NYTimes.com Article: Taking Spin Out of Report That Made Bad Into Good Health

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Taking Spin Out of Report That Made Bad Into Good Health

February 22, 2004

By ROBERT PEAR

WASHINGTON, Feb. 21 - The Bush administration says it

improperly altered a report documenting large racial and

ethnic disparities in health care, but it will soon publish

the full, unexpurgated document.

" There was a mistake made, " Tommy G. , the

secretary of health and human services, told Congress last

week. " It's going to be rectified. "

Mr. said that " some individuals took it upon

themselves " to make the report sound more positive than was

justified by the data.

The reversal comes in response to concerns of Democrats and

the Senate majority leader, Bill Frist, Republican of

Tennessee. They are pushing separate bills to improve care

for members of minorities.

" African-Americans and Native Americans die younger than

any other racial or ethnic group, " Dr. Frist said.

" African-Americans, Native Americans and Hispanic Americans

are at least twice as likely to suffer from diabetes and

experience serious complications. These gaps are

unacceptable. "

President Bush's budget would cut spending for the training

of health professionals and would eliminate a $34 million

program that recruits blacks and Hispanics for careers as

doctors, nurses and pharmacists.

On Wednesday, more than 60 influential scientists,

including 20 Nobel laureates, issued a statement

criticizing what they described as the misuse of science by

the administration to bolster its policies on the

environment, arms control and public health.

Representative Henry A. Waxman, Democrat of California,

said the changes in the report on health disparities were

" another example of the administration's manipulation of

science to fit its political goals. "

But A. Pierce, a spokesman for the Department of

Health and Human Services, said the changes had occurred as

part of a " routine review process " and were not intended to

minimize the problem.

The report, the first of its kind, was prepared under a

1999 law that requires officials to issue such reports

every year.

The theme of the original report was that members of

minorities " tend to be in poorer health than other

Americans " and that " disparities are pervasive in our

health care system, " contributing to higher rates of

disease and disability.

By contrast, the final report has an upbeat tone,

beginning, " The overall health of Americans has improved

dramatically over the last century. "

The report was prepared by the Agency for Healthcare

Research and Quality, led by Dr. Carolyn M. Clancy.

Administration officials said that she and her researchers

had fought hard, at some professional risk, to protect the

integrity of the report, but eventually went along with the

revisions.

" No data or statistics in the report were altered in any

way whatsoever, " Dr. Clancy said. But a close reading of

the evolving report shows that some entries in statistical

tables were deleted from the final version.

The final report acknowledges that " some socioeconomic,

racial, ethnic and geographic differences exist. " It says,

" There is no implication that these differences result in

adverse health outcomes or imply moral error or prejudice

in any way. "

But Dr. Alan R. , a former president of the American

Medical Association, said a large body of evidence

suggested that " unconscious biases and stereotypes among

physicians and nurses may play a role in causing racial and

ethnic disparities. " Dr. led a study of the issue by

a committee of the National Academy of Sciences.

Prof. M. Gregg Bloche of town University, a member of

the committee, said: " The administration's report does not

fabricate data, but misrepresents the findings. It

submerges evidence of profound disparities in an optimistic

message about the overall excellence of the health care

system. "

Dr. Sally L. Satel, a psychiatrist and scholar at the

American Enterprise Institute, said that agreeing to issue

the original report, " Secretary succumbed to

political pressure that was applied by members of Congress

who are identified with ethnic causes. " Critics, she said,

have grossly exaggerated the significance of changes in the

report.

Among those who wanted to rewrite the report was Arthur J.

Lawrence, a deputy assistant secretary of health and human

services.

" The present draft remains highly focused on the health

care system's supposed failings and flaws, " Mr. Lawrence

said in a memorandum to Mr. last fall. " In short,

the report lacks balance. "

Mr. Lawrence said that geography, income and other factors

could be more important than race. For example, he said,

whites in rural northern Maine may have worse heart

problems than blacks in big cities. In addition, he said,

the report should place more emphasis on " personal

responsibility for one's own health status " and on

" problems with the medical malpractice system. "

The original version of the report included these

statements, which were dropped from the final version:

¶ " We aspire to equality of opportunities for all our

citizens. Persistent disparities in health care are

inconsistent with our core values. "

¶ " Disparities come at a personal and societal price. "

¶ " Compared with whites, blacks experience longer waits in

emergency departments and are more likely to leave without

being seen. "

¶When hospitalized for heart attacks, " Hispanics are less

likely to receive optimal care. "

The original report included a stark, prominent statement

that " black children have much higher hospitalization rates

for asthma than white children. " The final version included

the data, without comment.

http://www.nytimes.com/2004/02/22/politics/22HEAL.html?ex=1078482240 & ei=1 & en=886\

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