Cobb

Hm. That's not so bad (and your first line preface is appreciated). I'd hafta mostly agree. Hell, the very name of the group screams "special interest." But there's nothing wrong with that. Some of these groups are actually worthwhile.

Ahma sit on the sidelines and watch this one, too. Scootch.

If you took race out of the equation, the NAACP wouldn't be a socialist organization. They've never called for the redistribution of wealth, only for the distribution of rights. If you took race out of the equation, they'd probably be like the logging industry...

I look at it as a watchdog organization. But to call it socialist is going way overboard.

Well, let's start with this exerpt from an NAACP press release dated August 6,2004.

The National Association for the Advancement of Colored People (NAACP) today expressed concern over findings of health care disparities in medical care given to elderly African Americans versus whites. In a report released in the August 5 New England Journal of Medicine, researchers found inadequate healthcare for black Medicare patients.

More than 25 percent of African American Medicare patients visited physicians who could not consistently deliver high-quality care, compared to less than 20 percent of white patients. The study reported that only 22 percent of all U.S. primary care physicians accounted for 80 percent of all visits by African American patients.

Kweisi Mfume, NAACP President and CEO, said: “While these findings are preliminary, the current state of affairs regarding health disparities is unacceptable. We urge the leaders
of this study to continue their investigation for greater comprehensive and accurate conclusions concerning the disparities between the African American community and the society at large. All Americans ought to have a reasonable expectation that our nation will be committed to ending such gross differences in the availability of quality health care.

Now these are disparities chalked up purely and simply to race. Not economics, not geography, not family history. There are no other factors are indicated. Why not?

I've been complaining about this kind of talk for a long time, because it perpetuates the notion that blacks who have access to the mainstream suffer equally with those who don't. It further implies that blacks as a whole are barred entry to the mainstream when it is clearly not the case.

Here we are talking about elderly blackfolks, those who are most likely to have little contact with the mainstream. So what should we tell them? Perhaps we should tell them that the white iceman has colder ice. It's clear from what I'm reading that they are going to separate and unequal healthcare providers, but I don't see where there is any indication about what part social mobility plays in that decision.

but I don't see where there is any indication about what part social mobility plays in that decision.

From what I've read, it doesn't matter what the economic status is of Blacks receiving health care. Even Blacks of means are less likely to be told about alternate means of treatment. This was discovered during a study on treatment of heart problems.

So, mobility may play a part, but not across the board.

Lester and I have been discussing the New England Journal Of Medicine article and I have the full article in front of me. In the same issue, is an editorial that is most interesting: "Health Care in America -- Still too Separate, Not yet Equal"

From my reading of what you attribute to the NAACP, they got some of the details of the article wrong, but are on point for taking a position on the findings.

We know that there is a general disparity between the health care outcomes of blacks and whites in this country. Lots of factors contribute to that disparity; many think racism plays a direct part.

This new study suggests that while racism may play an indirect role, there appears to be a large role played by the general capabilities of the physicians that treat groups of whites and groups of blacks.

The editorial goes into it better than the primary article, in my opinion. The study happens to use patients covered by Medicare so the patients tend to be older, but the issue is more about geography: physicians outside of the treating group but still in the same geographic area are less well trained and less prepared to delivery high quality care.

The editorial writer suggests that much of the issue lies with the "residue of segregation that probably accounts for differences in the locations where patients seek care ..."

So I think it is good for the NAACP to jump on this issue. Further reason: the way that concervatives are twisting it to fit their agendas.

On Friday, August 6th, there was an article in the Wall Street Journal: "A Case of Colorblind Care." Author: Sally Satel, described as a resident scholar at the American Enterprise Institute, and author of PC, M.D.: How Political Correctness is Corrupting Medicine."

Ms. Satel says: "It is long past time to put aside the incendiary claim that racism plays a meaningful role in the health status of African-Americans." Conservatives like to think that we have progressed well beyond the point where the residue of segregation/racism/white supremacy have their impact; as Dr. Epstein points out, we've still got far to go.

To your point, however: The NAACP is best served when it joins coalitions with other groups that press for civil and human rights. I'd like to see the NAACP do more in the health area: as they advocate for their constituency, all Americans would benefit. We need a comprehensive health care policy overhaul in this country and the NAACP should be on top of that change.

"Now these are disparities chalked up purely and simply to race. Not economics, not geography, not family history. There are no other factors are indicated."

The original article was entitled, "Primary Care Physicians Who Treat Blacks and Whites."

