Taking Spin Out of Report That Made Bad Into Good Health

New York Times

Published: February 22, 2004

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. Thompson, the secretary of health and human services, told Congress last week. "It's going to be rectified."

Mr. Thompson 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 William 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. Nelson, 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. Nelson led a study of the issue by a committee of the National Academy of Sciences.

Prof. M. Gregg Bloche of Georgetown 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 Thompson 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. Thompson 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.