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The Problems with Discrimination Research in Medicine

Like many professions in Western society, medicine is examining itself for the presence of racial inequities and strategies that can ameliorate these differences. Many publications have focused on the disproportionately poor outcomes of minorities in our healthcare system with an emphasis on systemic and structural forces that shape such inequities. As I concluded in my last article for Quillette, these discussions should proceed with the utmost scientific caution, as the answers and implications stand to affect the most vulnerable populations.

With this in mind, there are limitations in the current literature on alleged medical discrimination and the associated health outcomes. In addition, much of the literature on this topic relies heavily on surveys and patient self-reports to assess bias and discrimination while downplaying or ignoring alternative hypotheses. The narrative that has emerged from the conclusions of these limited studies could inadvertently cause some populations to avoid medical follow-up and form an inaccurate view of healthcare practices.

As background, the relevant literature appears to show that black and Hispanic patients tend to view medicine as more discriminatory than white patients do, and black patients often report poorer quality of care overall.1, 2 On top of this, even with greater levels of high school graduation, black patients reported feeling more discriminated against and having more unmet health needs than the Hispanic cohort. In the context of the coronavirus pandemic, a recent article discussed data demonstrating that not only were certain minority groups being affected disproportionally by the virus, but they also experienced more episodes of racist comments due to a perceived connection between their ethnicity and the pandemic. The belief that physicians of a different race act in a discriminatory manner appears to increase one’s preference for a physician of the same race,3 which makes it more notable that black, Hispanic, and Native American physicians are typically in short supply.4

The first thing to be aware of when evaluating these studies is that, although the affront caused by perceiving discrimination or racism may be real, the perception itself might still be false. Operating under the assumption that correlation of perceived discrimination with negative health outcomes implies an overt discriminatory cause not only perpetuates negative attitudes towards the medical profession, it also perpetuates research habits that can open the door to ideological speculation masquerading as a robust explanation. Dr. Danielle B. Moody has evaluated perceptions of discrimination in relation to health outcomes in multiple articles now, but even when confronted with data that conflicts with the hypothesis that discrimination is a main driver of poor health, researchers do not readily accept such findings.

For example, when studying whether or not an abnormality—in this case, something called “white matter lesion volume” (WMLV)—found on brain imaging studies correlated with self-reported discrimination in African Americans, the team found this abnormality increased with decreased ratings of discrimination in black youth. And yet the conclusions read:

Among older AA [African Americans], as lifetime discrimination burden and racial discrimination increased, so did WMLV. However, in younger AA, decreases in racial discrimination were associated with increased WMLV. Elucidation of complex mechanistic underpinnings, including potentially differential impacts of the acknowledgment versus suppression or underreporting of discriminatory experiences, among AA of different age cohorts, is critical to understanding the present pattern of findings.5

Asserting that younger subjects are merely engaging in “suppression” or “underreporting” as the only explanatory factors for this anomalous result can lead to downplaying other relevant factors for assessing and treating poor outcomes among specific groups—such as African Americans merely having a higher baseline prevalence of WMLV on average.6 Furthermore, the brain images were obtained around five years after the original self-reported discrimination ratings were completed—something the team acknowledged, as multiple aspects of this group were examined in stages years apart. Such a time lapse between the original discrimination ratings and the eventual brain images makes it difficult to establish any firm association between the two factors. This is not to disparage the labor of the researchers, which I am sure was immense. I simply wish to highlight that even outside of the narrative of discrimination, methodology can confound otherwise promising results.

A similar publication by Moody et al studied whether or not a marker of cell aging and overall lifespan was negatively influenced by perceived discrimination in subjects. The study concluded there was a significant correlation, but only for African American women and white women at higher socioeconomic status.7 The research team asserts this is explained by African American women with higher incomes being exposed to more white communities and therefore more “chronic, interpersonal discrimination.” When faced with the same finding in white women, the following rationale is offered: “perceptions of progress among racial minorities have been found to stoke concerns of destabilization of the traditional social hierarchy among non-racial minorities.”

