Medical racism and the rhetoric of exculpation: How do physicians think about race?

New Literary History

Volumn 38, Issue 3, 2007, Pages 505-525

  Hoberman, John ^a  

^a UNIVERSITY OF TEXAS AT AUSTIN   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

EID: 60950440794     PISSN: 00286087     EISSN: 1080661X     Source Type: Journal    
DOI: 10.1353/nlh.2007.0041     Document Type: Review

References (61)

1. H. Jack Geiger, "Race and Health Care," New England Journal of Medicine 335 (September 12, 1996): 816
2. "Black Americans have a much lower life expectancy and worse health outcomes than white Americans. Large differences in health outcomes between races have raised obvious questions about differences in health care that might contribute to these patterns. Numerous studies have documented racial disparities in the use of major, high-cost surgical procedures that are not explained by differences in patients' clinical characteristics. The racial differences in the use of surgical procedures occur for a broad range of clinical indications and are largely independent of the level of physician discretion involved in a procedure. Although overuse of these procedures in white patients may explain some of the disparity, studies suggest that black patients undergo fewer clinically important, evidence-based procedures than white patients." Also: "More than 600 studies have documented racial and ethnic differences in health care dating back at least to the 1980s." Ashish K. Jha et al., "Racial Trends in the Use of Major Procedures among the Elderly," New England Journal of Medicine 353 (August 18, 2005): 684, 690
3. See Rachel L. Johnson et al., "Patient Race/Ethnicity and Quality of Patient-Physician Communication During Medical Visits," American Journal of Public Health 94 (December 2004): 2086-87
4. Daniel S. Greenberg, "Black Health: Grim Statistics," The Lancet (March 31, 1990): 780
5. "The Origins of Racial/Ethnic Disparities," Health Affairs 24 (2005): 316
6. David Satcher et al., "What If We Were Equal? A Comparison of the Black-White Mortality Gap in 1960 and in 2000," Health Affairs 24 (2005): 459
7. See, for example, Ronald L. Braithwaite and Sandra E. Taylor, eds., Health Issues in the Black Community (San Francisco: Jossey-Bass Publishers, 2001): 8-9
8. Peter T. Kilborn, "Health Gap Grows, With Black Americans Trailing Whites, Studies Say," New York Times, January 26, 1998
9. The Booker T. Washington Papers, vol. 13, 1914-1915, ed. Louis R. Harlan and Raymond W. Smock (Urbana: Univ. of Illinois Press, 1984), 269. Also available online at http://www.historycooperative.org/btw/Vol.13/htrnl/269.html
10. "A Generation Behind," Time, April 7, 1947
11. Kilborn, "Health Gap Grows."
12. Barry Zuckerman, Deborah A. Frank, and Linda Mayes, "Cocaine-Exposed Infants and Developmental Outcomes," JAMA 287 (April 17, 2002): 1991
13. Sherwin B. Nuland, "Indoctrinology," The New Republic, February 19, 2001, 37
14. Thomas Bartlett, "An Ugly Tradition Persists at Southern Fraternity Parties," Chronicle of Higher Education (November 30, 2001): A33
15. Jha et al., "Racial Trends," 690
16. See, for example, Marcia Angell, "Privilege and Health - What is the Connection?" New England Journal of Medicine 329 (July 8, 1993): 126-27
17. Geiger, "Race and Health Care," 815-16
18. 2005 National Healthcare Disparities Report, (2005), Vol. 1.
19. Institute of Medicine, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care (Washington, DC: National Academies Press, 2002)
20. "Minorities More Likely to Receive Lower-Quality Health Care, Regardless of Income and Insurance Coverage," The National Academies News (March 20, 2002)
21. Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 5th ed. (New York: Oxford Univ. Press, 2001): 237-39
22. Neil D. Rosenberg, "Separate But UnEqual: U.S. Practices a System of Medicine That Shortchanges Minorities and Women," Milwaukee Journal Sentinel, April 14, 2001
23. M. Gregg Bloche," "Health Care Disparities - Science, Politics, and Race," New England Journal of Medicine (April 8, 2004): 1569
24. Owen Dyer, "Ethnic Minority Groups Criticize U.S. Report on Healthcare Disparities," BMJ 328 (February 7, 2004): 308
25. Bloche, "Health Care Disparities," 1569. Bloche points out (1568) that Secretary Thompson's role in altering the July 2003 version remains unclear. According to another account of Thompson's actions, the Secretary told a House hearing on February 10, 2004, that "we are putting out the original report just the way it was and without any changes whatsoever." He added: "I can explain it to you, but it's not something I am very happy about. Some individuals took it upon themselves and thought they were doing the right thing. They wanted to be more positive and when it came to me I said, 'No, we put it out the way it was. That's the way it's going to be.'. . . It was a mistake made and it's going to be rectified." Robert Steinbrook, "Disparities in Health Care - From Politics to Policy," New England Journal of Medicine 350 (April 8, 2004): 1487
26. Bloche, "Health Care Disparities," 1568
27. Robert Pear, "Taking Spin Out of Report That Made Bad Into Good," New York Times February 22, 2004
28. Pear, "Taking Spin Out of Report."
