Commentary
VCU Grand Rounds Become Pulpit for DEI-Infused Misinformation
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DEI acolytes are loathe to let facts get in the way of narratives. Hopefully, students and faculty at the Virginia Commonwealth University (VCU) School of Medicine can spot the difference.
On May 30th, internal medicine grand rounds featured a lecture from Dr. Quinn Capers, a professor at the Howard University College of Medicine. The topic was “Diversity in Medicine: Battling the Anti-DEI Backlash with Data.”
Dr. Capers began with the question: “Why do we seek diversity in medicine?” He offered possible answers in a multiple choice format:
- Underrepresented Minority Physicians Are More Likely to Serve the Undeserved.
- Because Minority Patients Are More Likely to Follow the Recommendations of Minority Physicians.
- Diversity on Research Teams Enhances Impact of Research
- A Diverse Physician Workforce Will Reduce Racial Healthcare Disparities.
Ultimately, to the surprise of no one, Dr. Capers claimed “all of the above.” The evidence cited reveals more about how DEI steers medicine away from the pursuit of truth than anything else.
The first claim—that physicians from minority groups are more likely to serve minority or low-income populations—is true. However, the claim represents a solution in search of a problem.
Constraints on the supply of physicians are due to a limited number of seats in medical schools, not the number of people who aspire to practice medicine. There are thousands of highly qualified applicants rejected from medical school every year who would gladly work in urban or low-income communities.
The best hope for closing health disparities between different racial groups is to ensure that everyone has access to high-quality doctors, not recruiting individuals from specific identity groups to treat members of that group.
The second claim—that minority patients are more likely to follow the recommendations of minority physicians—is simply untrue. Dr. Capers references two studies to justify this idea. However, he conveniently ignores that a larger body of evidence contradicts the theory.
For example, studies by Clark et al., 2004, Howard et al., 2001, Jibara et al., 2011, Konrad et al., 2005, Saha et al., 2003, Schoenthaler et al., 2012 and Walsh et al., 2009 contradict Capers’ claim. Cherry-picking evidence is a regrettably familiar tactic among DEI devotees, but that doesn’t make it any less concerning. Proper medical practice should entail considering the weight and quality of evidence on a topic, not selecting evidence that tracks with preferred narratives.
A lack of candor on the limitations of the two cherry-picked studies is also notable. The first (Saha & Beach, 2020) entails an experiment in which black and white patients with coronary artery disease view video vignettes in which a doctor recommends a coronary artery bypass graft (CABG). The study participants are randomly assigned to watch a vignette of a white doctor or a black doctor. Surveys administered right after the videos reveal that black patients who were assigned to watch the black doctor gave higher scores to the “perceived necessity of CABG” and the “likelihood of undergoing CABG.”
These findings represent tenuous evidence of the claim that minority patients follow the recommendations of minority physicians. It is well-documented that intentions reported on surveys are poorly predictive of behavior, including receipt of medical interventions. Respondents claiming that they are more likely to undergo CABG after watching a short video is a far cry from actually undergoing the procedure.
The other study (Alsan et al., 2019) referenced to plug the idea that minority patients follow the recommendations of minority doctors also offers tenuous evidence. The study consists of a two-part experiment. In the first part, black patients are shown a picture of a doctor and then surveyed about their willingness to undergo certain preventative health interventions.
Willingness to receive the treatments does not differ by the race of the doctor in the photo. Differences are only observed after the patients meet with the physicians. It wouldn’t be shocking if by random chance the six black doctors in the experiment happened to be more persuasive than the eight non-black doctors. It’s also possible that their persuasiveness was not coincidental. As the researchers admit, the doctors “could have inferred” that the study was about racial concordance and could have altered their behavior in response, a phenomenon known as a Hawthorne effect.
The third claim—that diversity on research teams enhances impact of research—is embellished. The authors of the paper cited by Capers (AlShebli et al., 2018) observe a correlation between research team diversity and the number of citations that papers receive. However, correlation is not causation, and there are confounding factors that more credibly explain the relationship. For example, liberals ascribe comparatively higher importance to racial diversity. That probably means, on average, racially diverse research teams produce research that more closely aligns with liberal orthodoxy and accrue more citations as a result.
Like the second claim, the fourth claim—that a diverse physician workforce will reduce racial healthcare disparities—is an assertion that relies on extreme cherry-picking. Dr. Capers cites one study—Snyder et al., 2023—to assert that black patients receive better care from black doctors. In fact, many studies address whether racial concordance is associated with improved outcomes, and those studied have been summarized across two systematic reviews published in the last five years, as Do No Harm documented, in a report on racial concordance in medicine. Systematic reviews are a useful mechanism to prevent cherry-picking and instead make sense of aggregated evidence. The two systematic reviews that touch upon racial concordance and outcomes emphatically reject a connection between them.
The one study that Dr. Capers cites to justify the claim that black patients receive better care from black doctors purports to show that, at the county level, a higher proportion of black primary care providers is associated with a longer life expectancy for black residents and a reduction in the black-white mortality gap. The way that it derives a result at odds with other studies on racial concordance and outcomes is not difficult to decipher. There are a limitless number of arbitrary decisions that researchers make in developing mathematical models. For example, researchers must decide which variables to include, what time periods to observe, and which statistical techniques to use. Generally, researchers demonstrate that their findings would have been the same if they made different judgements about these things. Doing so shows readers that the researchers did not engage in p-hacking, a regrettably common practice whereby researchers try different model specifications until they find one that produces their preferred result. That the authors of this study did not demonstrate whether their findings are sensitive to model specification represents an enormous red flag.
Wherever it appears, DEI inevitably reveals itself to be an ideology at war with reason, facts, and logic. Medical students at VCU and across the country deserve better.
