Health report to be reprinted in full; Bush edits smoothed over racial gaps

By Robert Pear
The New York Times

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WASHINGTON — The Bush administration says it improperly altered a report documenting large racial and ethnic disparities in health care, but it soon will publish the full, unexpurgated document. Experts say the changes distorted the focus of the document.

"There was a mistake made," Health and Human Services Secretary Tommy Thompson told Congress on Feb. 10. "It's going to be rectified."

Thompson said that "some individuals took it upon themselves" to make the report more positive than was justified by the data.

The reversal comes in response to concerns of Democrats and Senate Majority Leader Bill Frist, R-Tenn. They are pushing separate bills to improve care for members of minorities.

Some of the changes The original version of the report prepared by the Agency for Healthcare Research and Quality 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. — The New York Times

"African Americans and Native Americans die younger than any other racial or ethnic group," 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 2005 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.

More than 60 influential scientists, including 20 Nobel laureates, on Wednesday 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.

Rep. Henry Waxman, D-Calif., 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 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 Clancy. Administration officials said that she and her researchers had fought hard, at some professional risk, to protect the integrity of the report, but went along with the revisions.

"No data or statistics in the report were altered in any way whatsoever," 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 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."

Professor 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 Satel, a psychiatrist and scholar at the American Enterprise Institute, said that by 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 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," Lawrence said in a memorandum to Thompson last fall. "In short, the report lacks balance."

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."

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