The disturbing reason why doctors may undertreat their black patients

It’s not often a study makes me sit back and think, “Good lord, how is this still at thing?” But that was my reaction this week after reading new research into how doctors treat white and black patients for pain.

I was not alone in my shock. The study blew up the internet, with headlines from the subdued “Does a white doctor understand a black patient’s pain?” to the academic “False Beliefs of Med Students May Lead to Racial Bias in Pain Management.” Yet almost no headline could do the findings justice. The deeply disturbing study, published in the Proceedings of the National Academy of Sciences of the United States of America (PNAS), revealed that white people in this country still buy into wildly incorrect myths about black people and pain—myths that date back to slavery.

Perhaps even more alarming, the researchers found that not only does the public hold false beliefs about about biological differences between blacks and whites, but medical professionals do, too. And these misconceptions are contributing to the undertreatment of black patients when it comes to pain.

The study was conducted by researchers at the University of Virginia, who were intrigued by previous research showing that black people are systematically undertreated for pain in the United States and less likely to be prescribed pain medication, even when needed. The researchers wanted to gain a deeper understanding of why this discrimination happens. They hypothesized that the racial disparities may stem from falsely held beliefs regarding biological differences between races.

To test their hypothesis, the researchers conducted two studies—one with lay people and one with a combination of medical students and medical residents currently treating patients.

The first study enlisted 92 white people, recruited online. First, the participants were asked to report the amount of pain they would feel across 18 scenarios (e.g., a hand being slammed in a car door). Next, they were randomly assigned to rate the pain a black or white person of the same gender would feel across the same scenarios. They were also asked to rate to what extent they believe certain biological differences exist between blacks and whites on a six point scale ranging from “definitely untrue” to “definitely true.”

The biological differences included myths such as: Blacks age more slowly than whites, blacks’ nerve endings are less sensitive than whites’, blacks’ skin is thicker than whites’, and whites have larger brains than blacks. The list also included factual statements, such as whites are less susceptible to heart disease than blacks and blacks are less likely to contract spinal cord diseases. You can see the full list below.

According to the study, about 73% of the participants endorsed at least one of the false items (i.e., indicated that an item was possibly, probably, or definitely true).

Those who held more false beliefs about black people also rated black people as feeling less pain in scenarios such as slamming a car door on their hand. The authors write:

Interestingly, among this sample, the bias emerged because participants high in false beliefs rated the pain of the black target lower and the pain of the white target higher than did participants low in false beliefs. In other words, relative to participants low in false beliefs, they seemed to assume that the black body is stronger and that the white body is weaker.

For the second study, the researchers asked 222 white medical students and residents to respond to similar questions. The participants completed the same measurement of race-based biological beliefs as the lay participants. However, instead of rating their own pain, this time the participants were presented with two medical scenarios—one in which they were hypothetically treating a black patient and another in which they were hypothetically treating a white patient. In both scenarios, they could prescribe medication if needed.

On average, the med students and residents endorsed the falsehoods to a lesser degree. About 50% reported that at least one of the false belief items was possibly, probably, or definitely true—that’s 23% less than the lay participants, but still rather high considering their medical training.

But even more distressing was the discovery that their bias carried over into their diagnosis. The researchers found that participants who endorsed more biologically false beliefs also rated the black patient as feeling less pain than the white patient. The authors write:

In other words, as in study 1, participants in study 2 who endorsed false beliefs about biological differences between blacks and whites exhibited a racial bias in pain perception similar to the bias shown in previous work.

The authors also found that those who held more false beliefs were less accurate in their treatment of the patients. (In order to control for treatment options, the lead author on the study, Kelly Hoffman, told me that she and her team presented the same two medical cases to experienced, practicing physicians with the races removed.)

The authors say the study demonstrates the scary degree to which white medical students and residents harbor “false and fantastical” beliefs that, in turn, lead to racial bias in both pain perception and treatment.

“We’ve known for a long time that there are huge disparities in how blacks and whites are assessed and treated by the medical community,” Hoffman said in a statement. “Our study provides some insight to what might contribute to this—false beliefs about biological differences between blacks and whites. These beliefs have been around for a long time in our history. They were once used to justify slavery and the inhumane treatment of black people in medicine.”

The authors concluded that these same biases may now be contributing to the inadequate treatment recommendations for black patients’ pain.

The one upside of the study was that those medical students and residents who did not hold false beliefs did not show any racial bias in their diagnosis and treatment—leading the authors to believe that working to combat these myths could help eliminate the problem.

Of course, disturbing as these findings are, they likely come as no surprise to you—if you’re black.

Taryn Hillin is Fusion’s love and sex writer, with a large focus on the science of relationships. She also loves dogs, Bourbon barrel-aged beers and popcorn — not necessarily in that order.