reluctant to criticize others for being late, for criticizing wokeness and—in my view, the worst violation—”whole research areas being seen as off limits”. I’ll give two examples, one of which doesn’t show research as being off-limits, really, but showing criticism of presumably weak research being off limits. Herzog:
“Wokeness feels like an existential threat,” a doctor from the Northwest said. “In health care, innovation depends on open, objective inquiry into complex problems, but that’s now undermined by this simplistic and racialized worldview where racism is seen as the cause of all disparities, despite robust data showing it’s not that simple.”
“Whole research areas are off-limits,” he said, adding that some of what is being published in the nation’s top journals is “shoddy as hell.”
Here, he was referring in part to a study published last year in the Proceedings Of The National Academy Of Sciences. The study was covered all over the news, with headlines like “Black Newborns More Likely to Die When Looked After by White Doctors” (CNN), “The Lack of Black Doctors is Killing Black Babies” (Fortune), and “Black Babies More Likely to Survive when Cared for by Black Doctors” (The Guardian).
Despite these breathless headlines, the study was so methodologically flawed that, according to several of the doctors I spoke with, it’s impossible to extrapolate any conclusions about how the race of the treating doctor impacts patient outcomes at all. And yet very few people were willing to publicly criticize it. As Vinay Prasad, a clinician and a professor at the University of California San Francisco, put it on Twitter: “I am aware of dozens of people who agree with my assessment of this paper and are scared to comment.”
“It’s some of the most shoddy, methodologically flawed research we’ve ever seen published in these journals,” the doctor in the Zoom meeting said, “with sensational conclusions that seem totally unjustified from the results of the study.”
“It’s frustrating because we all know how hard it is to get good, sound research published,” he added. “So do those rules and quality standards no longer apply to this topic, or to these authors, or for a certain time period?”
At the same time that the bar appears to be lower for articles and studies that push an anti-racist agenda, the consequences for questioning or criticizing that agenda can be high.
The article below is the PNAS article at issue, and you can read it for free by clicking on the screenshot:
The popular summary from the article which, if true, is a pretty serious finding, and is apparently imputed to white doctors mistreating black newborns in a way that doubles their mortality! Here’s the author’s popular precis:
Significance
A large body of work highlights disparities in survival rates across Black and White newborns during childbirth. We posit that these differences may be ameliorated by racial concordance between the physician and newborn patient. Findings suggest that when Black newborns are cared for by Black physicians, the mortality penalty they suffer, as compared with White infants, is halved. Strikingly, these effects appear to manifest more strongly in more complicated cases, and when hospitals deliver more Black newborns. No such concordance effect is found among birthing mothers.
As Herzog notes above, many people see this study as weak (confession: I haven’t yet read it). If you want a series of problems that Ethan Milne found in the paper, he has a critique of the paper on Medium, though he hastens to add:
While I have included many disclaimers throughout this post, I want to be clear that I am 1) not a medical researcher, and 2) that you should read the paper yourself. The research itself has merit, and the biggest issue here is the way in which uncritical reporters overhype findings to satisfy their personal biases. The solution isn’t to throw our hands in the air and cry foul when research is flawed, but to build on that research in future work.
Milne shows how grossly the popular press distorted the results of this paper.
So read the paper or, if it’s above your pay grade, look around the Web to find other takes on it.
I’ll cite just one more example: somebody losing their position and status for maintaining that medicine is hyperracialized and is not systemically racist:
In February, the Journal of the American Medical Association (JAMA) released a podcast hosted by surgeon and then-deputy journal editor Edward Livingston, who questioned the value of the hyper focus on race in medicine as well as the idea that medicine is systemically racist.
“Personally, I think taking racism out of the conversation will help,” Livingston said at one point. “Many of us are offended by the concept that we are racist.”
It’s possible Livingston’s comments would have gone unnoticed but JAMA promoted the podcast on Twitter with the tone-deaf text: “No physician is racist, so how can there be structural racism in health care?”
Even more than in the case of Norman Wang, this tweet, and the podcast it promoted, led to a massive uproar. A number of researchers vowed to boycott the journal, and a petition condemning JAMA has received over 9,000 signatures. In response to the backlash, JAMA quickly deleted the episode, promised to investigate, and asked Livingston to resign from his job. He did.
If you try to access the podcast today, you find an apology in its place from JAMA editor-in-chief Howard Bauchner, who called Livingston’s statements, “inaccurate, offensive, hurtful and inconsistent with the standards of JAMA.” Bauchner was also suspended by JAMA pending an independent investigation. This Tuesday, JAMA announced that Bauchner officially stepped down. In a statement, he said he is “profoundly disappointed in myself for the lapses that led to the publishing of the tweet and podcast. Although I did not write or even see the tweet, or create the podcast, as editor in chief, I am ultimately responsible for them.”
Seriously, do you think that Livingston’s comments were inflammatory and odious enough to warrant this kind of “uproar,” much less forcing him to resign with the usual abject apology? I doubt it. And the JAMA’s promotion of the podcast was invidious and inflammatory enough to ignite this controversy.
