Implicit Bias

What is implicit bias? “‘Implicit bias’ is a term of art referring to relatively unconscious and relatively automatic features of prejudiced judgment and social behavior. While psychologists in the field of ‘implicit social cognition’ study ‘implicit attitudes’ toward consumer products, self-esteem, food, alcohol, political values, and more, the most striking and well- known research has focused on implicit attitudes toward members of socially stigmatized groups, such as African-Americans, women, and the LGBTQ community” (SEP entry on implicit bias: http://plato.stanford.edu/entries/implicit-bias/).

How is implicit bias measured? Implicit bias can be measured by some form of the IAT (implicit association test) which has been developed and used by social psychologists (first developed by Greenwald et al. 2008). These tests usually require its subject to pair features (such as adjectives) with something representative of the group one wishes to test bias about (for example, feminine and masculine names or ‘black’ and ‘white’ sounding names). For example, a test may see how quickly a subject can pair scientific words with masculine versus feminine names.

How is implicit bias measured? It is thought that if the subject can more quickly and easily pair masculine names with scientific words (think: hypothesis, microscope, etc), then this person has a bias against women in science, viewing men as more representative of being scientific. You can take a variety of IAT tests yourself at https://implicit.harvard.edu/implicit/selectatest.html

Philosophical questions regarding implicit bias How implicit are these biases? Meaning, are they really beyond our conscious access? Are we responsible for our implicit biases? What are ways that could help us get rid of/prevent these biases? Should we blame people for their biases, even if they are implicit?

Jennifer Tsai’s piece Tsai is talking about implicit bias revealing itself in the medical profession. It is an established fact that medical professionals are less likely to prescribe narcotic pain medication to patients who are not white (in comparison to white patients). Tsai is not expressing or charging that all of these doctor’s are overtly racist; rather, there seems to be a widespread implicit racial bias that is influencing their behaviour—and it’s a big problem!

What’s more There are other issues, such as prescriptions being 4 times as likely to be prescribed to children on medicaid who exhibit symptoms of behavioural issues (compared with those covered by private insurance). This type of bias reveals a link between perceptions of class and mental illness.

As Tsai writes, “Pain and mental illness especially cannot be measured by pricking your finger or stepping on a scale. In the absence of quantitative measures, it is ultimately physician judgment that will determine how to treat a patient. Physicians, however, do not render their perceptions within a vacuum. The cultural makeup of America inevitably shapes physician perception of patient moral and social character, which is not unrelated to the doctor’s formulation and judgment of that patient’s medical issues”.

Basically, doctors are not immune from the same prejudices of the general population. Judging things like pain, and mental illness, require the doctor’s own subjectivity to come into play in making the diagnosis, and unfortunately this means that their biases come into play, too. This issue is being insufficiently addressed, according to Tsai.

Connections to Ferguson The death of Mike Brown is understood, says Tsai, as a political issue revealing the depths of systemic racism and prejudice. Racism and bias in the medical profession should be understood in this way as well; they should be politicized. In short, medicine is not immune from political concerns, and this should be given attention!

In effect, the same sorts of biases that resulted in Ferguson are the ones that result in things like pain prescription disparity. It is associations race and criminality at play in both cases. As Tsai writes, we can’t imagine the same thing that happened to Mike Brown happening to a white woman.

Solutions? Tsai thinks that medical education needs to pay more attention to social context and social determinants of health, rather than focusing strictly on the dominant biomedical model. Medicine is not a neutral practice. It’s practitioners are not neutral. Racism and general bias within the medical community needs to be acknowledged before it can try to be diminished.

A video on discrimination… https://www.youtube.com/watch?v=RsldtV4jWA0