Your number 8 is crucial: In plain English they are sating is that we continuously modified the data until we got the result we wanted and then published it. P hacking is amateur compared to this
Having a PCP that belongs to the same ethnicity will foster better communication and cultural sensitivities. I've seen multiple western doctors advice their Indian vegetarian patients to eat more protein. They have no clue about Indian dietary habits and culture, which is predominantly starch based and give BS lifestyle advice that is unrelatable to an Indian immigrant for example.
One other thought: beware the power of the denominator.
The ratio of (number of Black PCPs/all PCPs) / (number of Black residents/all residents) will rise even if the only changing variable is _lower number of Black residents_.
In other words, a possible explanation would be gentrification. If rising property values forced poorer residents out of a county, and those residents were disproportionately Black and in poorer health, it would explain the study findings exactly.
“Encouraging blind acceptance of low quality analyses— as this paper is— because it aligns with our political side further fuels our stupidity. It might be the root of all evil.” 🎯
Thank you, Vinay. I read reference to this article and was immediately skeptical. Frankly, as a pediatric subspecialist, I did a pretty good job of relating to and caring for my patients of color. Medical schools are currently hellbent on DEI and increasing whole categories of medical students with absolutely no data and no interest in doing anything but adhering to the latest woke ideologies. Yes, there should not be an unfair barrier to admission to medical school for qualified students of any kind. Meritocracy must rule. Should we support preparatory programs for certain under-represented minorities? Yes, but we should study the impact of such policies. Do they get certain students into medical school only to have them either fail or end up in protected subspecialties and not serve the people who look like them?
Decades spent trying to say say Race doesn't matter. All un done by those trying to wield the sword cutting in their righteous way. Still the same sword. Racism.
By "race doesn't matter", do you mean "there are no substantial differences that correlate to race" or "we should not treat people differently simply because of race"? Those are two totally different ideas.
There are some differences. But how much do they matter? And god help you if you try to quantify them and they are somehow derogatory and able to be used to discriminate. Remember The Bell Curve?
> if public education were equal for all kids born in the US [...] then there is no reason to think that the fraction of black doctors would not be similar to the fraction of black people in America.
You are assuming intelligence distribution bell curves are the same across the races. Why?
Are there genetic reasons for any differences in intelligence distribution bell curves? AFIK, most intelligence tests relate strongly to vocabulary. My late wife teaching special ed students discovered most student did not know what an eel was. It was on one of those standardized tests. Many city kids have no clue about eels.
I must say, I don't know. I see articles like https://www.edubloxtutor.com/iq-test-scores/ for a recent discussion and got no closer. I only know the test I took so many years ago was mostly written with a bit of geometric stuff and a few math things. I can recall being told I was quite high and thus skipped a grade in middle school before there were formal middle schools, moving from the 6th grade to the 7th.
If there is a racial component to IQ, I might have missed that data. Genetics might play a part if there were some defect, but the marriage of two slow learners often product "normal" children seemingly more intelligent than their parents.
We know most Black doctors move to higher income areas (fewer Black proportion), thus the constant quest for incentives to have more Black medical school and residency graduates work in underserved areas. So we can pretty safely assume that many Black doctors see and treat fewer Blacks than their representation in the population.
Thank you for a good analysis - always gets me thinking and working to improve. I do think your suggestion that the k-12 education system is the reason for disparities is somewhat true but greatly confounded by historical government policies that break down opportunities for certain groups and cultural factors such as loving and stable home life, reading and learning encouraged, safe places to play outdoors etc.
Agree. While it is only a quick statement, bad (inner city) schools are not the cause. We are two full generations into affirmative action in education where we take the brightest students and give them opportunities in higher education and have built all types of programs to assist their development including maximum scholarships to overcome financial hardships. Since we are only talking about a small slice of the educated that have specific cognitive abilities (ability to pass organic chemistry) and a desire to become a physician, along with a very small amount of spots in medical schools, these programs should produce plenty of candidates of all races. If there is a dearth of candidates, it is because of other issues like actually wanting to go to school for close to a decade post HS or opportunity costs of becoming a doctor for folks who come out of poverty settings.
Now if we were talking about education in general, then we would have to look at the environments; nutritional deficiencies, violent crime, lack of fathers in the home, etc. before we look at the schools. Blaming schools is the easy way out. Poor schools is just another symptom of public policy herding poor people together into one big dysfunctional matrix.
