Race matters

A new study on race and medicine may sadden and anger UW Medical School’s Vanessa Northington Gamble, but it doesn’t surprise her. Professionally and personally, she knows all too well that skin color and cultural background figure in medicine, as in every other aspect of American life.

On TV Vanessa Northington Gamble will appear on ABC’s Nightline tonight, commenting on a study to be published in the New England Journal of Medicine Thursday, Feb. 25, that shows doctors are less likely to order cardiac diagnostic tests for blacks than for whites, even though all patients noted exactly the same symptoms of heart problems.

Vanessa Northington Gamble

Gamble learned a few weeks ago that a study to be published in the New England Journal of Medicine Thursday, Feb. 25, shows doctors are less likely to order cardiac diagnostic tests for blacks than for whites, even though all patients noted exactly the same symptoms of heart problems.

“This meticulous study shows us once again that — consciously or subconsciously — race and ethnicity shape the expectations, beliefs and sometimes the practices of physicians,” says Gamble, director of the UW Center for the Study of Race and Ethnicity in Medicine.

She will appear on several news programs, including ABC’s “Nightline,” this week, commenting on the study and offering her perspective as a nationally known expert on race and medicine.

“For a long time, people have mistakenly believed that doctors are above racism; that since their job is to heal people, they simply can’t be prejudiced,” she says. “This study is one of many to remind us that the medical profession is not immune to this difficult issue of race, and that disparities based on race exist in medical decision- making.”

Gamble’s life work is dedicated to the arduous task of getting people to honestly think about, discuss and try to understand the insidious role racism can play in interactions between doctors and patients. Her efforts were rewarded most visibly in spring 1997, when President Clinton formally apologized to the remaining survivors of the Tuskegee Syphilis Study.

The 40-year, federally sponsored study may have been the most compelling and sobering example of racism in American medicine, says Gamble, who served as chair of the legacy committee that sought the national apology. The study involved 400 poor, black sharecroppers who were led to believe they were being treated for syphilis, when in fact they weren’t.

“The apology was important because Tuskegee is a metaphor for why black Americans may not trust the medical establishment,” she says, noting that the mistrust may explain why some African Americans reject or don’t comply with certain treatment programs. “The gesture was a start toward rebuilding trust.”

Beyond the fleeting symbolism of a presidential apology, Gamble tries to bring historical perspective on race in American medicine to present-day health care policymaking. She’s a member of the Agency for Health Care Policy and Research’s National Advisory Council and is helping the agency develop a response to the Department of Health and Human Services’ “Race and Health” initiative. She’s consulted with and presented workshops for the Centers for Disease Control and the Association of American Medical Colleges. Gamble, an associate professor of history of medicine and family medicine, also pursues her mission at the UW Medical School center.

“Racial and ethnic diversity has increased dramatically in the entire country during the last 25 years, and this trend is likely to continue,” she says. “The center was created to understand the implications of these demographic changes on medical education, research and practice.”

Center staff investigate the often subtle ways race and ethnicity affect opinions and actions that can lead to inequities in health care delivery. Planned studies will examine, for example, why the incidence of some diseases and conditions is higher or lower in certain racial and ethnic groups.

“We want to identify and implement strategies to improve the health care status of racial and ethnic minorities throughout the state and nation,” she says. “We hope to achieve this through educational programs, outreach efforts, networks and clearinghouse activities.”

Gamble says there are plans to institute educational programs on race and ethnicity at all levels of medical education, although in the past, medical educators have been reluctant to include race issues in the formal curriculum.

“But the AAMC considered the topic important enough to address in a plenary session at its annual meeting last November,” she says, “and the current study dramatically makes the point — race matters.”