Medical doctors' unconscious racism affecting patient care

Does lurking racism affect the workings of our major institutions - government, the judiciary, medicine, and education? And how, if it is underground, can we even answer this question with anything more than speculation and opinion?

Where there's a will, there’s a way.

Psychological scientists have developed a tool called the Implicit Association Test that scientifically measures unconscious racism. That is, it can tell whether you have racial biases that you are not aware of. The test is being used to empirically assess for the presence of individual-level racism in societal institutions.

In the field of medicine, for example, we know that African Americans have higher infant mortality rates and death rates from cervical cancer, heart disease, and stroke than white patients. But are these differences due to outright racism on the part of doctors, or to other factors such as socioeconomic status or lack of health insurance?

While such macro-level factors are undoubtedly significant, a group of Harvard University psychology researchers have used the Implicit Association Test to prove that unconscious racial bias affects how doctors treat heart attack victims.

The study, reported in the current (September) issue of the Journal of General Internal Medicine, involved giving a hypothetical vignette to doctors about a patient suspected of having had a heart attack. In some cases, the patient was described a white; in others, he was described as black. In all other ways, the patient was the same. Doctors who scored high in unconscious racism on the Implicit Association Test tended to withhold aggressive treatment from the black patients.

The current issue of the journal also reports on another study – this one involving real patients - suggesting that similar racial factors play into doctors' decisions about whether to refer women for osteoporosis screening after a hip fracture.

These and other, recent studies suggest that the empirical study of individual-level racism is hitting its stride. Indeed, I posted recently about similar studies of automatic racial processes in the forensic realm, and how subtle racial bias on the part of police, probation officers, and others affects rates of arrest, prosecution, and incarceration.

Since unconscious bias is by definition outside of conscious awareness, and since racism is not as popular as it used to be, no one wants to admit to harboring it. Thus, it is difficult to confront without the empirical evidence of its existence.

Unfortunately, such study has barely touched the mental health field. Although we know that psychiatric diagnosis and treatment vary tremendously by race, for everything from schizophrenia to childhood Attention Deficit/Hyperactivity Disorder, the empirical study remains to be done on why this is so. Until we can identify the precise mechanisms, disparities will remain, affecting the quality of care and in some cases life or death itself.


You can take the Implicit Association Test online.

Reference: Green AR, Carney DR, Pallin DJ, Ngo LH, Raymond KL, Iezzoni LI, & Banaji MR. (2007). Implicit Bias among Physicians and its Prediction of Thrombolysis Decisions for Black and White Patients. Journal of General Internal Medicine, 22, 1231-1238.

Photo credit: Vanity Press (Creative Commons license)

Can government predict crimes before they occur?

U.S. to ratchet up surveillance with "Project Hostile Intent"

Did you know that when you go to the airport, a "behavior detection officer" might be scanning your face for hostile micro-aggressions?

You ain't seen nothing yet.

The Department of Homeland Security is set to launch Project Hostile Intent (PHI), which will use computers to scan the 400 million travelers who enter the U.S. each year for physical signs of hostile intent.

The Department's Advanced Research Projects Agency hopes to install sensors that will monitor people's pulse, perspiration rate, gait, breathing, eye movements, and other physiological signs through video and audio surveillance and by bouncing lasers or microwaves off your skin.

The full story, "Can you catch a killer before they commit a crime?" will appear in the Aug. 11 issue of New Scientist. Here’s the ominous lead-in:

"IMAGINE the scene. You arrive at New York's JFK airport, tired after a long flight, and trudge into line at passport control. As you wait, a battery of lasers, cameras, eye trackers and microphones begin secretly compiling a dossier of information about your body. The computer that is processing the data from these hidden sensors is not searching for explosives, knives, guns or contraband. Instead, it is working on a much tougher problem: whether you are thinking about committing a terrorist act, either imminently, or at sometime during your stay in the US. If the computer decides that might be your intention, you will be led off for interview with security officers."

Last night, I went to see the Bourne Supremacy, which featured the type of all-knowing, all-seeing state surveillance that is a staple of science fiction books and movies. (One of my favorite such films was 1997's Gattaca.) Watching Bourne (which I enjoyed despite its flaws), I thought the sophistication of the surveillance technology seemed a bit far-fetched. But now, I’m not so sure.

After all, New York City is poised to implement "ring of steel," a Homeland Security-funded system of interconnected license plate readers, surveillance cameras, a coordination center and roadblocks that can swing into action at a moment's notice. If the system works, I’m sure it will be coming soon to a city near you.