This is a dubious conclusion given the same finding was not seen for the white male cohort, but even when reviewing the citation used to support the above claim for white women, it reads as follows: “the effects on whites’ expectations of increased anti-white discrimination found in the present work were not primarily driven by increased concern about whites’ group status in a future ‘majority-minority.’”8 With this in mind, one cannot help but feel a more meretricious explanation was chosen to better support perceived discrimination as the explanation for the team’s findings. The results might be partly explained by average gender differences in levels of distrust during clinical trials9 but this does not support the narrative of discrimination as a health determinant, and so it does not get a thorough discussion.

The study on perceived discrimination as well as Moody’s latter article do concede that the bias of perceived discrimination studies can make the results questionable. Subjects can only report what they recall, and the very methods used may over-estimate the results and therefore the alleged effect of perceived discrimination. But these caveats did not stop the New England Journal of Medicine (NEJM) from citing the above literature and making the bold statement: “Discrimination and racism as social determinants of health act through biologic transduction pathways to promote subclinical cerebrovascular disease, accelerate aging, and impede vascular and renal function, producing disproportionate burdens of disease on black Americans and other minority populations.”10 Unfortunately, in the wake of George Floyd’s death, the NEJM and the Lancet have doubled down on publishing articles with increasingly hyperbolic rhetoric that sometimes stretch the boundaries of scientific journalism into platforms for radical thought-pieces.

Outside of these issues, medical literature can be communicated to providers in a way that reinforces discrimination as a major problem even if a study conveys contrary findings. This might have happened in a recent publication regarding hypertension (HTN) and its relation to lifetime discrimination burden. The summary for providers simply concludes in the highlights section, “A study of African Americans in Mississippi shows an association between experiencing discrimination over a lifetime and developing hypertension.” When reviewing the data in full: smoking status, having no high school diploma, lower physical activity, and higher age were significantly correlated with hypertension.11 In contrast, coping methods for discrimination, rating of lifetime discrimination, and factors patients attributed to lifetime discrimination, had no demonstrable link with incidence HTN. Interestingly, the stress attributed to lifetime discrimination burden was significantly correlated with HTN incidence, but the authors note: “The associations with stress from discrimination were weakened and no longer statistically significant after adjustment for hypertension risk factors.” I view this as overwhelmingly good news and I wish it were emphasized more, as we can modify certain risk factors to varying degrees without conveying to patients that perceived discrimination limits their agency in medical care.

The language used in perception-based studies can also dramatically alter results and over-state findings. The word “discrimination” can lead participants to believe their group is being discriminated against more than usual, and this effect is likely higher for minority participants. A study performed on university students demonstrated that manipulating the term “discrimination” in terms of the severity and frequency of events could modify both personal and group judgments, resulting in a disparity between claims of group discrimination in relation to individual discrimination.12 A separate study of this phenomenon demonstrated that using stereotyped examples of respective groups resulted in higher ratings of group discrimination than the personal variety, and each group was also quicker to perceive group rather than individual discrimination.13 This could be worsened when surveys are broad to the point where affirmative answers are almost inevitable. Such surveys include questions like “Do you think you have ever been unfairly fired or denied promotion?” and yes/no answers to having ever been treated with “less respect than others” or do you ever perceive that people think “they are better than you.” I find it unlikely these map on to most humans’ concept of discrimination.

The above finding is called the personal/group discrimination discrepancy: heightened claims of group discrimination despite lower experiences on an individual level. Although originally thought to be a mechanism by which groups suppressed personal experiences of discrimination, subsequent research has demonstrated that even when subjects reported experiencing clear prejudice, they still reported higher perceived levels of discrimination for their identity group in comparison to their own individual rating.14 The authors note that a possible explanation for higher claims of group discrimination are “claims of discrimination can be used as a basis for promoting social change designed to improve the status of the minority group,” and also noted there was no direct evidence for groups exaggerating claimed discrimination in this study, but there also did not appear to be evidence that ratings of discrimination are “reality-based.”15