There’s more in Herzog’s piece, including stuff about differential treatment of patients of different races. I will add that the study of infant mortality noted above has such serious implications that it, and studies like it analyzing disparate races of caregivers and care receivers, need to be repeated. We can’t just blow off the result, weak as the study may be, because people’s health and lives are at stake.
Today’s release (Friday 4 Jun 2021) on the Bari Weiss substack is again from the field of medicine (or at least, psychiatry or psychoanalysis), and like yesterday’s also features work by Katie Herzog. It includes a link to a very fuzzy audio of a guest lecture at Yale School of Medicine by Dr. Aruna Khilanani, a New York-based psychiatrist (with some UChicago credentials in her history); some printed transcribed excerpts, and brief commentary, which I took to be coming from Bari Weiss; and the transcript of an interview with that speaker conducted by Katie Herzog.
The lecture has the title “The Psychopathic Problem of the White Mind,” and the printed excerpts make the speaker seem consumed with anti-white disdain and even indirect gestures toward violence. The bit of the audio I was able to listen to make her sound reasonable and professional, and suggest that her provocations in the talk will be, not a prank, but intended to produce reactions the audience is asked to attend to. KH’s interview mostly accepts the professional standpoint, but she is not shy about questioning the speaker.
https://bariweiss.substack.com/p/the-psychopathic-problem-of-the-white
Well, I’m not convinced that racism is not a problem in medicine. The recent reports of the NFL’s “race-norming” of brain-injury claims includes this: “The NFL on Wednesday pledged to halt the use of “race-norming” — which assumed Black players started out with lower cognitive function — in the $1 billion settlement of brain injury claims and review past scores for any potential race bias…..The NFL noted that the norms were developed in medicine “to stop bias in testing, not perpetrate it.” And both Seeger and the league said the practice was never mandatory, but left to the discretion of doctors taking part in the settlement program. ….”
According to the NFL, a panel of neuropsychologists formed recently to propose a new testing regime to the court includes two female and three Black doctors.
https://apnews.com/article/pa-state-wire-race-and-ethnicity-health-nfl-sports-205b304c0c3724532d74fc54e58b4d1d?fbclid=IwAR1XGDLlPATWYYvOo6qlyJVrf7PzovrsGobUjxXmX4IVUlULgkLLOe7TG3k
Nobody, including me, said that racism isn’t a problem in medicine. The issue at hand is that it’s now being held responsible for things that may not be the case.
Of course. And certainly the study here is an example of terrible research. But, the NFL example strikes me as an appalling instance of ongoing systemic racism that has damaging consequences for many individual former players. The equally appalling comments by the recently ousted editor at JAMA suggests to me that there is a problem with ongoing systemic racism in the medical field that the AMA has not recognized and that needs to be addressed. I agree that such studies, as you cite here, are not helpful (at best).
Deciding whether someone suffered brain damage from sports should be based on individual measurements, like the difference between the same pre- and post career cognitive test, not on the place of the post-career measurement in norming tables. How to deal with cases where no such measurement was taken early in the career is a different (and difficult) question. I think one should err on the side of the players rather than deny them a right that might be correctly theirs. But there must be precedents how cases like these are handled in insurance law. Using group averages against the client is quite common, like assuming that a woman, no mattter what her personal health and age at death of her parents, will live longer than a man, thus will have to pay a higher premium to get the same pension.
Being “woke” is killing Americans and America in so many ways. Go woke go broke. This is just sickening!
I’m not good enough to pick out any ‘smoking guns’ for why the research was terrible, but here are a few things I did pick up on:
1. They eliminated from consideration any doctor and any baby not black or white (i.e. Hispanics, Asian, other). Then in another part of the study they talk about the need for more control groups. Hmm…. This really makes me wonder what including the full sample would’ve shown. Very late in the write-up they mention that they saw no similar effect for Latino babies whose mothers were on medicare/medicaid.
2. They have no record of doctor race. Instead, they looked at online pictures of the doctors and assigned race based on that (!!!!)
3. Their data shows no difference in the mother’s outcome based on mother and doctor race. Which means if the effect is real, it can’t be about racism related to admission or delivery.
4. They did not control for socio-economic status (of either doctors or the mothers).
5. They admit that they couldn’t really study the effect of doctor selection on the results, and have only some limited study on doctor specialty on results (pediatricians do better than non-pediatricians. Surprise!). The selection issue is important but I think it’s worth pointing out that even if selection was determined to be the key explanatory factor, that doesn’t necessarily mean ‘no racism.’ For example, let’s say we find out that white physicians are assigned to more of the difficult survival cases, and this selection explains the correlation between doctor race and black baby survival. That would still leave us with the question of why white doctors are given those cases more than black doctors.
Anyway, as I said, I’m not an expert and I could’ve missed the smoking gun entirely. But that’s what my layperson’s reading picked up on. The statistics seem big enough to draw conclusions – about 8k cases – but I’ll admit that i didn’t go closely through their charts to look at significance factors.
