Racial Bias in Heart Disease Treatment
By Rachel Walden — August 16, 2007
Guest blogger Rachel Walden of Women’s Health News is posting here this week, while Christine is on vacation.
The Washington Post is reporting on a new study of physicians’ attitudes and treatment of patients and how racial bias affects their decision-making.
Emergency and internal medicine physicians in Boston and Atlanta were surveyed about their biases, and presented with a case scenario of a hypothetical male patient, who some were told was white, and others were told was African-American.
The physicians demonstrated a number of unconscious biases, including judging the hypothetical black patients to be less cooperative with medical treatment and a decreased likelihood of providing appropriate anti-clot treatment to African-Americans, despite being more likely to identify those patients as having heart attacks.
As the CDC reports, death rates from heart disease were 30% higher in 2002 for African Americans than whites, prompting questions about whether the differences come from biological or treatment disparities. Despite heart disease being the number one killer of women, and African American women suffering from higher rates of death from heart disease than their white counterparts, no female hypothetical patients were included in the study. However, it does suggest that there is work to be done in making sure all patients receive appropriate, evidence-based care free of physician bias.
The Washington Post article requires registration; try BugMeNot if you have trouble logging in. The full-text of the study is freely available online.
Related to this topic, the Department of Health and Human Services’s Hospital Compare tool allows you to search for hospitals in your area and see how they perform on measures such as providing aspirin or other anti-clotting therapy to heart attack patients upon arrival, although this data is not broken down by race.
Also check out OBOS’s Judy Norsigian’s op ed, “Women and Heart Disease: Selling Statins.” The authors challenge the prevailing view that women at risk of heart disease, but who don’t actually have heart disease or diabetes, should take cholesterol-lowering drugs, and examines how the pharmaceutical industry promotes unproven treatments.
I don’t know how it has become the conventional wisdom that minorities — especially African Americans — are just “different” biologically, and as a result, they have higher rates of diseases.
We have a tendency in this country to deny racism — or hold off on it until the last resort. Think about how white commentators mock those who “cry racism all the time.”
How many times does it need to be proven that racism — conscious or unconscious — is alive and well and something we need to face and combat everyday?
Just speculating, but I think it’s really, really hard to get people (like doctors) to acknowledge that they’re doing things differently because of their own biases, so they tend to look for explanations that don’t expose those biases.
We had information presented to our medical school class on racial and gender based bias in treatment of disease recently. In study after study she presented, blacks and especially black women suffered higher rates of mortality and morbidity independent of education, age, or other confounders.
I was appalled and embarrassed by the response of many of the white members of our class. I heard a few mention, to other whites of course, that they thought the only reason this doctor, who happened to be a black woman, was presenting this information was because she was a black woman.
One asked why there were no other races included in one study comparing two white women, two black women, two black men, and two white men, all fictitious composite characters, as case reports to practitioners to see if their treatment suggestions were race based.
She answered that there have been many studies with different methods, and this one picked the two groups with the greatest disparity in treatment (this was a heart attack treatment) and examined it in depth, using a test of unconscious racial bias on all of the doctor subjects.
Well, the student doctors were not happy with this answer, as I heard evidenced in much grumbling later. I don’t know if this problem is going to get any better any time soon. As the presenter said, she can give us the information, but not the desire to reform the system.
The information on the reduction of deaths from heart disease and strokes comes from the Center for Disease Control in Atlanta.
http://www.amocare.com is a free service that has hospitals located in the U.S. that perform heart surgery for around 70% the cost of the price of the average cost. American Medical Outsourcing will help you with the entire process of the treatment. Heart bypass surgery usaly cost $45k-$55k. with AMO, the cost is around $10k-$13k. Go to http://www.amocare.com for more info.