Studies that rely upon reports of perceived discrimination can be flawed by bias in both the subjects and experimenters, but these examples demonstrate that perceptions vary greatly within groups and are more complex than explanations reliant on majority-minority discrimination. In one of the aformentioned articles regarding preferences for a same-race provider, we see that this preference diminishes when respondents perceived that discrimination was not a matter of race, but rather from healthcare in general or from positions of authority regardless of race. Additionally, although much of the contemporary discussion revolves around addressing systemic forces that result in unequal outcomes, polling data from a national survey demonstrated only a quarter of African Americans felt that the bigger problem regarding discrimination was based in law or government policy compared to nearly half of respondents feeling most discrimination was merely episodes of prejudice from individuals. This same poll demonstrated that personal experiences of discrimination in terms of “slurs,” “negative assumptions,” and feeling “people acting afraid of them” were much lower for African Americans earning less than $25,000 compared to those earning more than $75,000, which could indicate the perception of discrimination might be more of a luxury belief than one ailing the less fortunate. This might also convey that researchers strictly focusing on systemic factors have incongruent beliefs with the population of intended benefit.

As I stated previously, the focus and possible exaggeration of discrimination in medicine could have bad downstream effects for patients, and the insidious problem that could follow from this narrative might be higher external locus of control for minority groups. It seems well-supported that having a higher internal locus of control—a subject’s belief that they have personal power over their own fate—is well-correlated to improved healthcare outcomes while the opposite (an external locus of control) can have deleterious effects.16, 17 In one such examination, when controlling for baseline cognitive ability, education, health, and depression, higher external locus of control resulted in worse outcomes for memory-training exercise and reasoning ability for African Americans than for non-Hispanic whites (NHWs).18 While I’m all for genuine and thorough examinations of discrimination, making the “systemic” concept a forgone conclusion in a profession like medicine will cause certain patients to develop distrust of those tasked with providing care. This is demonstrated by studies regarding health locus of control showing decreased trust in healthcare professionals scales with the preconception that individual health is merely chance, or in other words, a sense that the patient’s actions do not matter.19 This would be incredibly unfortunate, because one thing the equity task forces have right is that creating mutual trust is crucial to recruiting and retaining underrepresented groups in clinical trials.

Nothing I have written here should be taken as evidence that professionals should not listen to patient complaints or stop investigating unfair treatment—those are incredibly important topics. At the same time, research into discrimination is quite complex and there are many flaws introduced when substituting discrimination with perceptive findings and assuming this represents healthcare discrimination. Such accusations still carry great weight and are counterproductive to continuing our positive gains in healthcare trust. In a 2018 publication on the trends of patient perceptions on health discrimination, the author noted that both reported trends on black patients experienced discrimination and the black-white difference in those same reports fell from 2008 to 2014.20 The author then postulates, as I have, that exacerbated racial rhetoric could reverse these positive trends. Nevertheless, she ends the piece with an odd proposal: “We must change reality to alter perceptions.”

Given that beliefs are far more malleable than reality, it would be my recommendation to focus on the former problem first.

 

Zachary Robert Caverley is a physician assistant specializing in cardiology and working in rural health clinics throughout the north-west coast.

References:

