If Black doctors offered better care, I'd expect them to have similar results with black mothers and white babies. Two alternative explanations: 1. Black mothers are less willing to trust the advice of white doctors; 2. Black doctors are more likely to recommend abortion if there is risk to baby - a kind of survivorship bias
If you are looking for an article which spreads rumors that endanger lives, this is it. The implication is that white doctors are racist and can’t be trusted, this will result in situations where black families refuse service by white doctors.
I am sorry but this is an extremely sinister form of rumor spreading on par with anti vaccine rumors.
I hate what America is turning into, I can’t view the data but I strongly suspect that it is highly questionable.
Next you will see similar articles about white teachers teaching black students etc. I hate this country.
It would be really-really important to use pre-registration especially in socially sensitive studies like this one. It is possible that these numbers are artifacts even if the stated p value is low.
I'm not saying that the study is wrong, just that shocking results like this one need extreme methodological rigor behind them before we start telling everyone that white doctors are killing black babies etc.
Black America is well aware of the fact that being black means that we will run into sub-part outcomes in US society. This isn't news to our community. Just because it causes feelings of racial anxiety in other groups doesn't mean it shouldn't be mentioned and be studied.
Before such a study, when black Americans would have noted that something seemed off, we would have been met with "You need data to back that up, X can't be racist!!!". Now that there is data to back up what we've known, it's "Your p-value is wrong!!!"
Exactly this, but you will of course be downvoted here for pointing out this truth.
For a purportedly open-minded set of hackers who claim to follow their intellectual curiosity, too many people here are very closed-minded about racism.
That comment is heavily upvoted. Your comment here, however, has rightly been downvoted and flagged, not just for being false, but for being flamebait and a supercilious dismissal. Please read https://news.ycombinator.com/newsguidelines.html and stick to the rules when posting here.
> ...before we start telling everyone that white doctors are killing black babies etc.
We aren't yelling that, though, and you're the first one to say it here. This fear of being accused of racism is intense; as if acknowledging that black people are actually treated worse by our society is actually more harmful than the loss of life that black people experience.
This is a preliminary study, and yes, it deserves a followup. If you're saying that preliminary studies should always be kept under wraps and not discussed, that's weird and anti-science. There are a couple of well-understood phenomena that can explain this. The first is unconscious bias -- it's been shown time and time again, across the board with various population differences, and could easily explain this. Second, bad training data -- if a doctor hasn't been trained with black patients, and pictures of black people with various ailments, then they might not recognize symptoms as readily (insert analogy to facial recognition). Also, a large proportion of black people in the US speak a different dialect than their white counterparts -- the way folks describe their symptoms differs between dialects -- so if a white doctor can't understand what their black patient is saying, they're operating on less information than a white doctor treating a white patient would be. Finally, a matter of trust -- psychosomatics are real -- black women know their history, and might not trust a white doctor as well as a black doctor, and that can impact outcomes. Rebuilding that trust will take generations of trustworthy, good faith efforts to correct the wrongs of the past.
> Preprints are preliminary reports of work that have not been certified by peer review. They should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
It's annoying when news websites report on research that isn't reviewed. It's been happening at an increasing rate over the last few years because these news websites are so hungry for advertising revenue. It undermines the public's trust in science. It threatens our ability to do research openly and inclusively.
This is not shocking. It's well known that Blacks don't live as long as Whites in the US and have generally poorer outcomes for all metrics -- health, economic status, etc. That's old news and common knowledge.
It's also old news and common knowledge that the difference is quite substantial. It's not a small difference at all.
And how is it 'more blacks are poor' persistently across the nation for hundreds of years having nothing to do with the color of their skin?
Blacks are last hired, first fired.
There is a history of laws being written to explicitly and intentionally exclude them and not all those laws have been expunged from the books.
Redlining and similar practices are well documented.
I don't know how anyone can suggest that poverty is the root cause of poor outcomes for Blacks and is wholly unrelated to their skin color and deny that skin color has any connection as a root cause when we know for a fact it does. We know for a fact that there is a long history in this country of Blacks being actively and intentionally denied access to the same things as Whites in this country because of the color of their skin.
Sounds like you don’t have much exposure to large companies these days. If anything it’s the opposite.
You’re incorrect that there are any racist laws remaining that might influence hiring, unless you are referring to govern contracts, in which minority owned businesses are given preference.
It is silly to introduce historical artifacts as though they are the situation today.
Black people account for about 12% of the U.S. population, but occupy only 3.2% of the senior leadership roles at large companies in the U.S. and just 0.8% of all Fortune 500 CEO positions
A close examination of wealth in the U.S. finds evidence of staggering racial disparities. At $171,000, the net worth of a typical white family is nearly ten times greater than that of a Black family ($17,150) in 2016.
If hiring practices have changed at big companies in recent years, it doesn't mean Blacks have achieved equality yet by any stretch of the imagination.
I know you know how statistics work, and you know this isn’t evidence of what you’re suggesting. I don’t know why anyone pretends that these stats suggest that companies are being racist about hiring. Having been involved with hiring for several of the major tech companies, and being aware of the DEI targets at others, I can tell you that they are fighting over non-white male and non-indian male talent. It’s simply not true. Given that you’ve seemingly been out of the workforce for some time, I don’t know why you insist on being so adamant about how hiring works.
