http://www.nytimes.com/2008/11/30/opinion/30dowd.html?hp
Maureen, your generally wonderful and nearly always witty column as usual raises so many interesting questions about our diverse MULTIPOLAR world, not just about journalism. That's the keyword -- multipolar. Unipolar is so 20th Century! The US including its journalists need to wake up to this fact. It will be healthy for US journalism, because there will be fresh and diverse perspectives through this new paperless glocal new media.
The quote about the Rose Bowl, I could see, being of Indian origin myself, was accurate -- it was in ONE of the scores of vibrant not necessarily grammatical Indian Englishes that are spoken and written in India.
EVERY country is outsourcing and ("insourcing"?) some product or service to and from someplace else. China and India both manufacturing and service powerhouses, outsource their commerce between themselves and with other producers.
New Media and New Labor (not Tony Blair's I-am-Bush's-poodle brand) are inextricably intertwined.
The Pasadena news is being 'contented' in India only because India is English-speaking, has an IT knowledge surplus, lots of workers and a 'free' market still controlled by the G-8
Now, where do you think Le Monde is being produced? I am not sure, but hopefully soon in Cote d'Ivoire!
Frankly, I'm waiting for Pasadena newsmaking to be outsourced to Palestine, where they desperately need the work, non-intervention by the U.S. and not a moment too soon -- PEACE.
Chithra KarunaKaran
Ethical Democracy As Lived Practice
http://www.EthicalDemocracy.Blogspot.com
====================================================================================
Sunday, November 30, 2008
IF YOU SEE SOMETHING SAY SOMETHING
"IF YOU SEE SOMETHING SAY SOMETHING."
This is the slogan that has protected us in New York City, since 9/11. This is the mentality, the thought process, the active public engagement we in India need.
The 72-year old harbor official in Mumbai who SAW the young men getting out of a speedboat at night with overloaded backpacks, should have SAID something because he SAW something. This is EVERY citizen's obligation.
Don't leave it to the politicians especially the rightwing, antisecular, anticonstitutional Hindutva elements, or sluggish, status-preserving lifetime salaried bureaucrats.
It's up to The People to say something, to kick the butts of their elected leaders, these paid/bribed political hacks, to DO the PEOPLES WILL.
NDTV and other media, Stop talking to the talking heads. Step aside and let The PEOPLE speak. Let the People Engage in vigilant antiterrorism, for the Greater Collective Good (GCG).
That is a critical and preferred path towards a People's
Democracy. We aren't there yet, either in India or the U.S. or South Africa or Brasil or anywhere else.
DEMOCRACY'S WORK IS NEVER DONE.
Chithra KarunaKaran
Ethical Democracy As Lived Practice
http://www.EthicalDemocracy.Blogspot.com
=====================================================================================
This is the slogan that has protected us in New York City, since 9/11. This is the mentality, the thought process, the active public engagement we in India need.
The 72-year old harbor official in Mumbai who SAW the young men getting out of a speedboat at night with overloaded backpacks, should have SAID something because he SAW something. This is EVERY citizen's obligation.
Don't leave it to the politicians especially the rightwing, antisecular, anticonstitutional Hindutva elements, or sluggish, status-preserving lifetime salaried bureaucrats.
It's up to The People to say something, to kick the butts of their elected leaders, these paid/bribed political hacks, to DO the PEOPLES WILL.
NDTV and other media, Stop talking to the talking heads. Step aside and let The PEOPLE speak. Let the People Engage in vigilant antiterrorism, for the Greater Collective Good (GCG).
That is a critical and preferred path towards a People's
Democracy. We aren't there yet, either in India or the U.S. or South Africa or Brasil or anywhere else.
DEMOCRACY'S WORK IS NEVER DONE.
Chithra KarunaKaran
Ethical Democracy As Lived Practice
http://www.EthicalDemocracy.Blogspot.com
=====================================================================================
Saturday, November 29, 2008
Global South Journalists -- Two Sellouts to U.S. dominant mainstream media
http://www.EthicalDemocracy.blogspot.com
Chithra KarunaKaran
South Asian Journalists Association (SAJA)
http://www.sajaforum.org/2008/11/mumbai-attacks-critique-the-media-coverage/comments/page/2/#comments
http://www.time.com/time/world/article/0,8599,1862650,00.html
a Time magazine article partly contributed by two journalists of South Asian origin.
Malcolm X had an excellently apt phrase which describes the standing of these two journalists vis a vis the dominant mainstream US media. Those who do not know X's accurate but often censored phrase, should look it up in his autobiography, as narrated to Alex Haley.
My comment:
South Asian colonial history is more critically appraised by subaltern writers -- Time magazine and its writers do not qualify.
Britain's role in West Asia (I never refer to it as the Middle East) and South Asia continues, particularly through its "special" relationship with the U.S.
It is interesting to note that in this article rightwing Time completely fails to narrate the U.S. neo-imperial distortion of West Asian and South Asian sub-continental geopolitics,
beginning all the way back from the imposed establishment of the state of Israel in West Asia and the creation of SEATO in South and South East Asia in the Dulles era of the U.S. Sate Department.
That constitutes the more recent and therefore relevant 60+years' U.S. dominant-power context update of the present terrorist activity, that Time cleverly (intentionally?) fails to provide in the above-mentioned article partially written by two Global South Journalists
The US took over from the Brits and expanded its own supremacist control over these regions, deploying a combination of the old divide-and-rule strategy & new capital gained from exploiting Global South natural resources.
Of course the subcontinental elites colluded, no doubt about that. They continue to collude to advance their own narrow profit-centered interests, at the expense of the Greater Collective Good -- food, shelter, health for The People.
The US 'model' of 'democracy' founded on and enriched by the profits from slavery and genocide and advanced through 'free' market exploitation of emerging post-colonial sovereign liberatory nation-states, needs to be emphatically and critically rejected in policy and practice by Global South regional economies and nation-states.
South-South cooperation is essential, real and already underway.
----------------------------------------------------------------------------------
The Times of India feeds and the BBC reports are far superior to anything coming out of the NYT or any section of the US media. However I have been writing comments on NYT, especially on the Lede blog.
I also listened to a terrific audio on The Times of South Africa website describing a dramatic rescue of 150 guests from the Taj by a South African "close protection" security specialist. Check it out.
Even though Bush is despicable, he had apt words in response to the horrific Mumbai events. Obama went one better and both focused on India's diverse democracy.
My suggestion is Let us all keep our Eyes on the Prize -- Indian Democracy. Indian Democracy is the prize the terrorists are really after.
Indian Prime Minister Manmohan Singh in contrast spoke as if he had been recently mummified. No sense of emotional connection to his suffering fellow citizens. Modi was his usual brash condemnable self and Patil was smirking about the Indian security response. Why does this fool still have a job?
I also picked up a story in Time magazine which I posted on my blog along with my comment which is pasted below:
http://www.time.com/time/world/article/0,8599,1862650,00.html
by aryn baker, With reporting by Jyoti Thottam / Mumbai and Ershad Mahmud / Islamabad
Jyoti Thottam and her Pakistani colleague both work for rightwing Time. Malcolm X had a choice phrase which describes their standing. Time and saja censorship would prevent me from using his phrase here, but it is an excellently apt one for these two sellout so-called journalists.
South Asian colonial history is more critically appraised by subaltern writers -- Time magazine and its writers do not qualify.
Britain's role in West Asia and South Asia which continues particularly through its "special" relationship with the U.S.
It is interesting to note that rightwing Time completely fails to narrate the U.S. neo-imperial distortion of West Asian and South Asian sub-continental geopolitics,
beginning all the way back from the imposed establishment of the state of Israel in West Asia and the creation of SEATO in the Dulles era of the U.S. Sate Department.
That constitutes the more recent 60+years' dominant-power context update of the present terrorist activity, that Time cleverly fails to provide.
The US took over from the Brits and expanded its own supremacist control over these regions,
with a combination of the old divide-and-rule strategy & new capital gained from exploiting Global South resources.
The US 'model' of 'democracy' founded on slavery and genocide and advanced through 'free' market exploitation of emerging post-colonial sovereign liberatory nation-states, needs to be emphatically and critically rejected in policy and practice by Global South regional economies and nation-states.
South-South cooperation is essential, real and already underway.
It's time Global South journalists located in the US stopped selling out/embedding with US mainstream media.
Oops, wrong place to make this observation, SAJA is part of the problem because it is located within the entrenched dominant U.S. media perspective that cravenly goes along with US foreign policy.
http://www.EthicalDemocracy.blogspot.com
Chithra KarunaKaran
Posted by: Chithra KarunaKaran | November 29, 2008 at 09:03 PM
Chithra KarunaKaran
Ethical Democracy As Lived Practice
http://www.EthicalDemocracy.Blogspot.com
===================================================================================================================
http://www.time.com/time/world/article/0,8599,1862650,00.html
Chithra KarunaKaran
South Asian Journalists Association (SAJA)
http://www.sajaforum.org/2008/11/mumbai-attacks-critique-the-media-coverage/comments/page/2/#comments
http://www.time.com/time/world/article/0,8599,1862650,00.html
a Time magazine article partly contributed by two journalists of South Asian origin.
Malcolm X had an excellently apt phrase which describes the standing of these two journalists vis a vis the dominant mainstream US media. Those who do not know X's accurate but often censored phrase, should look it up in his autobiography, as narrated to Alex Haley.
My comment:
South Asian colonial history is more critically appraised by subaltern writers -- Time magazine and its writers do not qualify.
Britain's role in West Asia (I never refer to it as the Middle East) and South Asia continues, particularly through its "special" relationship with the U.S.
It is interesting to note that in this article rightwing Time completely fails to narrate the U.S. neo-imperial distortion of West Asian and South Asian sub-continental geopolitics,
beginning all the way back from the imposed establishment of the state of Israel in West Asia and the creation of SEATO in South and South East Asia in the Dulles era of the U.S. Sate Department.
That constitutes the more recent and therefore relevant 60+years' U.S. dominant-power context update of the present terrorist activity, that Time cleverly (intentionally?) fails to provide in the above-mentioned article partially written by two Global South Journalists
The US took over from the Brits and expanded its own supremacist control over these regions, deploying a combination of the old divide-and-rule strategy & new capital gained from exploiting Global South natural resources.
Of course the subcontinental elites colluded, no doubt about that. They continue to collude to advance their own narrow profit-centered interests, at the expense of the Greater Collective Good -- food, shelter, health for The People.
The US 'model' of 'democracy' founded on and enriched by the profits from slavery and genocide and advanced through 'free' market exploitation of emerging post-colonial sovereign liberatory nation-states, needs to be emphatically and critically rejected in policy and practice by Global South regional economies and nation-states.
South-South cooperation is essential, real and already underway.
----------------------------------------------------------------------------------
The Times of India feeds and the BBC reports are far superior to anything coming out of the NYT or any section of the US media. However I have been writing comments on NYT, especially on the Lede blog.
I also listened to a terrific audio on The Times of South Africa website describing a dramatic rescue of 150 guests from the Taj by a South African "close protection" security specialist. Check it out.
Even though Bush is despicable, he had apt words in response to the horrific Mumbai events. Obama went one better and both focused on India's diverse democracy.
My suggestion is Let us all keep our Eyes on the Prize -- Indian Democracy. Indian Democracy is the prize the terrorists are really after.
Indian Prime Minister Manmohan Singh in contrast spoke as if he had been recently mummified. No sense of emotional connection to his suffering fellow citizens. Modi was his usual brash condemnable self and Patil was smirking about the Indian security response. Why does this fool still have a job?
I also picked up a story in Time magazine which I posted on my blog along with my comment which is pasted below:
http://www.time.com/time/world/article/0,8599,1862650,00.html
by aryn baker, With reporting by Jyoti Thottam / Mumbai and Ershad Mahmud / Islamabad
Jyoti Thottam and her Pakistani colleague both work for rightwing Time. Malcolm X had a choice phrase which describes their standing. Time and saja censorship would prevent me from using his phrase here, but it is an excellently apt one for these two sellout so-called journalists.
South Asian colonial history is more critically appraised by subaltern writers -- Time magazine and its writers do not qualify.
Britain's role in West Asia and South Asia which continues particularly through its "special" relationship with the U.S.
It is interesting to note that rightwing Time completely fails to narrate the U.S. neo-imperial distortion of West Asian and South Asian sub-continental geopolitics,
beginning all the way back from the imposed establishment of the state of Israel in West Asia and the creation of SEATO in the Dulles era of the U.S. Sate Department.
That constitutes the more recent 60+years' dominant-power context update of the present terrorist activity, that Time cleverly fails to provide.
The US took over from the Brits and expanded its own supremacist control over these regions,
with a combination of the old divide-and-rule strategy & new capital gained from exploiting Global South resources.
