September 18, 2024 - 8:00pm
A study published this week in a prestigious journal, Proceedings of the National Academy of Sciences, makes a claim that’s almost unheard of on the pages of leading medical journals: systemic racism and implicit bias are not the self-evident explanations for a pervasive racial disparity. To be precise: black newborns aren’t dying at higher rates when they’re treated by white doctors.
The study, conducted by a Harvard economist and a Manhattan Institute researcher, purports to debunk a widely circulated 2020 study, also published in PNAS, which concluded that black newborns attended by a white physician suffer a “mortality penalty” and are twice as likely to die. That study garnered incriminating headlines in USA Today, CNN, Science News, NPR, and The Washington Post. It was also so influential that it was cited by Supreme Court Justice Brown Jackson in the high court’s 2023 affirmative action case, in which the American Medical Association and 44 other parties declared in their amicus brief: “For high-risk Black newborns, having a Black physician is tantamount to a miracle drug.”
How could two teams of researchers look at the same data — 1.8 million childbirths in Florida between 1992 and 2015 — and reach diametrically opposite conclusions?
This time around, the researchers added one key variable that the 2020 researchers had overlooked — low birth weights — and the whole thing collapsed. The research design contained a fatal flaw, overlooking the fact that severely underweight babies, who have very high mortality rates to start with, tend to be treated by white doctors. Physicians who handle the most serious medical cases tend to see higher death rates.
It’s no exaggeration to say that this level of scholarly error raises serious questions about the hundreds of peer-reviewed studies published in the past five years that documented the prevalence of systemic racism in the medical profession and implicit bias among white doctors. Could the research design of those papers, some of which have been cited hundreds of times in subsequent papers, also have been flawed, so as to advance a progressive political agenda cloaked in the authority of objective science?
At the peak of the nation’s racial reckoning, between the years 2019 and 2021, the leading journals of the Anglosphere rushed to put out special issues and contrite reflections on anti-black racism and their journals’ institutional complicity in the brutal oppression of African Americans. Scientific American, Science, Nature, Health Affairs, and others assumed that systemic racism and implicit bias operate as natural laws which give researchers carte blanche to interpret all racial disparities as being governed by those laws.
Medical schools added lessons on critical race theory, intersectionality, identity, oppression, allyship, colonialism, patriarchy, fatphobia, power and privilege to their curricula, taking up time and space previously allotted to cell biology and anatomy. To date, more than 250 governmental bodies and private institutions have declared racism to be a public healthcare crisis, an escalation in urgency that morally justifies the prioritisation of non-whites for medical treatment, from Covid vaccinations to organ transplants, as a means to close the racial disparities gap in healthcare outcomes.
Much of the medical research of this period employs scientific terminology and statistical regression models, making it virtually impenetrable to a layperson, but the conclusions often don’t square with common sense. One study in Health Affairs concluded that neighbourhoods in New Orleans with high rates of police encounters experience significantly higher rates of smoking, poor physical health, low physical activity, violent crime and domestic violence — as if the police was the cause of these problems.
Media outlets owe it to the public to report on the latest study, rather than doubling down on advocacy journalism in the service of a monocausal moralistic metanarrative that may turn out to be flawed or even false.
The medical profession may be in for a reckoning of its own. Hundreds of peer-reviewed journal articles are ripe for an independent review that could result in corrections or possibly retractions.
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SubscribeI am, as Justin Webb calls me in this piece, an ‘idiot online’ who ‘discovered’ that he had been privately educated. This isn’t hard to do. If, like me, you listen to the news interactively with social media rather than simply passively as part of the voiceless audience, you develop habits like looking up the journalists involved as they speak. When, like me, you discover that time and again they have been privately educated you begin to wonder why. If only 7% of the population have had this experience why are they sometimes 100% of the presenters (as on Radio 4’s Today programme, for example, in fact the programme that Webb regularly presents)?
Webb says in his piece that the ‘more well-read’ of the idiots online imagine that private education is like the life described in A Dance To The Music of Time. I can assure him we idiots don’t, and that this is a straw man argument. The nasty privations, borderline if not actual abuse, forms of torture and subsequent damage done at many boarding schools has been well documented and is well-known. Most people, if they think about it for a moment, actually feel sorry for people ripped from their families – often because their families don’t want them at home – and sent to survive in the vicious society of other damaged children and frankly weird adults.
Webb, perhaps deliberately, perhaps not, confuses the ‘privilege’ we idiots accuse the 7% of having with something to do with luxury. We don’t. My own, often short of food but full of love childhood in a tiny house freezing in winter and boiling in summer, with attendance at the local grammar school, was clearly much nicer than his childhood. The privilege, however, was not there. My stellar O levels, equally stellar A levels and even more stellar degree at Birmingham University could not and would not overcome my very unstellar background or indeed, apparently, my ‘idiocy’. A concrete ceiling of many complex layers formed above my head. He, however, admits that he messed around during his O levels and was still OK because the school closed around him when he needed them. This is exactly what private education does in this country; it closes round its own. Careers, for example in law, at the BBC, in politics, in business, even, these days, in acting, are all but out of reach if you haven’t got a named school to call on to underline your suitability for polite society. We haven’t had two Eton PMs in ten years because they’re the best intellects this country can provide. We’ve had them because a privately educated sense of entitlement together with the way connections close around their own people makes for an unassailable combination, and that’s how things are still done in this country.
The title of this series: ‘Boarding school put me in my place’ couldn’t be more apt. Webb is safely in his place presenting the Today programme; the rest of us have to be content to be merely idiots online.