The issue of professional-football concussions might not seem all that important in the context of a global plague. Yet a dispute over how the NFL is addressing them illustrates a sort of racism that pervades the medical profession, and that is hampering the country’s efforts to defeat the pandemic.
Insult to injury. John Bazemore/Associated Press
Black NFL players are no less susceptible to concussions than those of other races. But according to a lawsuit filed by some of those players, they have struggled to tap the settlement money set aside to compensate for such injuries. Problem is, the required medical tests often employ racial norms that assume a lower baseline cognitive function for Black people, making it harder for them to demonstrate enough impairment to qualify.
The world might never know how many players such “race norming” has affected, because a federal judge recently dismissed the case and sent it to mediation. But from my day job auditing the algorithms that organizations use for everything from apartment rentals to driver’s license photographs, I can tell you that it’s the tip of the iceberg. I constantly encounter situations in which data, formulas and scoring have an embedded race norm – and it’s pretty much always biased against people of color.
Such bias is particularly unconscionable in matters of life and death, and helps explain why so many Black people don’t trust the medical establishment – and why vaccine hesitancy is so prevalent in the Black community. Consider how Black patients’ pain is taken less seriously, how Black women are two to three times more likely to die in childbirth, and how Black people are excluded from medical studies. Then there’s the Tuskegee Syphilis Study, in which Black men who were infected with syphilis were left untreated. Skepticism, or even outright suspicion, is the predictable outcome.
Correcting racial bias requires vigilance, because it can easily seep into calculations unnoticed. In deciding who should qualify for enhanced health care services, for example, one insurer sought to use historical medical costs as an indicator of underlying health – an approach that, according to a study by a group of U.S. researchers, excluded many poor and Black people who had lower costs merely because they hadn’t previously received the care they needed. Worse, clinical tests often apply explicit adjustments based on race – rather than on a patient’s actual condition – that can affect the chances of getting much-needed treatment, such as potentially life-saving surgery or assignment to a specialized cardiac ward.
None of this means doctors should stop using race altogether in decision making. Albeit complicated, accounting for race – or more specifically for ancestry – can be useful. For example, the prevalence of cancers caused by genetic mutations is higher among patients of Ashkenazi Jewish ancestry. This rightly qualifies Ashkenazi Jews for earlier screening and access to insurance coverage for genetic testing. African Americans are more susceptible to sickle cell disease – which might finally be curable, after being underresearched and often undertreated for far too long.
So, things are more nuanced than “let’s ignore race.” That would be impossible and unhelpful. Instead, one must keep the context in mind. In the case of the health insurer, adjusting for race might have helped more Black people get the enhanced services they needed. In the case of sickle cell, focusing research money could help address racial health disparities. But allocating cardiac-ward beds based on skin color could actually kill people.
It’s pretty clear where the NFL case fits in. Using general historical and surely biased statistics about the cognitive function of African Americans, without reference to their actual baseline cognitive abilities before they were professional players, seems designed to bilk them out of settlement money. It’s an extension of a horrible history of discrimination that needs to come to an end.
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