1 Benjamins, M.R.; Middleton, M. Perceived discrimination in medical settings and perceived quality of care: A population-based study in Chicago. PLOS ONE. April 25th, 2019. https://doi.org/10.1371/journal.pone.0215976
2 Hausmann, Leslie R M et al. “Impact of perceived discrimination in healthcare on patient-provider communication.” Medical care. vol. 49,7 (2011): 626-33. doi:10.1097/MLR.0b013e318215d93c
3 Malat, J.; Hamilton, M.A. Preference for Same-Race Health Care Providers and Perceptions of Interpersonal Discrimination in Health Care. Journal of Health and Social Behavior. Vol 47 (2006): p. 173–187.
4 Sex, Race, and Ethnic Diversity of U.S. Health Occupations (2011–2015). Rockville, Maryland : US Department of Health and Human Services, Health Resources and Services administration, National Center for Health
5 Beatty Moody DL, Taylor AD, Leibel DK, et al. Lifetime discrimination burden, racial discrimination, and subclinical cerebrovascular disease among African Americans. Health Psychol. 38 (2019): 63–74.
6 Nyquist, Paul A et al. “Extreme deep white matter hyperintensity volumes are associated with African American race.” Cerebrovascular diseases (Basel, Switzerland) vol. 37,4 (2014): 244–50. doi:10.1159/000358117
7 Beatty Moody, Danielle L et al. “Interpersonal-level discrimination indices, sociodemographic factors, and telomere length in African-Americans and Whites.” Biological psychology vol. 141 (2019): 1–9. doi:10.1016/j.biopsycho.2018.12.004
8 Craig, M.A.; Richeson, J.A. Information about the US racial demographic shift triggers concerns about anti-white discrimination among the prospective white “minority”. PLOS ONE. September 27th, 2017: https://doi.org/10.1371/journal.pone.0185389
9 Ding, Eric L et al. “Sex differences in perceived risks, distrust, and willingness to participate in clinical trials: a randomized study of cardiovascular prevention trials.” Archives of internal medicine. 167,9 (2007): 905–12. doi:10.1001/archinte.167.9.905
10 Evans, M.K.; Rosenbaum, L.; et al. Diagnosing and Treating Systemic Racism. N Engl J Med. 383 (July 16th, 2020): 274-276. DOI: 10.1056/NEJMe2021693
11 Forde, A.T.; Sims, M.; et al. Discrimination and Hypertension Risk Among African Americans in the Jackson Heart Study. Hypertension. 2020; 76: 00-00. DOI: 10.1161/HYPERTENSIONAHA.119.14492
12 Fuegen, K., Biernat, M. Defining Discrimination in the Personal/Group Discrimination Discrepancy. Sex Roles. 43 (2000): 285–310. https://doi.org/10.1023/A:1026691108491
13 Ruggiero, K.M. The Personal/Group Discrimination Discrepancy. The Society for the Psychological Study of Social Issues. 55,3 (Dec 1999): 519-536: https://doi.org/10.1111/0022-4537.00131
14 Taylor, D.M.; Wright, S.C.; et al. The Personal/Group Discrimination Discrepancy: Perceiving My Group, But Not Myself, to Be a Target for Discrimination. Personality and Social Psychology Bulletin. 16,2 (June 1990): 254–262.
15 Ibid
16 Infurna, Frank J et al. “Long-term antecedents and outcomes of perceived control.” Psychology and aging vol. 26,3 (2011): 559-75. doi:10.1037/a0022890
17 Lachman ME, Neupert SD, Agrigoroaei S. The relevance of control beliefs for health and aging. In: Schaie KW, Willis SL, editors. Handbook of the psychology of aging. 7. San Diego, CA: Academic Press; 2011. pp. 175–190
18 Zahodne, Laura B et al. “External locus of control contributes to racial disparities in memory and reasoning training gains in ACTIVE.” Psychology and aging vol. 30,3 (2015): 561–72. doi:10.1037/pag0000042
19 Brincks, Ahnalee M et al. “The influence of health locus of control on the patient-provider relationship.” Psychology, health & medicine vol. 15,6 (2010): 720–8. doi:10.1080/13548506.2010.498921
20 Betancourt, J.R. Perception is Reality, and Reality Drives Perception: No Time to Celebrate Yet. J GEN INTERN MED. 33 (2018): 241–242. https://doi.org/10.1007/s11606-017-4263-z

Photo by Clay Banks on Unsplash.

Comments

  1. Great article. Believe it or not, this subject came up on John Oliver recently. The show made the assertion that medical professionals were being taught, in error, that African Americans have thicker skin. Although the show presented this training as false, it is objectively true that African Americans have denser skin, potentially leading to the observation that their skin was more difficult to penetrate with needles and the like, and hence the somewhat false perception of thicker skin.

    It should also be noted that there are genuine instances of discrimination within medicine by race, such as the observation that African Americans are more likely to be suspected of false reporting of chronic pain in order to finagle pain medications because of a higher percentage of outliers within their group engaging in this activity. This is unfair, people should be treated as individuals, rather than lumped into groups and subjected to stereotypes. As with police, wariness and non-accusatory scrutiny might well be warranted, but should only proceed beyond mere wariness if there are additional observational cues to merit further scrutiny.

    But beyond these observations, this article shows that often a hyper-awareness of race can act to the detriment of solving very real structural disparities. We should all become better detectives, rather than making blanket assertions of bias, discrimination or racism. In the UK, there is an ongoing debate over sentencing disparities by race, even though previous enquiries have shown that almost all the disparities by race are caused by a lower likelihood of BAME individuals depriving themselves of the opportunity to plead guilty and avail themselves of substantial discounts in sentencing, for saving the Court’s time.

