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Ann Thorac Surg 2001;72:6-8
© 2001 The Society of Thoracic Surgeons

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Editorial

The question of racial bias in thoracic surgery: appearances and realities

Address reprint requests to Dr Jones, Department of Surgery, University of Missouri, M580 Health Sciences Center, Columbia, MO 65212
e-mail: jonesjw@health.missouri.edu

A decade ago the American Medical Association Council on Ethical and Judicial Affairs examined available data and concluded "that even when blacks gain access to the health care system, they are less likely than whites to receive certain surgical or other therapies." Their study focused particularly on expensive therapies, including coronary bypass procedures [1]. In ensuing years, the data suggesting racial bias in availability of cardiac surgical care has grown. A retrospective review of 33,641 male ischemic heart disease patients at 158 acute-care VA hospitals found that black patients received invasive procedures significantly less often than whites with equivalent diagnoses [2]. Gornick and colleagues [3] had similar findings in reviewing 1993 Medicare administrative data for 26.3 million beneficiaries 65 years of age or older (24.2 million whites and 2.1 million blacks), and concluded that black people with the same medical characteristics received coronary bypass treatment for ischemic heart disease only 40% as often as whites. Hispanics also received percutaneous transluminal coronary angioplasty and coronary artery bypass graft operations proportionately less often than whites [4]. In other studies, even when adjustments for severity of disease were made, coronary revascularization was still underutilized in black patients [5]. Black people received surgical therapy for ischemic heart disease 22% [6] to 68% [5] as often as symptomatically similar white people, with the difference remaining significant in every published study on the subject. Blacks received a disproportionately low share of many other expensive therapies as well. Nonetheless, because coronary bypass operation was the most commonly cited disparity, our assessment will explore conclusions implying widespread unwarranted racial bias in patient selection within the specialty of thoracic surgery.

Bias is morally neutral; it depends on context for ethical status [7]. In its medical or scientific context, it is commonly defined as "a . . . [Full Text of this Article]

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