Medical Students: False Beliefs About Blacks' Biology Common

Tara Haelle

April 04, 2016

Half of white medical students held at least one false belief about biological differences between black and white patients, a trend that affected both their perception of the patient's pain and the accuracy of their treatment recommendations, according to a study published online April 4 in the Proceedings of the National Academy of Sciences.

The more false beliefs the students held, the more likely they were to rate a black patient as experiencing less pain than a white patient in the same scenario, and the less likely they were to make an appropriate medical recommendation.

"The present work sheds light on a heretofore unexplored source of racial bias in pain assessment and treatment recommendations within a relevant population (i.e., medical students and residents), in a context where racial disparities are well documented (i.e., pain management)," write Kelly M. Hoffman, from the Department of Psychology, University of Virginia, Charlottesville, and colleagues. "It demonstrates that beliefs about biological differences between blacks and whites — beliefs dating back to slavery — are associated with the perception that black people feel less pain than do white people and with inadequate treatment recommendations for black patients' pain."

The researchers collected survey results from 222 white medical students, all native English speakers born in the United States, including 63 first-year students, 72 second-year students, 59 third-year students, and 28 residents. The students read two hypothetical medical cases about a black patient and a white patient and rated the pain they expected the patients felt on a scale of 0 (no pain) to 10 (worst possible pain). They also made medical recommendations based on the cases, which the researchers then coded as accurate or inaccurate.

The medical students also rated the accuracy of 15 statements (11 false and 4 true) about biological differences between blacks and whites on a scale of 1 to 6, from definitely untrue (1) to probably untrue, possibly untrue, possibly true, probably true, or definitely true (6).

Among the false statements they were asked to rate were that blacks age more slowly than whites, blacks' nerve endings are less sensitive than whites', whites have larger brains than blacks, blacks' skin is thicker than whites', and blacks have stronger immune systems than whites. True statements included that blacks have denser, stronger bones than whites and that whites are less likely to have a stroke than blacks.

Half the students rated at least one of the false statements as possibly, probably, or definitely true. On average, the students said 11.55% (standard deviation [SD] = 17.38) of the false beliefs were possibly, likely or definitely true.

Moreover, the authors found that medical students who endorsed more false believes also rated the black patient in the case as having less pain than the white patient.

Similarly, medical students "who endorsed more false beliefs (+1 SD) were less accurate in their treatment recommendations for the black target compared with the white target," whereas "participants who endorsed fewer false beliefs (−1 SD) did not differ in their treatment recommendation accuracy" between black and white patients. An additional analysis showed that rating black patients' pain as lower also correlated with making less accurate treatment recommendations, even after controlling for the students' belief in false statements about differences between blacks and whites.

"Although the effect sizes for these findings were not large...the practical importance is significant: those endorsing more false beliefs rated the pain of a black (vs. white) patient half a scale point lower and were less accurate in their treatment recommendations 15% of the time," the authors write.

In a separate portion of their study, Hoffman and colleagues investigated the beliefs of white laypeople, resulting in similar, but more pronounced, findings. The 92 white native English speakers born in the United States rated how painful they expected various scenarios to be for themselves and for a black or white person of the same sex on a scale of 1 to 4, from not painful to somewhat painful, moderately painful, or extremely painful. They also rated how much they believed the same statements about biological differences between blacks and whites.

The participants rated an average of 22.43% of the false beliefs as true, and about 73% of them believed at least one of the false statements was likely true. The white participants also tended to rate pain experiences as lower for black individuals than for white individuals, a perception that correlated with the number of false beliefs they endorsed. Meanwhile, "participants who endorsed fewer false beliefs (−1 SD) did not differ in their pain estimates for a black vs. a white target."

This study of white adults without medical training therefore showed that most of them held "at least some beliefs about biological differences between blacks and whites, many of which are false and fantastical in nature (e.g., black people's blood coagulates more quickly than white people's blood)." These beliefs, as among the medical students, correlated with a racial bias regarding pain perception for black and white individuals.

Despite the passage of 30 years since the 1985 Report of the Secretary's Task Force on Black and Minority Health, known as the Heckler Report, "[r]acial disparities in health and health care continue to be a problem in the United States," the authors conclude.

The authors have disclosed no relevant financial relationships.

Proc Natl Acad Sci U S A. Published online, April 4, 2016. Abstract