The US 'model' of 'democracy' founded on slavery and genocide and advanced through 'free' market exploitation of emerging post-colonial sovereign liberatory nation-states, needs to be emphatically and critically rejected in policy and practice by Global South regional economies and nation-states.
South-South cooperation is essential, real and already underway.
It's time Global South journalists located in the US stopped selling out/embedding with US mainstream media.
Oops, wrong place to make this observation, SAJA is part of the problem because it is located within the entrenched dominant U.S. media perspective that cravenly goes along with US foreign policy.
http://www.EthicalDemocracy.blogspot.com
Chithra KarunaKaran
Posted by: Chithra KarunaKaran | November 29, 2008 at 09:03 PM
Chithra KarunaKaran
Ethical Democracy As Lived Practice
http://www.EthicalDemocracy.Blogspot.com
===================================================================================================================
http://www.time.com/time/world/article/0,8599,1862650,00.html
Friday, November 28, 2008
A People's Democracy in a Time of Terror
129. November 28, 2008 3:15 pm Link November 28, 2008 9:32 am Link
http://thelede.blogs.nytimes.com/2008/11/27/eyewitness-updates-nariman-house/?apage=2#comments
Rabbi Gavriel Noach Holtzberg and his wife Rivkah Holtzberg, paid with their precious lives because they loved their Chabad Lubavitch religious beliefs and exercised their right to practice their religion freely in Mumbai India, with their peaceful co-adherents. The youthful and courageous Holtzbergs had lived in India since 2003, according to news reports.
Can anyone imagine Rabbi Holtzberg and his family and community living and practicing their religion -- in PAKISTAN?
Does anyone ever hear anything about Pakistan's minorities? Who are they? Where do they live? For that matter, what about Saudi Arabia's religious, ethnic and linguistic minorities, why are they made invisible?
Remember what happened to Daniel Pearl, the Wall Street Journal reporter whose throat was slit by terrorists in Pakistan?
Democracy is always imperfect and always in need of continual work by The People.
In India our democracy is most certainly imperfect and we in India must make tireless efforts in the spirit of Gandhi, a democracy that is an outgrowth of our own history and civilization.
A start towards democracy, ETHICAL DEMOCRACY, built upon her own unique and complex history is essential, in Pakistan.
Chithra KarunaKaran
Ethical Democracy As Lived Practice
http://www.EthicalDemocracy.Blogspot.com
==================================
Chithra Karunakaran
http://www.EthicalDemocracy.blogspot.com
I was interested in two sets of comments sent by Bradsher of the NYTimes The Lede blog. My own comments are followed by his:
My Comment #1.
Even though there is no clear evidence and there probably will not be, of exactly who is behind the attacks, the Indian Prime Minister has already claimed without hard evidence there are “external linkages.” This causes people to distrust their popularly elected govt. The Indian leadership, not just the government but also the numerous regional parties and alliances, have to face up to the strong possibility that this is a homegrown terror event with multiple homegrown causes. Such an admission would force the current coalition govt and opposition leaders at the federal regional and local levels to work together to address and resolve major social, economic and political inequities on the ground, including ending Indian army atrocities in Kashmir as well as attempt to quell cross-border incursions from Pakistan.
India is an unprecedented democracy, therefore shemust reach into her own particular extraordinary history of revolutionary liberatory dissent led by Gandhi and others,and it cannot merely imitate the West’s response to terror attacks, which have complex underlying causes that need to be understood before we can act on them.
Bradsher wrote;
There is still great uncertainty about who was responsible for the attacks and why it has taken so long for the Indian Army to overcome the attackers.
============================================
Comment #2
This is Indian democracy in action. This is a country of enormous numbers of people. We the People get a ringside seat! I see numerous examples of the Indian “way of democratic process” every time I return ‘home.’ Of course the safety of the public is important but can it be allowed to overrule the people’s right to know. first hand?
Bradsher wrote:
Date: Fri, 28 Nov 2008 11:10
The Indian army has not tried to clear residents from more than a radius of a block or two around combat sites. That radius might be adequate to protect spectators from grenade blasts, but it won’t save them from bullets fired by high-powered rifles, which can be deadly over distance of a couple miles.
The roads, rooftops and balconies around Nariman House are now crowded with over a thousand local gawkers. It is not clear if any have been injured.
==============================================
Chithra KarunaKaran
Ethical Democracy As Lived Practice
http://www.EthicalDemocracy.Blogspot.com
http://thelede.blogs.nytimes.com/2008/11/27/eyewitness-updates-nariman-house/?apage=2#comments
Rabbi Gavriel Noach Holtzberg and his wife Rivkah Holtzberg, paid with their precious lives because they loved their Chabad Lubavitch religious beliefs and exercised their right to practice their religion freely in Mumbai India, with their peaceful co-adherents. The youthful and courageous Holtzbergs had lived in India since 2003, according to news reports.
Can anyone imagine Rabbi Holtzberg and his family and community living and practicing their religion -- in PAKISTAN?
Does anyone ever hear anything about Pakistan's minorities? Who are they? Where do they live? For that matter, what about Saudi Arabia's religious, ethnic and linguistic minorities, why are they made invisible?
Remember what happened to Daniel Pearl, the Wall Street Journal reporter whose throat was slit by terrorists in Pakistan?
Democracy is always imperfect and always in need of continual work by The People.
In India our democracy is most certainly imperfect and we in India must make tireless efforts in the spirit of Gandhi, a democracy that is an outgrowth of our own history and civilization.
A start towards democracy, ETHICAL DEMOCRACY, built upon her own unique and complex history is essential, in Pakistan.
Chithra KarunaKaran
Ethical Democracy As Lived Practice
http://www.EthicalDemocracy.Blogspot.com
==================================
Chithra Karunakaran
http://www.EthicalDemocracy.blogspot.com
I was interested in two sets of comments sent by Bradsher of the NYTimes The Lede blog. My own comments are followed by his:
My Comment #1.
Even though there is no clear evidence and there probably will not be, of exactly who is behind the attacks, the Indian Prime Minister has already claimed without hard evidence there are “external linkages.” This causes people to distrust their popularly elected govt. The Indian leadership, not just the government but also the numerous regional parties and alliances, have to face up to the strong possibility that this is a homegrown terror event with multiple homegrown causes. Such an admission would force the current coalition govt and opposition leaders at the federal regional and local levels to work together to address and resolve major social, economic and political inequities on the ground, including ending Indian army atrocities in Kashmir as well as attempt to quell cross-border incursions from Pakistan.
India is an unprecedented democracy, therefore shemust reach into her own particular extraordinary history of revolutionary liberatory dissent led by Gandhi and others,and it cannot merely imitate the West’s response to terror attacks, which have complex underlying causes that need to be understood before we can act on them.
Bradsher wrote;
There is still great uncertainty about who was responsible for the attacks and why it has taken so long for the Indian Army to overcome the attackers.
============================================
Comment #2
This is Indian democracy in action. This is a country of enormous numbers of people. We the People get a ringside seat! I see numerous examples of the Indian “way of democratic process” every time I return ‘home.’ Of course the safety of the public is important but can it be allowed to overrule the people’s right to know. first hand?
Bradsher wrote:
Date: Fri, 28 Nov 2008 11:10
The Indian army has not tried to clear residents from more than a radius of a block or two around combat sites. That radius might be adequate to protect spectators from grenade blasts, but it won’t save them from bullets fired by high-powered rifles, which can be deadly over distance of a couple miles.
The roads, rooftops and balconies around Nariman House are now crowded with over a thousand local gawkers. It is not clear if any have been injured.
==============================================
Chithra KarunaKaran
Ethical Democracy As Lived Practice
http://www.EthicalDemocracy.Blogspot.com
Wednesday, November 26, 2008
Terror Strikes & India Grieves
http://community.nytimes.com/article/comments/2008/11/27/world/asia/27mumbai.html?s=1&pg=8
My Comment NYT#193. (a version)
November 26, 2008 9:30 pm
India and ALL the sovereign nation-states of South Asia can go forward ONLY if We the People collectively WAGE PEACE & JUSTICE while increasing VIGILANCE and SECURITY, vigorously encouraging our governments to pursue the governance we DESERVE.
I thank every person for their comments that show CONCERN for those who suffered and died and have been injured in these horrific attacks and I send my sympathy to their families and communities who have suffered such a grevious loss.
I deplore all comments on these NYT Comment pages against Muslims and Islam, made in response to the terror attacks inflicted upon the innocent people of Mumbai, allegedly by a group calling themselves the Deccan Mujahadeen. Terrorism has no religion, though religion is used as an excuse.
Economic/ Social/Political Justice is a powerful antidote against terror. A few of the millions who are despairing and marginalized by hunger, poverty, illiteracy, unemployment, discrimination can and do become pathological. They violate the rights of countless others with murderous, callous indifference. They can even lead seemingly comfortable middle class lives and still experience marginalization, as in the London bombings. Ethnic Tamil Hindus and ethnic Buddhists have been operating for decades with violence and murder in Sri Lanka.
What role have neo-imperial nation-states (U.S.) and former colonial powers (U.K.) played through invasion, occupation, sanctions, threats, settlement, militaristic intervention, resource consumption, in other formerly colonized, now emerging sovereign nation-states? Retaliatory extra-state terrorism and long-term state-sponsored corporate terrorism appear to be linked.
Mumbai is one amazing resilient global megacity, whether temporarily submerged by a powerful monsoon or by a powerful series of bloody bomb blasts. Mumbaikars are worthy of their/our great city and they are in our meditations and in our collective action.
Gandhi's lived message ("my life is my message") of peace and non-violence in this precise moment of terrorist violence, is especially relevant.
Chithra KarunaKaran
Ethical Democracy As Lived Practice
http://www.EthicalDemocracy.Blogspot.com
====================================================================================
My Comment NYT#193. (a version)
November 26, 2008 9:30 pm
India and ALL the sovereign nation-states of South Asia can go forward ONLY if We the People collectively WAGE PEACE & JUSTICE while increasing VIGILANCE and SECURITY, vigorously encouraging our governments to pursue the governance we DESERVE.
I thank every person for their comments that show CONCERN for those who suffered and died and have been injured in these horrific attacks and I send my sympathy to their families and communities who have suffered such a grevious loss.
I deplore all comments on these NYT Comment pages against Muslims and Islam, made in response to the terror attacks inflicted upon the innocent people of Mumbai, allegedly by a group calling themselves the Deccan Mujahadeen. Terrorism has no religion, though religion is used as an excuse.
Economic/ Social/Political Justice is a powerful antidote against terror. A few of the millions who are despairing and marginalized by hunger, poverty, illiteracy, unemployment, discrimination can and do become pathological. They violate the rights of countless others with murderous, callous indifference. They can even lead seemingly comfortable middle class lives and still experience marginalization, as in the London bombings. Ethnic Tamil Hindus and ethnic Buddhists have been operating for decades with violence and murder in Sri Lanka.
What role have neo-imperial nation-states (U.S.) and former colonial powers (U.K.) played through invasion, occupation, sanctions, threats, settlement, militaristic intervention, resource consumption, in other formerly colonized, now emerging sovereign nation-states? Retaliatory extra-state terrorism and long-term state-sponsored corporate terrorism appear to be linked.
Mumbai is one amazing resilient global megacity, whether temporarily submerged by a powerful monsoon or by a powerful series of bloody bomb blasts. Mumbaikars are worthy of their/our great city and they are in our meditations and in our collective action.
Gandhi's lived message ("my life is my message") of peace and non-violence in this precise moment of terrorist violence, is especially relevant.
Chithra KarunaKaran
Ethical Democracy As Lived Practice
http://www.EthicalDemocracy.Blogspot.com
====================================================================================
Tuesday, November 25, 2008
Tibet's Middle Way & Ethical Democracy
Barnett's piece "Did Britain just sell Tibet?" will almost certainly increase the profile of the Modern Tibetan Studies Program at Columbia University. Barnett will likely join the other talking heads on the US TV circuit, as yet another neoliberal dominant mainstream voice in the US-led global recession, which contextualizes British Prime Minister Gordon Brown's suggestion to China to provide capital to the IMF in return for voting power. Of course China is pleased with that craven suggestion, based on justifiable nationalistic pride in China's economic successes.
Q. Will the Tibetan people's interests be best served by either the British Government, The U.S. govt. or think tank programs in U.S. academe? The answer has got be an unqualified no, for now and the foreseeable future. Both the US (including its academic and other institutions) and Britain have very little to contribute. They both have the potential to do harm to the long term interest of Tibetans and Tibet.
The geopolitical configurations and reconfigurations of South and South East Asia (of which Tibet is a part) must be left to the sovereign nation-states of these regions because they are neighbors with historical ties and rapidly evolving contemporary cultural and economic relationships with nation states both within and outside their respective regions. BRIC (Brasil, India, China) would constitute such an example.