The Background for the article states:

"In the United States, black patients generally receive lower-quaility health care than white patients. Black patients may receive their care from a subgroup of physicians whose qualifications or resources are inferior to those of the physicians who treat white patients."

"Conclusions: Black patients and white pateints are to a large extent treated by different physicians. The physicians treating black patients may be less well trained clinically and may have less access to important clinical resources than physicians treating white patients. Further research should be conducted to address the extent to which these differences may be responsible for disparities in health care."

BTW, while many of the black patients receive their care from black physicians, the vast majority of caregivers in this study were white. Moreover, the credentials and resources available to non-treating physicians in the same geographic area were very similar to those treating patients in this study. Since the study was based on Medicare records, this is significant because Medicare patients tend to be older and the results are hard to generalize accross the total population. We know from other studies, however, that structural deficiencies in health care delivery tend to lead to poorer outcomes and disparities.

This is all I could get for free from NEJM

ABSTRACT
Background
In the United States, black patients generally receive lower-quality health care than white patients. Black patients may receive their care from a subgroup of physicians whose qualifications or resources are inferior to those of the physicians who treat white patients.

Methods
We performed a cross-sectional analysis of 150,391 visits by black Medicare beneficiaries and white Medicare beneficiaries 65 years of age or older for medical "evaluation and management" who were seen by 4355 primary care physicians who participated in a biannual telephone survey, the 2000–2001 Community Tracking Study Physician Survey.

Results
Most visits by black patients were with a small group of physicians (80 percent of visits were accounted for by 22 percent of physicians) who provided only a small percentage of care to white patients. In a comparison of visits by white patients and black patients, we found that the physicians whom the black patients visited were less likely to be board certified (77.4 percent) than were the physicians visited by the white patients (86.1 percent, P=0.02) and also more likely to report that they were unable to provide high-quality care to all their patients (27.8 percent vs. 19.3 percent, P=0.005). The physicians treating black patients also reported facing greater difficulties in obtaining access for their patients to high-quality subspecialists, high-quality diagnostic imaging, and nonemergency admission to the hospital.

Conclusions
Black patients and white patients are to a large extent treated by different physicians. The physicians treating black patients may be less well trained clinically and may have less access to important clinical resources than physicians treating white patients. Further research should be conducted to address the extent to which these differences may be responsible for disparities in health care.

Source Information

From the Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York (P.B.B., D.S., R.C.T.); and the Center for Studying Health System Change, Washington, D.C. (H.H.P., J.L.H.).

Address reprint requests to Dr. Bach at the Health Outcomes Research Group, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Box 221, New York, NY 10021.

Separate & unequal. The NAACP doesn't undo Massey & Denton, which is part of the complaint I wanted to talk about but forgot to put into my original comment.

I'll take a moment to defend Satel on the basis of this article which suggests that she's looked closer at race and genetics than a brief interpretation might suggest.

Science and politics do not mix very well, particularly when it comes to such hot-button issues as diversity. That's certainly the case with the stem cell debate. Although this effect is surely unintended, if federally funded research is limited to the 64 stem cell lines approved by the Bush administration, potential cures could end up being most useful to a narrow sliver of the world's population: whites of mostly European ancestry and some Asians. Much of the rest of the world will find that some promising therapies developed from these lines do not work very well.

The problem lies in the lack of genetic and "racial" diversity of the 64 lines. Most of them were harvested from embryos at U.S., Swedish and Israeli fertility clinics, where patients are overwhelmingly white. Based on discussions with most of the 10 laboratories with approved cell lines, we have concluded that as many as 49 of the lines are from white couples. As Alan Robins, chief science officer for one of the labs, BresaGen Inc. in Athens, Ga., told us, "Although we do not know for certain the racial background of our donors, it is reasonable to assume they are from white couples." About 15 of the lines, harvested at clinics in Singapore and India, are of South and East Asian parentage, we believe, based on those discussions. Even if all of these stem cell lines are shown to be viable for research, that's a very narrow segment of the world's population and a tiny fraction of what is necessary to ensure genetic diversity in therapies eventually developed from the cells.

And that's a problem because, as with whole organ transplants, therapies and tissues derived from stem cells will likely share the body's tendency to reject as foreign those that come from different populations. Patients with stem cell transplants will have to take drugs that suppress the immune system -- drugs that can cause substantial problems themselves. A menu of far more than 64 lines of embryonic stem cells would be necessary to accommodate the vast immunological variety of human beings.

Cobb: what administration limits us to 64 stem cell lines? Was it the work of the Democrats or the Republicans?

C'mon now. You know I'm in denial.

