Race Preferences for Medical Practice

Back in December ’04 UCLA Law Professor Richard Sanders published A Systemic Analysis of Affirmative Action in American Law Schools in the Stanford Law Review which detailed the costs to African-American students of being recipients of Affirmative Action (see here and here for the Cliff Notes versions.) As you can imagine this set off a fire storm of protest, similar in tone, though subdued in fury, to what followed the publication of Rushton and Jensen’s paper Thirty Years of Research on Race Differences in Cognitive Ability. Critics lined up to take their shots at Sanders. A good summary of the ensuing battle can be found at the Volokh Conspiracy, here and here (Be sure to read the comments.)

As with Ruston & Jensen’s paper, the controversy that followed Sanders was a clear case of conflicting Axioms with many of the rebuttals arguing from the Axiom of Equality, the Axiom of Proportionalism and Axiom of Social Justice, and were primarily worried about the decreased African American presence in law schools that would result if Affirmative Action was eliminated. In reading many of these rebuttals I was struck by the game theoretic aspects which argued that if Affirmative Action was eliminated that many African-American students would transfer their ambitions to other Professional Schools that still employed Affirmative Action policies. The critics argued that Law Schools shouldn’t abandon the crutch they’ve provided to minority students thereby foreclosing the prospect of losing these unqualifed students to rival faculties. The critics seemed to completely miss that Sanders was arguing from the Axiom of Merit, which he felt trumped the existing policies of the Law Schools.

After reading through the back and forth volleys I got to wondering why no similar study had been conducted on the effects of Affirmative Action within the medical community. Afterall, the stakes are certainly greater in that a medical student’s performance impacts on the health of patients, rather than simply their well-being (civil law) or freedom (criminal law.) What I really wanted to see was how medical malpractice suits were broken down by race of the physician but I couldn’t find any data at all. If anyone has access to such data, please leave a comment or e-mail me with the particulars.

I’m guessing the data is proprietary to insurance companies and is probably essential in determining insurance rates. After reading some of the data from the National Medical Association, which represents the interests of African-American physicians, it’s clear that obtaining malpractice insurance is a significant problem for its members, but considering that we’re in the middle of a malpractice crisis, it’s imposible to ascertain whether African-American physicians’ rates, and difficulty in obtaining insurance, are any different from the physican community as a whole.

However, even without the medical malpractice data, the consequences of Affirmative Action are evident in how minorities perform in medical school and in subsequent licensing examinations:

The study examined admissions records in two separate years at the five medical schools: the Medical College of Georgia, Michigan State University College of Human Medicine, the University of Oklahoma College of Medicine, the State University of New York’s Brooklyn College of Medicine, and the University of Washington School of Medicine.

[ . . . . . ]

For example, at Michigan State University’s College of Medicine in 1999, the median grade point average (GPA) for white admittees was 3.61, nearly an A-, while the median GPA for black admittees was 2.93, slightly below a B. Furthermore, the median MCAT score for blacks admitted to Michigan State that year was 29 (out of a possible 51 points) compared to 36 for whites.

[ . . . . . ]

These differences in admissions rates mirror the racial disparities in accomplishment on the first stage of the medical licensing exam. Scores from Michigan State averaged over a three year period show that 14% of black students failed the Step 1 of the exam, and 10% failed to take it, while among white students the failure rate was only 1% and the untested rate, 4%. Thus cumulatively, 24% of black medical students at Michigan State failed to complete the first stage of obtaining a medical license compared to only 5% of white students. Among Hispanics the combined rate was 8% and among Asians, 2%.

[ . . . . . ]

These figures are especially stark when one considers that the scores reported by Michigan State are final scores. Medical students are allowed to take Step 1 up to six times, and when a student fails several times, only the final result is reported. Thus the 14% of black students at Michigan State who are noted as failing the exam, may in fact have repeatedly failed to pass the exam and have a failure listed as their final result, and will not be able to obtain a medical license unless they are able to pass Step 1.

More disturbing than even the failure rate of minorities on the licensing exam, Clegg asserted, “is that even among the students who ultimately pass the exam it’s fair to assume that they are not going to be as successful as doctors as students who are academically better qualified would have been.” He continued, “You know one of the responses that we heard to our study was, well, what’s wrong with racial and ethnic preferences because no one’s going to be qualified to become a doctor unless they pass the exam…as far as patients are concerned, not only will there be fewer doctors, but the doctors who finally do become admitted are not going to be as good. The idea isn’t simply to admit students who are able to scrape by with a passing grade after taking the medical exam several times. We should be trying to have the best possible doctors, not doctors who are simply minimally qualified.”