There is a dynamic balance of competing interests between the power economies of the sovereign nation-states of China and India.
The majority of Tibetan exiles live in India. China, a dictatorship "claimed" Tibet. India, a democracy "claimed" Sikkim. China's 'Tibetan question' is somewhat equivalent to India's 'Kashmir question'. Both think there is no "question."
The tacit support of one for the other in the corridors and conference halls of the U.N. have maintained the balance of power between them in the larger South and South East Asia regional contexts. Other sovereign-states, (even when they might only qualify as failing or failed states) in the region, Pakistan, Afghanistan are also part of the strategic equation. In addition, Russia is our neighbor. Iran is our neighbor, Iraq is our neighbor. The U.S. and Britain are not.
British Colonial control is still a shameful memory in the South and South East Asia regions. Britain was in the habit of "selling" territory and people of these regions during their period of Empire. U.S. neo-imperialism causes grave distrust among all countries in South and South East Asia.
The Dalai Lama has chosen the "non-violent Middle Way" to avoid the slaughter of Tibetans in their homeland and the destruction of their living religious and cultural heritage
To continue to persevere with this preferred Middle Way, in a highly complex inter-regional context with possible global repercussions,it is Tibetans and their leaders, first and foremost, who can best engage with the Chinese and their leaders, from safe havens and democratic spaces in Tibet, India and elsewhere.
Chithra KarunaKaran
Ethical Democracy As Lived Practice
http://www.EthicalDemocracy.Blogspot.com
see:
http://www.nytimes.com/2008/11/25/opinion/25barnett.html?hp
====================================================================================
Q. Will the Tibetan people's interests be best served by either the British Government, The U.S. govt. or think tank programs in U.S. academe? The answer has got be an unqualified no, for now and the foreseeable future. Both the US (including its academic and other institutions) and Britain have very little to contribute. They both have the potential to do harm to the long term interest of Tibetans and Tibet.
The geopolitical configurations and reconfigurations of South and South East Asia (of which Tibet is a part) must be left to the sovereign nation-states of these regions because they are neighbors with historical ties and rapidly evolving contemporary cultural and economic relationships with nation states both within and outside their respective regions. BRIC (Brasil, India, China) would constitute such an example.
There is a dynamic balance of competing interests between the power economies of the sovereign nation-states of China and India.
The majority of Tibetan exiles live in India. China, a dictatorship "claimed" Tibet. India, a democracy "claimed" Sikkim. China's 'Tibetan question' is somewhat equivalent to India's 'Kashmir question'. Both think there is no "question."
The tacit support of one for the other in the corridors and conference halls of the U.N. have maintained the balance of power between them in the larger South and South East Asia regional contexts. Other sovereign-states, (even when they might only qualify as failing or failed states) in the region, Pakistan, Afghanistan are also part of the strategic equation. In addition, Russia is our neighbor. Iran is our neighbor, Iraq is our neighbor. The U.S. and Britain are not.
British Colonial control is still a shameful memory in the South and South East Asia regions. Britain was in the habit of "selling" territory and people of these regions during their period of Empire. U.S. neo-imperialism causes grave distrust among all countries in South and South East Asia.
The Dalai Lama has chosen the "non-violent Middle Way" to avoid the slaughter of Tibetans in their homeland and the destruction of their living religious and cultural heritage
To continue to persevere with this preferred Middle Way, in a highly complex inter-regional context with possible global repercussions,it is Tibetans and their leaders, first and foremost, who can best engage with the Chinese and their leaders, from safe havens and democratic spaces in Tibet, India and elsewhere.
Chithra KarunaKaran
Ethical Democracy As Lived Practice
http://www.EthicalDemocracy.Blogspot.com
see:
http://www.nytimes.com/2008/11/25/opinion/25barnett.html?hp
====================================================================================
Monday, November 24, 2008
A neocon tries to make sense
http://www.nytimes.com/2008/11/24/opinion/24kristol.html?_r=1&hp
November 24th, 2008 6:39 am
Kristol:
The truth is, Schumer hasn’t a well-grounded view, or even a well-informed clue, as to how large the stimulus package “has to be".
But you Kristol do? At this particular financial market moment, No ONE does. The crystal ball is covered with soot.
But like Schumer, it is better to err on the side of The People, than to err against them. Kristol generally supports the latter stance whether in Iraq or at home.
My personal solution is to bail myself out. Spend as little as possible and grow or otherwise produce something of my own making -- a winter herb garden, crocheted gifts. Silly impractical me, but I have shown fiscal restraint all my life and I am not an economist or a talking head.
Chithra KarunaKaran
Ethical Democracy As Lived Practice
http://www.EthicalDemocracy.Blogspot.com
November 24th, 2008 6:39 am
Kristol:
The truth is, Schumer hasn’t a well-grounded view, or even a well-informed clue, as to how large the stimulus package “has to be".
But you Kristol do? At this particular financial market moment, No ONE does. The crystal ball is covered with soot.
But like Schumer, it is better to err on the side of The People, than to err against them. Kristol generally supports the latter stance whether in Iraq or at home.
My personal solution is to bail myself out. Spend as little as possible and grow or otherwise produce something of my own making -- a winter herb garden, crocheted gifts. Silly impractical me, but I have shown fiscal restraint all my life and I am not an economist or a talking head.
Chithra KarunaKaran
Ethical Democracy As Lived Practice
http://www.EthicalDemocracy.Blogspot.com
Sunday, November 23, 2008
U.S. Exceptionalism & the American Terrorism Industry
Comment #
162. November 23, 2008 1:12 pm Link
Mr. Kristof:
How about the most important foreign policy strategy for the US? Stop meddling in Pakistan and Afghanistan and elsewhere in the world.
This non-interference is what most sovereign nation-states in the world are practising in their own foreign policy relationships. And even on those occasions when they don't, it is NOT for the U.S. to play SuperCop.
Who elected the U.S., Who appointed the U.S., to perform this extra-legal, extra-state function?
Most sovereign states are attempting multi-polar alliances but the US continues to be uni-polar, dominant and supremacist. How 20th century!
Mr. Kristof, I don't think it is for YOU or anyone in the U.S. to prescribe the following:
"Third, we should push much harder for a peace deal in Kashmir — including far more pressure on India — because Kashmir grievances empower Pakistani militants."
The relations between India and Pakistan are the ongoing concern of these two sovereign nation-states. It is a complex dynamic socio-historical relationship. Both Pakistanis and Indians continue to face the grave challenges of hunger, malnutrition, illiteracy, homelessness, disease.
Both ordinary Pakistanis and ordinary Indians are threatened by daily acts of terrorism in their streets, shopping areas and places of work; We don't need the US, with its laughable "intelligence" capabilities to hunt "insurgents." while actually killing innocent civilians.
In fact I am an admirer of the ordinary people of Pakistan and have deep friendships with a few of them. Like people everywhere in the world, especially if they can escape being meddled with by dominant self-serving superpowers or their own homegrown unscrupulous political elites, ordinary Pakistanis want peace, education, shelter, health, prosperity. They have suffered under uncaring political leadership and the machinations of the US in the South Asia region, all the way back to the Dulles era.
I really don't expect Kristof to understand this core point, because the strategic ideology of U.S. EXCEPTIONALISM ('we are the best, we are the greatest, we are the biggest, we can do whatever we want, wherever we want') pervades his thinking, no less than it pervades the thinking of the DoD or the Congress or the White House or the Department of State. Generations of Americans have been fed the hype of American individualism which since the Cold War era has morphed into US exceptionalism.
The U.S. presently runs a terrorism industry -- invading and occupying sovereign nation-states, hunting "terrorists" and "insurgents" increasing its undercover presence in parts of the world through "secret orders". Even the numerous books that detail US activities in Iraq and Afghanistan; the embedded anthropologists, sociologists and political scientists of the Human Terrain System (HTS) of the U.S. Army; the wounded veterans, the amputees and their resulting rehab with remarkable advances in engineering of prosthetic limbs etc etc, the PTSD sufferers and their innovative clinical interventions -- all these are spinoffs of the U.S. terrorism industry.
I respect Kristof's personal courage and writing. But Kristof just doesn't get it and it doesn't surprise me.
Chithra KarunaKaran
Ethical Democracy As Lived Practice
http://www.EthicalDemocracy.Blogspot.com
Link to Nicholas Kristof's article:
http://www.nytimes.com/2008/11/23/opinion/23kristof.html
===================================================================================
162. November 23, 2008 1:12 pm Link
Mr. Kristof:
How about the most important foreign policy strategy for the US? Stop meddling in Pakistan and Afghanistan and elsewhere in the world.
This non-interference is what most sovereign nation-states in the world are practising in their own foreign policy relationships. And even on those occasions when they don't, it is NOT for the U.S. to play SuperCop.
Who elected the U.S., Who appointed the U.S., to perform this extra-legal, extra-state function?
Most sovereign states are attempting multi-polar alliances but the US continues to be uni-polar, dominant and supremacist. How 20th century!
Mr. Kristof, I don't think it is for YOU or anyone in the U.S. to prescribe the following:
"Third, we should push much harder for a peace deal in Kashmir — including far more pressure on India — because Kashmir grievances empower Pakistani militants."
The relations between India and Pakistan are the ongoing concern of these two sovereign nation-states. It is a complex dynamic socio-historical relationship. Both Pakistanis and Indians continue to face the grave challenges of hunger, malnutrition, illiteracy, homelessness, disease.
Both ordinary Pakistanis and ordinary Indians are threatened by daily acts of terrorism in their streets, shopping areas and places of work; We don't need the US, with its laughable "intelligence" capabilities to hunt "insurgents." while actually killing innocent civilians.
In fact I am an admirer of the ordinary people of Pakistan and have deep friendships with a few of them. Like people everywhere in the world, especially if they can escape being meddled with by dominant self-serving superpowers or their own homegrown unscrupulous political elites, ordinary Pakistanis want peace, education, shelter, health, prosperity. They have suffered under uncaring political leadership and the machinations of the US in the South Asia region, all the way back to the Dulles era.
I really don't expect Kristof to understand this core point, because the strategic ideology of U.S. EXCEPTIONALISM ('we are the best, we are the greatest, we are the biggest, we can do whatever we want, wherever we want') pervades his thinking, no less than it pervades the thinking of the DoD or the Congress or the White House or the Department of State. Generations of Americans have been fed the hype of American individualism which since the Cold War era has morphed into US exceptionalism.
The U.S. presently runs a terrorism industry -- invading and occupying sovereign nation-states, hunting "terrorists" and "insurgents" increasing its undercover presence in parts of the world through "secret orders". Even the numerous books that detail US activities in Iraq and Afghanistan; the embedded anthropologists, sociologists and political scientists of the Human Terrain System (HTS) of the U.S. Army; the wounded veterans, the amputees and their resulting rehab with remarkable advances in engineering of prosthetic limbs etc etc, the PTSD sufferers and their innovative clinical interventions -- all these are spinoffs of the U.S. terrorism industry.
I respect Kristof's personal courage and writing. But Kristof just doesn't get it and it doesn't surprise me.
Chithra KarunaKaran
Ethical Democracy As Lived Practice
http://www.EthicalDemocracy.Blogspot.com
Link to Nicholas Kristof's article:
http://www.nytimes.com/2008/11/23/opinion/23kristof.html
===================================================================================
Saturday, November 22, 2008
Aging & Ethical Democracy
http://newoldage.blogs.nytimes.com/2008/11/20/unenforced-filial-responsibility-laws/
21. November 22, 2008 8:44 am
Link
http://www.nytimes.com/2008/11/22/us/22home.html?hp
Aging & Ethical Democracy
I’m trying to understand this. The fact is, elderly persons could indeed move to retirement communities even in these parlous economic times times. They should if they want to. But their children, inheritors of their parents’ assets, want the biggest bang for their real estate buck and you simply cant get that now.
I say don’t hold parents and grandparents hostage to the economic situation. Don’t foreclose their finite future. If you cant sell, rent it out and wait out the economic maelstrom. The elderly have a few more golden years to live and the present mess isn’t going to straighten out for a while.
Also, to continue to live out their years in familiar surroundings is psychologically beneficial for the elderly and their younger kin. Transitions are stressful. Staying put in the home you love and dying in it eventually is maybe the best thing. So maybe NOT being able to move because of the real estate mess is actually a blessing in disguise for the elderly and their children and grandchildren.
Money isn’t everything as we are all finding out. The problem is not money but greed.
In fact, money turns out to be worthless but it can turn the world upside down.
