Mortality rate for Black babies plummets when they’re delivered by Black doctors

https://www.washingtonpost.com/health/black-baby-death-rate-cut-by-black-doctors/2021/01/08/e9f0f850-238a-11eb-952e-0c475972cfc0_story.html

by jgwil2 • 6 years ago

116 83 6 years ago

washingtonpost.com

sz4kerto3• 6 years ago

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.

https://en.m.wikipedia.org/wiki/Preregistration_(science)

x86_64Ubuntu6• 6 years ago

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!!!"

4gotunameagain• 6 years ago

Well we could avoid "black/white America" terms probably if we were more careful about the statistical significance of such inflammatory statements.

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.

klyrs2• 6 years ago

...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.

jart• 6 years ago

If you're saying that preliminary studies should always be kept under wraps and not discussed, that's weird and anti-science.

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.

DoreenMichele7• 6 years ago

just that shocking results like this

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.

nomdep• 6 years ago

Because more blacks are poor, not (directly) because the color of their skin.

satokema• 6 years ago

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.

macintux3• 6 years ago

https://1410c6d1-d135-4b4a-a0cf-5e7e63a95a5c.filesusr.com/ug...

Shared404• 6 years ago

Disabling JS prevents the paywall.

CyberRabbi2• 6 years ago

First: correlation is not causation.

Second: what percentage of obgyns are black? Could Simpson’s paradox be at play?

dgellow2• 6 years ago

For people who don't know:

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.

lern_too_spel• 6 years ago

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).

macintux3• 6 years ago

Link to the paper: https://1410c6d1-d135-4b4a-a0cf-5e7e63a95a5c.filesusr.com/ug...

x86_64Ubuntu6• 6 years ago

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.

https://1410c6d1-d135-4b4a-a0cf-5e7e63a95a5c.filesusr.com/ug...

CyberRabbi2• 6 years ago

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.

x86_64Ubuntu6• 6 years ago

Did you read the study? What are the technical reasons for the study being flawed.

sz4kerto3• 6 years ago

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.

x86_64Ubuntu6• 6 years ago

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.

MarkMc2• 6 years ago

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.

gamblor956• 6 years ago

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.

dgellow2• 6 years ago

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_.

abrown28• 6 years ago

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.

polishdude20• 6 years ago

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.

0-_-0• 6 years ago

To put your idea differently: The study might be showing that places where a greater ratio of Blacks become doctors have better health outcomes.

saltyfamiliar• 6 years ago

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.

jjeaff4• 6 years ago

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.

watwut4• 6 years ago

There was no doctor race correlation if baby was white. Which means that it is not just general healthcare quality issue.

iagovar3• 6 years ago

The root, she says, lies in structural racism.

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.

DoreenMichele7• 6 years ago

I submitted this twelve days ago and it got no traction, but it's an interesting read: https://news.ycombinator.com/item?id=25567826

iagovar3• 6 years ago

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.

vharuck• 6 years ago

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.

iagovar3• 6 years ago

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.

croissants4• 6 years ago

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?

[1] https://www.pnas.org/content/pnas/suppl/2020/08/12/191340511...

busythrowaway22• 6 years ago

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?

Bostonian2• 6 years ago

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.

Bostonian2• 6 years ago

I would be interested to know why my comment was downvoted to -1. I did not think it was controversial.

DoreenMichele7• 6 years ago

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.

tzs• 6 years ago

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.

uniqueid2• 6 years ago

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'.

croissants4• 6 years ago

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?

snayan2• 6 years ago

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.

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.

uniqueid2• 6 years ago

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.

watwut4• 6 years ago

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.

snayan2• 6 years ago

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.

lawnchair_larry4• 6 years ago

This should absolutely be the default response.

babesh• 6 years ago

Could people please read articles before reacting?

cambalache• 6 years ago

This is study is so bad that it is not even wrong. Read this key paragraph and identify at least 4 major methodological blunders

https://i.imgur.com/A70HEXn.png

coverband• 6 years ago

Is there an improvement when looking at Black doctors with White patients? Does the gender of the doctor make a difference?

f137• 6 years ago

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.

chestertn• 6 years ago

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?

Jkvngt• 6 years ago

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?

christkv• 6 years ago

Did they correct for economic class? It's well known economic class correlates with health.

jjeaff4• 6 years ago

What would that have to do with Black vs white doctor?

karmakaze• 6 years ago

(sorry only skimmed the article)

Didn't see anything adjusting for the success rates between the groups of black vs white doctors in general. Are these differences present?

jopsen• 6 years ago

Curious, in many other studies we see that minorities are somewhat equally biased. Maybe, seeing a tiny reflection of yourself helps mitigate cultural bias..

Or could it be that black doctors are just overall better?

Assuming it's harder for a black person to become a doctor, it could stand to reason that those that do are among the very best. (Or skews that way statistically)

jjeaff4• 6 years ago

Or that they were raised with the idea that if they want to get what a white person has, they will need to work twice as hard.

MarkMc2• 6 years ago

I wonder if there's an underlying connection here with studies showing that Black teachers improve outcomes for Black students: https://www.usnews.com/news/education-news/articles/2018-11-...

Mortality rate for Black babies plummets when they’re delivered by Black doctors

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