How about Marxist? Can we call the NAACP Marxist? They are such a joke, and I don't say that lightly. I try not to be so flip about it and give more heft to my response, but there's no heft there. A bunch a bourgeois Negroes throwing parties and patting themselves on the back as stalwarts against race discrimination for filing frivolous lawsuits against whatever will garner press that week.

A total joke. The only good use of the NAACP left is to blog about their antics and post pictures of a dinosaur.

You've got an interesting thesis that might be developed in here. I see two different themes that jump out at me (pardon the oversimplification):

--There's inequality among different groups of people, and it should be addressed in a different and more effective way.

--Organizations over time mutate, lose their original mandate, or change effectiveness. It is nearly impossible to kill off a nonprofit like you kill off a product line (and only partially because "there's still nose cancer" or whatever.) This Insta link has some good points from Rev. Sensing and others about this and the Southern Poverty Law Center.

(As an aside, I remember as a college freshman being told that a certain Socialist Party, founded in the 1920's, disbanded--because all their goals were met! This *was* the New Deal era, after all.)

In regards to medical inequality, there's more there when you pull the string. If you're not a 165-pound white male, then most of the studies done for a technique or training or drug weren't done specifically for you. Women have similar difficulties. Hell, as a big fat white guy I have dosing issues that aren't caught unless I check (800mg Motrin does much less for me than it does my wife, for instance).

Even without income inequality, patient education, or what group you're in, there is inequality of care. One key may be reworking the medical care system to be able to adapt more effectively to different people--but that means that you need more than a hundred white 165 pound male college students for FDA approval of a palliative--much harder--and a system of processes that allow for more variability. It's much more complicated as a system than shifting from the "any color you want, as long as it's black" Model T to the "custom order your Mini Cooper over the internet" of today.

If you're interested in following that line of inquiry, drop me a note. I can ask my docs over here on the ship to see if they've got some observations or research.

I, like many, believe that the NAACP has outlived its initial purpose and are now simply card carrying victims. Any organization that claims to be non-partisan yet turn around and call this president a Nazi is reprehensible in my book. What is even more annoying is the hubris with which they assume that Bush, after being insulted on more than one occassion, would actually accept their invitation to speak at their annual convention. I guess the president is not so stupid afterall.

The use of "victimology" is rhetorical hyperbole that makes my head spin.

Am I the only one to find DarkStar's protest ambiguous?

Cobb:

Your not in denial: The Bush administration only limited 'government' spending on embryonic stem cell research (the private sector can do what it wants). The Bush administration increased spending on stem cell research overall (including stem cells from placenta, umbilical cords, adult stem cells, etc.)

PDN

I think Darkstar's complaint is on point. There are simply better and worse ways of dissing the NAACP. That's one of the reasons that I tried to talk about in my Right Wing Epiphany/a>. We may actually come to the same soundbite, but it's important that we speak our reasons. I don't dismiss the NAACP's heart and its intent to improve the lives of blackfolks. But if it simultaneously monopolizes their worldview, if blackfolks end up thinking that no other political organization can do for them, then the NAACP becomes a permanent crutch. Right now, the NAACP is capable of making millions of African Americans dismiss the Republican party. That's absurd.

Consider this overblown rhetoric from Mfume:

"When the ultraconservative right-wing attacker has run out of attack strategy," Mr. Mfume said, "he goes and gets someone that looks like you and me to continue the attacks."

Paraphrasing a line from a 2002 speech by NAACP Chairman Julian Bond, he said, "And like the ventriloquist's dummies, they sit there in the puppet master's voice, but we can see whose lips are moving, and we can hear his money talk."
In a speech punctuated by cheers from the audience, Mr. Mfume said: "They can't deal with the leaders we choose for ourselves, so they manufacture, promote and hire new ones."

What exactly is it about the NAACP's mission that makes it battle against school vouchers? I say little except the fact that it can pit them against Republicans. Mfume goes on to punch Project 21 in the face. He has a right to speak out on any issue, of course, but I think GWBush was right to insinuate that the NAACP is only interested in working with Democrats. That's a problem.

What exactly is it about the NAACP's mission that makes it battle against school vouchers?

The history of vouchers is enough to make the NAACP battle against school vouchers. My mother hates the idea because she remembers the "whites only private acadamies" that were established to bypass desegregation. She also remembers that these "private acadamies" were funded by vouchers.

I support them only because I believe things are that drastic. But I don't overlook that a few of the "big money supporters" also advocate the end of government run schools. That means ending funding at the fed and local level.