UPDATE: A critical Ethics Alarms reader informed me that in his view the text of this post was too similar to that of its main source, The Daily Signal, in an article by Jay Greene. Although I linked to the piece and also credited Greene with a quote, upon reviewing the post I agree that it included too many substantially similar sentences and phrasings. I apologize to the Daily Signal, Jay, and Ethics Alarms readers. I was using several articles in preparing the piece (including one from another source that was also extremely close to the Signal article), and for whatever reason, did not notice that I had leaned so heavily on Green’s phrasing. It has happened before over the past 13 years, though not often, and never with the intention to deceive. Thus I have revised the post; in the future, if anyone feels that an Ethics Alarms article does not properly credit sources or seems insufficiently original, the favored response is to alert me, rather than to accuse me in obnoxious terms of “plagiarism.”
Fans of affirmative action reacted to Justice Ketanji Brown Jackson’s depressing defense of racial discrimination by praising her remarkably hypocritical dissent in the recent 6-3 decision by the Supreme Court declaring Harvard’s and the University of North Carolina’s admission policies unconstitutional. Those who believe that Justices should base their analyses on law rather than group loyalties were appropriately critical. Both, however missed some really ugly trees for the metaphorical forest, as Jackson injected false statistics into her dissent. They were, of course—we’re used to this phenomenon—uncritically accepted and used in subsequent media propaganda condemning the decision.
Justice Ketanji Brown Jackson wrote in part,
“Beyond campus, the diversity that UNC pursues for the betterment of its students and society is not a trendy slogan. It saves lives. For marginalized communities in North Carolina, it is critically important that UNC and other area institutions produce highly educated professionals of color. Research shows that Black physicians are more likely to accurately assess Black patients’ pain tolerance and treat them accordingly (including, for example, prescribing them appropriate amounts of pain medication). For high-risk Black newborns, having a Black physician more than doubles the likelihood that the baby will live, and not die.”
Wow! Racial discrimination saves lives! The problem, or rather problems, are that as Jay Greene of the Daily Signal points out, 1) the claim that survival rates for black newborns double when they have black physicians attending is based on a misleading analysis 2) Even if the results of the Proceedings of the National Academy of Sciences study were as Justice Jackson claimed, they are unbelievable and 3) even if Jackson had described the results of the study accurately, and even if those results were credible, they still wouldn’t justify the use of racial preferences in medical school admissions.
The study Jackson cited as authority did not find a “doubling” in survival rates when black newborns have a black attending doctor. The study claimed that 99.6839% of black babies born with a black attending physician survived compared with 99.5549% of black babies born with white attending physicians, a difference of 0.129%, not 100%.
Well, that’s why Jackson went into law instead of mathematics, I guess.
The study itself reeks bias pollution, and was sloppy even as far as its 0.129% finding goes. Its comparison of death rates for newborns with doctors of different races glossed over the fact that black newborns have a greater incidence of serious medical problems. The physicians assigned to treat those urgent cases are likely to be white, because most of teh doctors qualified to do so are white. Black newborns are almost three times as likely as white newborns to weigh less than 1,500 grams, and the doctors assigned to treat very low-weight babies are more likely to be specialists rather than regular pediatricians.
Black doctors are significantly less likely to be qualified in those specialized fields. While more than 5% of pediatricians or family practice physicians are black, only 3.8% of neonatologists and pediatric cardiologists and 1.8% of pediatric surgeons are black. So the study Jackson misunderstood did not confirm the benefits of black newborns having black doctors, because black newborns are more likely to have severe issues that increase their risk of infant mortality, and “those severe cases are more likely to have white attending physicians because white doctors are more prevalent in the specialized fields that treat those complications.”
What needed to be studied in order to support the argument Jackson embraces is whether black newborns with identical conditions would fare better, worse, or no differently with a black or white doctor attending. Jackson, in short, fell into the confirmation bias trap. That’s a human tendency, but a competent Supreme Court Justice is expected to avoid that tendency.
Finally, as Jay Greene, who is a senior research fellow in the Center for Education Policy at The Heritage Foundation, also notes in his analysis, increasing the number of black doctors so that every black newborn could be ensured to have one would require significant dilution in the quality of specialists, so that the modest benefit claimed in the study would likely be swamped by the harm of less capable physicians.”
Matching black newborns to this supposedly desirable larger number of black doctors, he adds, would require racial segregation in health care.
