Activists Trot Out Bogus Studies to Defend DEI in Medicine

A look around the political and corporate landscape reveals that DEI is in retreat. Its champions are trying to salvage it with claims that it’s beneficial, but they remain as wrong as ever. 

Take, for example, an article published November 11 in STAT News called Cardiovascular health disparities persist in puzzling ways, studies find. The author admits that DEI is facing “political winds” but insists that four recent studies demonstrate why DEI is supposedly beneficial. Closer inspection reveals this assertion to be false.  

The first “study” mentioned in the STAT News article is called “Relationship Between Race, Predelivery Cardiology Care and Cardiovascular Outcomes in Pre-Eclampsia/Eclampsia Among a Commercially Insured Population.” The researchers observe that among white mothers with eclampsia or preeclampsia (dangerous hypertensive pregnancy disorders), receipt of predelivery cardiology care is associated with a lower incidence of major adverse cardiovascular events, or MACE (a composite measure of heart failure, acute myocardial infarction, stroke, or death). However, for black mothers with eclampsia or preeclampsia, receipt of cardiology care is not associated with a lower incidence of MACE. 

In making sense of the different outcomes, the researchers couch their explanation in default DEI positions, blaming “structural racism” and “racial biases in the delivery of appropriate and timely post-partum cardiology care.” As is so often the case with health disparities, a closer look reveals less interesting but more sensible explanations. 

One plausible explanation for the disparity is that preeclampsia is “more severe in women with African ancestry.” Likely, black women with preeclampsia who receive cardiology care have worse outcomes because they have more severe disease. The researchers theoretically address this concern by statistically adjusting their estimates to account for differences in preexisting heart conditions (cardiac dysrhythmia, valvular heart diseases, ischemic heart diseases, cardiomyopathies, and heart failure) and clinical morbidities (e.g. diabetes, assisted reproductive technology, dyslipidemia, hypertension, gestational hypertension, stroke, obesity, and obesity in pregnancy). However, this data does not perfectly capture differences in health across populations, and these differences can matter when interpreting results. A study purporting to show that black babies were less likely to die if assigned to black doctors was recently debunked by the discovery that researchers did not account for differences in the incidence of “very low birth weight.” In a similar vein, controlling for “obesity” masks significant racial differences in the incidence of morbid/clinically severe obesity. 

Another factor that plausibly explains the phenomena observed by the researchers is average group differences in how patients interact with the health care system. Black women are more than twice as likely as white women to receive late or no prenatal care. Likely, many who receive delayed care would have received an earlier referral to cardiology and better outcomes if they had secured timely care. In writing about limitations, the researchers correctly note that “we were unable to ascertain the frequency and timing of cardiology care throughout the pregnancy period. We appreciate that these factors may have [a] substantial impact on the care and outcomes for both races.” Nevertheless, this possibility is eschewed in favor of a radical, racialized hypothesis. 

The second “study” in the STAT News article is called “Racial and Ethnic Differences in Semaglutide Prescriptions for Veterans with Overweight or Obesity in the Veterans Affairs Healthcare System.” The researchers observe that black veterans in the VA health system are marginally less likely to be prescribed semaglutide as a treatment for obesity (8.9% for black veterans vs. 9.1% for white veterans). As the authors reasonably argue, the small difference masks the true magnitude of the disparity since black patients are, on average, in greater clinical need of weight loss treatment. 

What the researchers get wrong is asserting “structural bias” as a plausible explanation for the disparity. The idea that structural bias permeates the healthcare system is born of the fallacious ideas that group differences are indicators of maltreatment and that the pseudoscience of “implicit bias” provides meaningful insight into American healthcare. Likely, the lower receipt of semaglutide simply reflects average group differences in demand for treatment or treatment hesitancy. 

Not only is the assertion about “structural bias” wrong, it is also logically inconsistent. The next study highlighted by STAT News is called “Social Determinants of Health and Disparities in Guideline-Directed Medical Therapy Optimization for Heart Failure.” According to that study, black and Hispanic patients with heart failure with reduced ejection fraction (HFrEF) are more likely than white patients with the same condition to receive quadruple therapy optimization, the optimal treatment plan for that condition. According to the logic that disparities that disadvantage a group are evidence of maltreatment against that group, the findings would suggest – absurdly – that “structural bias” in healthcare exists against white patients. In reality, disparities that at times favor one group and at other times favor a different group reveals the complex, multifaceted nature of health disparities as well as the absurdity of DEI orthodoxy and its default explanation of racism.

The final study cited by STAT News is called “Perceptions About Diversity, Equity, and Inclusion Among Cardiovascular Fellows‐in‐Training.” The “researchers” observe that some of the cardiovascular fellows-in-training who answered their survey feel that DEI efforts in their programs are insufficient. For example, “Although 66% felt DEI was an institutional priority and 63% a fellowship priority, 34% of participants strongly or somewhat agreed that community engagement and outreach was not valued by their institution.” The trouble is that the efficacy and wisdom of DEI aren’t ultimately determined by the sentiment of a small group of activist physicians but by how DEI impacts medical education and patient outcomes. The verdict couldn’t be clearer.