As for laws on the books, you found a historical artifact that has no legal effect, which the article you linked explains. It’s a reminder of a racist past, yes. These reminders will always exist in our society, and while it makes sense to continue to scrub them from legal documents over time, it’s not a good faith argument to cite such a thing as though it has any legal effect today.
To be intellectually honest, you should also be upset that virginia makes it illegal for unwed couples to live together. It’s also illegal to kill a sasquatch in Washington. In Kansas, it’s illegal to put ice cream on cherry pie.
To falsely say that blacks are hired last and fired first in America is not only preposterous, but extremely counterproductive to the outcome you’re presumably looking for. This is just inventing bogus reasons for Americans to feel hostile towards each other, and discouraging more people from even trying.
I don’t know why anyone pretends that these stats suggest that companies are being racist about hiring.
That isn't anything I said.
I don’t know why you insist on being so adamant about how hiring works.
That's not what I'm doing. You latched onto that as a thing to argue with me about in a way that ignores everything else I say and is a tactic that looks very bad faith. It looks like it is hand waving off known widespread racial bias in the name of "this one detail you said is inaccurate."
It's like attacking someone over a misplaced comma to imply they are stupid without bothering to engage anything they have said.
What I originally said is just that this is not shocking and talked about generally known statistics and you are latching onto "This woman knows nothing about hiring and I am going to dog her to the ends of the earth about that while pretending it is a good faith argument and overlook how shitty and racist it looks to deal with her in this fashion."
This is a routine thing that whenever racism, sexism and similar come up, someone wants to go to town and nitpick something in a way that looks extremely dismissive of the very existence of the problem because they want to argue they aren't guilty of something. Some people have an expression for that along the lines of "moves to innocence" -- in other words, it is vastly more important to most White people to insist "I'm not a racist and I don't do that and that's not how hiring works" than to actually talk about how racism does work and how to remedy it. Defending their own claimed innocence is their highest priority rather than working on understanding how racism persists and what needs to be done to remedy it.
"Last hired and first fired" was very much a known and standard thing for a lot of years and you have not provided any citations and I haven't gone looking because this style of arguing is so bad faith I don't want to engage it by agreeing that I need to "prove" that long-known practice remains true.
There can be lots of ways that still happens without any hiring managers intentionally discriminating against Blacks. There are lots of ways that someone can be effectively removed from the pipeline before it gets to the point of applying for a particular job which is one of the things that contributes to people fighting over the few qualified candidates who do apply and have certain traits.
Since what grandparent is actually encoding in there statement is the implication that the Black hires aren't deserving of their hire rather than desirable Black hires aren't selected for
I have no idea what you are trying to say. (I am not even sure if you are on my side or not. I'm not accusing you of anything at all.)
But "Last hired, first fired" is not and has never been exclusively about "Hiring managers are just racist assholes who look for bullshit reasons to not hire Blacks."
It's an observation about general trends that result in worse unemployment for Blacks. Some ways that can play out without any hiring manager being blatantly racist and intentionally wanting to exclude Blacks:
1. It's harder to get a job with a criminal record and you are more likely to have a criminal record if you are Black.
2. It's harder to get a job if your criminal record is for certain kinds of crimes and Blacks are more likely to be convicted and do hard time rather than get probation for the same thing.
3. It's harder to get a job if you have less education and education costs money and Blacks tend to have less of that than others.
4. It's harder to get a job if your education is from a less prestigious institution and the prestigious institutions cost more money.
5. Certain classes of jobs may be cut at a big company to save money because they are deemed "less essential" and those classes of jobs may be typically held by Blacks while the "essential" jobs are typically held by Whites.
At my corporate job during a recession, they cut janitorial service to save money. They stopped having all trash removed daily and had it removed every other day.
Janitorial jobs and cleaning jobs are very often held by people of color.
You don't have to be a racist piece of shit to go "Oh, the company is not doing well. We need to make some cuts. Um...let's have the trash taken out less." You can do that for completely good reasons that aren't inherently racist and it can still result in higher rates of unemployment for some groups than others.
I don't really want to argue this further. I cannot believe I am being given so much grief over this as if no one on the planet has heard that "racism is alive and well in the US of A."
I think you also know better than that when it comes to how statistics work. And I don’t know why you’re telling me that white people are not oppressed. That isn’t related to my comment.
Paywalled article. so of course, there's no way to confirm what paper is being cited with what assumptions, and what confounders have been addressed or looked into. Discarded.
I suspect this is a confounder (selection bias for where black doctors work?) being paraded as some racial finding.
> Simpson's paradox, which also goes by several other names, is a phenomenon in probability and statistics, in which a trend appears in several different groups of data but disappears or reverses when these groups are combined.
The percentage of obgyns that are black is not a factor for Simpson's paradox. The only thing that matters is if the black patient population for black doctors is different from that of white doctors (like if the black patient population for black doctors has a smaller percentage of diabetics).