    A couple of queries on the medical data presented. Higher social mobility is correlated with fathers in the community, whilst longer telomeres are correlated with fathers in the home. However, the former is far more strongly correlated with boys than with girls- could this be the root of the rapid ageing in some higher status women? Second, vitamin D deficiency has been shown to correlate with hypertension, but studies have failed to find causation, even though there is causation with higher blood pressure and vitamin D deficiency. Could the comorbidities mentioned have a causative link with the higher blood pressure caused by vitamin D deficiency? If so, the studies into a causative link between hypertension and vitamin D deficiencies might be unduly eliminating comorbities from their studies. It’s a complicated question to which I’m not sure I see an obvious answer, but it does bear thinking about.

  2. Individuals who have the mindset that white people are racist will always discover (fabricate) “evidence” to prove their bias. Medicine is a people over things profession and there are entire ideological herds in medicine who possess anti-white animus.

    How hard would it be to find that “racism” is the cause of the medical problems suffered by “marginalized people”. Critical Race Theology makes it perfectly clear that “marginalized people” have absolutely no agency and can never do anything to improve their own health outcomes.

    All these woke medical researchers have to do is wave their “systemic racism” wand and, poof, “racism” magically appears as the cause of the problem. It’s called woke science and it’s always the fault of white people.

    And let’s be frank, nobody is ever going to accuse the medical profession of rocket science. I’m sure there are some brilliant people in medicine, but, on average, not so much, especially these days with diversity admissions and diversity promotions. The articles mentioned demonstrate the less than stellar intelligence of some medical researchers.

    Researchers that publish in woke medical journals should list their biological gender and all the courses they studied in university. Let’s see how much exposure our medical people have had to critical race theology and social justice. Let’s see if there is a correlation between articles promoting woke science and the academic and gender backgrounds of the authors.

    Some of the woke articles in the Lancet and the New England Journal of Medicine are starting to sound like the airhead ideas published in Queer Studies. What’s written in medical journals must now be taken with a grain of salt and scrutinized for ideological bias. This kind of nonsense must never be allowed to influence public policy.

  3. I have a hard time imagining how any study could prove that lifetime perceived discrimination is a cause of any medical outcome. Socalled researchers must therefore take as face value a subject’s report of perceived discrimination as the a priori cause of the problem at hand. Woke medicine at its finist,

  4. The belief that physicians of a different race act in a discriminatory manner appears to increase one’s preference for a physician of the same race, which makes it more notable that black, Hispanic, and Native American physicians are typically in short supply

    And thus in high demand for those who do the hard work. So much opportunity is squandered by claiming others should provide the services some demand.

    I used to enjoy Scientific American, but when so much was being interpreted by this new intersectionality without evidence, I realized the magazine no longer served as a source of scientific knowledge, and that’s a real loss without any gain.

  5. Perhaps others shouldn’t get to control whether “free” adults are allowed to care or feel for themselves?

  6. I’m of the opinion that poorer health treatment is more common in poorer areas and especially for the poorest members of those areas (which disproportionately include certain minorities), though not necessarily for the reasons investigated in this article (i.e., racial discrimination). As a disclaimer, this post ventures deep into anecdotal territory, so feel free to disregard it if you’d like.

    I have friends who worked at hospitals serving poorer neighborhoods. From some of the stories they shared, it seems that hospital morale is difficult to keep high when (a) patients are less compliant with prescribed therapy, and thus experience poorer outcomes, (b) healthcare professionals are much more likely to be physically assaulted by patients. Healthcare workers may find themselves more guarded and less helpful when dealing with patients who appear poor/uneducated (based on dress, speech, behaviors, and/or race) due to previous experiences. As one example among the many horror stories I’ve heard, I knew a nurse who was punched in the gut by a poor, uneducated, female patient (who also happened to be black) merely for asking her to describe her pain. (“That’s what it feels like,” the patient said, then stormed out of the hospital. The nurse didn’t attempt to press charges, despite developing gallbladder issues possibly stemming from the incident.) Would you blame that nurse for being less thorough when questioning a future patient with a similar socioeconomic background?