Chithra KarunaKaran
Ethical Democracy As Lived Practice
http://www.EthicalDemocracy.Blogspot.com
21. November 22, 2008 8:44 am
Link
http://www.nytimes.com/2008/11/22/us/22home.html?hp
Aging & Ethical Democracy
I’m trying to understand this. The fact is, elderly persons could indeed move to retirement communities even in these parlous economic times times. They should if they want to. But their children, inheritors of their parents’ assets, want the biggest bang for their real estate buck and you simply cant get that now.
I say don’t hold parents and grandparents hostage to the economic situation. Don’t foreclose their finite future. If you cant sell, rent it out and wait out the economic maelstrom. The elderly have a few more golden years to live and the present mess isn’t going to straighten out for a while.
Also, to continue to live out their years in familiar surroundings is psychologically beneficial for the elderly and their younger kin. Transitions are stressful. Staying put in the home you love and dying in it eventually is maybe the best thing. So maybe NOT being able to move because of the real estate mess is actually a blessing in disguise for the elderly and their children and grandchildren.
Money isn’t everything as we are all finding out. The problem is not money but greed.
In fact, money turns out to be worthless but it can turn the world upside down.
Chithra KarunaKaran
Ethical Democracy As Lived Practice
http://www.EthicalDemocracy.Blogspot.com
Thursday, November 20, 2008
Time to Retire the Electoral College?
http://community.nytimes.com/article/comments/2008/11/20/opinion/20thu1.html?s=1&pg=5
Post #110.
November 20, 2008 9:48 am
Link
Nothing and nobody should stand between The People and their vote in a democracy. Maybe a significant movement of tectonic plates but certainly not the Electoral College
The Electoral College, each individual within which, has only ONE vote, (the one they and all of us cast on Election Day), gets to vote TWICE, in a show of dominant power over the mass public electorate. In fact the electoral college loomed over the entire primary season as well as the election itself, as electoral college votes were counted state by state to determine the outcome.
Its unsavory beginnings as a holdover from slavery should be really enough to get the electoral college thrown out.
I agree that the U.S. Electoral College should be abolished, but the need for a constitutional amendment, like the battle for the ERA, will mean this will not happen.
If the media continues to throw light on the Electoral College not only before December 15, perhaps there will be enough momentum for an amendment to the Constitution. This constitutional amendment might follow after successful ballot referenda in every state?
Chithra KarunaKaran
http://www.EthicalDemocracy.blogspot.com
— EthicalDemocracy, http://www.EthicalDemocracy.blogspot.com
Recommend Recommended by 0 Readers
November 20, 2008 7:28 am
Nothing and nobody should stand between The People and their vote in a democracy. Maybe a significant movement of tectonic plates but certainly not the Electoral College
The Electoral College, each individual within which, has only ONE vote, (the one they and all of us cast on Election Day), gets to vote TWICE, in a show of dominant power over the mass public electorate. In fact the electoral college loomed over the entire primary season as well as the election itself, as electoral college votes were counted state by state to determine the outcome.
Its unsavory beginnings as a holdover from slavery should be really enough to get the electoral college thrown out.
I agree that the U.S. Electoral College should be abolished, but the need for a constitutional amendment, like the battle for the ERA, will mean this will not happen.
If the media continues to throw light on the Electoral College not only before December 15, perhaps there will be enough momentum for an amendment to the Constitution. This constitutional amendment might follow after successful ballot referenda in every state?
Chithra KarunaKaran
Ethical Democracy As Lived Practice
http://www.EthicalDemocracy.Blogspot.com
====================================================================================
Post #110.
November 20, 2008 9:48 am
Link
Nothing and nobody should stand between The People and their vote in a democracy. Maybe a significant movement of tectonic plates but certainly not the Electoral College
The Electoral College, each individual within which, has only ONE vote, (the one they and all of us cast on Election Day), gets to vote TWICE, in a show of dominant power over the mass public electorate. In fact the electoral college loomed over the entire primary season as well as the election itself, as electoral college votes were counted state by state to determine the outcome.
Its unsavory beginnings as a holdover from slavery should be really enough to get the electoral college thrown out.
I agree that the U.S. Electoral College should be abolished, but the need for a constitutional amendment, like the battle for the ERA, will mean this will not happen.
If the media continues to throw light on the Electoral College not only before December 15, perhaps there will be enough momentum for an amendment to the Constitution. This constitutional amendment might follow after successful ballot referenda in every state?
Chithra KarunaKaran
http://www.EthicalDemocracy.blogspot.com
— EthicalDemocracy, http://www.EthicalDemocracy.blogspot.com
Recommend Recommended by 0 Readers
November 20, 2008 7:28 am
Nothing and nobody should stand between The People and their vote in a democracy. Maybe a significant movement of tectonic plates but certainly not the Electoral College
The Electoral College, each individual within which, has only ONE vote, (the one they and all of us cast on Election Day), gets to vote TWICE, in a show of dominant power over the mass public electorate. In fact the electoral college loomed over the entire primary season as well as the election itself, as electoral college votes were counted state by state to determine the outcome.
Its unsavory beginnings as a holdover from slavery should be really enough to get the electoral college thrown out.
I agree that the U.S. Electoral College should be abolished, but the need for a constitutional amendment, like the battle for the ERA, will mean this will not happen.
If the media continues to throw light on the Electoral College not only before December 15, perhaps there will be enough momentum for an amendment to the Constitution. This constitutional amendment might follow after successful ballot referenda in every state?
Chithra KarunaKaran
Ethical Democracy As Lived Practice
http://www.EthicalDemocracy.Blogspot.com
====================================================================================
Tuesday, November 18, 2008
Unconscious Racial Bias & Ethical Democracy
16. November 18, 2008 9:26 am Link
Your comment is awaiting moderation.
What were the doctors? All white or racially and ethnically diverse?
Who were the patients? All Black or racially and ethically and economically diverse?
I may have missed these points in my quick initial reading of this article, so please excuse.
Some thoughts:
Race INTERSECTS with class, gender and sexual orientation but race frequently TRUMPS these other factors, in U.S. society.
We continue to be a racialized society in which Whiteness is the dominant system, structure and ideology, albeit highly nuanced in these times.
One doesn’t have the be white to perform and uphold Whiteness, a point that is essential to the maintenance of the dominant power of the Whiteness system.
A finding of unconscious racial bias is therefore a more plausible result, given the racialization of all discourses in U.S. society.
I might add:
commodified racialized discourses (from Black slavery and indigenous genocide onwards).
Chithra Karunakaran
http://www.EthicalDemocracy.blogspot.com
Findings
In Bias Test, Shades of Gray
Viktor Koen
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By JOHN TIERNEY
Published: November 17, 2008
Last year, a team of researchers at Harvard made headlines with an experiment testing unconscious bias at hospitals. Doctors were shown the picture of a 50-year-old man — sometimes black, sometimes white — and asked how they would treat him if he arrived at the emergency room with chest pains indicating a possible heart attack. Then the doctors took a computer test intended to reveal unconscious racial bias.
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The doctors who scored higher on the bias test were less likely than the other doctors to give clot-busting drugs to the black patients, according to the researchers, who suggested addressing the problem by encouraging doctors to test themselves for unconscious bias. The results were hailed by other psychologists as some of the strongest evidence that unconscious bias leads to harmful discrimination.
But then two other researchers, Neal Dawson and Hal Arkes, pointed out a curious pattern in the data. Even though most of the doctors registered some antiblack bias, as defined by the researchers, on the whole doctors ended up prescribing the clot-busting drugs to blacks just as often as to whites. The doctors scoring low on bias had a pronounced preference for giving the drugs to blacks, while high-scoring doctors had a relatively small preference for giving the drugs to whites — meaning that the more “biased” doctors actually treated blacks and whites more equally.
Does this result really prove dangerous bias in the emergency room? Or, as critics suggest, does it illustrate problems with the way researchers have been using split-second reactions on a computer test to diagnose an epidemic of racial bias?
In a series of scathing critiques, some psychologists have argued that this computerized tool, the Implicit Association Test, or I.A.T., has methodological problems and uses arbitrary classifications of bias. If Barack Obama’s victory seemed surprising, these critics say, it’s partly because social scientists helped create the false impression that three-quarters of whites are unconsciously biased against blacks.
The I.A.T., which has been taken by millions of people on an academic Web site, measures respondents’ reaction times as they follow instructions to associate words like “joy” or “awful” with either blacks or whites. It generally takes whites longer to associate positive words with blacks than with whites, although some do show no bias. (To meet one of these exceptional cases, go to TierneyLab, at nytimes.com/tierneylab.)
The test is widely used in research, and some critics acknowledge that it’s a useful tool for detecting unconscious attitudes and studying cognitive processes. But they say it’s misleading for I.A.T. researchers to give individuals ratings like “slight,” “moderate” or “strong” — and advice on dealing with their bias — when there isn’t even that much consistency in the same person’s scores if the test is taken again.
“One can decrease racial bias scores on the I.A.T. by simply exposing people to pictures of African-Americans enjoying a picnic,” says Hart Blanton, a psychologist at Texas A&M. “Yet respondents who take this test on the Web are given feedback suggesting that some enduring quality is being assessed.” He says that even the scoring system itself has been changed arbitrarily in recent years. “People receiving feedback about their ‘strong’ racial biases,” Dr. Blanton says, “are encouraged in sensitivity workshops to confront these tendencies as some ugly reality that has meaning in their daily lives. But unbeknownst to respondents who take this test, the labels given to them were chosen by a small group of people who simply looked at a distribution of test scores and decided what terms seemed about right. This is not how science is done.”
Two of the leading I.A.T. researchers, Anthony Greenwald of the University of Washington and Mahzarin Banaji of Harvard, say that some of the past criticism about their measurement techniques has been useful. But they dismiss most of the current objections as moot because the I.A.T.’s validity has been confirmed repeatedly.
In a new a meta-analysis of more than 100 studies, Dr. Greenwald, Dr. Banaji and fellow psychologists conclude that scores on I.A.T. reliably predict people’s behavior and attitudes, and that the test is a better predictor of interracial behavior than self-description. Their critics reach a different conclusion after reanalyzing the data in some of those studies, which they say are inconsistent and sometimes demonstrate the reverse of what has been reported. They have suggested addressing the scientific dispute over bias — and the researchers’ arguments about the legal implications for affirmative-action policies — by having the two sides join in an “adversarial collaboration.”
One critic, Philip Tetlock, a psychologist at the University of California, Berkeley, said he had found prominent research groups and scholars willing to mediate joint experiments. But so far nothing has happened — and each side blames the other. Dr. Greenwald says he tried proposing a joint experiment to Dr. Tetlock only to have it rejected. Dr. Tetlock says that he tried a counterproposal and offered to work out a compromise, but that the I.A.T. researchers had refused two invitations to sit down with independent mediators.
After all the mutual invective in the I.A.T. debate, maybe it’s unrealistic to expect the two sides to collaborate. But these social scientists are supposed to be experts in overcoming bias and promoting social harmony. If they can’t figure out how to get along with their own colleagues, how seriously should we take their advice for everyone else?
Journal List > J Gen Intern Med > v.22(9); Sep 2007
Abstract
>Full Text
PDF (213K)
Contents
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Related material:
PubMed articles by:
Green, A.
Carney, D.
Pallin, D.
Banaji, M.
J Gen Intern Med. 2007 September; 22(9): 1231–1238.
Published online 2007 June 27. doi: 10.1007/s11606-007-0258-5.
PMCID: PMC2219763
Copyright © Society of General Internal Medicine 2007
Implicit Bias among Physicians and its Prediction of Thrombolysis Decisions for Black and White Patients
Alexander R. Green, MD, MPH,corresponding author1 Dana R. Carney, PhD,2 Daniel J. Pallin, MD, MPH,3 Long H. Ngo, PhD,4 Kristal L. Raymond, MPH,5 Lisa I. Iezzoni, MD, MSc,4 and Mahzarin R. Banaji, PhD2
1The Disparities Solutions Center, Massachusetts General Hospital, Harvard Medical School, 50 Staniford Street, Suite 901, Boston, MA 02114 USA
2Department of Psychology, Harvard University, Boston, MA USA
3Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
4Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA USA
5University of North Carolina–Chapel Hill, Chapel Hill, NC USA
6The Institute for Health Policy, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
Alexander R. Green, Phone: +1-617-7241913, Fax: +1-617-7264120, Email: argreen@partners.org.
corresponding authorCorresponding author.
Received October 30, 2006; Revised March 23, 2007; Accepted June 1, 2007.
Small right arrow pointing to: This article has been cited by other articles in PMC.
Top
>Abstract
BACKGROUND
METHODS
RESULTS
COMMENT
REFERENCES
Abstract
Context
Studies documenting racial/ethnic disparities in health care frequently implicate physicians’ unconscious biases. No study to date has measured physicians’ unconscious racial bias to test whether this predicts physicians’ clinical decisions.
