Baltimore Press

Wealth Trumps Race in Contemporary Health Care

The media have consistently misreported the effect of race in getting proper medical attention, according to the edi­tors of both the New England Journal of Medicine (NEJ) and the Annals of Internal Medicine (AIM).

The editors said it was erro­neous to conclude from a February article in the New England Journal of Medicine that African-Americans were 40% less like­ly to be referred to a heart spe­cialist for serious cardiac dis­ease than whites, a statistic widely reported by newspapers including the Baltimore Sun.

Locally, the Baltimore Sun reported that blacks were 40% less likely to be referred to a heart specialist for serious car­diac disease than whites, which the editors said was an erroneous conclusion drawn from an article printed in February by NEJ.

Last week, the editors of NEJ stated that “although racism and sexism are preva­lent in American life, the evi­dence of racism and sexism in this study was overstated.” The authors of the article conceded that the data had “the potential to mislead read­ers who are unfamiliar with statistical methods.”

Dr. Frank Davidoff, an AIM editor, agreed about “the pervasiveness of racism and sexism in American life.”
But he said the study’s conclusions were “disturbing” and that its “narrow perspective has unfortunately led to the unwarranted interpretation in the press that the physician’s own bias is the predominant reason for the known differences in the use of catheteriza­tion. In actual practice, however, the situation is considerably more com­plex.”
The Sun reported the “erroneous” data, which was supplied to them by The Associated Press, even though a seven year study by The Johns Hopkins University School of Medicine was published just three weeks before. The Hopkins study reported the difference in care between the groups to be less than one percent.

“It is tempting to place the blame for what went wrong in the coverage of the study by Schulman et al. [the authors of the study in question], on reporters, science writers, and editors in the media and to demand that they improve their reporting,” argued Dr. Gilbert Welsh of the VA Outcomes Group, who co-wrote a letter to the New England Journal of Medicine that sparked this controversy. “To a large extent, however, the media sim­ply reported what they were told.”
The pertinent issue, which was evi­dently not reported in the media, was that those in prominent economic or social classes were much more likely to receive the proper medical treat­ment, regardless of color.

According to the NEJ study, both whiteness and maleness were the fac­tors that insured a higher level of care. Black men, white women, and white men all received the same level of care, but black women received less care than any other group in the study, by 2 to 4%. The study showed that 55- year-old men, both black and white, would be referred to a cardiac special­ist 90.1% of the time when complain­ing of the same symptoms. White women of the same age are referred at 92.2% while 55-year-old black woman were referred only 84.4% of the time.

Outside these clinical studies—in the real world—a white person is three times as likely to receive the heart surgery in question than an African- American. The Hopkins study noted this, but showed that with adequate health care insurance and access to a proper health care facility, the dispari­ty disappears.

The studies point to the impoverish­ment and ghettoization of African-American populations, particularly black women, as the culprit. As long as large segments of the black population work in low-paying service-economy jobs without health care plans, the access to proper treatment for severe heart disease will remain lower than whites, the studies say.

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