A widely-cited study that claims black babies were more likely to die under white doctors’ care had a serious methodological problem — one that appears to explain the study’s troubling conclusion, according to a new report from the Manhattan Institute.
Manhattan Institute scholars George Borjas and Robert VerBruggen found that the authors of the influential 2020 study did not consider that white doctors were more likely to care for black babies with low birth weight, which dramatically increases the chance a baby will die. When controlling for low birth weight, the scholars found no significant difference in outcomes for newborns based on a doctor’s race.
Their findings call into question the legitimacy of the study, which has been cited to demonstrate supposed inherent racism among white doctors.
“This fact that Black newborns do so much better under the care of Black physicians warrants greater investigation by researchers and medical practitioners into drivers of differences between higher- and lower-performing physicians, and why Black physicians systemically outperform their colleagues when caring for Black newborns,” study co-author Aaron Sojourner claimed in 2020.
Justice Ketanji Brown Jackson cited the study in her dissent from the Supreme Court’s decision striking down affirmative action in higher education. “For high-risk black newborns, having a black physician more than doubles the likelihood that the baby will live, and not die,” Jackson wrote.
When controlling for birth weight, the data doesn’t actually show that white doctors were performing poorly when working with black patients.
“Controlling for very low birth weight — i.e., comparing newborns within the same weight class — eliminates the racial concordance result in the most detailed statistical models. This happens because black doctors disproportionately care for black newborns with healthy birth weights,” Borjas and VerBruggen wrote. “Conversely, white doctors care for a disproportionately large share of the black babies most at risk, those who have a very low birth weight.”
Borjas and VerBruggen argue that the difference can be explained by controlling for babies treated with healthy birth weights and those born at a dangerously low weight. They argued that controlling for birth weight rendered the seeming disparity in treatment meaningless.
To analyze the original study, Borjas and VerBruggen obtained the same data set used by the George Mason researchers and attempted to replicate their findings. The data was pulled from births in Florida between 1992 to 2015.
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The scholars said that the outcome for black newborns could be improved by focusing on ensuring healthy pregnancies.
“In short, our analysis suggests that the potential for improving neonatal outcomes for black infants lies more in reducing the incidence of newborns born with very low birth weights (and in improving care for those infants) than in the color of their doctors’ skin,” the scholars wrote. “Fortunately, care for premature infants has improved rapidly in recent years—though not all hospitals routinely do, or are equipped to do, everything that is possible.”
Brad Greenwood, the lead author of the 2020 study, told The Daily Wire that he welcomed academic discussion on the issue.
“I am glad that there is a continued and robust dialogue in the scholarly community about the means by which the racial mortality gap in birthing outcomes can be ameliorated,” he said. “It is important work that needs to be continued.”
Borjas and VerBruggen first published their study on the report last month in an article in the Proceedings of the National Academy of Sciences.
