JAMA Once Again Favors Orthodoxy Over Rigor, Curiosity

A new study published in the Journal of the American Medical Association (JAMA) observes that black patients on dialysis are less likely than others to be placed on the kidney transplant waitlist. In what appears to be a matter of orthodoxy for JAMA, the researchers assume that differences in outcomes represent evidence of discrimination.

In Disparities in Kidney Transplant Waitlist Among Young Patients Without Medical Comorbidities, “researchers” observe that 22 percent of young black patients without comorbidities are placed on the kidney waitlist within a year of initiating dialysis. Among young whites and Asians without comorbidities, 34 and 42 percent are referred within a year, respectively. The researchers don’t scrutinize the various potential reasons for this phenomenon, instead concluding that it is “likely reflective of structural racism in access to transplants.”

Logic and evidence for the conclusion is wanting. If group differences alone provide proof of racism, one ought to wonder how Asians supplanted whites as the primary benefactor of structural racism. The higher likelihood of referral for Asian patients is never explained in the text.

Less interesting but more sensible explanations for group differences in referral to the kidney transplant waitlist point to factors other than racism. When doctors weigh which patients should be prioritized for kidney transplantation they consider factors such as social support, medical literacy, likelihood of adherence to a strict medical protocol, history of substance abuse, and willingness of candidates to undergo a rigorous medical evaluation that sometimes entails cardiac catheterization. Potential average group differences in any of these factors plausibly explain the observed disparities in referral for the kidney transplant waitlist.

Researchers interested in understanding the root cause of differences in organ transplantation would have considered multiple explanations. Unfortunately, JAMA and activist “researchers” favor dogma over rigor or intellectual curiosity, and American healthcare is forced to bear the consequences.