Even though there are only 3 comments in the thread, they are still rife with dismissive and bad-faith arguments. It's extremely telling how when black America mentions something about systemic racism in the context of the US, the response is "what's the p-value", "I don't like that sample size", "correlation != causation".
The article has studies with authors from the BIG 10 and with Ivy League heritage, but it's the mention of race that causes people to trot out canned and thinly supported reasons of doubt. Here is one of the studies if anyone is interested.
I used to take these results at face value because I am against racism, but time and time again many of these analyses have been shown to be flawed so now I am more critical. Has nothing to do with not liking the conclusion.
Sadly, HN has been infested with a load of "I'm not racist, but" type racists, who will say anything to downplay the obvious racism in US society. Even when there is evidence.
I'm not sure. Psychology and sociology has such a horrible track record when it comes to reproducibility of studies that have some kind of political significance that we just have to be careful.
In case of these topics, there's a relatively strong publication pressure here.
Also: the raw data is unfortunately not enough without pre-registration. (For obvious reasons.)
"bad faith" is absolutely required in science. Especially in sociology and psychology, unfortunately.
I'm not sure there is a crisis of reproducibility in a study like this. We can tell with accuracy what the race of the physician is, the race of the baby and whether or not the baby dies or not.
Maybe they picked up outstanding doctors who deliver outstanding results regardless of patients race? I mean the dataset is so small, one off can derail any conclusion
> I mean the dataset is so small, one off can derail any conclusion
What do you mean? Per the Supplement, their data comes from a pool of ~4k white doctors and ~500 black doctors, with hundreds of thousands of observations/patients. This dataset doesn't seem "so small"?
It really all depends on the methodology. I recommend some reading about 'p-hacking'. It is not that hard to find to find really shocking findings in large datasets -- the question is how hard you look. In this particular case, the question is how many hypotheses have been evaluated, i.e. has the author 'mined the data' for correlations. If yes, then the acceptable p value is much smaller than normal.
I think it's a bit of a reach to suggest that this is p-hacking. Some of the relevant authors have studied this hypothesis (a gap in pregnancy-related outcomes between black and white people) across multiple papers, and the effect found here -- ignoring any p calculation -- is pretty big. It's not like they're picking some extremely specific combination of factors.
And this is the narrative that I'm speaking of when I mention how these discussions go. It's a gish-gallop of saying that since we have imperfect knowledge, we can't draw a single conclusion about phenomena and systems that are well documented. First it's the lack of studies, then you get a study and it's a hidden bias in the populations used in the study, then it's the "low sample size" (that's a favorite), after that it's p-hacking or whatever else.
And it goes on and on, even though for hundreds of years, the country and society were tuned to ensure that the black community enjoyed degraded outcomes in all aspects of life.
Thanks for posting this, I must have misread the original article. The samples are x10 larger than I understood at first. However, please keep in mind that the subset of white ph/patients is almost 4 times larger than black ph/black patient. Data fitting seem questionable from there on. 4x is not that large of a scale but still analyses should have been more nuanced from here. For example, hospitals are not considered a variable at all. I would think that it is a major one
Are you sure you don't just have some unconscious bias that is keeping you from objectively seeing this study for what it is?
There are about 4x more white people in America than Black. So it makes perfect sense that you would have 4x as many white patients as Black in the study.
My comment wasn't meant to be 'dismissive'. The idea that Black doctors provide a better standard of care for Black babies is a reasonable explanation for the data - perhaps even the most likely. I just thought other explanations should also be considered.
For those trying to assert some sort of bizarre abortion-based theory for skewing the statistics: the study is specifically only about the mortality rate of Black babies delivered in a medical facility.
It does not study the mortality rate of babies whose mothers had Black obstetricians during their pregnancies.
The researchers did not attempt to identify a cause for this disparity in this study, and noted only that this disparity does not appear to exist for other doctor-patient racial pairings where the mother was not Black.
The point of this study was simply to identify that a disparity exists, so that follow-up research can identify why and hopefully address the disparity in outcomes.
> The researchers did not attempt to identify a cause for this disparity in this study
I think that's an important point. I see people already jumping to the conclusion they prefer in other comments, but from what I understand we don't know what is causing the disparity. The paper points that it exists and should be studied more in details. Which is quite important, but it's too early to declare that a specific cause is _the cause_.
I'm a cynic. I doubt they will follow up since the initial report will be used to arrive at the conclusion most people seem to want anyways. If the researchers do follow up and find a non-racist cause it will be ignored.
Just speculating here but could it be that, in neighborhoods where a black person is more likely to become a doctor, those neighborhoods have a better healthcare system in place? The cities/neighborhoods with higher black poverty probably have less black doctors in general.
This was my conclusion as well. Maybe because I (naively) have trouble imagining that white doctors would reliably care less about black babies than white babies. Regardless, it should be simple to test for: just compare the outcome of all medical care administered in hospitals with relatively high amounts of black doctors to those with low amounts of black doctors.
Caring less does not have to be the only reason. I find it very possible that white doctors are less attuned to the small social and even physical differences (higher risk of certain things) for Black patients. For example, there are studies showing that white doctors are less likely to prescribe pain medication to Black women because they think they are overreacting. Part of that could be overt racism. But lack of time spent around Black people could be another culprit. One being individual racism, the other more a result of systemic racism.