Jackson’s claim that diversity saves lives, then, was based on bias, statistical ignorance and cherry-picking research results that she didn’t think every hard about. In the spirit of the times, Facts Don’t Matter even to a SCOTUS justice who believes the ends justify the means. It should disturb everyone, however, that Jackson’s false argument was based on an amicus brief filed by the Association of American Medical Colleges referencing the study that appeared in the Proceedings of the National Academy of Sciences, and no one—not the AAMC staff, nor Jackson’s law clerks, detected the errors.
Then the news media accepted Jackson’s arguments with a similar absence of due diligence. Washington Post columnist Ruth Marcus, as is her wont, repeated what supported the Left’s narrative: diversity saves lives, she argued A New York Times editorial repeated the canard that “black infants, for example, are more likely to survive under the care of a black doctor.”
If you can’t trust a Supreme Court Justice to get the facts straight, who can you trust?
[Additional Note: the revision above took me all of ten minutes, and improved the article. This episode is a reminder that in my constant battle between covering the topic in the limited time I have available and doing each post as well as possible, I must not allow time to undermine integrity. Again, I’m sorry for failing on this occasion.]
Ethics Alarms 
Francis Menton covered this as well as other magical thinking in liberal SCOTUS dissents:
https://www.manhattancontrarian.com/blog/2023-7-6-how-to-think-like-a-liberal-supreme-court-justice-part-ii
I have no idea how Francis Menton survives living on Manhattan. A braver man than I.
Ooops. OB.
OK. Statistics are weird. Comparing survival rates and comparing death rates would seem to be the same thing. But if we look at the latter, there does seem to be at least some correlation: a black baby is roughly 40% more likely to die under the care of a white physician.
That risk is still negligible, being technically true does not mean a statement isn’t deceptive, 40% is considerably less than 100%, and the other factors you cite are relevant. So there’s plenty of room for criticism. But I do think we should be comparing death rates instead of survival rates.
(Curmie)
Curmie,
But, is correlation also causation? Does that mean white doctors don’t treat black babies with the same care as they would white or non-black babies? What are the health conditions involved in that statistic? Low birth weight seems like an easy problem to . . . erm . . . address, depending on the weight of the baby, right? A serious;y underweight baby is going to have other serious health conditions, right? That would mean vital organs might not be developed or that the baby is premature, again resulting in other serious conditions. Some of these health issues may also result from poor health care during pregnancy. This study intimates that racism accounts for the higher amount of black infant mortality, a dubious proposition at best.
jvb
To be clear, the 40% figure is a reduction in excess deaths, not a 40% reduction in infant mortality. Second, statistical analysis often looks at relative differences, i.e. infant mortality, comparing race of doctors, but all relative risks need to be assessed with absolute risk in mind. For example, the 40% reduction in excess infant mortality is a lot more meaningful when infant mortality is 20% compared to when it is 0.5%.
Lastly, this race effect goes away when looking at maternal outcomes, ‘among birthing mothers cared for by White physicians, Black mothers experience an additional 14 deaths per 100,000 births, tripling White mothers’ mortality rate of 7 per 100,000 births. There is no difference in mortality rates based on physician race.’
Observational studies are very hard to analyze accurately; they are subject to many confounded associations that lead to biased estimates. Further complicated by this type of analysis were race is the exposure. What is race measuring here? The functional hypothesis is that medical care varies by race, a profoundly racist hypothesis itself. Further, I find it hard to believe that skin color is the best proxy for pediatric medical quality. Serious researchers interested in improving infant mortality outcomes should look at much more quantifiable, meaningful, and predictive exposures than the skin color of the attending.
I don’t think the argument is black doctors should only attend to black people. But that having more black people in the medical profession would lead to better medical insights and awareness so that these disparities can be addressed.
Also, where did this data come from in the study? I don’t see it:
In its most fully specified model, the study claimed that 99.6839% of black babies born with a black attending physician survived compared with 99.5549% of black babies born with white attending physicians.
Other than skin color, aren’t black and white people anatomically identical? I just don’t see “lived experience” as bringing anything of any benefit to medical education, training and practice. Frankly, I don’t see it of any benefit in any field requiring any training. There’s simply a body of knowledge that needs to be mastered.
Could the alleged difference between outcomes by black and white attending physicians be explained by the relatively small sample size of children attended by black physicians? According to the Justice, aren’t there microscopically few black physicians?
OB
Could be white doctors aren’t aware of certain medical/hereditary issues facing black babies more than white babies, maybe they aren’t aware of certain comorbidities or complications with the mother since they see black babies less than white babies.