Objective
To test whether physicians show implicit race bias and whether the magnitude of such bias predicts thrombolysis recommendations for black and white patients with acute coronary syndromes.
Design, Setting, and Participants
An internet-based tool comprising a clinical vignette of a patient presenting to the emergency department with an acute coronary syndrome, followed by a questionnaire and three Implicit Association Tests (IATs). Study invitations were e-mailed to all internal medicine and emergency medicine residents at four academic medical centers in Atlanta and Boston; 287 completed the study, met inclusion criteria, and were randomized to either a black or white vignette patient.
Main Outcome Measures
IAT scores (normal continuous variable) measuring physicians’ implicit race preference and perceptions of cooperativeness. Physicians’ attribution of symptoms to coronary artery disease for vignette patients with randomly assigned race, and their decisions about thrombolysis. Assessment of physicians’ explicit racial biases by questionnaire.
Results
Physicians reported no explicit preference for white versus black patients or differences in perceived cooperativeness. In contrast, IATs revealed implicit preference favoring white Americans (mean IAT score = 0.36, P < .001, one-sample t test) and implicit stereotypes of black Americans as less cooperative with medical procedures (mean IAT score 0.22, P < .001), and less cooperative generally (mean IAT score 0.30, P < .001). As physicians’ prowhite implicit bias increased, so did their likelihood of treating white patients and not treating black patients with thrombolysis (P = .009).
Conclusions
This study represents the first evidence of unconscious (implicit) race bias among physicians, its dissociation from conscious (explicit) bias, and its predictive validity. Results suggest that physicians’ unconscious biases may contribute to racial/ethnic disparities in use of medical procedures such as thrombolysis for myocardial infarction.
KEY WORDS: unconscious bias, thrombolysis, race, clinical decisions, disparities
Top
Abstract
>BACKGROUND
METHODS
RESULTS
COMMENT
REFERENCES
BACKGROUND
Widely documented racial/ethnic disparities are particularly striking in the treatment of cardiovascular disease,1,2 with whites up to twice as likely as blacks to receive thrombolytic therapy for myocardial infarction.3–7 Whether health professionals’ biases contribute to such disparities in care has been a subject of speculation and study.1,8–14 For example, physicians might believe that black patients are less likely to adhere to treatment recommendations than whites, and thus offer treatment less often.12 Some researchers speculate that unconscious bias is more likely to underlie treatment disparities than overt prejudice.12,15–18
The computer-based Implicit Association Test (IAT), first introduced in 1998, is now used widely to measure bias that may not be consciously recognized.19 The IAT measures the time it takes subjects to match representatives of social groups (e.g., age, gender, and race) to particular attributes (e.g., good, bad, cooperative, and stubborn). The IAT operationalizes unconscious bias by hypothesizing that subjects will match a group representative to an attribute more quickly if they connect these factors in their minds, regardless of their awareness of this connection. For instance, the more strongly subjects associate pictures of white persons with good concepts and pictures of black persons with bad concepts, the more quickly they will match them, and vice versa. The computerized IAT measures the aggregate time required for these matching tasks under two conditions (pairings). A difference in average matching speed for opposite pairings (e.g., black+bad/white+good vs black+good/white+bad) determines the IAT score (Fig. 1). Subjects are typically aware that they are making these connections but unable to control them given the rapid response times and structure of the test. To understand the IAT procedure, readers can sample the test at www.implicit.harvard.edu.20
Figure 1 Figure 1
Implicit Association Test (IAT) sample screens and stimuli. This figure displays sample screens and stimuli from the race preference (black-white/good-bad) IAT. Sample screens a, b, c, and d represent examples of pairing tasks that participants rapidly (more ...)
Although more than 200 studies have employed numerous versions of the IAT,19,20–24 and data from 5 million tests has accumulated from www.implicit.harvard.edu, the test has not been used to systematically observe the behavior of health care professionals. Given questions about the source of observed disparities in health service use, the IAT might provide insight into the contribution of implicit biases among physicians. In this study, we used a race preference IAT to measure implicit biases among emergency medicine and internal medicine residents. We also developed two new tests to measure stereotypes about general cooperativeness and specific cooperation with medical procedures. We tested whether both preferences and stereotypes affected physicians’ clinical decisions for white and black patients. More specifically, using a case vignette with patient race assigned randomly, three IATs, and a questionnaire, we sought to determine whether implicit or explicit race biases predict physicians’ decisions to give thrombolysis for acute myocardial infarction.
Top
Abstract
BACKGROUND
>METHODS
RESULTS
COMMENT
REFERENCES
METHODS
Participants and Study Procedures
In April and May 2005, we e-mailed a study invitation and three weekly reminders to all 776 internal medicine and emergency medicine residents in four academic medical centers in Boston, Mass, and Atlanta, Ga. The emails included a link to the research web site and a login code. Using an honor system administered by the chief residents, we offered participants a $10 gift certificate and entry into a lottery ($200 and $100 prizes for each site) for completing the 20-minute, anonymous, web-based study. Of the 776 residents, 393 (50.6%) participants completed the randomized vignette questionnaire and explicit bias section of the study. We excluded 25 participants who were not residents in an eligible program (n = 2) or had previously completed part of the study (n = 23). Fifty-seven participants failed to complete the IATs or had unusable IAT results, as described elsewhere.21 Twenty-four participants failed to complete the demographics section. This left 287 participants (37.0% of 776) who completed all aspects of the study. On a posttest question, 67 of these 287 participants reported some awareness of what the study was about through discussions with colleagues who had completed it. Because this awareness may have biased their responses to the case vignette, we omitted these participants from the analyses. All results (unless otherwise specified) are based on the 220 participants (28.4%) who completed the study and were unaware of the nature of the study.
Study Design
We created a web-based survey instrument that randomly assigned participants to see a picture of a black or white patient while reading a clinical vignette. From hundreds of shareware photographs, we chose 58 whose facial expressions appeared neutral. We created new patient images by morphing together these photographs using Photo Morpher Software (Morpheus Software, LLC, Santa Barbara, Calif, USA). The 21 best quality images were chosen and 19 independent evaluators (physicians, research assistants, and graduate students of various racial/ethnic backgrounds and not involved in the study) reviewed these. We chose four (two black and two white) that were most closely matched on apparent age (approximately 50 years) and attractiveness (7-point scale). The vignette (see Appendix) describes a 50-year-old male presenting to the emergency department with chest pain and an electrocardiogram suggestive of anterior myocardial infarction. It is stated that primary angioplasty is not an option and no absolute contraindications to thrombolysis are evident.
We asked participants to rate the likelihood that the chest pain was because of coronary artery disease (CAD) (5-point scale, very unlikely to very likely), whether they would give the patient thrombolysis (yes/no), and the strength of their recommendation (5-point scale, definitely to definitely not). To assess explicit bias, the software then asked participants several questions about whether they preferred white or black Americans (5-point scale with preference expressed as somewhat or slightly prefer black or white Americans, and 10-point thermometer scale of warm feelings toward each group separately). We also asked about their beliefs about patients’ cooperativeness in general and with regard to medical procedures such as thrombolysis (5-point scale—black patients somewhat less cooperative, slightly less cooperative, equally cooperative; white patients slightly less cooperative or somewhat less cooperative). Finally, the online survey included queries about respondent demographics, effectiveness of thrombolysis, and pre- and posttest opinions on unconscious bias and IATs. The vignettes and survey are available upon request.
Participants also completed three IATs corresponding to the explicit bias questions. The Race Preference IAT measured implicit association of white and black race with good and bad terms. We created the next two IATs specifically for this study. The Race Cooperativeness IAT measured implicit associations between race and general cooperativeness. The Race Medical Cooperativeness IAT measured implicit associations between race and cooperativeness with medical recommendations. All IAT scores are expressed as normally distributed continuous variables. For efficiency we used a 5-block structure for the IATs, with the specific pairing received first (e.g., black-bad/white-good) counterbalanced across participants. We scored IATs according to published guidelines with zero representing no racial bias, positive values representing prowhite bias, and negative scores representing problack bias (range typically −0.6 to 1.2).21 Figure 1 shows the faces representing white or black race and the terms used as stimuli for the concepts of good/bad and cooperativeness/uncooperativeness.
Analysis
We examined differences in demographic characteristics, likelihood of CAD, and decisions to treat with thrombolysis between participants assigned to black versus white patients using chi-square and t tests as appropriate. We compared mean IAT scores for various demographic groups using t tests. To look for relative disparity by race between diagnosis and treatment, we compared participants’ ratings of the likelihood that the chest pain was because of CAD (the diagnosis variable, 1–5 scale as above) with the likelihood of treating the patient with thrombolysis (the treatment variable, yes/no). To do this we put both the diagnosis and treatment variables on the same scale using z-scores. We then subtracted the treatment variable from the diagnosis variable to create a delta variable. A delta score of zero indicated that treatment was commensurate with diagnosis. A negative score indicated that treatment was more likely than diagnosis, and a positive score indicated that diagnosis was more likely than treatment. We used a one-way ANOVA to test whether diagnosis-treatment delta was different for black versus white patients.
To test whether bias predicted physicians’ use of thrombolysis for black and white patients, we used moderated multiple linear regression analysis with thrombolysis decision as the dependent variable, bias (implicit or explicit) as the independent variable, and patient race (black or white) as the moderator, adjusting for analysis-relevant covariates (e.g., physician race, sex, socioeconomic background, explicit race bias, implicit race bias, and belief in the effectiveness of thrombolysis). We then added the 67 physicians who were aware of the nature of the study back into the dataset and used moderated multiple linear regression to examine the potentially moderating impact of physician awareness on the relation between bias and thrombolysis decision. We performed all analyses using SPSS statistical software (SPSS Inc., Chicago, Ill, USA). The study received approval from the Institutional Review Boards at Beth Israel Deaconess Medical Center, Partners HealthCare System, and Emory University.
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Abstract
BACKGROUND
METHODS
>RESULTS
COMMENT
REFERENCES
RESULTS
Table 1 describes demographic characteristics of the participants stratified by whether they were randomly assigned a black or white patient. Participants assigned black vs white patients did not differ significantly, except that first- and second-year residents were more likely to be assigned white patients. Year of residency did not have any significant effect on either likelihood of recommending thrombolysis (chi-square P = .98) or on IAT scores however. Table 1 shows mean IAT scores for all three IATs by participants’ demographic characteristics. Physician race was the only consistent demographic predictor of IAT scores. Black physicians had mean scores on all three IATs near zero, whereas all other groups had scores in the positive, prowhite range. Emergency medicine residents also had somewhat less prowhite IAT sores on the general cooperativeness IAT. There was no difference in the IAT scores of participants randomized to black versus white patient vignettes.
Table 1 Table 1
Baseline Characteristics and IAT Scores of Physician Participants
Physicians’ Explicit and Implicit Racial Biases
On the measures of explicit bias, participants expressed equal preference for black and white Americans on the 5-point scale of race preference (mean difference = 0.03, P = .36) and on the 10-point thermometer scale measuring warmth toward black and white Americans separately (mean difference = 0.04, P = .61). They reported black and white patients to be equally cooperative on a 5-point scale of cooperativeness with medical procedures (mean difference = 0.01, P = 1.00) and on a 10-point thermometer scale measuring cooperativeness separately for black and white patients (mean difference = 0.08, P = .49).
On the measures of implicit bias, all three IATs showed statistically significant effects (P < .001), with stronger associations of negative attributes (e.g., bad and uncooperative) to blacks than to whites. Figure 2 displays a graph of the magnitude of physicians’ bias on the 4 explicit measures (top half) and 3 implicit measures (bottom half). Because measures of explicit bias (5- and 10-point scales) and implicit bias (reaction time scores ranging from −1.01 to +1.35) were on different scales, the magnitude of physicians’ bias across the seven measures could only be directly compared by converting them all to the same metric—Cohen’s effect size d. Cohen’s d is conceptually defined as the magnitude of an effect independent of sample size (see conversion formula at the bottom of Fig. 2) and is widely used in empirical research and meta-analysis in the behavioral sciences. Cohen’s d values range in size from small (0.20), to medium (0.50), and large (0.80).25 As shown in Figure 2, none of the explicit effects approached the cutoff for a small effect. In contrast, all of the implicit effects were medium or large in magnitude.
Figure 2 Figure 2
Magnitude of physicians’ explicit (self-reported) and implicit (Implicit Association Test) race bias on a standardized scale—Cohen’s effect size d
Aggregate scores on the three separate IATs were all somewhat correlated (average pairwise correlation r = .32, P = .001). We found some correlation between implicit bias (IAT score) and explicit bias (composite 5-point scale and 10-point feeling thermometer) for general racial preference (r = .28, P = .001) and no correlation for cooperativeness with medical procedures (r = .05, P = .50).
