Race and discretion in American medicine.

Abstract

Rarely has a piece of social science research received more attention than the 1999 study by Kevin Schulman and others reporting large differences in physicians’ responses to identical heart disease symptoms presented by black and white actors portraying patients. The 720 physician-subjects who participated in the study referred lower proportions of African-American than white age and sex matched “patients” for cardiac catheterization, a costly, state-of-the-art diagnostic measure, even after the researchers controlled for physicians’ subjective impressions of disease likelihood and severity. Critics quickly found errors in the authors’ statistical methodology—errors that exaggerated these racial disparities. The New England Journal of Medicine, in which the article appeared, then took the extraordinary step of issuing a partial retraction. Yet publication of the Schulman study did more than any other single event to put the matter of racial disparities in health and medical care on the American public policy agenda—and to frame political discussion of the topic. Hundreds of prior publications reported powerful evidence of racial gaps in life expectancy, morbidity from various illnesses, access to health insurance and services, and the clinical management of disease. But the Schulman study’s use of African-American and white actors with identical scripts presented a stark picture of pure racial bias, uncomplicated by the potentially mediating roles of educational background, economic status, or other social cues. The study received