More Race Concordance Falsities

The medical establishment is arguably the center of resistance to President Trump’s rollback of “diversity, equity, and inclusion.” While federal agencies and private companies alike are responding to the President’s actions by ditching DEI, medical schools, providers, and associations remain stubbornly committed to this divisive ideology.

The medical establishment argues that DEI – especially a diverse healthcare workforce – is critical for patient care. For example, the Association of American Medical Colleges insists that patients from groups “underrepresented in medicine” (i.e. black or Hispanic) benefit when patients can see doctors who share their skin color – a de facto form of segregation known as race concordant care.

But this claim is fallacious. Do No Harm recently discovered through a FOIA request that the study that forms the lynchpin of race concordance hysteria was produced by “scholars” who candidly admit to concealing certain data because they would “undermine the narrative” about “saving black infants.”

While the candor and lack of academic integrity among the researchers of that study is shocking, dishonesty and activism are the norm when race concordance is involved. The latest ideologically-driven, concocted attempt to peddle concordant care as a solution to health disparities comes via a recent systematic review published in the Journal of Racial and Ethnic Health Disparities. 

Systematic reviews can be a useful technique for aggregating evidence on a topic and then making a judgement based on the weight of the evidence. Five of six previous systematic reviews on racially concordant care concluded that it has no health benefits, while the one that purported to observe evidence of benefit was fraught with methodological problems. 

But this systematic review is unique from the others in that it only examines medication adherence as an outcome. Such a review could be valuable if properly executed. Unfortunately, it turns out to be woke agitprop.

The researchers identify five studies that fit the scope of the review. In describing those studies, the review claims that four observed better medication adherence among “BIPOC” (black, indigenous, and people of color) patients in concordant dyads. Based on these claims, the review concludes that race concordance is beneficial.

The description of the five studies is plainly inaccurate. Two of the studies – one by Adamson et al. (2017) and one by Traylor et al. (2010) – observe evidence of benefit for black patients, though not for Hispanic patients. Two other studies – one by Schoenthaler et al. (2012) and one by Schoenthaler et al. (2014) – only examined black patients and did not observe any benefit.

The fifth study was authored by Nguyen et al. (2020). The study was profiled in a Do No Harm report about methodological issues in studies that are regularly cited in defense of DEI. As the critique notes, “The sample’s demographics are not spelled out and results are not disaggregated by racial group. The authors could be hiding that the findings are not statistically significant when the analysis is limited to groups ‘underrepresented in medicine.’” The systematic review describes the outcome as “adherence increased for all races,” but this claim can’t possibly be inferred from the information provided in the Nguyen study. 

In total, then, two studies in the systematic review observe a race concordant benefit for black patients and two do not. The two studies that include Hispanic patients do not observe any benefit, while the Nguyen study obfuscates which groups benefit. The systematic review’s conclusion that “Four studies found that patient-provider race concordance was associated with higher cardiovascular and dermatological medication adherence rates in BIPOC patients” is plainly fictional. An honest review of the literature would reasonably conclude that evidence is mixed or inconclusive. 

So why all the dishonesty around race concordance? Because the idea of matching patients and physicians by race is essential to validating continued DEI efforts in medicine. If concordant care is seen as beneficial, then racial preferences in medical school admissions are simply a matter of “following the science.” Similarly, the concordance hypothesis would help justify efforts to train doctors on “implicit bias” by implicating the alleged bigotry of Asian and white doctors when it comes to health disparities.

As the Schoenthaler et al. (2014) study observes, trust is important for medication adherence. The medical establishment is sacrificing trust on the altar of identity politics. Americans can see through the charade. And so should the Trump administration, which could easily call out – and pressure – the medical establishment for maintaining a DEI edifice that’s built on a foundation of lies.