Black Doctors, Black Babies

There’s a paper out claiming that black infant infant mortality is much higher when they’re treated by white doctors, rather than black doctors.

Could it be that MCAT scores have negative predictive value?

No, there’s a simpler explanation: the report is nonsense.  A metaphorical cee-gar to the first person to explain why.

And the next question is: why do the pinheads that authored this paper have jobs?

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60 Responses to Black Doctors, Black Babies

  1. Jakub says:

    Stupid doctors treat simple cases.

  2. White doctors, being on average more competent, are more likely to be employed in the serious cases and thus are more exposed to risks.

  3. Albert says:

    More serious conditions are treated by better doctors. However even with the better doctors, the babies with more serious conditions die more often than babies with less serious conditions.

    • gcochran9 says:

      In much the same way, if you get referred to a neurosurgeon, you’re much more likely to die than if you’re being treated by a GP. Generally, you’re only referred to a neurosurgeon if you’re in genuinely deep shit. They lose half their patients, last time I looked.

      • Dan Eggum says:

        Don’t know their method and expect its bullshit, but how do you account for this? “Strikingly, these effects appear to manifest more strongly in more complicated cases”

      • gcochran9 says:

        For some reason I assumed the authors were MDs. Not so: business school, public health. I can only hope that they become more familiar with how medicine actually works – much more familiar, and soon.

      • ApacheTrout says:

        I get your overall point but you’re a little off base about neurosurgeons losing half of their patients. Most neurosurgeons these days do primarily or exclusively spine surgery because that’s where the money is. No where near 50% mortality. Same for functional neurosurgeons ( DBS, radiosurgery, pain, etc.). Neurosurgeons seeing primarily trauma, cerebrovascular disease (aneurysms, AVMs, strokes), and brain tumors may approach your “half” criteria but I think that is probably also over the top. BTW, I appreciate your iconoclastic views and your willingness to take on controversial topics.

        • gcochran9 says:

          I heard that claim a long time ago, probably more than 30 years. I don’t think spine surgery was that big a thing, back then (?), and one hopes that techniques have improved.

          Around that time I also heard of a very fetching young neurosurgeon that was a nymphomaniac: she and this guy ( friend of a friend) were supposed to be on call at an ER, but she was demanding. The nurses kept calling, and she’d pick up the phone and yell “Give him some Tylenol !”, slam it down, and get back to work. I have not enough data to think that this is typical.

      • glenndc says:

        Day late, but with dollars.
        Had to laugh at your comment. I’ve always thought that the one person I didn’t want to see at the foot of my hospital bed is the Nephrologist.

  4. Karl Liebhardt says:

    Could it be that blacks with more money choose black drs and poorer ones don’t have as much choice and usually get white drs. Poorer blacks probably run other health risks which are likely to create issues for gestation and delivery.

  5. Vaguely related; is it dumb to worry about mutational load from low rates of infant mortality due to muh science? Seems long term bad. How long is long? 2 generations? 1?

    • mishsandbox says:

      Assume mere 5% fitness loss per generation, now going on a dozen generations since industrial revolution, non-linear additive effects and you should see scary picture. Now look around and compare.

      In 1900 8% of newborn did not survive past 15 – and that is from all causes, including accidents for population that was still mostly rural/farming.
      How many children now would not survive a year with 1900 level of medical technology?

      • Wolf says:

        – 90% of the 8% now survive
        – survivors suffer a 50% fitness penalty
        – 80% heritability of defect
        – 5 generations

        An additional 13.2% to the 8% wouldn’t survive. So 21.2%?

    • david says:

      Dr edward dutton writes about this frequently

    • Steve says:

      Here’s an interesting take on that topic from 2017:
      “Social Epistasis Amplifies the Fitness Costs of Deleterious Mutations, Engendering Rapid Fitness Decline Among Modernized Populations”
      (Paywalled, but full text can be found on scihub/ libgen)
      If human societal structure is at least partly an emergent product of individual human behavioral tendencies, and if those tendencies have a significant genetic component, and if at least a third of human genes are expressed primarily in the brain, then relaxation of selection against deleterious mutations leads to… mouse utopia?