And, if they didn’t control for the complexity of the case and other health factors (I don’t know if they did) then they can’t make their conclusions.
They did look at health factors, but it was pretty basic. They tracked 65 comorbidity factors, and split the babies into two groups; group that had none, group that had 1 or more. They say the effect holds in both groups.
With 65 factors you’re going to find a correlation somewhere just on random chance. So while the question “what comorbidities does the effect hold for” is interesting, we’d have to be really careful of data dredging (I believe that’s the name for it).
Thanks!
> let’s say we find out that white physicians are assigned to more of the difficult survival cases, and this selection explains the correlation between doctor race and black baby survival.
This is really the obvious answer. Babies in danger of dying get transferred to major hospitals & treated by big-shot specialists. That’s what you’d want! Those are much more likely to be 60+ white men than the junior doctors doing routine deliveries.
(I thought that everyone’s intro stats class had almost exactly this example, to caution against naive readings of the data. If most of the deaths happen under one surgeon, he could be the worst, or he could be the best, who gets called in precisely because things look dicey.)
> That would still leave us with the question of why white doctors are given those cases more than black doctors.
Right, but this is an independent, fact which you can investigate in much more straightforward ways. Like looking them up on the website. Or looking at some medical school graduation photos from 1980.
This seems like a claim that should be able to be substantiated or not. Regarding the study’s methodological flaws, if they do exist, they certainly should be criticized. And then hopefully some researchers will design a better study to look at the issue.
I can’t get on board with this, however. His offense at a vague notion that others might consider him racist is not a good reason to ignore or fail to study the issue. We just need better data – and data don’t lie, as the kids say.
I have reported here before on the UW School of Medicine’s “affinity caucuses”, which sprang into organized life last summer: three racially separate caucuses (Black, non-Black non-white, and white), which held a series of zoom meetings. They were apparently organized by a DEI office, and other DEI activities and committees have metastasized everywhere at the SOM in the past year. This may have something to do with current UW hiring policies, which evidently flow from a “Diversity Directive” of the state Human Resources office. This is explained as follows in a bulletin from the UW Human Resources office.
“The requirements for the Implicit Bias training come to us from State Human Resources and are specific to “hiring supervisors, managers and designees.” …Departments may offer training in addition to these two required trainings. However, they cannot replace these two trainings which UW uses to meet objectives related to diversity, equity, and inclusion and requirements under employment law and directives. The Implicit Bias training was developed to meet the objectives set by the State HR Director as a part of the Diversity Directive.”
Long story short: the explosive recent growth of DEI bureaucracies (and associated DEI doctrines, notably the racialization of everything) could be viewed as a recent variation of the slower, steadier amoeboid growth of the HR mandarinate over the last generation.
Just wanted to take the opportunity to plug Herzog’s podcast Blocked and Reported again.
This is a good time to make a point about rate statistics, and how you should always look at both ends of the stick. In this case, I mean look at rate of survival as well as the rate of mortality.
Take this basic data from the paper:
“Under the care of White physicians, the White newborn mortality rate is 290 per 100,000 births, as implied by the constant term (0.290). Black newborn mortality is estimated at 894 per 100,000 births (0.290 + 0.604).”
If we look at the other end of the stick, the survival rate for white babies is 99.710%, and for black babies is 99.106%, a difference of 0.604%. While that is not nothing, it is also not huge.
Then this data on race of doctor:
“Under the care of White physicians, Black newborns experience 430 more fatalities per 100,000 births than White newborns (column 4). Under the care of Black physicians, the mortality penalty for Black newborns is only 173 fatalities per 100,000 births above White newborns, a difference of 257 deaths per 100,000 births, and a 58% reduction in the racial mortality difference.”
This reduction of the mortality difference by 58% is nevertheless a change of just 0.257% in the survival rate. Yes it is worth finding out if there is a way to save the life of an additional 257 babies per 100,000, but it is not as dramatic a difference as they would like to make it out to be.
Maybe I should call it the inverse statistic, or something. But always look at both statistics!
Im am afraid this overstating of effect sizes by using relative risk measurements instead of absolute percentages is quite common in medicine. Scanned the study, it looked methodologically no worse than a lot of what gets published. We all know not all effects can be replicated.
In case the hypothesis for the causation were true, that would be a truly sad thing, and an argument for “separate but equal”, which I find quite horrible.
It’s totally disheartening to see respected institutions like JAMA go along with this crap. It parallels GOP politicians going all-in for Trump. Both Trump/GOP and the Woke are weaponizing racism and using fear of reprisal to enforce their respective hegemony. Anyone who bucks the accepted wisdom is thrown out of their job. Many find it easier simply to go along with it.
How is being criticized for being late possibly construed as racism? Is a certain sense of entitlement involved? (It might be a cultural thing. When my navy ship changed homeports to Guam, I was informed of “Guam Time.” I should think that hospitals would necessarily operate on the basis of “a New York Minute.”) Are residents going to make that claim if the Head Resident or Chief of Staff is a POC? Do these residents meander and sashay down the hall when a “Code Blue” is called?