It appears that Affirmative Action’s lenient admission standards weeds out the weaker candidates before the time for placement through the National Resident Matching Program sifts and sorts the nation’s medical school graduates and places them into residency programs. Surprisingly I didn’t find any declarative statements that the program grants any preferential treatment to minorities, so if this is a true condition, we’d expect to see more of a merit-based sorting based on the competitiveness of the various disciplines.

It’s frustrating that the data I’m seeking is not available, for I think it would be informative to get a racial breakdown of medical specialties and compare the results to the difficulty of winning admission into the medical specialties.

I did find this breakdown of Black Physicians in New Orleans, and using the competitiveness data above, 9% belong to the Extremely Competitive specialities, 15% to the Very Competitive, 30% to the Competitve and 46% to the Less Competitive. Again, the corresponding data from the medical community as a whole is difficult to extrapolate without access to more data s
ources. Here is a datasource on State Health Facts that some may find useful.

So what is the ripple effect of admitting minority students to medical school under preferential quotas? The evidence is clear that a sizable portion of minority students simply won’t get licensed to practice. Of those that do get licensed, I’d dearly like to know how well they perform without institutional favoritism shielding them from the full effects of competition and how well they adhere to professional standards.

Once out of medical school, the results of Affirmative Action can have real consequences:

This debate over the possible benefits of racial preferences at the nation’s medical schools was most famously raised by the 1978 Supreme Court case, Regents of the University of California v. Bakke, in which the Court ruled that the use of racial quotas in admissions was unconstitutional but continued to allow for an applicant’s race to “tip the balance” in his favor.

One famous beneficiary of racial preferences in admissions is Bernard Chavis, whose admission into the University of California’s medical school despite his inferior academic accomplishment prompted Bakke to file suit against the university. Long upheld as an example of the success of racially biased admissions programs, Chavis made a career serving poor minority communities until the Medical Board of California suspended his license to practice medicine in 1997, warning of his “inability to perform some of the most basic duties required of a physician” after one woman died and two more suffered serious complications after receiving liposuction from Chavis.

We also see problems with institutional slipping of standards, as Godless noted the problems facing two black medical schools:

A Courant analysis of disciplinary actions against doctors nationwide found, however, that both Howard and Meharry produce troubled doctors more frequently than most other schools – at rates about 10 times greater than the schools with the lowest numbers. The actions ranged from a simple citation to permanent license revocation for a range of misdeeds including medical incompetence, ethical lapses and criminal behavior.

The findings – controversial and politically sensitive as they are – defy simple explanation. [Really?…]

Howard and Meharry are not offshore schools with little accountability to U.S. regulators. Their programs are regularly reviewed and are subject to the same accreditation standards as all other American medical schools. They graduate many fine doctors.

So what accounts for the higher rates of disciplinary actions?

With the consequences of incompetence being so much greater in the field of medicine than in law, a study similar to the one conducted by Professor Sanders is urgently called for. If the Axiom of Merit loses ground to the Axiom of Proportionalism, we could see calls for increased enrollment under preferential guidelines for minority students as reported in The Right Thing to Do, The Smart Thing to Do: Enhancing Diversity in Health Professions by the National Academies Press:

A projection model developed by Libby yielded results indicating that in order to reach 218 physicians per 100,000 persons for each racial/ethnic group, the numbers of first year residents would need to roughly double for Hispanic and black physicians, triple for Native American physicians, and be reduced by two-fifths for white and Asian physicians.

Note how Asians are Honorary Whites in that report.

It’s difficult to model how reduced standards for minority students can be ameliorated if they are not as prepared as their colleagues for the rigors of medical school, have higher failure rates during their education, have a more difficult time passing licensing examinations, and with some schools at least, have a disproportionate presence in disciplinary hearings. Are we to believe that simply practicing their craft on innocent patients will over time increase their competence to the same level of their colleagues who weren’t admitted under preferences schemes?