If "Traveling while Black" (or Arab) is perilous now, it will be a lot more difficult, and traumatic, once security forces are empowered to use subjective factors like pulse rate and gait as indicators of nefarious intent.

Photo credit: gruntzooki (bird surveillance cameras at Oakland airport), Creative Commons license. Also see Flickr's Panopticon network, dedicated to photographing surveillance cameras.

Guest commentary: 'Predator' gets caught in its own trappings

As "To Catch a Predator" spins off into ever-more-ludicrous dimensions such as "To Catch an i-Jacker," a newspaper columnist ponders what about American culture spawns such voyeurism

by Steven Winn

S.F. Chronicle, August 8, 2007, posted with the written permission of the author

It's a familiar stop on a night of channel surfing. The ballgame's over, the kids are tucked in bed, the dishwasher's whirring - everything's primed for a spell of vicarious "watchdog" justice. It's time "To Catch a Predator."

That's the title of a queasily transfixing series about uncovering and punishing pedophiles that's been airing on the TV newsmagazine "Dateline NBC" since 2004. The network's sister channel, MSNBC, faithfully reruns episodes, just as religious channels recycle the best sermons of their ace televangelists. MSNBC is where many nocturnal channel browsers find these real-life mini morality plays.

Why are we so eager to watch these televised takedowns? Are we witnessing an activist form of TV journalism that bracingly takes grave matters into its own hands? Or are those hands behaving in ways that bear much closer scrutiny, doubt and reflection? A pending lawsuit and an unsettling new piece in Esquire magazine are fuel for thought.

The show's concept is simple: Adults from a group called Perverted Justice pose as children online to attract men trolling for sex. A meeting is arranged by telephone. The purported predator arrives at the meeting place, a house that has been rigged with multiple hidden cameras. With the videotape rolling, the show's clean-cut, youthful-looking star, Chris Hansen, enters and begins his solemn litany of revelation.

Depending on the visitor's response - some make excuses or invent other reasons for their presence, some walk out the door, some confess - Hansen might read from a printed log of the salacious online chat that's preceded the visit. Back in the studio, more evidence is piled on. Sometimes, we learn, the man has sent pictures or videos of his penis to the child he thinks he's going to meet. We might be told about a prior record of sexual solicitations.

Finally, the man is invited to leave, if he hasn't done so already. As soon as he's outside the house, local law enforcement teams rush him, wrestle him to the ground and make the arrest. Off he goes to be booked, arraigned and often, as a postscript indicates, convicted and jailed. One "Predator" show was shot locally, in Petaluma.

There are a number of ways to view the hold that "To Catch a Predator" exerts on the viewer. There is, of course, the power of its apparent authenticity, in high contrast to the numbingly synthetic "reality" that reality TV sells in all its iterations. NBC's "Predator" is like some deadly serious episode of "Candid Camera." Instead of laughing along with the folly of human nature, we're caught up short and cleave instinctively to Hansen's stoic righteousness.

And righteous is what we feel we are right to be. Adults seeking out children and young teenagers for sex carries the unmitigated onus of evil, the stench of the powerful preying on the powerless. Unlike many other crimes - robbery, assault, maybe even murder, which can emerge from a tangled web of human interaction, history and passion-fueled circumstances - sexual predation seems chillingly unambiguous.

For similar reasons, the specific allegations in the dogfighting case against football star Michael Vick and his associates carry a blackly poisonous stain. (Dogs were reportedly bludgeoned, hanged or electrocuted if they failed to perform well in fights.) Animals, like children, are innocent and defenseless, we feel. They require our vigilant unconditional protection.

Watching the parade of alleged pedophiles on a recent rerun of "To Catch a Predator," I felt a stony indifference to the nabbed men's deer-in-the-headlights looks and wheedling prevarications. "People play roles," one said of chat-room life. "People just talk." Another insisted he doesn't need 14-year-old girls. "I can get all kinda girls." A third said he was deeply sorry and would never do it again. In an hour, the show perp-walked 11 men, ages 21 to 49, past the cameras. By the end of it, I felt dragged out and worn down, as if I'd been on some marathon stakeout myself.