"bad (inner city) schools are not the cause"? To a large extent the poverty stricken inner city schools are denied opportunities and those who escape them are quite exemplary. I did try to examine poverty levels in 1955 to now but can't find any ability to match circumstances, except now there seem to be many more black households with a single parent. I found https://blackdemographics.com/households/poverty/amp/ not helpful in understanding.
To my mind education is the only way out of poverty and then an environment allowing/creating children that can prosper.
I never said poverty wasn't an issue, in fact I believe poverty IS the issue. In fact, I posted poverty rates earlier. The black poverty rate dropped from over 80% in 1940 to 55% in 1959. It's now 17% up from 16% pre-pandemic. My point always has been that by now there are plenty of Blacks living in the middle and upper middle classes attending suburban schools. The prep schools are now significantly more diverse adding more blacks into the potential medical school population. There are more than enough to fill medical schools quota's that is for sure. I'm not sure how many times I need to demonstrate/post the same set of facts. Along with the fact that few children of any race that grow up in poverty are matriculating to medical schools. This whole discussion of black poverty is a red herring when we are talking about medical schools.
I found it hard to get to poverty rates in earlier times. Your comment (https://sensiblemed.substack.com/p/does-black-representation-save-lives/comment/15033365) didn't cite the earlier numbers. Not to quibble "I believe poverty IS the issue" vs "poverty is a red herring". But we do agree that the pathway to medical school is missed by many. Perhaps learned helplessness along with low expectations might be an issue? Not everybody is excited by the prospect of a really long time in education and practicum.
I served on a committee at the University of Arkansas for Medical Sciences in the 1980s which looked at the under-representation of blacks in the classes of UAMS, the only med school in the state. It became clear that there were too few qualified black students graduating from college to increase the meager % of Black med students (about 5%). We looked at the data and saw that to make a difference, a program would need to focus on students in junior high school, if not elementary school. This problem lingers today and the quality of early education leaves many children of color below average in testing and achievement. No bias of promotion from college to med school will make a difference. The ratio of Black women to Black men in med schools is quite uneven indicating that factors other than racism and intelligence are at play.
We don't live in the same world as 1980. Black poverty, for example was 32% in 1980 and is currently 17%; 47% lower. In 1980 affirmative action was just starting, we are now 2 generations into affirmative action. Blacks living in the suburbs was 24% in 1980, now 54%, more than doubling.
Academic achievement in black males has lagged behind. Quality of schools has NOT improved in any significant way. I wonder why. What do you think, Dave?
I think you are wrong in your statement about quality of schools to begin with. With half of black families living in the suburbs now, they are receiving "better education." And I would also say that the important part of "black males" is the male part. Because males, in general, are "lagging behind" in academic achievment (over 60% of college undergraduates are women). HS drop out rates are higher for males than females and the gap is not trending down. While whites drop out less than blacks, the rates have been getting closer to together for 50 years and if present trajectories remain will be the same relatively soon.
That is exactly what I was thinking too. All inequities cannot be solved by the government. A great shift in cultural expectations is needed more than government intervention.
Ahhhh, but what if feelings and narratives are THE MOST important factors? Then this paper fits the bill, no? Hell it's a homerun. Follow the narrative, Dr. Prasad! And medical schools not requiring MCATs/GPA's and law schools not requiring LSATs, what will happen to the quality of doctors/lawyers of future? This is the best we can do? Where have all the sane people gone?
I just finished reading the article. It is so terrible that I doubt it would have even been published if it were on a different topic. They are really grasping at straws.
What made the essay terrible? I found the JAMA article quite shallow. Are you commenting about the JAMA paper or on this essay about the article. I am confused.
Your number 8 is crucial: In plain English they are sating is that we continuously modified the data until we got the result we wanted and then published it. P hacking is amateur compared to this
Having a PCP that belongs to the same ethnicity will foster better communication and cultural sensitivities. I've seen multiple western doctors advice their Indian vegetarian patients to eat more protein. They have no clue about Indian dietary habits and culture, which is predominantly starch based and give BS lifestyle advice that is unrelatable to an Indian immigrant for example.
One other thought: beware the power of the denominator.