What an eggregious claim that black doctors avoid risky childbirths in black communities and pass them to white doctors instead. WP is being racist again.
Another HNr deleted his comment, but this needs more substance before thrown around. When I was studying sociology I noticed this trend of finding some general stat and the author follows with statements such as is systemic xism.
Most of the times it comes as intellectually weak. Why not researching further, before typing such gross statement. Often it is a non sequitur fallacy, and probably a sort of ecological fallacy too.
Of course, her recipe is not only to train doctors in the particular needs of other races (IDK the validity of this, since I'm not physician nor a biologist) and follow up this people and check them often, but to train doctors on racism and social justice.
It seems interesting as an hypothesis, but it could also be wrong.
In the Internet most of the times you don't know who you're talking to, so just in case I come across as rude, bear in mind, I'm not in or from the US, and I already shared my experience studying sociology.
I somewhat agree, but for maybe a different reason. I think racism probably is a major root cause, but think it's intellectually lazy because identifying it doesn't help much.
Racial disparities exist in virtually every important measure of health (and I only say "virtually" because I don't know them all off the top of my head). Genetics plays a part in some, but the root cause of many is the current or lingering effects of racism: families that never accrued much wealth, communities who had much worse professional prospects so education wasn't as valued, "bad" neighborhoods where towns invested less in public transportation or sanitation. A bunch of ways racism shapes communities.
However, pointing out the racism root is only useful for long-term sociological planning. You also need to focus on the immediate causes. Systemic racism is actually a perfect example of this: even if a system becomes "race blind," the effect of past racism means non-white people are at a disadvantage.
Actionable public policy is difficult and requires to think stuff twice, measure results and to be practical. Even for general guidelines (unless you just want to dump money around).
I can tell you about public policy that mentions no racism that would change the life of poor black people in the US, allowing them to capitalize themselves easier, and have a better life.
It probably wouldn't be the most trendy, but it works.
If you're interested in the raw data behind these conclusions, it looks like the paper supplement [1] has some.
One potentially meaningful point from Table S1A of the supplement: it looks like there are 360k white doctor-black patient observations and 97k black doctor-black patient observations, and the mean length of stay for white doctor-black patient observations is 4.73 days vs. 3.37 days for black doctor-black patient. If I understand these figures, that means that on average white doctors keep black patients 40% longer than black doctors keep black patients.
I don't know what that means for the quality of care. Is keeping patients around good or bad? The Medicaid/Medicare/Self-pay numbers are very similar for the two groups, so it shouldn't be that the black patients going to white doctors are just paying for more care, right? Does it say something about case difficulty?
I know very little about this topic. Hopefully somebody who knows more can chime in. But that gap seems...significant?
If you have the time, take a look at the supporting information for Materials and Methods. This is interesting to me as well, but my understanding of the English language is not as good.
Some key takeaways:
-They use delivery data from different categories of births, including 'complications occurring during the course of labor and delivery'. Do they account for the conditions in which the babies were born, and then attribute that to the types of doctors handling those deliveries? In other words, do they make a distinction saying emergency white doctors perform worse than emergency black doctors? Because I cannot find that information in the research.
-Since doctor race data isn't codified in Florida's database (where they use the data from), they used web pictures and determine if the doctor is white or black. They narrowed this task down to 4 people who were good at it.
-Black female doctors performed the best, they mention some control of the gender but I do not fully understand how they did it.
-They used a Latino doctor group as well to account for differences, but found that while there is a distinction, it is much smaller than Black-White.
I also don't understand if/how they control for the quality of the hospital. Is there one bad low income hospital with white doctors in a predominantly black area?
Doctors care about the welfare of all of their patients. If the study is valid, we should learn what the black doctors are doing differently that reduces infant mortality, so that other doctors can follow suit.
I am reminded of an anecdote I read many years ago where a White doctor talked about delivering Black babies by forceps because he couldn't be bothered to wait around and give such children the time he gave White children to come into this world without such brutal intervention.
I read a study many years ago from a country that valued boy children over girls. Boys -- especially first-born boys -- were more likely to be fed their favorite foods, taken to the doctor the same day instead of "in the morning" and so forth. These were relatively small things, like delaying seeing a doctor by a few hours, and nothing anyone would likely characterize as abuse of the girls, yet the difference could be measured in terms of mortality.
Think about this: You can die of dehydration in as little as two days and you can die of lack of oxygen within minutes.
These are not stats for people of frail health or something. Anyone can die of lack of oxygen within minutes, no matter their current state of health.
Making excuses and saying "But they must have been in a weakened state to begin with or something..." amounts to denial of the racism that we all know is rampant within this country.
This reminds me, in a general way, of another study I saw.
That one looked at patients at a walk-in clinic. Patients would be randomly assigned a doctor for their visit. The doctor would diagnose them, treat them, prescribe drugs if needed, and give them instructions on how to care for themselves after they left.
The study found that the patients were significantly more likely to follow the doctor's instructions after they left if the doctor was the same race as the patient.