In May, in a wrongful dismissal lawsuit filed by a former "Dateline" employee, Marsha Bartel outlined a series of ethical misgivings about "To Catch a Predator" that some media critics have raised themselves. Among other things, Bartel argues that paying Perverted Justice for its services gives the group "a financial incentive to lie to and trick targets of its sting." She's not the only ex-employee, incidentally, to discuss the show's underlying methods. Former "Dateline" anchor Stone Phillips has said that in many of the contrived Internet chats, "the decoy is the first to bring up the subject of sex."

Bartel's assertions about the relationship between NBC and law enforcement are more disturbing. Contrary to the network's claim of "parallel investigations" with police, she says, "Dateline" pays or otherwise reimburses law enforcement officials, trades its video services for information and for dramatically staged arrests, and illegally provides video feeds to prosecutors.

A piece in the forthcoming September Esquire turns the spotlight on the problem in graphic and grim detail. (Esquire, like The Chronicle, is a Hearst publication.) In telling the story of a Dateline "Predator" operation that ended in a man's suicide by gunshot when the police stormed his house with NBC's cameras poised outside, writer Luke Dittrich portrays a network hungry for real-life drama at any cost and a Murphy, Texas, police department only too avid to play along. When the man, a former district attorney named Bill Conradt Jr., failed to show up at the trysting house as arranged, Esquire shows, NBC pressed police to obtain a warrant for his arrest and force a confrontation at his own home. The last footage shot was of the SWAT team loading Conradt's body into the ambulance.

In a mordant footnote to the tragedy, Dittrich reports that because of various problems, including crime venue problems and the lack of proper warrants, the county's district attorney was unable to prosecute any of the 23 men arrested in Murphy during the Texas "Dateline" encampment.

While NBC doesn't comment on future "To Catch a Predator" episodes, the network plainly feels it has established a vital franchise. Spin-offs include "To Catch a Car Thief," "To Catch an ID Thief," "To Catch a Con Man" and the ludicrous "To Catch an i-Jacker." The latter involves leaving iPods around in public and tracking the people who pick them up. "So what's the lesson here?" Hansen asked a teenager who was caught and hauled before the cameras on a recent "Dateline." "Don't steal," he dutifully replied.

Like the multiple versions of "Law & Order," the "To Catch" series may satisfy a simple desire to see the cleansing social order working properly. But in blurring the lines between law enforcement and entertainment, police procedure and sleazy curiosity, "Dateline" is engaging in a much more vexing business, one that's closer to the car-chase videos of "Cops" than it is to some new form of TV justice.

The series capitalizes on America's fantasy of being on the inside track, embedded, empowered by the media's intoxicating blend of intimacy and might. In the end, as Bartel puts it in her lawsuit, NBC may just be feeding "American culture's interest in public humiliation." It may be irresistible to watch, but maybe the old model is worth rethinking. Let law enforcement do law enforcement, and let the media pay very close attention to how it's doing it.

E-mail Steven Winn

Yesterday’s tmz.com features news and video about the current court case of prominent oncologist Maurice Wolin, recently trapped by Dateline NBC.

My previous post on the Predator series is here.

Happy ending for wrongfully deported Mexican-American man

Two months ago, I posted here about a cognitively handicapped Mexican-American man who was illegally deported to Mexico and disappeared.

Pedro Guzman, born in the United States, was mistakenly deported after being jailed in his native Los Angeles on a minor trespassing charge. A former Special Education student, the 29-year-old is described by family members as a slow learner with memory problems.

In the last three months, Guzman said he made repeated attempts to get home, but was turned away by U.S. border agents.

Meanwhile, as he walked the 100 miles from Tijuana to Mexicali, eating out of garbage cans and bathing in rivers, his family was desperately searching for him. The family's pleas for help from both the U.S. and Mexican governments fell on death ears.

Guzman was finally picked up when U.S. authorities at the Calexico border realized he had an outstanding arrest warrant. The warrant, ironically, was for missing probation hearings during the time that he was trying to get home.

Although the U.S. government had promised to immediately notify the family if Guzman was located, he was instead jailed for two days before the family was notified and he was released.

Guzman appeared traumatized and was nearly unrecognizable, family members said at a news conference.

The family's last contact with Mr. Guzman had been on May 11, when he called his sister-in-law from a borrowed cell phone to say he had been deported. The call cut off. Although family members rushed to Tijuana, they were unable to find him.

This is not the first time that a U.S. native has been illegally deported. A similar case 30 years ago also involved a Mexican-American who was mentally disturbed and unable to care for himself. Like Guzman, Daniel Cardona of Clovis (near Fresno) wandered the streets of Tijuana for nearly five months while his frantic family searched for him.