  6. Ryan spagniola says:

    More complicated cases go to white docs?

  7. catte says:

    (hey Mr Cochran I accidentally got the name and email fields mixed up in a previous comment, could you please delete the message? thank you.)

    Anyway, isn’t this Simpson’s Paradox?

  8. I have a story about something related to this. I know a doc who treats a lot of diabetics, in a heavily African-American area. One of the key issues with diabetes is getting the patients to actually do the things that will help them: eat better, exercise, take their meds on time. This doc hit on a way to get elderly black ladies to do what they’re supposed to: she refers those patients to a very handsome black diabetes doc in the area. He tells them exactly the same things, and the patients are substantially more likely to do it.

    • Durga says:

      These elderly black ladies are probably old enough to remember the Tuskegee Syphilis Experiments, likely have heard the story of Henrietta Lacks, and may possibly be aware of the experiments of JM Sims…

  9. Your mom says:

    Biggest problem I see here is the geographical distribution of race in Florida. Blacks tend to be clustered more heavily on the Georgia border (Jacksonville, Tallahassee and surrounds), not in the more affluent areas in the Southern Panhandle and coastal areas.

    I’m guessing successful black physicians are delivering White and Latino babies along the coasts and in the suburbs where there is a surplus of great doctors. Even though they only used Latino doctors as their check (to which they found no difference between White doctors), the sad truth is that Black babies die at roughly the same rate regardless of the race of the doctor.

    P.S., I’m glad they were able to narrow this down to racist Smith and Jones’s with their cold, blue eyes. Last thing we need is a half-Korean, half-Jewish, half-Mexican doctor with blood on his hands.

    • Smithie says:

      There’s a poetic line I like about the aftermath of a medieval battle:
      “Many a blue eye were buried in the cold clay.”

      I think it would make a good scene in a movie that allowed for a little narration.

  10. Purplehermann says:

    I should expect this to hold true for white infants as well, what am I missing?

  11. STEM Caveman says:

    Ben Carson, for example, had some of his Siamese twin separations end in the death of the children. Doctors who get the harder cases as, as a group, better qualified and have worse statistical outcomes — if the statistics are done naively.

    A similar illustration is that your outcome, as measured by grades attained, will be lower if you study engineering at MIT than at the state university. Does not mean you will learn less at MIT.

  12. Gord Marsden says:

    The white doctors are at high risk clinics

  13. teageegeepea says:

    This is off-topic, but Scott Alexander’s most recent discusses selection against mental disorders and how that affects whether we should consider them “diseases”:
    It’s exactly the sort of Darwinian logic Greg normally dings the DSM for ignoring.

  14. Ur-man says:

    They look smart to me.

    tell authority (i.e. their funders) what it wants to hear
    no one is socially permitted to point out the logical flaw in their work

    Maybe the lead author bought a boat.

  15. saintonge235 says:

    How do the authors have jobs? They say the things their ‘bosses’ want to hear, ‘bosses’ in this case being those who give out grants and hire for institutions.

    I’m surprised I have to point this out.

  16. mtkennedy21 says:

    There was a study published in the last ten years on maternal and fetal mortality that disproved this thesis. It was done on military members and dependents who received identical prenatal care. Blacks had the worst outcomes and Hispanics the best. Birth weight and morbidity/mortality. Unfortunately, I can’t find the reference.

  17. rgressis says:

    Off topic, but: does anyone know whether there is good evidence that allows us to answer the following question with high confidence: “if you get a COVID-19 vaccine, how likely are you to still spread the virus?”

  18. Rob says:

    Greg, if you were science and tech dictator for the government, what are the big projects you’d like to see concerted effort and funding for?

    Von Neumann factories?
    Preventing/reversing aging?
    Intelligence increase/eugenics?
    Rebuilding meritocracy?
    Funding for blue sky projects?
    AI that is more than pattern matching?
    Safe clean fission or fusion?
    Reverse global warming?