Related: What do you call a black doctor? and ER Meets Reality and Bell Curve For Doctors

Tales of chromosomes

Carl has a nice post up on chromosomal changes on the heels of an article he wrote on the topic recently. He references two papers, one comparing the macaque and human genomes, and another that compares various mammalian orders. I have previously pointed to a paper (you can read the full text at the link) which reviewed gene expression differences in human and chimpanzee brains and found that differentially expressed genes tended to be found on the 10 chromosomes which seemed to be rearranged in humans vis-a-vi chimpanzees. The correlation between these two genomic features (differences) is certainly worthy of further exploration. Also, please note that the domestic and wild (Przewalski) horse have 64 and 66 chromosomes each, and hybrids have 65, while another cross with the domestic horse results in 64. This page has more references of similar crosses (different chromosome numbers in the parental generation but viable fertile offspring).

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Intergroup violence

PNAS finally posted the paper The evolution of lethal intergroup violence (previously discussed).1 I’ve uploaded the PDF in the files section of the gnxp forum as “intergroupviolence” for readers who are interested (you might have to register to view files).

1 – It is rather annoying that webmasters are often days late posting papers that the press often reports as “available on the website today.”

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What Americans believe about religion (sort of)

Newsweek and Beliefnet conducted a poll in early August and the results are in. There’s a lot of data to digest, and I think it is important to understand how Americans view their own religion since there are so many analogies we use and comparisons we make assuming the character of American religion as a given (“American Taliban,” “Muslim fundamentalists,”1 etc.). Here is the most interesting result to me:

Can a good person who isn’t of your religious faith go to heaven or attain salvation, or not?

Yes
Evangelical Protestants – 68%
Non-Evangelical Protestants – 83%
Catholics – 91%
Non-Christians – 73%
Total – 79%

No
Evangelical Protestants – 22%
Non-Evangelical Protestants – 10%
Catholics – 3%
Non-Christians – 3%
Total – 12%

Don’t know
Evangelical Protestants – 10%
Non-Evangelical Protestants – 7%
Catholics – 6%
Non-Christians – 24%
Total – 9%

The question is broadly stated. My personal communication with many evangelicals is that they tend to demur in responding to a query as to whether Roman Catholics may attain salvation, and often are open to the possibility, but will affirm that non-Christian religions are a definite path to hell. Nonetheless, it is an intertesting gauge of the situation in a country that is both extremely religious (at least by affirmation) and pluralistic.2

1 – The term “fundamentalist” is originally from the early 20th century in relation to the Protestant literalist movement and its revolt against modernist interpretations and scripture and adherence to a set of “fundamentals.”

2 – If you click the link and check the survey you will note that only 77% of those between the ages of 18-39 affirm a Christian faith, as opposed to 90% of those older, so the variance in religious belief is getting larger.

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Beyond MC1R

I finally read Heather Norton’s review of worldwide MC1R polymorphism. In case you forgot MC1R is a locus that has been implicated in the expression of pigment in human beings, and mutations on it are often correlated with the various phenotypes we see around us (red hair, light skin, etc. etc.). The major take home point of Heather’s paper is there is more than meets the eye than MC1R. For example….

1) Heather points out that there is no association (ie; mutation ~ change in phenotype) between eye color and MC1R. Something else is controlling the expression of eye color. This is interesting because Joe Birdsell in Microevolutionary Patterns in Aboriginal Australia states that iris color is often inverted in direction of trend from hair and skin color in many populations as a function of sex (including Australian Aboriginals). In other words, males tend to have lighter eyes and darker hair and skin than females.

2) There are likely gene-gene interactional effects between MC1R and other loci. In other words, there isn’t going to be a simple and elegant prediction equation like the ideal gas law (PV=nRT) which maps various additive loci onto a phenotype (different combinations can lead to the same phenotype, for one, and the genetic effect of a locus is dependent on the alleles at the other loci).

3) Europeans are extremely diverse on this locus vis-a-vi other populations. There are 30 alleles which break the 1% threshold within European populations It seems that Heather and her coauthor suggest that relaxation of functional constraint (UV radiation) is the most plausible hypothesis, but the power of the statistical tests doesn’t warrant a final conclusion (ie; it could be some sort of diversifying selection).

4) East Asians tend to exhibit very high frequencies of the Arg163gln allele (as high as 80% among the Dai of Yunnan province in China, decreasing to 40% among the Uighers of Xinjiang and less than 10% in South Asia [ie; India]). The authors suggest that this allele might have been subject to strong directional selection in the recent past. They note that “under neutral expectation, the estimated arrival time of the Arg163Gln allele is older than the age of modern humans….” Things that make you go hhhmmm….

