Unconscious Bias Against Blacks Can Contribute To Inferior Care

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Unconscious bias might explain why blacks are less likely than whitesto receive potentially lifesaving treatment, such as clot-busting drugsfor heart attacks, according to a new study published on the Web siteof the Journal of General Internal Medicine, the Boston Globe reports.

For the study, lead author Alexander Green of Massachusetts General Hospital,and colleagues asked 220 people training in Boston and Atlanta tobecome emergency department physicians to diagnose a hypothetical casein which a 50-year-old man arrived at the ED experiencing sharp pain.Participants viewed a computer-generated image of the patient, either ablack or white male, shown from the chest up with a neutral facialexpression. Researchers asked the participants -- who were white,Asian, Hispanic and black -- whether they believed the man was having aheart attack and if they would administer a clot-busting drug commonlyused to stabilize patients having a heart attack.

The physicians also participated in a 20-minute, computer-based testdesigned to detect overt and implicit prejudice. In the test, white,Asian and Hispanic participants were slow to associate positiveconcepts, such as cooperativeness, and quick to associate negativeconcepts with black patients. Black participants were as likely todemonstrate bias against black patients as they were against whites.The concept behind the test is that the strength of participants'perception is related to the speed in which they match certainqualities with pictures of patients.

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Researchers comparedresults of the test with physicians' decisions to administerclot-busting drugs to the hypothetical patient. They found that doctorswhose ratings of blacks were the most negative also were less likely toadminister the drugs to blacks.

"It's not a matter of youbeing a racist. It's really a matter of the way your brain processesinformation is influenced by things you've seen, things you'veexperienced, the way media has presented things," Green said. He addedthat he could not determine a reason for the findings.

According to the Globe, other experts suggested that medical personnel take a test to measure unconscious bias. Mahzarin Banaji, a psychologist at Harvard Universitywho helped design the bias test used in the study, said, "The greatadvantage of being human, of having the privilege of awareness, ofbeing able to recognize the stuff that is hidden, is that we can beatthe bias."

Amal Trivedi, a racial health disparities specialist at Brown Medical School,said, "At the end of the day, even among very well-intentioned people,implicit biases can be both prevalent and in some situations, canimpact clinical decisions. What this study can do is raise awareness ofthat finding" (Smith, Boston Globe, 7/20).
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Reprinted with permission fromkaisernetwork.org.You can view the entire KaiserWeekly Health Disparities Report, search the archives,and sign up for email delivery at kaisernetwork.org/email. The Kaiser Weekly Health Disparities Report is published forkaisernetwork.org,a free service of The Henry J. Kaiser Family Foundation.

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