Color-blind medicine?

• Author: Longman, Phillip

In 2002, the Institute of Medicine published an oft-cited and controversial report entitled Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. The report concluded that members of minority groups, even when fully insured, tend to receive substandard care from their doctors. It cited disparities in how often whites and minorities received even routine medical procedures, as well as how often they underwent specific operations, such as coronary artery bypass surgery.

The resulting headlines were sensational--"Is Your Doctor a Bigot?" asked one. And there soon followed fulsome denunciations of the report's conclusions, notably by Dr. Sally Satel and Jonathan Klick of the American Enterprise Institute.

In their 2006 book, The Health Disparities Myth, Klick and Satel claimed that "[n]ot only is the charge of bias divisive, it siphons energy and resources from endeavors targeting system factors that are more relevant to improving minority health."

Today, both sides in this debate have refined their positions and can point to new information. Professor David R. Williams of the Harvard School of Public Health still criticizes Satel as "coming at it from an ideological perspective." But, he adds, "I will say one thing in her defense. At the time of the IOM report, our conclusion about the role of unconscious discrimination was based on circumstantial evidence."

That changed in 2007, when the Journal of General Internal Medicine published the results of a study of residents at four academic medical centers. Participants were asked to review the medical record of an imaginary patient complaining of chest pain. For half the participants, the record included a picture of a middle-aged black man; for the rest, a middle-aged white man. Participants were asked to rate on a scale of 1 to 5 whether they thought the patient suffered from coronary artery disease, and, if so, whether they believed that the patient should receive a drug treatment known as thrombolysis.

The study also asked participants to complete what are known as Implicit Association Tests, or IATs. These tests are designed to uncover unconscious bias by, for example, asking test takers a series of questions about whether they associate the word "happiness" with the word "white" or with the word "black." In this instance, the test also asked the residents whether they associated black patients with being more or less cooperative with a doctor's orders.

The study found...