Diagnosis of CAD and Treatment with Thrombolysis
On a scale from 1 (less than 20% likely) to 5 (more than 80% likely), physicians were more likely to diagnose black patients (M = 4.08) than white patients (M = 3.71) with CAD as a cause of their chest pain (P = .02). However, participants were equally likely to give thrombolysis for black (52%) and white (48%) patients (chi-square P = .68). In absolute numbers 29.8% (33/112) of physicians who saw a white patient vignette thought he was very likely to have CAD versus 40.1% (43/108) for black patients. Within this subgroup 58.2% of physicians were very likely to offer white patients thrombolysis versus 42.7% for black patients (P = .12) (results not shown). Using the delta score (z-score relating likelihood of diagnosis and treatment) we were able to adjust for covariates and show a racial disparity in thrombolysis relative to CAD diagnosis. For blacks, delta was 0.11, indicating lower likelihood of thrombolysis relative to the physician’s perception of the likelihood of acute myocardial infarction. For whites, delta was −0.14, indicating higher likelihood of thrombolysis (P = .06).
Implicit (But Not Explicit) Bias Predicts Differences in Physicians’ Thrombolysis Decisions
Physicians’ explicit (self-reported) attitudes toward patients (preference) or stereotypes about cooperativeness by race did not influence their decision to give thrombolysis for black versus white patients. A moderated multiple linear regression analysis showed no evidence of an interaction between self-reported attitude and patient race on thrombolysis recommendation (P = .82) (results not shown). This result remained nonsignificant after controlling for physicians’ implicit bias, race, sex, socioeconomic status (SES), and belief in thrombolysis effectiveness (P = .64).
Physicians’ implicit biases, however, showed strong associations with their decisions to give thrombolysis. Figure 3 illustrates how each of the three IAT results and the combined IAT composite predicted thrombolysis decisions for black and white patients. Subpanel A shows that as the degree of antiblack bias on the race preference IAT increased, recommendations for thrombolysis for black patients decreased. The interaction between implicit antiblack bias and patient race on treatment recommendation was significant (P = .009). After controlling for physicians’ explicit race bias, race, sex, SES, and belief in thrombolysis effectiveness, the interaction effect of patient race and thrombolysis remained significant. A composite IAT measure combining all three IATs (race, attitude, and stereotypes) showed the same pattern (subpanel D) and was statistically significant both with and without the covariates included in the model (P = .04). The same general pattern also held for the medical cooperativeness IAT (subpanel C); however, the interaction was not statistically significant (P =.21).
Figure 3 Figure 3
Relationship between physician race preference Implicit Association Test (IAT) score and thrombolysis decisions by patient race. *P < .05, **P = .05–0.11, B values are standardized regression coefficients (more ...)
Participants Who Were Aware of the Study’s Purpose
Results presented above excluded the 67 participants who reported some awareness of the nature of the study. Additional analyses including these 67 aware physicians demonstrated a two-way interaction between awareness and IAT score on thrombolysis recommendation (P = .001) (Fig. 4). As unaware physicians’ bias on the composite IAT variable increased, their likelihood of recommending thrombolysis to black patients decreased, as described above. In contrast, increase in bias among aware physicians was associated with more thrombolysis for black patients. All P values remained significant after adjusting for covariates and the same general pattern held for all three IATs.
Figure 4 Figure 4
Relation between physicians’ awareness of the study’s purpose and Implicit Association Test (IAT) bias on recommendation for thrombolysis (black patients only). B values are standardized regression coefficients that describe the magnitude (more ...)
Before completing the IAT section of the study, 60.5% of physicians agreed or strongly agreed with the statement: “Subconscious biases about patients based on their race may affect the way I make decisions about their care without my realizing it.” When shown the same statement after taking the IATs, 71.6% of physicians agreed or strongly agreed with this statement (difference in mean 5-point score = 0.33, P < .001 by paired t test). Meanwhile 74.8% felt that taking IATs is a worthwhile experience for physicians, and 76.1% felt that learning more about unconscious biases could improve their care of patients.
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Abstract
BACKGROUND
METHODS
RESULTS
>COMMENT
REFERENCES
COMMENT
The IAT has been used to study implicit preferences and stereotypes for over a decade. It is a new method in its application to studying health care provider bias as a potential root cause of racial/ethnic disparities in health care. This is the first study to use a sociocognitive measure of bias among physicians, and to correlate this with treatment decisions according to patient race. It also represents the first time that the IAT, first published in 1998,19 has been modified to measure and demonstrate an implicit stereotype specific to medical care (i.e., that black patients are less willing to undergo medical procedures).
Not surprisingly, most physicians did not admit to any racial biases explicitly. However, on the implicit measures of bias (IATs), most nonblack physicians demonstrated some degree of bias favoring whites over blacks. Participants’ scores on the race preference IAT showed a range of implicit race bias similar to previous experiments on nonphysicians.21,26 The new cooperativeness IATs were normally distributed and somewhat correlated with the well-studied race preference IAT, suggesting that they measure different but related components of race bias.
Findings of implicit bias and its effects on clinical decisions may surprise physicians who tend to view their work as both altruistic and evidence-based.27 Implicit race biases are prevalent in the United States in general,26 and as such it should not be surprising that they are prevalent among physicians as well. The neural and cognitive processes underlying these biases are assumed to reflect both evolutionary bases and socially acquired orientations. The content of implicit biases(e.g., that black Americans are less cooperative than white Americans) are assumed to derive from sociocultural learning (e.g., explicit instruction and implicit messages) that accumulate over time. Implicit biases are primarily unconscious and do not imply overt racism. This is supported by the strong dissociation in the average level of expressed, explicit preferences and elicited, implicit ones, as well as the low correlation between explicit and implicit preference observed in this study. Critics of implicit measure of social cognition have asserted that such preferences and beliefs may reflect messages about the state of social groups in the larger culture but cannot be said to reflect an individual’s own preferences. If that were the case, doctors’ own decisions should not have been predicted so clearly by their implicit biases. The fact that they do remind us that implicit biases may affect the behavior even of those individuals who have nothing but the best intentions,24 including those in medical professions.12,13,15 The IAT is but one method for detecting implicit social cognition and it is the first to be put to use in the present study in a medical context. As such, the meaning and significance of implicit biases in health care deserves much greater investigation.
We found no difference in the crude rate of thrombolysis between study participants assigned a black patient versus those assigned a white patient. However, this race equality in treatment occurred in the presence of greater diagnosis of CAD in black than white patients. Equal treatment in the face of unequal diagnosis between the two groups constitutes a disparity.
The result of interest did not depend on demonstrating disparities in treatment. Rather, this study was designed to determine whether physicians’ implicit biases (IAT scores) predicted different patterns of thrombolysis recommendation for black and white patients. We found that implicit bias against blacks (as measured by the race preference IAT) was negatively correlated with likelihood of recommending thrombolysis for black patients and positively correlated with likelihood of recommending thrombolysis for white patients. This finding suggests that unconscious race biases among physicians may influence their decisions about important interventions such as thrombolysis for suspected myocardial infarction. Whereas several studies have pointed to unconscious biases as one potential root cause for racial and ethnic disparities in health care,9–14 this is the first evidence directly supporting this link. We were encouraged to find most resident physicians open to the idea that unconscious biases could affect their clinical decisions, and that learning more about these biases could improve their care of patients. After completing the IATs, residents acknowledged greater vulnerability to unconscious bias than they did at the start, suggesting that the experience heightened their awareness. Also, those physicians who were aware that the study had to do with racial bias, and who had higher levels of implicit prowhite bias, were more likely to recommend thrombolysis to black patients than physicians with low bias—the opposite of the study’s main effect. This suggests that implicit bias can be recognized and modulated to counteract its effect on treatment decisions. These finding support the IAT’s value as an educational tool.
There are several limitations inherent in this study. Response rates were relatively low and the sample size smaller than ideal, making it difficult to detect smaller effects that may exist. Resident physicians, particularly those at large academic health centers in Boston and Atlanta may differ from physicians who typically make thrombolysis decisions, so it remains to be seen if those with greater experience show the same pattern. Nevertheless, our primary findings are based on an experimental manipulation involving randomized assignment of the physician to a black or white patient vignette, which provides confidence in the causal interpretations that are drawn. A second limitation derives from the use of a computerized presentation of a patient, which may, for reasons that may not be obvious, have contributed to an outcome that may not occur in a typical in-person encounter. The result of predictive validity we report may be an overestimation, but equally likely an underestimation of the role of implicit bias in clinical decision making.
Future studies might do well to examine actual patient-physician interactions, introducing such dimensions as communication, rapport, and other nonverbal behaviors that are known to be related to implicit discrimination. It may in fact be the subtleties of interracial interactions that lay the foundation for differential treatment to occur.28 IATs can be developed to provide a broader range of clinically relevant stereotypes, in addition to the tests we used. Studies should continue to obtain detailed measures of participant awareness because this did show impact on treatment decisions in our study.
In conclusion, our findings suggest that physicians, like others, may harbor unconscious preferences and stereotypes that influence clinical decisions. Further study is needed to confirm our findings, and to determine the extent to which unconscious racial biases contribute to health care disparities. Given the potential existence of these biases, new approaches to addressing disparities might include confidential feedback mechanisms to make physicians aware of disparities in their own cohort of patients, securely and privately administered IATs to increase physicians’ awareness of unconscious bias, and targeted education to mitigate its effects on clinical decision making. We cannot and do not suggest that unconscious bias among health professionals is the largest or most important factor leading to disparities in health care. However, the fact that it is, by its very nature, hidden from conscious awareness suggests that it receive explicit attention.
Acknowledgment
We are grateful to Joseph Betancourt at Massachusetts General Hospital and to Ron Walls and Tom Stair at Brigham and Women’s Hospital for support and mentorship; to Elizabeth Donahue at Massachusetts General Hospital for assistance preparing the manuscript; and to Elizabeth Mela at Harvard University for help with all stages of this research and manuscript preparation. We are also grateful to Brian Nosek and his team at University of Virginia for developing the web-based study software and implementation. We are especially grateful to those who helped us coordinate data collection at each site: Art Kellerman, Phillip Shayne, Donald Brady, Joshua Larned, and Inginia Genao at Emory University, Carlo Rosen, Nate Shapiro, Eileen Reynolds, and Janet Buccola at Beth Israel Deaconess Medical Center, Valerie Stone and Deborah Wexler at Massachusetts General Hospital, and Eric Nadel, Peter Reese, and Joel Katz at Brigham and Women’s Hospital.
Funding and Support This study was funded by the Esther B. Kahn Fund of the Department of Emergency Medicine of Brigham and Women’s Hospital. Dr. Green received support from a National Research Service Award, grant no. T32HP11001-15. Dr. Banaji and Dr.Carney received support from the Mind, Brain, and Behavior Initiative at Harvard University and Dr. Banaji received support for the development of the internet-based portion of this study from the National Institute of Mental Health Grant HL-0000013 as well as the Mind Science Foundation. The funding organizations had no role in the design and conduct of the study, including data collection and management, analysis, interpretation of the data, and preparation, review, or approval of the manuscript.
Conflict Of Interest None disclosed.
Appendix
Clinical case vignette
Mr. Thompson is a 50-year-old man with a history of well-controlled hypertension and smoking, but no other risk factors for CAD, who presents to the emergency department with chest pain. He appears to be in a lot of pain describing it as “sharp, like being stabbed with a knife” and pointing to the midsternum. He has had it about 3 hours, and it has waxed and waned, but is now an 8 out of 10 in intensity. The pain is not exacerbated by movement or deep inspiration. It does not radiate and is not accompanied by shortness of breath, nausea, or diaphoresis. His vital signs, oxygen saturation, and physical exam are normal except for some mild sternal tenderness to palpation. His EKG shows 2 mm horizontal ST elevations in the anterior leads (not J-point elevation), but there is no prior EKG for comparison and there is no time for cardiac enzymes. He did not have access to a cardiac catheterization lab. He has no absolute contraindications to thrombolysis.
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Abstract
BACKGROUND
METHODS
RESULTS
COMMENT
>REFERENCES
REFERENCES
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Smedley BD, Stith AY, Nelson, AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. Washington, DC: Institute of Medicine; 2003.
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Kressin NR, Petersen LA. Racial differences in the use of invasive cardiovascular procedures: review of the literature and prescription for future research. Ann Intern Med. 2001;135(5):352–66. [PubMed].
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Petersen LA, Wright SM, Peterson ED, Daley J. Impact of race on cardiac care and outcomes in veterans with acute myocardial infarction. Med Care. 2002;40(1 suppl):I86–96. [PubMed].
