Comedian John Oliver seeks to entertain and inform on his HBO show Last Week Tonight. Oliver recently tackled a topic that we have also been discussing: bias in medicine. Earlier this week, we discussed LGBT bias in doctors. Last month, we discussed woman who whose medical conditions were being inaccurately attributed to menopause or perimenopause.
In this segment, Oliver tackles two specific biases found in medicine: those affecting women and those affecting people of color. When discussing gender bias, he touched on a variety of studies that examine the difference in treatment between men and women. This included:
- a study which found that women were less likely than men to be referred for knee replacement surgery, even when this treatment was necessary for female patients
- a study which found that women who were over 50 and critically ill were less likely to receive life-saving interventions
- a study which found that women who visit the ER for urgent abdominal pain, women were less likely to receive any pain medicine compared to male patients
- a study which found that female patients were seven times more likely to be misdiagnosed when having a heart attack and sent home
Differences in treatment between male and female patients can be attributed to factors other than inherent bias in practitioners. For decades, women were systematically left out of medical research. In one extremely poignant clip, Oliver points to a 1990 study in which the National Cancer Institute looked at the impact of diet on estrogen metabolism and its links to cancer of the breast and uterus. All of the subjects were men.
Oliver next turns to the differences in treatment based on race. He again touched on various findings, including:
- a study found that the "mortality gap" between black and white patients in the US is so stark that about 83,000 "excess deaths" occur per year
- a study found that black patients were less likely to receive recommended care for a wide variety of medical issues, including pneumonia, hip fractures, breast, lung, and prostate cancer
- a study found that misinformation about African-American patients was rampant among medical students and doctors: 25% of respondents erroneously believed black skin to be thicker than the skins of white individuals; 14% of medical students believed nerve endings were less sensitive in black patients; 17% of medical students believed that black people's blood coagulates more quickly than that of white people
- a study found black patients were 34% less likely to be prescribed opioids for pain than white patients with similar conditions
Oliver finishes his discussion with an incredibly troubling discussion about childbirth mortality and race. The United States has the highest rate of childbirth mortality in the developed world, and women of color have odds of dying which are 3-4 times higher than white women.
While Oliver infuses his report with humor, these problems are no laughing matter for the millions of Americans who are at risk for misdiagnosis and other serious outcomes due to disparate treatment.