Overall, skin color is a messy polygenic trait. It is almost certainly not a nice Fisherian topography, but we have mapped the rugged gene-gene interactions at work so generalizations are hard to come buy that add any value to our knowledge-base. Additionally, some loci like MC1R are likely to have particularly strong effects because they lay at the nexus of various regulatory pathways. Finally there is the hypothesis that Greg Cochran and others have put forward which opines that perhaps some of these alleles (look at how many Europeans carry!) “jumped” from other ancient hominid lineages and were under selection subsequent to the hybridzation event.

Update: Lei has more.

Related: Blonde Australian Aboriginals. Black and strawberry. What controls variation in human skin color? Genetics of Hair Color (again). Genetics of hair color. It’s better on fire. An email Heather sent me. Evolutionary speculations.

Kapu: Charles Murray on Race, Sex, and Intelligence

I’m off the computer until this evening, but Commentary has Charles Murray’s September issue article The Inequality Taboo up on their website now, available for reading.

Update from Dobeln: The most interesting thing about this essay is not the text itself – it’s a wrap-up, with no new revelations. Rather, it’s the fact that it got linked by blogging powerhouse Instapundit. This in turn indicates that the Instapundit is a card-carrying member of “the stealth consensus”. Something tells me unorthodox ideas will be harder to squelch in the Internet era…

more inside

Jason M. Adds: Who’s listening?

Al Fin+
American Kernel +
Andrew Sullivan +
Armed and Dangerous +
Bellhorn at Bat +
Blogospherical Ruminations +
Brainster’s Blog +
Chris A. Miller +
The Citizen-Journal +
Steven Donohue +
Dustbury+
I, Ectomorph +
Evan Kaiser +
EvoWeb +
Instapundit +
Kaiser +
Logical Meme +
Mad Kvalsvik +
Mahalanobis +
Mankind Minus One +
NoSpeedBumps +
Paco Pond +
ParaPundit +
Penultimate +
Random Thoughts +
Red Hill +
Res Ipsa Loquitur +
Spartacus +
Steve Sailer +
Sweet and Sour +
Thrasymachus +
Tjic +
Vulgar Morality+
Weekend Pundit +
Wide Awake Cafe+

Action Potential +/-
Begging to Differ +/-
Bilious Vapors +/-
Free Republic +/-
Hatful of Hollow +/-
Intelligence Testing +/-
Lies and Statistics +/-
The Plonkers +/-
Washington Monthly +/-

Atrios
Best of Both Worlds
Brad Delong
Echidne of the Snakes
Effin’ Kidding
Lawyers, Guns and Money
Matt Stevens
Matthew Yglesias
Minipundit
Steve Gilliard

(I’ll probably do this with the Lynn study news too, which seems to be generating a lot of talking)

Rikurzhen: remembering the 90s – Mainstream Science on Intelligence – signed by 52 experts, Intelligence: Knowns and Unknowns – from the American Psychological Association

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Conditional response….

HUMAN SEXUAL DIMORPHISM IN SIZE MAY BE TRIGGERED BY ENVIRONMENTAL CUES:

Evolutionary biologists mostly assume that polygyny increases sexual dimorphism in size because, under polygyny, larger males monopolize mating opportunities and pass on their ‘large male’ genes to their sons. Available data on parent–child correlations in height among humans (Homo sapiens) do not support the crucial assumption that height is transmitted along sex lines. This paper instead suggests that human sexual dimorphism in size emerged, not because men got taller, but because women got shorter by undergoing early menarche in response to polygyny. It further speculates that, rather than genetically transmitted, the sexual dimorphism may emerge anew in each generation in response to the degree of polygyny in society. The analysis of comparative data supports the prediction that polygyny reduces women’s height, but has no effect on men’s, and is consistent with the speculation that the origin of human sexual dimorphism in size may be cultural, not genetic.

The authors present evidence that women who enter menarche earlier reach a shorter adult height while in societies where polygyny (defined as male reproductive variance:female reproductive variance) is more pronounced also tend to exhibit more sexual dimorphism. At the end of the paper the authors hypothesize that a biological-proximate process that might affect menarche are pheromones produced by the father which interact with his daughter’s physiology. Evidence which shows later menarche for girls who spent a greater time with their fathers is brought forward, the logic being that polygynous fathers can provide their daughters far less individual attention (ergo, pheromones).

Related: Father absence and reproductive strategy: an evolutionary perspective.