    It’s a complicated issue, to be sure, and racial tensions (or outright discrimination) may play a role. The perception-oriented methods used in the studies cited in this article do not appear remotely capable of finding the degree of any actual discriminatory practices among healthcare professionals, however – and as the author points out, they are being trumpeted by progressive publications as iron-clad proof of systemic injustice, leading to racial tension that will most likely worsen relationships between healthcare workers and patients.

  7. For your first question: yes, there are many articles that make the claim that discrimination not only affects health outcomes, but is a fundamental determinant of them. I actually had to edit this heavily given how many examples I had saved. Some examples were truly dumbfounding - such as multiple stage studies taking place over years and claiming that discrimination affected health outcomes for African Americans…and having no other racial group as a control during the study to prove race had anything to do with the outcomes.

    Stress can certainly affect someone’s health, and working in Cardiology, I have no doubt about this. Just as one example, after suffering the death of a loved one, it is possible to be so overcome with grief and stress that patients can suffer “stress-induced cardiomyopathy” - where a certain portion of your heart balloons out and fails to pump properly. This can simulate a heart attack and usually resolves with urgent medical care, but can also be lethal.

    In my opinion, many of these studies rely on broad questionnaires to the point where determining if any actual experienced “discrimination” cannot be determined realistically, but researchers continue to use phrases like “the stress experienced from chronic discrimination.” I could just as well substitute the phrases “experiencing rudeness” or “feeling left out” much of the time. This is kind of speculation, but it could be that people who feel this way all the time do not take as good of care of themselves, are less compliant with medical care, or have such levels of distrust that they become quite lonely and depressed which creates other problems. I believe this is why in the studies I read where multiple racial groups were analyzed, race often did not significantly contribute to perceived discrimination as a determining factor in health outcomes (like the Moody study where telomeres were shorter in both white and black women with higher perceived discrimination levels), although I admit this is not always the case.

  8. The harsh reality is that most medical research, unless done at the national meta level, is garbage. You could argue even some of that is garbage in the context of homogeneous populations. They usually misuse statistics (especially of small data sets) to validate positions that are normative.

    It all comes down to three factors.

    Number one is money. You can not get funding for any research that doesn’t really benefit the entity paying for it. You certainly cant get money to prove that the funding entity is wrong.

    Number two is that you can not test many potentially relevant scenarios because it would be unethical as you can not withhold treatment or risk true harm. That is why drug approval standards are “comparable” and not “better” so we end up with 27 versions of the same drug. Some of the most useful studies in the history of medicine could not be repeated today for this very reason.

    Finally medicine, as a community, will not acknowledge how little we actually know. During my first day of med school the professor joked that 50% of what we would be taught was wrong and the other 50% would be wrong within 5 years. His point was continuous learning. My takeaway was that we dont know much. For example you can not use statistics to validate the findings of a smallish sample when you can not say that the sample is truly random. And if you dont understand all the variables at work or how they interact how can you say the sample is randomized? Just like rationale investors is the underlying problem with Efficient Capital Markets (thanks for the asset bubbles Fama), random sampling is the problem with most medical research.

    Oh by the way its not racism at fault for bad outcomes its mostly economics, education, and culture. There are very few truly relevant examples where race comes in. Sickle Cell being the obvious choice as a protective agent from Malaria. But that is evolution not racism. Not that evolution is biting them in the ass a couple of thousand of years later.

  9. The problem is that the hard left and someof its lberal enablers aren’t interested in a discussion. They just wat the conservtives to give in. The expereinces of @Tj2mag in his workplace are symptomatic of this. He can face te sack f he even attempts ‘‘to discuss’’ race.

    The point is that it not ‘‘race’’ we have to discuss but morality and politics. The left is deluded into thinking that the problems of blacks stem from ‘‘racism’’ so they play politics in order to divide the races more. How about playing politics to stop all this divisive rubbish?

    Sentient was actually correct, though he may have phrased things a wee bit better. No Porgreesive worth his or her salt may think that all whites are racist, but he or she does think that white institutions are systemically racist. He or she also thinks that much political opposition to existence of systemic racism is itself racist.