The latest on the Guzman case is at the ACLU of Southern California’s web site.

AP coverage is online through the San Francisco Chronicle.

The “Witness LA” blog has also been covering the story.

But for the most extensive coverage of all, see the excellent L.A. Weekly feature by Daniel Hernandez, “Lost in Tijuana."

Photo (Guzman and his brother) posted with the permission of the ACLU of Southern California.

Sentencing reform may target parole system

California is the nation’s uncontested leader in criminal recidivism. We send about 7 out of 10 released prisoners back to prison within two years. That’s a far greater proportion than any other state.

Why?

That’s easy to answer. Unlike some other states, California puts everyone coming out of prison on parole. Then, when they miss an appointment with a parole agent or have a “dirty” urinalysis, it’s back to prison for them.

These “technical violators” make up about two-thirds of prison admissions at any given time. Most are non-violent, non-serious offenders. They rotate in and out of prison, staying for an average of five months each time, at an estimated cost of $900 million a year.

Individual parole agents make these decisions, with little or no public oversight.

So, what would happen if traditional parole were eliminated entirely?

That's an intriguing idea that will be debated soon by the American Law Institute as part of its ongoing revision of the Model Penal Code.

The topic came up this week at the annual conference of the National Association of Sentencing Commissions, meeting this week in Oklahoma City. Officials from 27 states - including lawmakers, attorneys, judges, professors, researchers and corrections officials – are meeting under the theme "New Frontiers in Sentencing." And reducing imprisonment through drastic sentencing reform is one aspect of that theme.

"Every state that has tried, beginning with Minnesota and Washington in the 1980s, to deliberately take control of prison growth has had success in doing it," conference presenter Kevin Reitz, a law professor at the University of Minnesota, was quoted by the AP as saying. "An awful lot have done that without sacrificing public safety.”

"We're going to have to do something different,” agreed Oklahoma state Senator Richard Lerblance. “We're going to have to get over the thought that we're soft on crime because we're addressing these issues. We're going to have to get over the idea that we're going to lock them up and leave them there."

The tone of this conference is yet more evidence of the pendulum swing that I’ve been posting about recently. Only, the reformist mood may be slower to reach California, which isn't even a member of the federal and multi-state sentencing consortium.

Hat tip to the “Sentencing Law & Policy” blog for alerting me to this conference. Photo credit: "Remuz" (Creative Commons license).

For more on the California parole system, see "California's Parole Experiment," California Journal, August 2002.

International criminal justice problems spawn unusual solutions

"Mobile courts," "ghetto courts" spring up in India and Jamaica

Most Americans tend to be pretty ignorant about the rest of the world. I'm no exception. I have to admit that, while I write a lot about criminal justice issues, I don't know as much as I'd like to about the systems in many other nations. So, I thought I'd share a bit that I just learned about a couple of widely disparate criminal justice trends.

First, India:

We know that our own prisons are overcrowded, but did you know that theirs are, too? And that they, like us, are implementing a massive new prison construction program to augment and replace their old prisons, mostly built by the British between 1860 and 1930?

Much of the problem of overcrowding in Indian prisons stems from a massive backlog of "undertrials," according to yesterday's Times of India. That term, I gathered, is the Indian word for pretrial detainee. About two-thirds of the prison population are "undertrials."

And now, in an innovative effort to make the court system more accessible "to remote and backward areas," India has just launched its first "mobile court."

The mobile court is housed in a bus and staffed like a regular court to conduct full civil and criminal trials. It will travel to different regions each week, starting in a very "backward" district with an "abysmal literacy rate," according to yesterday's edition of The Hindu newspaper.

Meanwhile, a different trend of vigilante-style courts is emerging in Jamaica, apparently due to popular mistrust of the official police and court system.

The underground community tribunals in urban ghettos mete out their own forms of justice, including beatings, the breaking of bones and "sun-dance," a punishment in which an individual must "kneel on bottle-stoppers in the sun for prolonged periods, according to an editorial in yesterday's Jamaica Gleaner.

The editorial, by retired judge and former government minister Hugh Small, sounded an alarm over the potential human rights issues raised by such courts.

"Why has nothing been done, especially when they are said to impose punishments that would be regarded by the formal justice system as being cruel and inhuman?" asked Small. "If the existence of these courts is accepted in these communities as preferable to the formal system, what does this mean for nurturing awareness for the right to challenge abuses of human rights by the citizenry and the police?"

Well, that's it for this little dose of international perspective.