The ratio of (number of Black PCPs/all PCPs) / (number of Black residents/all residents) will rise even if the only changing variable is _lower number of Black residents_.
In other words, a possible explanation would be gentrification. If rising property values forced poorer residents out of a county, and those residents were disproportionately Black and in poorer health, it would explain the study findings exactly.
“Encouraging blind acceptance of low quality analyses— as this paper is— because it aligns with our political side further fuels our stupidity. It might be the root of all evil.” 🎯
Thank you, Vinay. I read reference to this article and was immediately skeptical. Frankly, as a pediatric subspecialist, I did a pretty good job of relating to and caring for my patients of color. Medical schools are currently hellbent on DEI and increasing whole categories of medical students with absolutely no data and no interest in doing anything but adhering to the latest woke ideologies. Yes, there should not be an unfair barrier to admission to medical school for qualified students of any kind. Meritocracy must rule. Should we support preparatory programs for certain under-represented minorities? Yes, but we should study the impact of such policies. Do they get certain students into medical school only to have them either fail or end up in protected subspecialties and not serve the people who look like them?
Decades spent trying to say say Race doesn't matter. All un done by those trying to wield the sword cutting in their righteous way. Still the same sword. Racism.
By "race doesn't matter", do you mean "there are no substantial differences that correlate to race" or "we should not treat people differently simply because of race"? Those are two totally different ideas.
Yes to both.
The former is simply contrary to basic facts of biology, but okay.
There are some differences. But how much do they matter? And god help you if you try to quantify them and they are somehow derogatory and able to be used to discriminate. Remember The Bell Curve?
> if public education were equal for all kids born in the US [...] then there is no reason to think that the fraction of black doctors would not be similar to the fraction of black people in America.
You are assuming intelligence distribution bell curves are the same across the races. Why?
Are there genetic reasons for any differences in intelligence distribution bell curves? AFIK, most intelligence tests relate strongly to vocabulary. My late wife teaching special ed students discovered most student did not know what an eel was. It was on one of those standardized tests. Many city kids have no clue about eels.
"Are there genetic reasons for any differences in intelligence distribution bell curves?"
Of course there are.
"AFAIK, most intelligence tests relate strongly to vocabulary."
No, modern IQ and analogous tests have moved far beyond that, decades ago.
I must say, I don't know. I see articles like https://www.edubloxtutor.com/iq-test-scores/ for a recent discussion and got no closer. I only know the test I took so many years ago was mostly written with a bit of geometric stuff and a few math things. I can recall being told I was quite high and thus skipped a grade in middle school before there were formal middle schools, moving from the 6th grade to the 7th.
If there is a racial component to IQ, I might have missed that data. Genetics might play a part if there were some defect, but the marriage of two slow learners often product "normal" children seemingly more intelligent than their parents.
> If there is a racial component to IQ, I might have missed that data.
well, don't expect mainstream media attention to such things, but in evolutionary biology, it's pretty much settled
https://kirkegaard.substack.com/p/modern-neuroscience-confirms-race
Speaking of the dirty word ivermectin, what's the skinny on the Medincell result? At least there is a poster now. Homerun? Fraud? April fool's? https://www.medincell.com/wp-content/uploads/2023/04/20230401-Poster-SAIVE_VD.pdf
We know most Black doctors move to higher income areas (fewer Black proportion), thus the constant quest for incentives to have more Black medical school and residency graduates work in underserved areas. So we can pretty safely assume that many Black doctors see and treat fewer Blacks than their representation in the population.
Thank you for a good analysis - always gets me thinking and working to improve. I do think your suggestion that the k-12 education system is the reason for disparities is somewhat true but greatly confounded by historical government policies that break down opportunities for certain groups and cultural factors such as loving and stable home life, reading and learning encouraged, safe places to play outdoors etc.
Agree. While it is only a quick statement, bad (inner city) schools are not the cause. We are two full generations into affirmative action in education where we take the brightest students and give them opportunities in higher education and have built all types of programs to assist their development including maximum scholarships to overcome financial hardships. Since we are only talking about a small slice of the educated that have specific cognitive abilities (ability to pass organic chemistry) and a desire to become a physician, along with a very small amount of spots in medical schools, these programs should produce plenty of candidates of all races. If there is a dearth of candidates, it is because of other issues like actually wanting to go to school for close to a decade post HS or opportunity costs of becoming a doctor for folks who come out of poverty settings.