Note that the doctors were not the patient's regular doctor. These were either patients who did not have a regular doctor, or patients who were going to the clinic because of an urgent condition when their regular doctor was not available. I'm not aware of any studied that looked at whether patients obey their regular doctor more often if the doctor is the same race as the patient.
I wonder if anyone has conducted a study on how many internet comments on articles alleging bias are variations of 'now hang on a second, there may be an innocent explanation here'.
Eh. It's not like the internet has a shortage of people happy to read a study's editorialized conclusion on Twitter, take it as truth, and go on with their day. A little critical thinking --- and this means going beyond "I don't like this, so I'll say correlation does not imply causation and move on to something else" --- seems fine if you're trying to do it honestly and carefully?
I 100% agree, but I was curious so I went through a few pages of hacker news posts, looking for some other scientific studies to see the general sentiment in the comments.
Far from scientific, but there seems to be a general acceptance of the study in the comments of that article. I cannot say the same of this one. Now obviously the sample size and statistics of the studies are not identical, but it seems to me we're seeing significantly more 'critical thinking' in this thread than that one. I would love to drill into this further and see if this trend holds in further comment threads, but I'm late for a hike.
Studies that blame a large demographic of malicious behavior is likely to be received with less acceptance than one that does not.
If there were a covid study that said that Americans was more likely to become sick because they don't care enough about they fellow beings to follow recommendation, even with great sample size and statistics, most would look at such conclusion with skepticism.
Oh, I wouldn't want to see no comments casting doubt. When I posted, every comment here was skeptical. Most likely, the people who took the least time writing their posts were the least... open to the possibility of bias.
But like, whenever there is positive study about computer games, HN is not critical at all. Instead, it is completely non critical, extrapolates findings, even if the n is like 5 and study weak.
My point is, some studies are knee jerkly believed and others are knee jerkly doubted.
The set of studies accepted or rejected out-of-hand varies depending upon the individual or group. A fact of life, since individuals come to a proposition with different life experiences, both educational and directly experiential.
If you are saying that HN as a community has commonality in beliefs about what is “generally accepted as true” and “generally accepted as false”, you are basically saying the HN community has shared experiences somewhat unique to that community. You are probably right.
If the community is challenging more findings on bias, they probably have life experiences that suggest such findings are incorrect or that too many such studies themselves have, in the past, been of low-quality, self-serving and/or misleading. Putting the quote marks around social “science” in general. There is also the natural bias for people to want to ignore problems outside of their scope or vision...24 hours in a day and so forth.
If HN is infested with IT professionals who have worked in environments where everyone is a minority of one sort or another and observed or managed the dynamics, their lived experience in ethnic/gender dynamics and opportunities may differ from other groups. If HN skews older, then they also have had the lived experience of both the many successes and many failures of the Civil Rights movement on which to base opinions.
On the specific issue of computer games, there is a dramatic difference in societal and economic impact between Fortnite and the direct personal welfare of tens of millions of people. The latter warrants more due care and attention. There have been a few posts on the psychological harm from gaming, so some balance there.
Right? While I think it's important to have open dialogue and discussion in society, the comments here are making me sad. Based on everything we know about American society, the claims this study makes don't seem terribly outlandish, but lord some people really want to refute it.
Well, some time ago I read a similar study for some Asian country. Childbirth mortality was higher in the hospitals in big towns than in villages. The reason is simple - whenever possible, they transport complicated cases to big hospitals.
This is interesting, I couldn’t read the article that the WaPo references since it is paywalled, but lots of doctors today are ethnically Asian and Indian - can the experiment be extrapolated to this doctors too?
I’ve seen also some calls to the need of training more Black doctors to address inequalities in the healthcare due to racial biases. Should this also be extended to other races or ethnicities? (e.g Iranians, Vietnamese, Latinx, Greeks) Should we maintain a ratio of doctors according to race percentages? What should we do with those ethnicities that are over represented in medicine, should we curtail them? What do we do with mixed race patients?
Can we break this down by race even further? Do Indian doctors perform worse on with black babies than Jewish doctors, or better? Where do non-Jewish and non-Hispanic whites fall on this?
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[ 4.2 ms ] story [ 163 ms ] threadI am sorry but this is an extremely sinister form of rumor spreading on par with anti vaccine rumors.
I hate what America is turning into, I can’t view the data but I strongly suspect that it is highly questionable.
Next you will see similar articles about white teachers teaching black students etc. I hate this country.
I'm not saying that the study is wrong, just that shocking results like this one need extreme methodological rigor behind them before we start telling everyone that white doctors are killing black babies etc.
https://en.m.wikipedia.org/wiki/Preregistration_(science)
Before such a study, when black Americans would have noted that something seemed off, we would have been met with "You need data to back that up, X can't be racist!!!". Now that there is data to back up what we've known, it's "Your p-value is wrong!!!"
For a purportedly open-minded set of hackers who claim to follow their intellectual curiosity, too many people here are very closed-minded about racism.
If it is indeed the case, then it is a horrible thing that should be researched more, and dealt with.
If not, publishing it is just racist and divisive.
https://1410c6d1-d135-4b4a-a0cf-5e7e63a95a5c.filesusr.com/ug...