Could be a lot of things.
All of which should be readily available in the literature. Or are you saying physicians just sort of learn on the fly? I hope not.
The more I think about this idea that black doctors are better for black patients, the more angry I get. It’s preposterous. The justice wants separate but equal medical care? Only black doctors can attend black people? So, if I’m in the ER and a black doctor walks in, I can say, “Uh. No. I want a white doctor, please.” I should only be treated by what, largely Irish Catholic/Anglo American doctors? No Jews? No Indian doctors for me, thanks. And Jewish doctors should only treat Jews. And while we’re at it, only black mechanics should work on black people’s cars? Their lived experience tells them important things to know about how to fix cars owned by black people. And only guy doctors should treat guys. A woman doctor walks in and I can say, “Uh. No thanks, Doc. You’re a woman. I need a man doctor. And a white one and half Irish Catholic.”
Absurd. The human body is a complex organism. I just want someone who knows how the hell it works and how to fix anything that’s not working.
Well… There actually is medical evidence that common respiratory infections affect men more severely than women. This is directly responsible for the ‘Man Flu’ pejorative.
Does this also mean that a female doctor treating a man for the same symptoms results in a lower standard of care? Good luck finding finding to study this variety of sexism. I’m sure there’s plenty to go around for comparing male and female OBGYNs though.
I think the best shade thrown in that case might be the Robert’s shade on the Jackson dissent, from page 39 of the opinion:
“At the same time, as all parties agree, nothing in this opinion should be construed as prohibiting universities from considering an applicant’s discussion of how race affected his or her life, be it through discrimination, inspiration, or otherwise. See, e.g., 4 App. in No. 21–707, at 1725– 1726, 1741; Tr. of Oral Arg. in No. 20–1199, at 10. But, despite the dissent’s assertion to the contrary, universities may not simply establish through application essays or other means the regime we hold unlawful today. (A dissenting opinion is generally not the best source of legal advice on how to comply with the majority opinion.)“
I hope the college and university administrators don’t us that part of the opinion as a hole to drive a truck through. I fear they may. I think there will be all sorts of future cases litigating the work arounds the enlightened will implement. They’ve been very brazen in tipping their hand. My college’s president sent out a letter to the alumni saying they college had joined with other similar schools and retained counsel to figure out how to keep admitting thirty percent black kids despite the recent ruling. These people are incorrigible.
OB
The left (politicians, activists, voters, and even judges) are always about feelings and compassion (more often than misguided and doing more harm than good), and will never let reason, logic, or facts, let alone ethics, get in their way.
They are the side of 100% pathos and (almost) 0% logos and ethos.
Just realized, she needs better clerks. Someone should have caught this. Competence issue. Or maybe all her clerks are suffering from confirmation bias.
The simpler option is that they knew and did it intentionally.
ALERT TO EA READERS:
Just learned through a circuitous route that Jack is neither ill nor too despondent to post today. A lightening strike took out his internet and apparently fried his computer. Hopes to be back soon and and that readers will check in over the next couple of days.
If Jack is out of commission, we clearly have an ethical obligation to run amuck in the comment section. 😁 Perhaps we should use Friday’s open forum to analyze all the ethical issues we see in his stead.
A precision lightning strike hits Chez Marshall? The deep state has called in mother nature? NPR’s revenge?
Thanks for letting us know! I was worried after yesterday and this morning saw no new posts.
“Black newborns are more than twice as likely to die in their first year as White newborns [1,090 vs. 490 deaths per 100,000 births, respectively].”
The above line in the introduction to the original research paper seems to be the source. But it was flipped around (changing “twice as likely to die” into “twice as likely to live”) and then errantly linked to the study’s measures (white vs. black physician caring for black newborns).
“Thunder rolls
and the lightning strikes!
Another blog goes cold
On a sleepless night!”
But seriously, I hope our host returns soon!
[Another Mike]
Back to the doctors: When the comparison is “attending physicians” are we talking the doc present at the birth, or the doctor who has attended the mother throughout the pregnancy? There is a difference.
And…. Are black expectant mothers who are black skew to black doctors when choosing their OB? What is the difference in survival of the baby (or death of…) when there is full-term medical care vs. the first medical involvement at the ER when the water broke? In the latter there is no choice of physician and the odds of a problem delivery is most likely greater due to the lack of prenatal care.
There are a lot of wild cards in that statistical deck.