Placebo response reveals bias against black female doctors

Jhe doctor-patient relationship is an important part of helping and healing. But it can be hijacked by racial or other biases that either party holds.

the novel study published Monday using placebo response as a measure of bias shows how patients’ unconscious responses to their doctor’s gender or race can have lingering physiological effects and even drive health outcomes.

In the study, 187 white women and men underwent an allergy skin test, after which a doctor applied an inert cream to the skin, but told participants it was an antihistamine cream that would alleviate any allergic reaction. Every interaction was the same — same treatment room, doctor’s medical credentials, and verbal instructions given to the patient — except for the doctor’s gender and race. The 13 male and female doctors were either Asian, black or white.


White patients who were treated by black and female health care providers had greater skin test responses than those treated by white and male physicians, suggesting attenuation based on placebo response biases to skin cream. The results were published in the Proceedings of the National Academy of Sciences.

“Bias is complex,” said Lauren Howe, associate professor of management at the University of Zurich and lead author of the study.


Although patients in the study rated female physicians as “warmer” and more knowledgeable than men, and black and Asian providers were rated warmer and equally knowledgeable than white providers, and most of patients were highly motivated to control biased responses, “they still showed this reaction under the skin, which I think points to the fact that biases are really multi-faceted and that the effects of biases can potentially persist.

Howe said the study looked at white, Asian, and black doctors because white providers have historically been overrepresented in medicine, and black and Asian doctors face different stereotypical associations — Asians often seen as a “minority highly competent model and blacks faced with long-held negative stereotypes. The study was conducted in the San Francisco Bay Area, where Asian physicians are almost as prevalent as white physicians (about 30% each of the physician population), while only 2.5% identified themselves as black.

One of the reasons the researchers undertook the study was to explore the impact of changing demographics among healthcare providers who are boosted by diversity and inclusion initiatives in the healthcare industry. health. In 2017, for example, women made up 50.7% of medical students in the United States, surpassing the male entries for the first time in history. In 2021, women made up 55.5% medical school enrollees.

A substantial body of research shows that provider bias can influence patient care. “Our approach in this study was to look at the opposite,” Howe said: Could the biases held by patients affect their responses to treatment?

Bias can be a two-way street, influencing doctors and patients alike, said Charlotte Blease, a philosopher, interdisciplinary health researcher and co-founder of the Society for Interdisciplinary Placebo Studies. “We’re not really the best at accessing the subconscious part of ourselves that carries or holds implicit biases. This speaks to the need for representation and true diversity.

While this study showed that bias could potentially inhibit a patient’s response to treatment, it could also give some people a boost in their care through nothing the provider does other than the color of their skin or their gender, Blease pointed out, adding that this study is part of a needed conversation “about social justice and caregiving which is the makeup of the people who provide care.”


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