Professor says perceptions may mislead, prompt patients to avoid seeking healthcare
Alleged racial discrimination is not the same as real racism, yet the medical community treats it as such to the detriment of patients, according to a University of Montana professor.
Stewart Justman (pictured), a professor emeritus of liberal studies at the University of Montana, recently published the article in the Journal of Controversial Ideas titled “What If Perceived Discrimination in Medicine Isn’t the Same as Real Discrimination?”
The article argues the current medical literature often treats perceived racial discrimination and real racial discrimination as the same thing.
“In reality, however, the supposed signals of implicit bias in the clinical encounter are too ambiguous, too uninterpretable, and too conflicting to be discerned with any certainty by anyone,” the article states. “What is clear is that if the perception of bias can lead patients to forgo treatment, so can the misperception of bias.”
“Literature that assumes that medicine is polluted with concealed bias validates misperceptions, foments mistrust, and sends the incautious message that black patients can expect poor treatment,” according to the abstract.
Justman told The College Fix in a recent email he wrote the article after noticing a “glaring absence of criticism in the medical literature of the doctrine that medicine itself is a racist institution.”
He has written a number of books and scholarly articles about medicine, covering topics such as medical overdiagnosis, cancer, antidepressants, inoculation, and the placebo effect.
His new article addresses the theory that “minority patients have a sort of sixth sense that enables them to perceive this racism accurately,” he said.
“To me, each of these claims—that medicine is racist from the roots up, that minority patients have a sixth sense, that perceived racism IS racism—needs to be subjected to critical scrutiny,” Justman told The Fix.
In the journal article, he wrote, “As uncontroversial as the nonidentity of perception and reality ought to be, many appear to believe that this principle should be waived in at least one instance, that of racial discrimination.”
“Especially at a time when allegations of discrimination are magnified by the traffickers of news and opinion, the distinction between real and alleged discrimination should be respected, not blurred on principle,” according to the article.
Yet, “there seems to be no behavioral characteristic too minor to serve as a signal of bias,” he wrote.
The article cited the Institute of Medicine’s 2003 report “Unequal Treatment,” which argued even “reduced eye contact” and an “increased rate of blinking” by healthcare workers could be signs of bias toward ethnic and racial minority patients.
In some cases, perceived racism may just be a doctor who has a “cold” bedside manner, Justman wrote.
One of the effects of racial discrimination in medicine often cited as a concern is that patients will avoid seeking treatment, he wrote.
His article cited a 2008 study in the Journal of Health Care for the Poor and Underserved about diabetes management and racial/ethnic discrimination – which is given “as evidence of the ‘systemic’ racism of American medicine.”
However, only 4 percent of diabetes patients in the study, 26 percent of whom were black or Hispanic, said they were “treated unfairly or disrespectfully because of race or ethnicity” by healthcare workers, Justman wrote.
No bias was shown because “white and nonwhite patients adhered at identical rates to recommended procedures for diabetes management,” according to the article. “… among Whites, 89.4%, 71.1%, 73.5%, and 87.1% reported HbA1c, foot exam, eye exam, and blood pressure tests, respectively. Correspondingly, among nonWhites the estimates were 88.7%, 74.9%, 74.4%, and 90.6%, respectively,” the article stated.
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Justman told The Fix his ideas are controversial because they push back against “an entire literature” on health care and racism.
“As I mention in the article, the founding document of the ‘anti-racist’ medical literature, the Institute of Medicine’s Unequal Treatment, has been cited over 10,000 times. This report equates perceived and real discrimination, though its arguments are poor,” he said.
Asked if he has received criticism for the article, he told The Fix that he has not yet but he expects to.
A spokesperson for Do No Harm, a medical watchdog organization that opposes “identity politics” in healthcare, said Justman’s article makes a critically important point.
“Perceived discrimination is not necessarily real discrimination,” research director Ian Kingsbury told The Fix in a recent email. “As one study notes, interpersonal perception is ‘as much a function of the perceiver as the perceived’ and is clearly linked to negative emotionality (i.e. neuroticism).’”
Racism and healthcare have become a major research topic in academia.
The National Institutes of Health spent more than $297 million to fund scholars’ studies on the topic in 2022 alone, The Fix reported. So far this year, the taxpayer-funded entity has spent $136 million on racism-focused studies, according to a recent Fix analysis.
Meanwhile, major medical associations also have launched projects specifically about the issue. The American Nurses Association, for example, has a National Commission to Address Racism in Nursing.
Neither the ANA nor the NIH responded to two emailed requests for comment from The Fix over the past week asking about Justman’s article and concerns about mis-perceived racial discrimination in medical research.
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IMAGE: University of Montana, Journal of Controversial Ideas
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