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Allison JJ, Kiefe CI, Centor RM, Box JB, Farmer RM. Racial differences in the medical treatment of elderly Medicare patients with acute myocardial infarction. J Gen Intern Med. 1996;11(12):736–43. [PubMed].
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Canto JG, Allison JJ, Kiefe CI, et al. Relation of race and sex to the use of reperfusion therapy in medicare beneficiaries with acute myocardial infarction. N Engl J Med. 2000;342(15):1094–100. [PubMed].
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Weitzman S, Cooper L, Chambless L, Rosamond W, Clegg L. Gender, racial, and geographic differences in the performance of cardiac diagnostic and therapeutic procedures for hospitalized acute myocardial infarction in four states. Am J Cardiol. 1997;79(6):722–6. [PubMed].
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Taylor JHA, Canto JG, Sanderson B, Rogers WJ, Hilbe J. Management and outcomes for black patients with acute myocardial infarction in the reperfusion era. Am J Cardiol. 1998;82(9):1019–23. [PubMed].
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Ayanian JZ, Cleary PD, Weissman JS, Epstein AM. The effect of patients’ preferences on racial differences in access to renal transplantation. N Engl J Med. 1999;341(22):1661–9. [PubMed].
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Bogart LM, Catz SL, Kelly JA, Benotsch EG. Factors influencing physicians’ judgments of adherence and treatment decisions for patients with HIV disease. Med Decis Making. 2001;21(1):28–36. [PubMed].
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van Ryn M. Research on the provider contribution to race/ethnicity disparities in medical care. Med Care. 2002;40(1 suppl):I140–51. [PubMed].
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Schulman KA, Berlin JA, Harless W, et al. The effect of race and sex on physicians’ recommendations for cardiac catheterization. N Engl J Med. 1999;340(8):618–26. [PubMed].
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Devine PG. Stereotypes and prejudice: their automatic and controlled components. J Pers Soc Psychol. 1989;56(1):5–18.
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Greenwald AG, McGhee DE, Schwartz JL. Measuring individual differences in implicit social cognition: the implicit association test. Am J Public Health. 1998;74(6):1464–80.
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What were the doctors? All white or racially and ethnically diverse?
Who were the patients? All Black or racially and ethically and economically diverse?
I may have missed these points in my quick initial reading of this article, so please excuse.
Some thoughts:
Race INTERSECTS with class, gender and sexual orientation but race frequently TRUMPS these other factors, in U.S. society.
We continue to be a racialized society in which Whiteness is the dominant system, structure and ideology, albeit highly nuanced in these times.
One doesn’t have the be white to perform and uphold Whiteness, a point that is essential to the maintenance of the dominant power of the Whiteness system.
A finding of unconscious racial bias is therefore a more plausible result, given the racialization of all discourses in U.S. society.
I might add:
commodified racialized discourses (from Black slavery and indigenous genocide onwards).
Chithra Karunakaran
http://www.EthicalDemocracy.blogspot.com
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In Bias Test, Shades of Gray
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By JOHN TIERNEY
Published: November 17, 2008
Last year, a team of researchers at Harvard made headlines with an experiment testing unconscious bias at hospitals. Doctors were shown the picture of a 50-year-old man — sometimes black, sometimes white — and asked how they would treat him if he arrived at the emergency room with chest pains indicating a possible heart attack. Then the doctors took a computer test intended to reveal unconscious racial bias.
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The doctors who scored higher on the bias test were less likely than the other doctors to give clot-busting drugs to the black patients, according to the researchers, who suggested addressing the problem by encouraging doctors to test themselves for unconscious bias. The results were hailed by other psychologists as some of the strongest evidence that unconscious bias leads to harmful discrimination.
But then two other researchers, Neal Dawson and Hal Arkes, pointed out a curious pattern in the data. Even though most of the doctors registered some antiblack bias, as defined by the researchers, on the whole doctors ended up prescribing the clot-busting drugs to blacks just as often as to whites. The doctors scoring low on bias had a pronounced preference for giving the drugs to blacks, while high-scoring doctors had a relatively small preference for giving the drugs to whites — meaning that the more “biased” doctors actually treated blacks and whites more equally.
Does this result really prove dangerous bias in the emergency room? Or, as critics suggest, does it illustrate problems with the way researchers have been using split-second reactions on a computer test to diagnose an epidemic of racial bias?
In a series of scathing critiques, some psychologists have argued that this computerized tool, the Implicit Association Test, or I.A.T., has methodological problems and uses arbitrary classifications of bias. If Barack Obama’s victory seemed surprising, these critics say, it’s partly because social scientists helped create the false impression that three-quarters of whites are unconsciously biased against blacks.
The I.A.T., which has been taken by millions of people on an academic Web site, measures respondents’ reaction times as they follow instructions to associate words like “joy” or “awful” with either blacks or whites. It generally takes whites longer to associate positive words with blacks than with whites, although some do show no bias. (To meet one of these exceptional cases, go to TierneyLab, at nytimes.com/tierneylab.)
The test is widely used in research, and some critics acknowledge that it’s a useful tool for detecting unconscious attitudes and studying cognitive processes. But they say it’s misleading for I.A.T. researchers to give individuals ratings like “slight,” “moderate” or “strong” — and advice on dealing with their bias — when there isn’t even that much consistency in the same person’s scores if the test is taken again.
“One can decrease racial bias scores on the I.A.T. by simply exposing people to pictures of African-Americans enjoying a picnic,” says Hart Blanton, a psychologist at Texas A&M. “Yet respondents who take this test on the Web are given feedback suggesting that some enduring quality is being assessed.” He says that even the scoring system itself has been changed arbitrarily in recent years. “People receiving feedback about their ‘strong’ racial biases,” Dr. Blanton says, “are encouraged in sensitivity workshops to confront these tendencies as some ugly reality that has meaning in their daily lives. But unbeknownst to respondents who take this test, the labels given to them were chosen by a small group of people who simply looked at a distribution of test scores and decided what terms seemed about right. This is not how science is done.”
Two of the leading I.A.T. researchers, Anthony Greenwald of the University of Washington and Mahzarin Banaji of Harvard, say that some of the past criticism about their measurement techniques has been useful. But they dismiss most of the current objections as moot because the I.A.T.’s validity has been confirmed repeatedly.
In a new a meta-analysis of more than 100 studies, Dr. Greenwald, Dr. Banaji and fellow psychologists conclude that scores on I.A.T. reliably predict people’s behavior and attitudes, and that the test is a better predictor of interracial behavior than self-description. Their critics reach a different conclusion after reanalyzing the data in some of those studies, which they say are inconsistent and sometimes demonstrate the reverse of what has been reported. They have suggested addressing the scientific dispute over bias — and the researchers’ arguments about the legal implications for affirmative-action policies — by having the two sides join in an “adversarial collaboration.”
One critic, Philip Tetlock, a psychologist at the University of California, Berkeley, said he had found prominent research groups and scholars willing to mediate joint experiments. But so far nothing has happened — and each side blames the other. Dr. Greenwald says he tried proposing a joint experiment to Dr. Tetlock only to have it rejected. Dr. Tetlock says that he tried a counterproposal and offered to work out a compromise, but that the I.A.T. researchers had refused two invitations to sit down with independent mediators.
After all the mutual invective in the I.A.T. debate, maybe it’s unrealistic to expect the two sides to collaborate. But these social scientists are supposed to be experts in overcoming bias and promoting social harmony. If they can’t figure out how to get along with their own colleagues, how seriously should we take their advice for everyone else?
Journal List > J Gen Intern Med > v.22(9); Sep 2007
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Banaji, M.
J Gen Intern Med. 2007 September; 22(9): 1231–1238.
Published online 2007 June 27. doi: 10.1007/s11606-007-0258-5.
PMCID: PMC2219763
Copyright © Society of General Internal Medicine 2007
Implicit Bias among Physicians and its Prediction of Thrombolysis Decisions for Black and White Patients
Alexander R. Green, MD, MPH,corresponding author1 Dana R. Carney, PhD,2 Daniel J. Pallin, MD, MPH,3 Long H. Ngo, PhD,4 Kristal L. Raymond, MPH,5 Lisa I. Iezzoni, MD, MSc,4 and Mahzarin R. Banaji, PhD2
1The Disparities Solutions Center, Massachusetts General Hospital, Harvard Medical School, 50 Staniford Street, Suite 901, Boston, MA 02114 USA
2Department of Psychology, Harvard University, Boston, MA USA
3Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
4Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA USA
5University of North Carolina–Chapel Hill, Chapel Hill, NC USA
6The Institute for Health Policy, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
Alexander R. Green, Phone: +1-617-7241913, Fax: +1-617-7264120, Email: argreen@partners.org.
corresponding authorCorresponding author.
Received October 30, 2006; Revised March 23, 2007; Accepted June 1, 2007.
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>Abstract
BACKGROUND
METHODS
RESULTS
COMMENT
REFERENCES
Abstract
Context
Studies documenting racial/ethnic disparities in health care frequently implicate physicians’ unconscious biases. No study to date has measured physicians’ unconscious racial bias to test whether this predicts physicians’ clinical decisions.
Objective
To test whether physicians show implicit race bias and whether the magnitude of such bias predicts thrombolysis recommendations for black and white patients with acute coronary syndromes.
Design, Setting, and Participants
An internet-based tool comprising a clinical vignette of a patient presenting to the emergency department with an acute coronary syndrome, followed by a questionnaire and three Implicit Association Tests (IATs). Study invitations were e-mailed to all internal medicine and emergency medicine residents at four academic medical centers in Atlanta and Boston; 287 completed the study, met inclusion criteria, and were randomized to either a black or white vignette patient.
Main Outcome Measures
IAT scores (normal continuous variable) measuring physicians’ implicit race preference and perceptions of cooperativeness. Physicians’ attribution of symptoms to coronary artery disease for vignette patients with randomly assigned race, and their decisions about thrombolysis. Assessment of physicians’ explicit racial biases by questionnaire.
Results
Physicians reported no explicit preference for white versus black patients or differences in perceived cooperativeness. In contrast, IATs revealed implicit preference favoring white Americans (mean IAT score = 0.36, P < .001, one-sample t test) and implicit stereotypes of black Americans as less cooperative with medical procedures (mean IAT score 0.22, P < .001), and less cooperative generally (mean IAT score 0.30, P < .001). As physicians’ prowhite implicit bias increased, so did their likelihood of treating white patients and not treating black patients with thrombolysis (P = .009).
Conclusions
This study represents the first evidence of unconscious (implicit) race bias among physicians, its dissociation from conscious (explicit) bias, and its predictive validity. Results suggest that physicians’ unconscious biases may contribute to racial/ethnic disparities in use of medical procedures such as thrombolysis for myocardial infarction.
KEY WORDS: unconscious bias, thrombolysis, race, clinical decisions, disparities
Top
Abstract
>BACKGROUND
METHODS
RESULTS
COMMENT
REFERENCES
BACKGROUND
Widely documented racial/ethnic disparities are particularly striking in the treatment of cardiovascular disease,1,2 with whites up to twice as likely as blacks to receive thrombolytic therapy for myocardial infarction.3–7 Whether health professionals’ biases contribute to such disparities in care has been a subject of speculation and study.1,8–14 For example, physicians might believe that black patients are less likely to adhere to treatment recommendations than whites, and thus offer treatment less often.12 Some researchers speculate that unconscious bias is more likely to underlie treatment disparities than overt prejudice.12,15–18
The computer-based Implicit Association Test (IAT), first introduced in 1998, is now used widely to measure bias that may not be consciously recognized.19 The IAT measures the time it takes subjects to match representatives of social groups (e.g., age, gender, and race) to particular attributes (e.g., good, bad, cooperative, and stubborn). The IAT operationalizes unconscious bias by hypothesizing that subjects will match a group representative to an attribute more quickly if they connect these factors in their minds, regardless of their awareness of this connection. For instance, the more strongly subjects associate pictures of white persons with good concepts and pictures of black persons with bad concepts, the more quickly they will match them, and vice versa. The computerized IAT measures the aggregate time required for these matching tasks under two conditions (pairings). A difference in average matching speed for opposite pairings (e.g., black+bad/white+good vs black+good/white+bad) determines the IAT score (Fig. 1). Subjects are typically aware that they are making these connections but unable to control them given the rapid response times and structure of the test. To understand the IAT procedure, readers can sample the test at www.implicit.harvard.edu.20
Figure 1 Figure 1
Implicit Association Test (IAT) sample screens and stimuli. This figure displays sample screens and stimuli from the race preference (black-white/good-bad) IAT. Sample screens a, b, c, and d represent examples of pairing tasks that participants rapidly (more ...)