29. Sally Satel, "The Indoctrinologists Are Coming," The Atlantic Monthly, January 2001, 59-64. Satel expanded this magazine article into a chapter for her book PC, M.D.: How Political Correctness Is Corrupting Medicine (New York: Basic Books, 2000), 155-92. This chapter, like the Atlantic Monthly article that announced her book's publication, is lightly researched and unreliable as a basis for thinking about the multiple origins of racial health disparities. As Nuland notes in his review of PC, M.D.: "Her statistics, and her descriptions of biological differences in disease patterns, read like feeble protests in the face of the experience of anyone who has ever trained in the teaching divisions of a large hospital, by which I mean the great majority of American physicians." Nuland, "Indoctinology," 37
30. Institute of Medicine, Unequal Treatment, 10
31. Joseph A. Flaherty and Robert Meagher, "Measuring Racial Bias in Inpatient Treatment," American Journal of Psychiatry 137 (1980): 681
32. Geiger, "Race and Health Care," 816
33. To watch a socially conscious physician wrestling (I think ineffectually) with these issues, see Geiger, "Race and Health Care."
34. See Nancy R. Kressin et al., "Racial Differences in Cardiac Catheterization as a Function of Patients' Beliefs," American Journal of Public Health 94 (December 2004): 2096
35. Mark B. Wenneker and Arnold M. Epstein, "Racial Inequalities in the Use of Procedures for Patients With Ischemic Heart Disease in Massachusetts," JAMA 261 (January 13, 1989): 257
36. David Satcher, "Does Race Interfere With the Doctor-Patient Relationship?" JAMA 223 (March 26, 1973): 1498-99
37. John M. Eisenberg, "Sociologic Influences on Decision-Making by Clinicians," Annals of Internal Medicine 90 (1979): 957-64
38. David Levy, "White Doctors and Black Patients: Influence of Race on the Doctor-Patient Relationship," Pediatrics 75 (1985): 639-43
39. Talmadge E. King, Jr. and Paul Brunetta, "Racial Disparity in Rates of Surgery for Lung Cancer," New England Journal of Medicine 341 (October 14, 1999): 1231-32
40. "Federal Support Grows for Research on the Role of Race in Public-Health Problems," Chronicle of Higher Education (November 24, 2000): A25
41. Richard L. Lichtenstein et al., "Black/White Differences in Attitudes Toward Physician-Assisted Suicide," Journal of the National Medical Association 89 ( 1997) : 132
42. S. W. Douglas, "Difficulties and Superstitions Encountered in Practice among the Negroes," Southern Medical Journal 19 (1926): 737
43. Viola Vaccarino et al., "Sex and Racial Differences in the Management of Acute Myocardial Infarction, 1994 through 2002," New England Journal of Medicine 353 (August 18, 2005): 680
44. John Z. Ayanian, "Heart Disease in Black and White," New England Journal of Medicine 329 (August 26, 1993): 657
45. Flaherty and Meagher, "Measuring Racial Bias," 681
46. Ford Fessenden, "A Difference of Life and Death," Newsday, November 29, 1998, A5. The researcher quoted is Michelle van Ryn of the State University of New York at Albany
47. Jeff Whittle et al., "Racial Differences in the Use of Invasive Cardiovascular Procedures in the Department of Veterans Affairs Medical System," New England Journal of Medicine 329 (August 26, 1993): 626
48. See L. M. Schwartz et al., "Misunderstandings about the Effects of Race and Sex on Physicians' Referrals for Cardiac Catheterization," New England Journal of Medicine 341 (July 22, 1999): 279-83
49. "Race, Sex, and Physicians' Referrals for Cardiac Catheterization," letters, New England Journal of Medicine 341 (July 22, 1999): 285-88
50. Kevin A. Schulman et al., "The Effect of Race and Sex on Physicians' Recommendations for Cardiac Catheterization," New England Journal of Medicine (February 25, 1999): 624-25
51. "Indeed, racial differences in health care preferences are often invoked as a more tolerable explanation than health care system bias when studies find that racial disparities in health care remain after adjusting for access to care and clinical appropriateness." Katrina Armstrong et al., "Patient Preferences Can Be Misleading as Explanations for Racial Disparities in Health Care," Archives of Internal Medicine 166 (May 8, 2006): 950
52. Wenneker and Epstein, "Racial Inequalities in the Use of Procedures," 256
53. Michelle D. Holmes, David Hodges, and John Rich, "Racial Inequities in the Use of Procedures for Ischemic Heart Disease," letter, JAMA (June 9, 1989): 3242
54. Johnson et al., "Patient Race/Ethnicity and Quality of Patient-Physician Communication," 2086
55. "Thus, the literature lacks comprehensive studies that simultaneously examine patients' and physicians' beliefs and attitudes and their potential association with actual racial variations in invasive cardiac procedure use while also controlling for sociodemographic and clinical variables." Kressin et al., "Racial Differences in Cardiac Catheterization," 2091 (emphasis added)
56. Eisenberg, "Sociologic Influences on Decision-Making," 957
57. "There is also the fact that doctors are unwilling to blow the whistle on other doctors. It's somehow bad manners or breaking the faith of the medical profession to report a bad doctor." John Pekkanen, Doctors Talk About Themselves (New York: Delacorte, 1988), 222-23
58. Levy, "White Doctors and Black Patients," 642
59. Dorothy E. Roberts, "Reconstructing the Patient: Starting with Women of Color," in Susan B. Wolf, ed., Feminism and Bioethies (New York: Oxford Univ. Press, 1996): 117-18, 121
60. Quoted in Roberts, "Reconstructing the Patient," 120
61. Pamela Sankar, "Hasty Generalization and Exaggerated Certainties: Reporting Genetic Findings in Health Disparities Research," New Genetics and Society 25 (December 2006): 250