    So I’m all for having a discssion. But if the lefties want to condemn me as ‘raaaaacccciiiiiissssstttt’’’ and cancel me for being immoral if I raise a point they don’t like, then all I can say is sod that for a game of soldiers.

    And meanwhile the lives of minorities will fail to improve. But I suppose in that way that is how the left keeps the plantation going. Sad really.

    I’ve said it on these forums many times, but I will say it again. The best way to solve this issue is for the lefties to ban ‘‘racism’’ from their lexicon and for the right to engage so that bipartisan efforts can be made to help the blacks overcome this cultural crisis in which so may of them find themselves. it may be that real issue that we need to address the problems of the poor of all races. But theright has to push the benefit of bourgeois values, and stop the idea that conforming to those values s somehow ‘‘acting white.’’

    I rememebr @Kiashu quite rightly extolling the one politican who actually went to talk to the aboriginal protestors in Melbourne recently, rather than talking to the ‘‘white allies’’. I think the same needs to be done by conservatives in the US. I understand that Trump actually did call groups of black communities to the White House a hile back. Maybe he needs to do so again.

  10. I seem to recall reading an article in WSJ sometime ago that delved into this. It turned out that America, unlike other countires, included the deaths of premature babies in the infant mortality figures. This was beause America is more technologically advanced and can attempt to care for such babies whereas in other countries they are not able to do so.

    The article concluded that the infant mortality figures in the US were thus not being fairy compared to those of other countries. But this was some years ago. Things could have changed since then.

  11. Hi jerjapan,

    You’re trying to be sensible, - that won’t work. Your statement above is blasphemy - literally.

    1. Social Justice Theology states that ALL white people are racist. This is the only correct answer.

    Be careful, this is the second time you’ve blasphemed.

    1. Social Justice Theology states that it is impossible for non-white people to be racist. Only whites can be racist and all whites are racist.

    Statements 1 and 2 above are axioms of Social Justice Theology. They cannot be questioned.

    If you don’t accept them then you are not progressive.

  12. The issue is “What is a cause?” in a medical issue. A cause can be:

    1. Genetic - you can have a genetic predisposition to have sickle-cell disease, Tay-Sachs, etc
    2. Microorganism - flu, certain cancers, possibly diabetes, possibly Alzheimer’s, are caused by virus or other invasive organisms
    3. Trauma - problems can be caused by accidents

    Can “race” be a cause?

    1. If race leads to differential treatment, yes. But this is very frequently a class issue, as POC are often lower class, and this has implications for treatment options.
    2. Some say that racial discrimination leads to stress which leads to problems. There are other groups which have stress (poor whites, hispanics, etc) which should have the same problems. Do they?
    3. If race is CORRELATED with something, no. Being AA leads to a FAR HIGHER likelihood of sickle cell condition (other genetic heritages also, BTW). But race does not cause sickle cell - both are a consequence of a genetic heritage
    4. If subgroups associated with race have patterns of behavior, then race is again correlated. Blacks are more likely to be diabetic, which is caused by poor eating and mismanagement of weight. Race does not cause diabetes, but is associated with black eating patterns

    I contend that race is never a cause. The issue of 1) differential treatment is often a class issue, as all poor people have poor medical care.

    It is incumbent upon those who claim “discrimination based on race” to first eliminate other more first causes. Race is a tertiary “cause”, and is related to other genetic issues. So, if we are finding a higher proportion of POC dying from COVID, is it due to their overweight, diabetes, or other life-style issues? When I see pix of those who have died who are POC, they seem over-whelmingly over-weight. Is that the issue?

  13. Hello Alex, thanks for response!

    You got lucky and luck can run out. Any zealot can ruin your career on a whim.

    You are right here. No chance I try that ‘calling out the black kids’ move again, for that reason.

    If you are not subservient to the doctrine then you are its enemy.

    But this has to be true on both sides of the spectrum, no? And you seem a very reasonable guy, I’m sure you are surrounded by reasonable conservatives. I’m surrounded by reasonable progressives (and plenty of reasonable conservatives, for that matter). ‘Doctrinaire’ progressives are further from me ideologically than rational conservatives. They do not represent the rank and file, just as many of Trump’s more problematic ramblings don’t represent average conservatives.

    I guess I just find this idea of a rigidly monolithic doctrine to be overblown, to such an extent that this idea is harming dialogue.

