The research establishment studying racial disparities in health care has a big problem. It has made a concerted effort to ignore any literature that contradicts the narrative that racial animus underlies the health-care disparities between white and black patients.
As in any field, the more evidence you can cite in favor of your theory, the more acceptance your theory will gain. In medical literature, acceptance of ideas is achieved when other researchers cite the supporting studies for those concepts. In fact, “impact” in the medical literature is judged by frequency of citations.
A most favored hypothesis these days holds that black patients need access to black physicians to receive optimal medical care. This concept is a major motivating force behind the search for greater numbers of blacks to enter the health-care workforce. Unfortunately, the research cited to support it is often disingenuous or, at worst, dishonest.
But even more pernicious than shoddy research are efforts to silence contradictory ideas by simply failing to acknowledge them. Take, for example, two publications that appeared in the same time period in 2022. One, entitled “Patient-Physician Racial Concordance Associated with Improved Healthcare Use and Lower Healthcare Expenditures in Minority Populations,” (published in the Journal of Racial and Ethnic Health Disparities) shows that racial concordance between patients and physicians led to a marginally lower use of emergency care between white and Hispanic patients and a small (4 percent) difference in health-care expenditures for black patients. Yet the authors conclude, “These results add to the body of evidence supporting the hypothesis that racial concordance contributes to a more effective therapeutic relationship and improved healthcare. These results emphasize the need for medical education surrounding cultural humility and the importance of diversifying the healthcare workforce.” This paper, which, despite the authors’ claims, provides zero information about health-care quality, outcomes, or anything else that might influence health-care disparities, has been cited by 49 other publications in the year since its publication.
Now contrast the citation history of the first paper with a second: “Associations Between Gender and Racial Patient-Physician Concordance and Visit Outcomes Among Hypertensive Patients in Primary Care” has been cited only twice in the medical literature. One of the citations characterized it as “inconclusive,” yet the paper provides much more useful information about actual health-care outcomes. A group in the VA health-care system from the University of Wisconsin found, albeit studying a smaller cohort of patients, no substantive benefits for racial concordance when it comes to treating hypertension. The authors conclude, “There are few differences in communication, shared medical decision-making, trust, or adherence between patient-provider dyads that were gender or racially concordant, compared to discordant ones.” An additional 432 studies of this topic have been conducted since the paper’s publication. Researchers’ failure to cite it suggests purposeful ignorance.
Moreover, the second paper appeared in a much more influential journal (the Journal of General Internal Medicine). A journal’s “impact factor” is a measure of how widely read and frequently cited its various articles tend to be. The medical journal in which the first paper was published has a five-year impact factor of 3.307, while the second paper’s journal boasts a much higher impact factor of 6.985. This is further evidence for the existence of bias against research that fails to support the racial-concordance concept.
In fact, the largest study of racial concordance, which included 56,000 patients, failed to show a benefit. Yet the train of articles favoring the concept rolls along, unimpeded by the data.
The medical profession risks its reputation by avoiding an honest, open, and complete discussion of racial concordance—or of any topic, for that matter. Refusing to acknowledge contradictory studies is a prescription for failure.