    Like imagine you got to direct a budget like SDI had. What should we do?

  19. romue says:

    infants are colorblind at birth

  20. Roland H Müller says:

    Babies start to see colours with four months

  21. mapman says:

    “why do the pinheads that authored this paper have jobs?”

    Because these days, in their jobs, not understanding is what actually provides jobs security. Some of these people (small fraction, admittedly) actually do understand that they are publishing bullshit.

  22. Henry Scrope says:

    And the next question is: why do the pinheads that authored this paper have jobs?

    Because what they say suits the zeitgeist, the obvious weakness, even falsity, is ignored.

  23. akarlin says:

    Cochran is truly lord of the succinct take.

  24. HK111 says:


    this is a bit off-topic, but have any of you had time to look into the paper “A Bayesian analysis concludes beyond a reasonable doubt that SARS-CoV-2 is not a natural zoonosis but instead is laboratory derived” by Steven Quay?

    I am currently at page 47 and think that some arguments sound strong, e.g. that no other Coronaviruses in the same subgenera have furin cleavage sites, but at the same time adding a furin site was done in the laboratory.
    “Since 1992 the virology community has known that the one sure way to make a virus deadlier is
    to give it a furin cleavage site at the S1/S2 junction in the laboratory. At least eleven gain-of-
    function experiments, adding a furin site to make a virus more infective, are published in the
    open literature, including Dr. Zhengli Shi, head of coronavirus research at the WIV.”


    • ghazisiz says:

      Engineered. OK. Lots of people believe that. But what is the raison d’etre? A full conspiracy theory needs at least that additional detail. US bioweapons folk create it and spread it around a Chinese bioweapons facility to embarrass the Chinese? US DeepStaters take it to China to create a worldwide pandemic so that Trump loses the election? A Chinese bioweapons low-level employee steals lab animals to sell in the local food market and inadvertently releases an engineered pathogen?

      • Mark Pontin says:

        Raison d’etre if COV19 is a bioweapon? Those you’ve suggested are implausible. Here are a couple that are more convincing —

        [1] To sabotage globalized supply chains and put neoliberal globalization in reverse.

        [2] To expose a U.S. looted out by financial extraction and elite rent-seeking (and so having no decent healthcare structure) to a slow-motion Chernobyl-type event whereby the supposedly ‘exceptional’ first among first-world nations is revealed as the incompetent kleptocracy it’s become and the Empire’s collapse is thereby accelerated. (Because that’s where it’s going. Biden, for instance, almost makes Breshnev, Andropov, Gromyko, and company look sprightly and intelligent by comparison.)

        That said, classical agents resulting from nature’s mutation machine (which in the fullness of time would inevitably hit on the cited furin cleavage site at the S1/S2 junction, forex) are almost always more pernicious and virulent than designer pathogens — at least, thus far. It seems more likely that COV19 is NOT a designer pathogen.

        I don’t rule it out, though. The aim of any military action is to change the enemy’s behavior. Bioweapons are slow and unreliable for killing people compared to bombs etc, and their release can blow back disastrously. But all through history they’ve been great at changing human behavior. Now, COV19 has changed human behavior on a global scale.

        • Datapointer says:

          Hello there,

          just for context, the paper I referred to does not argue that SARS-CoV-2 is a bioweapon. What they argue is that the likelihood that it was built in and escaped from the Wuhan institue of virology is very high.

          Best regards.

  25. rgressis says:

    Off topic, but Greg, would you be willing to accept money to do another of your book reviews? I’m particularly interested in your thoughts on Adam Rutherford’s How to Argue with a Racist.

  26. mtkennedy21 says:

    The best study I have seen (can’t find it at the moment) was done by the Army. The patients were active duty and dependents. All got the same exact prenatal care. The best infant weights and APGAR scores were Hispanics. Whites were next, then blacks, who had the highest incidence of premature birth and low birth weight.

  27. skeptic16 says:

    This review shows the results were predetermined to reach the desired conclusions. White newborns were destined to survive by definition regardless of tge race of tge physician.

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