We aren't yelling that, though, and you're the first one to say it here. This fear of being accused of racism is intense; as if acknowledging that black people are actually treated worse by our society is actually more harmful than the loss of life that black people experience.
This is a preliminary study, and yes, it deserves a followup. If you're saying that preliminary studies should always be kept under wraps and not discussed, that's weird and anti-science. There are a couple of well-understood phenomena that can explain this. The first is unconscious bias -- it's been shown time and time again, across the board with various population differences, and could easily explain this. Second, bad training data -- if a doctor hasn't been trained with black patients, and pictures of black people with various ailments, then they might not recognize symptoms as readily (insert analogy to facial recognition). Also, a large proportion of black people in the US speak a different dialect than their white counterparts -- the way folks describe their symptoms differs between dialects -- so if a white doctor can't understand what their black patient is saying, they're operating on less information than a white doctor treating a white patient would be. Finally, a matter of trust -- psychosomatics are real -- black women know their history, and might not trust a white doctor as well as a black doctor, and that can impact outcomes. Rebuilding that trust will take generations of trustworthy, good faith efforts to correct the wrongs of the past.
See https://www.medrxiv.org/
> Preprints are preliminary reports of work that have not been certified by peer review. They should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
It's annoying when news websites report on research that isn't reviewed. It's been happening at an increasing rate over the last few years because these news websites are so hungry for advertising revenue. It undermines the public's trust in science. It threatens our ability to do research openly and inclusively.
This is not shocking. It's well known that Blacks don't live as long as Whites in the US and have generally poorer outcomes for all metrics -- health, economic status, etc. That's old news and common knowledge.
It's also old news and common knowledge that the difference is quite substantial. It's not a small difference at all.
Blacks are last hired, first fired.
There is a history of laws being written to explicitly and intentionally exclude them and not all those laws have been expunged from the books.
Redlining and similar practices are well documented.
I don't know how anyone can suggest that poverty is the root cause of poor outcomes for Blacks and is wholly unrelated to their skin color and deny that skin color has any connection as a root cause when we know for a fact it does. We know for a fact that there is a long history in this country of Blacks being actively and intentionally denied access to the same things as Whites in this country because of the color of their skin.
Sounds like you don’t have much exposure to large companies these days. If anything it’s the opposite.
You’re incorrect that there are any racist laws remaining that might influence hiring, unless you are referring to govern contracts, in which minority owned businesses are given preference.
It is silly to introduce historical artifacts as though they are the situation today.
https://www.cbsnews.com/news/black-professionals-hold-only-3...
A close examination of wealth in the U.S. finds evidence of staggering racial disparities. At $171,000, the net worth of a typical white family is nearly ten times greater than that of a Black family ($17,150) in 2016.
https://www.brookings.edu/blog/up-front/2020/02/27/examining...
There are still laws on the books that were written expressly to exclude Blacks.
https://wset.com/features/special-reports/racists-laws-are-s...
If hiring practices have changed at big companies in recent years, it doesn't mean Blacks have achieved equality yet by any stretch of the imagination.
As for laws on the books, you found a historical artifact that has no legal effect, which the article you linked explains. It’s a reminder of a racist past, yes. These reminders will always exist in our society, and while it makes sense to continue to scrub them from legal documents over time, it’s not a good faith argument to cite such a thing as though it has any legal effect today.
To be intellectually honest, you should also be upset that virginia makes it illegal for unwed couples to live together. It’s also illegal to kill a sasquatch in Washington. In Kansas, it’s illegal to put ice cream on cherry pie.
To falsely say that blacks are hired last and fired first in America is not only preposterous, but extremely counterproductive to the outcome you’re presumably looking for. This is just inventing bogus reasons for Americans to feel hostile towards each other, and discouraging more people from even trying.
That isn't anything I said.
I don’t know why you insist on being so adamant about how hiring works.
That's not what I'm doing. You latched onto that as a thing to argue with me about in a way that ignores everything else I say and is a tactic that looks very bad faith. It looks like it is hand waving off known widespread racial bias in the name of "this one detail you said is inaccurate."
It's like attacking someone over a misplaced comma to imply they are stupid without bothering to engage anything they have said.
What I originally said is just that this is not shocking and talked about generally known statistics and you are latching onto "This woman knows nothing about hiring and I am going to dog her to the ends of the earth about that while pretending it is a good faith argument and overlook how shitty and racist it looks to deal with her in this fashion."
This is a routine thing that whenever racism, sexism and similar come up, someone wants to go to town and nitpick something in a way that looks extremely dismissive of the very existence of the problem because they want to argue they aren't guilty of something. Some people have an expression for that along the lines of "moves to innocence" -- in other words, it is vastly more important to most White people to insist "I'm not a racist and I don't do that and that's not how hiring works" than to actually talk about how racism does work and how to remedy it. Defending their own claimed innocence is their highest priority rather than working on understanding how racism persists and what needs to be done to remedy it.
"Last hired and first fired" was very much a known and standard thing for a lot of years and you have not provided any citations and I haven't gone looking because this style of arguing is so bad faith I don't want to engage it by agreeing that I need to "prove" that long-known practice remains true.
