Med Media Mangle

The media holds medicine to a lower standard than it holds alternative medicine, such as say crystal healing. No way would an article in a major paper complain that we aren’t subsidizing crystals enough for poor folks, based on the observation that rich folks buy more crystals and rich folks are healthier. But for medicine, that sort of correlation is enough.

For example, this week the Post has not one but two long articles celebrating a new breast cancer study, which it says shows:

“Nearly five black women die needlessly per day from breast cancer” because they don’t have information about the importance of breast screening and they don’t have access to high quality care.

But in fact, the study shows only that across 25 US cities, the ratio of the black vs. white breast cancer death rates correlates (barely significantly) with median city income and a measure of city racial segregation. It is a huge leap to conclude from these correlations that black women don’t have enough info or care!

The very robust health-status correlation predicts more health for higher status folks, and thus more race-health disparity when there is a higher race-status disparity. It seem quite plausible that the race-status disparity is higher in cities where races are segregated and incomes are low.

More from the Post:

It would be nearly nine months before she told herself it was time to act. By then, the lump was the size of a small egg. … Doctors and advocates say the fear that kept her from acting quickly is all too common among black women. It is among the factors that contribute to a disturbing trend: Although they are less likely than white women to get breast cancer, black women are more likely to die from it. … Poverty and racial inequities are the primary factors driving the disparity, according to a study. … The study, which compared mortality rates between black and white women in the nation’s 25 largest cities, states that “nearly five black women die needlessly per day from breast cancer” because they don’t have information about the importance of breast screening and they don’t have access to high quality care. The authors … said genetics play only a small role in the disparity.

More from the study:

[In] the 25 largest cities in the US, … non-Hispanic Black : non-Hispanic White [breast cancer death] rate ratios (RRs) were calculated … Almost all the NHB rates were greater than almost all the NHW rates. … From among the 7 potential correlates, only median household income (r = 0.43, p = 0.037) and a measure of segregation (r = 0.42, p = 0.039) were significantly related to the RR.

Note that white women may seem to “get” more breast cancer because they are tested more often for it.

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  • Miley Cyrax

    “It would be nine months before she told herself it was time to act… genetics play only a small role in the disparity…”

    *cough* future time orientation *cough*

  • Poelmo

    I don’t think we should look at who gets to have treatment (most people get it from the hospital eventually), but at who continues to live happily after the treatment and who will later die in a cardboard box because off debt.

    Poor women will go to a doctor if they know they have breast cancer, but they won’t go to regular check ups that cost them money.

    There is enough medical care available in the United States, but it’s overpriced and not affordable to a large segment of the population.

    Man, I can’t imagine the stress of not knowing for sure if you’ll be taken care of when you get sick or get in an accident… How do people live like that? Is this why 11% of Americans are taking anti-depressants?

  • http://daedalus2u.blogspot.com/ daedalus2u

    You are making the ecological fallacy again.

    https://en.wikipedia.org/wiki/Ecological_fallacy

    There is no individual in the group that has characteristics of the average of the group.

    Mortality from breast cancer is highly non-linear with access to health care. If you have access below the level that detects breast cancer timely and treats it effectively, and you get breast cancer, you are very likely to die of breast cancer.

    If you have a level of health care that detects breast cancer timely and treats it effectively, then you are will have a lower breast cancer death rate.

    Also, NHB women have higher relative death rates from other things than white women and they have a lower life expectancy.

    In 2007 there were 141,246 deaths in NHB women and 1,050,200 in white women, a ratio of 1 to 7.4.

    Final data for 2007. National vital statistics reports; vol 58 no 19.

    From breast cancer in NHB women there were 5,799 deaths and 33,485 in white women, a ratio of 1 to 5.7. Breast cancer is a relatively small cause of death in women, only about 3.2% of white women and 4.1% of NHB women.

    For complications of childbirth there were 484 and 918 deaths NHB vs white. For cancer of the uterus & cervix there were 2100 and 8,999. For accidents there were 4,291 and 38,193. For suicide there were 352 and 6,623. For homicides there were 1,286 and 2,373. For HIV there were 2,284 and 875, one of the very few causes of death where more black women died than white women.

    For a few causes of death there are excess deaths in NHB women compared to white women.

    Looking at the pattern of death rates, it is plausible that lack of access to health care is a causal factor.

    It is well known that NHB women are poorer than white women. It is well known that poverty correlates with a lack of access to good health care. It is well known that a lack of access to good health care correlates with not as good health.

    Why are you shocked that excess breast cancer deaths would be attributed to known differences between the two populations that are known to affect outcomes?

  • Daniel

    Note that white women may seem to “get” more breast cancer because they are tested more often for it.

    How do they miss it? If you get tested often, you’ll catch it early, but if you have it, I’d expect you’d find out eventually. Are people dying of other things before it gets to stages where it’s noticeable? Are people getting false positives and “curing” it, then getting counted towards having it?

    • Poelmo

      This answers your question: http://www.bbc.co.uk/news/health-17585735 Apparently untreated breast cancer is not always fatal and sometimes doesn’t even cause symptoms. So it is possible for black women to get breast cancer but never finding out.