    They would claim that you suffer from white complicity and white fragility.

    Not in my experience, although I have seen those ideas in the media. Again, not accurately representative of real people.

    Don’t be seduced by the siren call of virtue.

    I’m likely at the low end of any virtue scale, tbh. I have made more mistakes than most. And make no mistake - that siren is looking to seduce conservatives too - I’d say that she’s just appearing in a different guise.

    What is this conservative ideology that is ascendant, I don’t quite follow you here but will try to keep an open mind.

    Appreciated!

    well, what I primarily meant was neo-liberalism, which has dominated global politics and trade for decades, and that’s a conservative ideology. The Dems are a centre-right party, to my mind, (as are the Libs here in Canada). The idea that there is a massive campaign to undermine conservative values and lifestyles is wildly overblown, although there are elements of truth in this fear. And the political climate has become an anything goes free-for-all, hard to argue that this trend is not influential, and hard to argue that Trump isn’t primarily responsible.

    The idea that BLM supporters hate white people isn’t a conservative lie, it is progressive doctrine.

    If that’s true, I’m a statistical oddity in that, progressive HS teacher me has never encountered it. Never. I think it may be true of some on the fringes, but as doctrine, not in my mind.

    We are in dangerous waters and the time for political reflection has past. Our civilization rests on the precipice. The urgent thing to do is take decisive action and drive a stake through the heart of social justice theology.

    For me, climate change is a far more essential issue than social justice theology - a doctrine which dominated in the mid 90s in universities too, and then receded until recently.

    The right appears to have more empathy than the left can even detect.

    I believe there is empathy on both sides of all these debates - abortion, capital punishment (which doesn’t work, aside as retribution, and is enormously expensive). I think at the end of the day a conservative is perhaps more likely to act from a CLEAR moral perspective than a progressive, (often a religious one), and that religious practice does improve one’s capacity to love and to act morally. But it can also lead to judgement.

    I think we agree more than we disagree, Sentient, and I appreciate the conversation.

  14. When neoliberalism began under Thatcher and Reagan, it was desperately needed. This was the late stages of Keynesian economics in the seventies. The world was experiencing hyperinflation and nationalised industries existed upon taxpayer subsidies.

    The problem was it went too far. There was a strong argument for offshoring lower value jobs to the Developing World where those jobs undoubtedly did a lot of good- but exporting high value jobs was a grave mistake. It’s interesting that now that China is offshoring to Africa, they definitely aren’t making the same mistake.

    I don’t know whether I would call neoliberalism an ideology though- more a reaction to the times, or the ‘software’ of a particular brand of economics, which ended up going too far. It’s certainly a powerful lobbying interest, with both the GOP and the Corporate Dems somewhat captive to these ideas. It’s probably at its most harmful in the US when it’s expressed by the finance industry.

    The 2008 crash was caused by the cosy little quid pro quo relationship between Washington and finance- what began as a noble attempt to end redlining, quickly ended up becoming one of the quickest accumulations of toxic debt in human history, with Government promising a bailout before the event.

    I have found the same. I don’t know whether I’ve ever mentioned this, but until quite recently I was a lifelong LibDem voter in the UK- which is probably moderate liberal in American terms. What changed my mind was reading The Righteous Mind by Jonathan Haidt. I simply shifted a fair bit before we met online.

    I think the key difference between Conservatives and Liberals is that whilst both have empathy, Conservatives have far less faith in the power of Government to enact positive change.They are probably right about 80% of the time. The one blindspot they seem to have relates to reform-based approaches- both in terms of LEADs programs (Law Enforcement Assisted Diversion) and prison reform for non-violent offenders (although Trump has shifted the goalposts somewhat here- it’s the main positive thing he has done, other than on the economy).

    Our approach in the UK is hardly the ultraliberal reform ideology endorsed by the Europeans- but we’ve still managed to cut recidivism rates down to around 30% for most crimes.

  15. Neoliberalism is one of those loaded words that is usually used as a form of abuse. It isn’t really much use as a descriptor because there are so many examples of government intervention in all sorts of areas of life at all levels that make a nonsense of the left’s complaints that free enterprise is being allowed to run rampant.

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