There can be lots of ways that still happens without any hiring managers intentionally discriminating against Blacks. There are lots of ways that someone can be effectively removed from the pipeline before it gets to the point of applying for a particular job which is one of the things that contributes to people fighting over the few qualified candidates who do apply and have certain traits.
But "Last hired, first fired" is not and has never been exclusively about "Hiring managers are just racist assholes who look for bullshit reasons to not hire Blacks."
It's an observation about general trends that result in worse unemployment for Blacks. Some ways that can play out without any hiring manager being blatantly racist and intentionally wanting to exclude Blacks:
1. It's harder to get a job with a criminal record and you are more likely to have a criminal record if you are Black.
2. It's harder to get a job if your criminal record is for certain kinds of crimes and Blacks are more likely to be convicted and do hard time rather than get probation for the same thing.
3. It's harder to get a job if you have less education and education costs money and Blacks tend to have less of that than others.
4. It's harder to get a job if your education is from a less prestigious institution and the prestigious institutions cost more money.
5. Certain classes of jobs may be cut at a big company to save money because they are deemed "less essential" and those classes of jobs may be typically held by Blacks while the "essential" jobs are typically held by Whites.
At my corporate job during a recession, they cut janitorial service to save money. They stopped having all trash removed daily and had it removed every other day.
Janitorial jobs and cleaning jobs are very often held by people of color.
You don't have to be a racist piece of shit to go "Oh, the company is not doing well. We need to make some cuts. Um...let's have the trash taken out less." You can do that for completely good reasons that aren't inherently racist and it can still result in higher rates of unemployment for some groups than others.
I don't really want to argue this further. I cannot believe I am being given so much grief over this as if no one on the planet has heard that "racism is alive and well in the US of A."
It is not just racism/sexism but, seriously, white people are not oppressed.
I suspect this is a confounder (selection bias for where black doctors work?) being paraded as some racial finding.
Second: what percentage of obgyns are black? Could Simpson’s paradox be at play?
> Simpson's paradox, which also goes by several other names, is a phenomenon in probability and statistics, in which a trend appears in several different groups of data but disappears or reverses when these groups are combined.
The article has studies with authors from the BIG 10 and with Ivy League heritage, but it's the mention of race that causes people to trot out canned and thinly supported reasons of doubt. Here is one of the studies if anyone is interested.
https://1410c6d1-d135-4b4a-a0cf-5e7e63a95a5c.filesusr.com/ug...
In case of these topics, there's a relatively strong publication pressure here.
Also: the raw data is unfortunately not enough without pre-registration. (For obvious reasons.)
"bad faith" is absolutely required in science. Especially in sociology and psychology, unfortunately.
What do you mean? Per the Supplement, their data comes from a pool of ~4k white doctors and ~500 black doctors, with hundreds of thousands of observations/patients. This dataset doesn't seem "so small"?
[1] https://www.pnas.org/content/pnas/suppl/2020/08/12/191340511...
And it goes on and on, even though for hundreds of years, the country and society were tuned to ensure that the black community enjoyed degraded outcomes in all aspects of life.
There are about 4x more white people in America than Black. So it makes perfect sense that you would have 4x as many white patients as Black in the study.
It does not study the mortality rate of babies whose mothers had Black obstetricians during their pregnancies.
The researchers did not attempt to identify a cause for this disparity in this study, and noted only that this disparity does not appear to exist for other doctor-patient racial pairings where the mother was not Black.
The point of this study was simply to identify that a disparity exists, so that follow-up research can identify why and hopefully address the disparity in outcomes.
I think that's an important point. I see people already jumping to the conclusion they prefer in other comments, but from what I understand we don't know what is causing the disparity. The paper points that it exists and should be studied more in details. Which is quite important, but it's too early to declare that a specific cause is _the cause_.
Another HNr deleted his comment, but this needs more substance before thrown around. When I was studying sociology I noticed this trend of finding some general stat and the author follows with statements such as is systemic xism.
Most of the times it comes as intellectually weak. Why not researching further, before typing such gross statement. Often it is a non sequitur fallacy, and probably a sort of ecological fallacy too.
Of course, her recipe is not only to train doctors in the particular needs of other races (IDK the validity of this, since I'm not physician nor a biologist) and follow up this people and check them often, but to train doctors on racism and social justice.
In the Internet most of the times you don't know who you're talking to, so just in case I come across as rude, bear in mind, I'm not in or from the US, and I already shared my experience studying sociology.
Racial disparities exist in virtually every important measure of health (and I only say "virtually" because I don't know them all off the top of my head). Genetics plays a part in some, but the root cause of many is the current or lingering effects of racism: families that never accrued much wealth, communities who had much worse professional prospects so education wasn't as valued, "bad" neighborhoods where towns invested less in public transportation or sanitation. A bunch of ways racism shapes communities.
However, pointing out the racism root is only useful for long-term sociological planning. You also need to focus on the immediate causes. Systemic racism is actually a perfect example of this: even if a system becomes "race blind," the effect of past racism means non-white people are at a disadvantage.
I can tell you about public policy that mentions no racism that would change the life of poor black people in the US, allowing them to capitalize themselves easier, and have a better life.
It probably wouldn't be the most trendy, but it works.
