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Letter to the Editor

Letter to the Editor

White Physicians Don't Necessarily Have Bias

doi: 10.1097/01.EEM.0000719148.86508.07


    Dr. Sandra Scott Simons' recent article on racial bias in health care asserts that while white physicians consciously think they are not racist, they are because of implicit bias, which is the assumption that although they may not act, think, or have done anything racist, deep down inside, they are, just not conscious of it. (“The Racial Biases Lurking in Our Subconscious,” EMN. 2020;42[8]:1;

    Her proof? The popular yet seriously flawed implicit association test (IAT), a computerized, timed test, which claims that 90-95 percent of Americans harbor the “roots of unconscious prejudice.” The media crowned it a revolutionary psychosocial tool because it could identify those with inner racial bias and predict real-world discriminatory behavior. (The Cut. Jan. 11, 2017;

    The IAT, however, has major shortcomings, the first being its reliability (results should roughly be the same from one test to another) and its validity (it measures what it claims to be measuring). A good psychological tool has both. The IAT demonstrates neither. (The Heritage Foundation. Dec. 12, 2017;

    Published standards agree that the standard coefficient of reliability (r) for a test should be 0.8 (ranging from 0 to 1). The IAT's reliability is 0.55. If you take the test and then three retests over two weeks, the r plunges to a dismal 0.27. (Psychol Sci. 2001;12[2]:163;

    Its lack of validity was verified by a recent meta-analysis of 492 studies with 87,418 participants that concluded implicit bias was not a strong predictor of how someone will act in real life. (J Pers Soc Psychol. 2019;117[3]:522.) Not every thought, good or bad, results in behavior. Makes sense to me. If you disagree, explain how to stop an unconscious thought from manifesting itself into behavior if you don't know that you are having it.

    Many societal disparities aren't due to racism. Besides, it is destructive to accuse someone, without any evidence, whom you have never met of something simply because of their skin color. We have a name for that—it is called racism.

    Daniel Trueba Jr., MD

    Oceanside, CA

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