Now if we were talking about education in general, then we would have to look at the environments; nutritional deficiencies, violent crime, lack of fathers in the home, etc. before we look at the schools. Blaming schools is the easy way out. Poor schools is just another symptom of public policy herding poor people together into one big dysfunctional matrix.
"bad (inner city) schools are not the cause"? To a large extent the poverty stricken inner city schools are denied opportunities and those who escape them are quite exemplary. I did try to examine poverty levels in 1955 to now but can't find any ability to match circumstances, except now there seem to be many more black households with a single parent. I found https://blackdemographics.com/households/poverty/amp/ not helpful in understanding.
To my mind education is the only way out of poverty and then an environment allowing/creating children that can prosper.
I never said poverty wasn't an issue, in fact I believe poverty IS the issue. In fact, I posted poverty rates earlier. The black poverty rate dropped from over 80% in 1940 to 55% in 1959. It's now 17% up from 16% pre-pandemic. My point always has been that by now there are plenty of Blacks living in the middle and upper middle classes attending suburban schools. The prep schools are now significantly more diverse adding more blacks into the potential medical school population. There are more than enough to fill medical schools quota's that is for sure. I'm not sure how many times I need to demonstrate/post the same set of facts. Along with the fact that few children of any race that grow up in poverty are matriculating to medical schools. This whole discussion of black poverty is a red herring when we are talking about medical schools.
I found it hard to get to poverty rates in earlier times. Your comment (https://sensiblemed.substack.com/p/does-black-representation-save-lives/comment/15033365) didn't cite the earlier numbers. Not to quibble "I believe poverty IS the issue" vs "poverty is a red herring". But we do agree that the pathway to medical school is missed by many. Perhaps learned helplessness along with low expectations might be an issue? Not everybody is excited by the prospect of a really long time in education and practicum.
I served on a committee at the University of Arkansas for Medical Sciences in the 1980s which looked at the under-representation of blacks in the classes of UAMS, the only med school in the state. It became clear that there were too few qualified black students graduating from college to increase the meager % of Black med students (about 5%). We looked at the data and saw that to make a difference, a program would need to focus on students in junior high school, if not elementary school. This problem lingers today and the quality of early education leaves many children of color below average in testing and achievement. No bias of promotion from college to med school will make a difference. The ratio of Black women to Black men in med schools is quite uneven indicating that factors other than racism and intelligence are at play.
We don't live in the same world as 1980. Black poverty, for example was 32% in 1980 and is currently 17%; 47% lower. In 1980 affirmative action was just starting, we are now 2 generations into affirmative action. Blacks living in the suburbs was 24% in 1980, now 54%, more than doubling.
Academic achievement in black males has lagged behind. Quality of schools has NOT improved in any significant way. I wonder why. What do you think, Dave?
I think you are wrong in your statement about quality of schools to begin with. With half of black families living in the suburbs now, they are receiving "better education." And I would also say that the important part of "black males" is the male part. Because males, in general, are "lagging behind" in academic achievment (over 60% of college undergraduates are women). HS drop out rates are higher for males than females and the gap is not trending down. While whites drop out less than blacks, the rates have been getting closer to together for 50 years and if present trajectories remain will be the same relatively soon.
That is exactly what I was thinking too. All inequities cannot be solved by the government. A great shift in cultural expectations is needed more than government intervention.
Ahhhh, but what if feelings and narratives are THE MOST important factors? Then this paper fits the bill, no? Hell it's a homerun. Follow the narrative, Dr. Prasad! And medical schools not requiring MCATs/GPA's and law schools not requiring LSATs, what will happen to the quality of doctors/lawyers of future? This is the best we can do? Where have all the sane people gone?
No one wants to comment on this article on Jama.
The problem with Vinay's claim is that causes are *definitely* helped by bad research. I don't think that can be denied.
I just finished reading the article. It is so terrible that I doubt it would have even been published if it were on a different topic. They are really grasping at straws.
What made the essay terrible? I found the JAMA article quite shallow. Are you commenting about the JAMA paper or on this essay about the article. I am confused.
The JAMA article.
You are a legend who has restored my faith in medicine. Will you support my open letter to substack leadership about protecting free speech? https://substack.com/profile/64905469-yuri-bezmenov/note/c-14787883