One potentially meaningful point from Table S1A of the supplement: it looks like there are 360k white doctor-black patient observations and 97k black doctor-black patient observations, and the mean length of stay for white doctor-black patient observations is 4.73 days vs. 3.37 days for black doctor-black patient. If I understand these figures, that means that on average white doctors keep black patients 40% longer than black doctors keep black patients.
I don't know what that means for the quality of care. Is keeping patients around good or bad? The Medicaid/Medicare/Self-pay numbers are very similar for the two groups, so it shouldn't be that the black patients going to white doctors are just paying for more care, right? Does it say something about case difficulty?
I know very little about this topic. Hopefully somebody who knows more can chime in. But that gap seems...significant?
[1] https://www.pnas.org/content/pnas/suppl/2020/08/12/191340511...
Some key takeaways:
-They use delivery data from different categories of births, including 'complications occurring during the course of labor and delivery'. Do they account for the conditions in which the babies were born, and then attribute that to the types of doctors handling those deliveries? In other words, do they make a distinction saying emergency white doctors perform worse than emergency black doctors? Because I cannot find that information in the research.
-Since doctor race data isn't codified in Florida's database (where they use the data from), they used web pictures and determine if the doctor is white or black. They narrowed this task down to 4 people who were good at it.
-Black female doctors performed the best, they mention some control of the gender but I do not fully understand how they did it.
-They used a Latino doctor group as well to account for differences, but found that while there is a distinction, it is much smaller than Black-White.
I also don't understand if/how they control for the quality of the hospital. Is there one bad low income hospital with white doctors in a predominantly black area?
I read a study many years ago from a country that valued boy children over girls. Boys -- especially first-born boys -- were more likely to be fed their favorite foods, taken to the doctor the same day instead of "in the morning" and so forth. These were relatively small things, like delaying seeing a doctor by a few hours, and nothing anyone would likely characterize as abuse of the girls, yet the difference could be measured in terms of mortality.
Think about this: You can die of dehydration in as little as two days and you can die of lack of oxygen within minutes.
These are not stats for people of frail health or something. Anyone can die of lack of oxygen within minutes, no matter their current state of health.
Making excuses and saying "But they must have been in a weakened state to begin with or something..." amounts to denial of the racism that we all know is rampant within this country.
That one looked at patients at a walk-in clinic. Patients would be randomly assigned a doctor for their visit. The doctor would diagnose them, treat them, prescribe drugs if needed, and give them instructions on how to care for themselves after they left.
The study found that the patients were significantly more likely to follow the doctor's instructions after they left if the doctor was the same race as the patient.
Note that the doctors were not the patient's regular doctor. These were either patients who did not have a regular doctor, or patients who were going to the clinic because of an urgent condition when their regular doctor was not available. I'm not aware of any studied that looked at whether patients obey their regular doctor more often if the doctor is the same race as the patient.
Here's one I found on an antidepressants impact on covid hospitalizations: https://news.ycombinator.com/item?id=25701446
Far from scientific, but there seems to be a general acceptance of the study in the comments of that article. I cannot say the same of this one. Now obviously the sample size and statistics of the studies are not identical, but it seems to me we're seeing significantly more 'critical thinking' in this thread than that one. I would love to drill into this further and see if this trend holds in further comment threads, but I'm late for a hike.
If there were a covid study that said that Americans was more likely to become sick because they don't care enough about they fellow beings to follow recommendation, even with great sample size and statistics, most would look at such conclusion with skepticism.
My point is, some studies are knee jerkly believed and others are knee jerkly doubted.
If you are saying that HN as a community has commonality in beliefs about what is “generally accepted as true” and “generally accepted as false”, you are basically saying the HN community has shared experiences somewhat unique to that community. You are probably right.
If the community is challenging more findings on bias, they probably have life experiences that suggest such findings are incorrect or that too many such studies themselves have, in the past, been of low-quality, self-serving and/or misleading. Putting the quote marks around social “science” in general. There is also the natural bias for people to want to ignore problems outside of their scope or vision...24 hours in a day and so forth.
If HN is infested with IT professionals who have worked in environments where everyone is a minority of one sort or another and observed or managed the dynamics, their lived experience in ethnic/gender dynamics and opportunities may differ from other groups. If HN skews older, then they also have had the lived experience of both the many successes and many failures of the Civil Rights movement on which to base opinions.
On the specific issue of computer games, there is a dramatic difference in societal and economic impact between Fortnite and the direct personal welfare of tens of millions of people. The latter warrants more due care and attention. There have been a few posts on the psychological harm from gaming, so some balance there.
Those are not just result of experience, but also result of "what you really really want to be true" and "what you really prefer to be false".
https://i.imgur.com/A70HEXn.png
I’ve seen also some calls to the need of training more Black doctors to address inequalities in the healthcare due to racial biases. Should this also be extended to other races or ethnicities? (e.g Iranians, Vietnamese, Latinx, Greeks) Should we maintain a ratio of doctors according to race percentages? What should we do with those ethnicities that are over represented in medicine, should we curtail them? What do we do with mixed race patients?
Didn't see anything adjusting for the success rates between the groups of black vs white doctors in general. Are these differences present?