Tuskegee and transplantation

Here's a complex story from the Chicago Tribune, that conveys just some of the complicated ways that many African Americans relate to transplantation:

Chicago has one female, African-American organ transplant surgeon. She fights disease — and distrust of doctors

“I’ve had patients tell me that they know transplant is experimental,” Simpson said. “I’ve had patients tell me they know white people get preference when it comes to time on the waiting list.”

"(Neither is true.)

“Patients are very frank with me in telling me they know things are unfair or experimental, and they’re the hardest to convince otherwise,” Simpson said. “Those are some of the most heartbreaking cases for me.”

"In some families, a deeply ingrained sense of betrayal, passed down through generations, can permeate doctor visits. It’s a product of medical experiments widely performed on slaves in the mid-1800s, a product of the 40-year Tuskegee syphilis experiment, begun in 1932, that denied hundreds of black men a proper diagnosis or treatment for a debilitating disease, a product of quality medical care existing just out of geographic reach."
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This remindes me of two related papers on the Tuskegee effect on black patients' relationships to American medicine, coauthored by my remarkable colleague Marcella Alsan:

Tuskegee and the Health of Black Men

Marcella Alsan and Marianne Wanamaker

The Quarterly Journal of Economics, Volume 133, Issue 1, 1 February 2018, Pages 407–455,https://doi.org/10.1093/qje/qjx029

Abstract

For 40 years, the Tuskegee Study of Untreated Syphilis in the Negro Male passively monitored hundreds of adult black men with syphilis despite the availability of effective treatment. The study’s methods have become synonymous with exploitation and mistreatment by the medical profession. To identify the study’s effects on the behavior and health of older black men, we use an interacted difference-in-difference-in-differences model, comparing older black men to other demographic groups, before and after the Tuskegee revelation, in varying proximity to the study’s victims. We find that the disclosure of the study in 1972 is correlated with increases in medical mistrust and mortality and decreases in both outpatient and inpatient physician interactions for older black men. Our estimates imply life expectancy at age 45 for black men fell by up to 1.5 years in response to the disclosure, accounting for approximately 35% of the 1980 life expectancy gap between black and white men and 25% of the gap between black men and women. 

and (from a previous post)

Saturday, August 18, 2018

Diversity isn't just about role models: Alsan, Garrick and Graziani on black male doctors and patients

Medical compliance--following the doctor's "orders,"--is a big issue in medical care, and here's an article that reports a novel field experiment suggesting that black male doctors treating black men may have more success than non-black docs.

Does Diversity Matter for Health? Experimental Evidence from Oakland
Marcella Alsan, Owen Garrick, Grant C. Graziani
NBER Working Paper No. 24787

"We study the effect of diversity in the physician workforce on the demand for preventive care among African-American men. Black men have the lowest life expectancy of any major demographic group in the U.S., and much of the disadvantage is due to chronic diseases which are amenable to primary and secondary prevention. In a field experiment in Oakland, California, we randomize black men to black or non-black male medical doctors and to incentives for one of the five offered preventives — the flu vaccine. We use a two-stage design, measuring decisions about cardiovascular screening and the flu vaccine before (ex ante) and after (ex post) meeting their assigned doctor. Black men select a similar number of preventives in the ex-ante stage, but are much more likely to select every preventive service, particularly invasive services, once meeting with a doctor who is the same race. The effects are most pronounced for men who mistrust the medical system and for those who experienced greater hassle costs associated with their visit. Subjects are more likely to talk with a black doctor about their health problems and black doctors are more likely to write additional notes about the subjects. The results are most consistent with better patient-doctor communication during the encounter rather than differential quality of doctors or discrimination.Our findings suggest black doctors could help reduce cardiovascular mortality by 16 deaths per 100,000 per year — leading to a 19% reduction in the black-white male gap in cardiovascular mortality.
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And here's a related very recent obituary:
Bill Jenkins, Who Tried to Halt Tuskegee Syphilis Study, Dies at 73

"Bill Jenkins, a government epidemiologist who tried to expose the unethical Tuskegee syphilis study in the 1960s and devoted the rest of his career to fighting racism in health care, died on Feb. 17 in Charleston, S.C. He was 73."