Although more than 200 studies have employed numerous versions of the IAT,19,20–24 and data from 5 million tests has accumulated from www.implicit.harvard.edu, the test has not been used to systematically observe the behavior of health care professionals. Given questions about the source of observed disparities in health service use, the IAT might provide insight into the contribution of implicit biases among physicians. In this study, we used a race preference IAT to measure implicit biases among emergency medicine and internal medicine residents. We also developed two new tests to measure stereotypes about general cooperativeness and specific cooperation with medical procedures. We tested whether both preferences and stereotypes affected physicians’ clinical decisions for white and black patients. More specifically, using a case vignette with patient race assigned randomly, three IATs, and a questionnaire, we sought to determine whether implicit or explicit race biases predict physicians’ decisions to give thrombolysis for acute myocardial infarction.
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Abstract
BACKGROUND
>METHODS
RESULTS
COMMENT
REFERENCES
METHODS
Participants and Study Procedures
In April and May 2005, we e-mailed a study invitation and three weekly reminders to all 776 internal medicine and emergency medicine residents in four academic medical centers in Boston, Mass, and Atlanta, Ga. The emails included a link to the research web site and a login code. Using an honor system administered by the chief residents, we offered participants a $10 gift certificate and entry into a lottery ($200 and $100 prizes for each site) for completing the 20-minute, anonymous, web-based study. Of the 776 residents, 393 (50.6%) participants completed the randomized vignette questionnaire and explicit bias section of the study. We excluded 25 participants who were not residents in an eligible program (n = 2) or had previously completed part of the study (n = 23). Fifty-seven participants failed to complete the IATs or had unusable IAT results, as described elsewhere.21 Twenty-four participants failed to complete the demographics section. This left 287 participants (37.0% of 776) who completed all aspects of the study. On a posttest question, 67 of these 287 participants reported some awareness of what the study was about through discussions with colleagues who had completed it. Because this awareness may have biased their responses to the case vignette, we omitted these participants from the analyses. All results (unless otherwise specified) are based on the 220 participants (28.4%) who completed the study and were unaware of the nature of the study.
Study Design
We created a web-based survey instrument that randomly assigned participants to see a picture of a black or white patient while reading a clinical vignette. From hundreds of shareware photographs, we chose 58 whose facial expressions appeared neutral. We created new patient images by morphing together these photographs using Photo Morpher Software (Morpheus Software, LLC, Santa Barbara, Calif, USA). The 21 best quality images were chosen and 19 independent evaluators (physicians, research assistants, and graduate students of various racial/ethnic backgrounds and not involved in the study) reviewed these. We chose four (two black and two white) that were most closely matched on apparent age (approximately 50 years) and attractiveness (7-point scale). The vignette (see Appendix) describes a 50-year-old male presenting to the emergency department with chest pain and an electrocardiogram suggestive of anterior myocardial infarction. It is stated that primary angioplasty is not an option and no absolute contraindications to thrombolysis are evident.
We asked participants to rate the likelihood that the chest pain was because of coronary artery disease (CAD) (5-point scale, very unlikely to very likely), whether they would give the patient thrombolysis (yes/no), and the strength of their recommendation (5-point scale, definitely to definitely not). To assess explicit bias, the software then asked participants several questions about whether they preferred white or black Americans (5-point scale with preference expressed as somewhat or slightly prefer black or white Americans, and 10-point thermometer scale of warm feelings toward each group separately). We also asked about their beliefs about patients’ cooperativeness in general and with regard to medical procedures such as thrombolysis (5-point scale—black patients somewhat less cooperative, slightly less cooperative, equally cooperative; white patients slightly less cooperative or somewhat less cooperative). Finally, the online survey included queries about respondent demographics, effectiveness of thrombolysis, and pre- and posttest opinions on unconscious bias and IATs. The vignettes and survey are available upon request.
Participants also completed three IATs corresponding to the explicit bias questions. The Race Preference IAT measured implicit association of white and black race with good and bad terms. We created the next two IATs specifically for this study. The Race Cooperativeness IAT measured implicit associations between race and general cooperativeness. The Race Medical Cooperativeness IAT measured implicit associations between race and cooperativeness with medical recommendations. All IAT scores are expressed as normally distributed continuous variables. For efficiency we used a 5-block structure for the IATs, with the specific pairing received first (e.g., black-bad/white-good) counterbalanced across participants. We scored IATs according to published guidelines with zero representing no racial bias, positive values representing prowhite bias, and negative scores representing problack bias (range typically −0.6 to 1.2).21 Figure 1 shows the faces representing white or black race and the terms used as stimuli for the concepts of good/bad and cooperativeness/uncooperativeness.
Analysis
We examined differences in demographic characteristics, likelihood of CAD, and decisions to treat with thrombolysis between participants assigned to black versus white patients using chi-square and t tests as appropriate. We compared mean IAT scores for various demographic groups using t tests. To look for relative disparity by race between diagnosis and treatment, we compared participants’ ratings of the likelihood that the chest pain was because of CAD (the diagnosis variable, 1–5 scale as above) with the likelihood of treating the patient with thrombolysis (the treatment variable, yes/no). To do this we put both the diagnosis and treatment variables on the same scale using z-scores. We then subtracted the treatment variable from the diagnosis variable to create a delta variable. A delta score of zero indicated that treatment was commensurate with diagnosis. A negative score indicated that treatment was more likely than diagnosis, and a positive score indicated that diagnosis was more likely than treatment. We used a one-way ANOVA to test whether diagnosis-treatment delta was different for black versus white patients.
To test whether bias predicted physicians’ use of thrombolysis for black and white patients, we used moderated multiple linear regression analysis with thrombolysis decision as the dependent variable, bias (implicit or explicit) as the independent variable, and patient race (black or white) as the moderator, adjusting for analysis-relevant covariates (e.g., physician race, sex, socioeconomic background, explicit race bias, implicit race bias, and belief in the effectiveness of thrombolysis). We then added the 67 physicians who were aware of the nature of the study back into the dataset and used moderated multiple linear regression to examine the potentially moderating impact of physician awareness on the relation between bias and thrombolysis decision. We performed all analyses using SPSS statistical software (SPSS Inc., Chicago, Ill, USA). The study received approval from the Institutional Review Boards at Beth Israel Deaconess Medical Center, Partners HealthCare System, and Emory University.
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Abstract
BACKGROUND
METHODS
>RESULTS
COMMENT
REFERENCES
RESULTS
Table 1 describes demographic characteristics of the participants stratified by whether they were randomly assigned a black or white patient. Participants assigned black vs white patients did not differ significantly, except that first- and second-year residents were more likely to be assigned white patients. Year of residency did not have any significant effect on either likelihood of recommending thrombolysis (chi-square P = .98) or on IAT scores however. Table 1 shows mean IAT scores for all three IATs by participants’ demographic characteristics. Physician race was the only consistent demographic predictor of IAT scores. Black physicians had mean scores on all three IATs near zero, whereas all other groups had scores in the positive, prowhite range. Emergency medicine residents also had somewhat less prowhite IAT sores on the general cooperativeness IAT. There was no difference in the IAT scores of participants randomized to black versus white patient vignettes.
Table 1 Table 1
Baseline Characteristics and IAT Scores of Physician Participants
Physicians’ Explicit and Implicit Racial Biases
On the measures of explicit bias, participants expressed equal preference for black and white Americans on the 5-point scale of race preference (mean difference = 0.03, P = .36) and on the 10-point thermometer scale measuring warmth toward black and white Americans separately (mean difference = 0.04, P = .61). They reported black and white patients to be equally cooperative on a 5-point scale of cooperativeness with medical procedures (mean difference = 0.01, P = 1.00) and on a 10-point thermometer scale measuring cooperativeness separately for black and white patients (mean difference = 0.08, P = .49).
On the measures of implicit bias, all three IATs showed statistically significant effects (P < .001), with stronger associations of negative attributes (e.g., bad and uncooperative) to blacks than to whites. Figure 2 displays a graph of the magnitude of physicians’ bias on the 4 explicit measures (top half) and 3 implicit measures (bottom half). Because measures of explicit bias (5- and 10-point scales) and implicit bias (reaction time scores ranging from −1.01 to +1.35) were on different scales, the magnitude of physicians’ bias across the seven measures could only be directly compared by converting them all to the same metric—Cohen’s effect size d. Cohen’s d is conceptually defined as the magnitude of an effect independent of sample size (see conversion formula at the bottom of Fig. 2) and is widely used in empirical research and meta-analysis in the behavioral sciences. Cohen’s d values range in size from small (0.20), to medium (0.50), and large (0.80).25 As shown in Figure 2, none of the explicit effects approached the cutoff for a small effect. In contrast, all of the implicit effects were medium or large in magnitude.
Figure 2 Figure 2
Magnitude of physicians’ explicit (self-reported) and implicit (Implicit Association Test) race bias on a standardized scale—Cohen’s effect size d
Aggregate scores on the three separate IATs were all somewhat correlated (average pairwise correlation r = .32, P = .001). We found some correlation between implicit bias (IAT score) and explicit bias (composite 5-point scale and 10-point feeling thermometer) for general racial preference (r = .28, P = .001) and no correlation for cooperativeness with medical procedures (r = .05, P = .50).
Diagnosis of CAD and Treatment with Thrombolysis
On a scale from 1 (less than 20% likely) to 5 (more than 80% likely), physicians were more likely to diagnose black patients (M = 4.08) than white patients (M = 3.71) with CAD as a cause of their chest pain (P = .02). However, participants were equally likely to give thrombolysis for black (52%) and white (48%) patients (chi-square P = .68). In absolute numbers 29.8% (33/112) of physicians who saw a white patient vignette thought he was very likely to have CAD versus 40.1% (43/108) for black patients. Within this subgroup 58.2% of physicians were very likely to offer white patients thrombolysis versus 42.7% for black patients (P = .12) (results not shown). Using the delta score (z-score relating likelihood of diagnosis and treatment) we were able to adjust for covariates and show a racial disparity in thrombolysis relative to CAD diagnosis. For blacks, delta was 0.11, indicating lower likelihood of thrombolysis relative to the physician’s perception of the likelihood of acute myocardial infarction. For whites, delta was −0.14, indicating higher likelihood of thrombolysis (P = .06).
Implicit (But Not Explicit) Bias Predicts Differences in Physicians’ Thrombolysis Decisions
Physicians’ explicit (self-reported) attitudes toward patients (preference) or stereotypes about cooperativeness by race did not influence their decision to give thrombolysis for black versus white patients. A moderated multiple linear regression analysis showed no evidence of an interaction between self-reported attitude and patient race on thrombolysis recommendation (P = .82) (results not shown). This result remained nonsignificant after controlling for physicians’ implicit bias, race, sex, socioeconomic status (SES), and belief in thrombolysis effectiveness (P = .64).
Physicians’ implicit biases, however, showed strong associations with their decisions to give thrombolysis. Figure 3 illustrates how each of the three IAT results and the combined IAT composite predicted thrombolysis decisions for black and white patients. Subpanel A shows that as the degree of antiblack bias on the race preference IAT increased, recommendations for thrombolysis for black patients decreased. The interaction between implicit antiblack bias and patient race on treatment recommendation was significant (P = .009). After controlling for physicians’ explicit race bias, race, sex, SES, and belief in thrombolysis effectiveness, the interaction effect of patient race and thrombolysis remained significant. A composite IAT measure combining all three IATs (race, attitude, and stereotypes) showed the same pattern (subpanel D) and was statistically significant both with and without the covariates included in the model (P = .04). The same general pattern also held for the medical cooperativeness IAT (subpanel C); however, the interaction was not statistically significant (P =.21).
Figure 3 Figure 3
Relationship between physician race preference Implicit Association Test (IAT) score and thrombolysis decisions by patient race. *P < .05, **P = .05–0.11, B values are standardized regression coefficients (more ...)
Participants Who Were Aware of the Study’s Purpose
Results presented above excluded the 67 participants who reported some awareness of the nature of the study. Additional analyses including these 67 aware physicians demonstrated a two-way interaction between awareness and IAT score on thrombolysis recommendation (P = .001) (Fig. 4). As unaware physicians’ bias on the composite IAT variable increased, their likelihood of recommending thrombolysis to black patients decreased, as described above. In contrast, increase in bias among aware physicians was associated with more thrombolysis for black patients. All P values remained significant after adjusting for covariates and the same general pattern held for all three IATs.
Figure 4 Figure 4
Relation between physicians’ awareness of the study’s purpose and Implicit Association Test (IAT) bias on recommendation for thrombolysis (black patients only). B values are standardized regression coefficients that describe the magnitude (more ...)
Before completing the IAT section of the study, 60.5% of physicians agreed or strongly agreed with the statement: “Subconscious biases about patients based on their race may affect the way I make decisions about their care without my realizing it.” When shown the same statement after taking the IATs, 71.6% of physicians agreed or strongly agreed with this statement (difference in mean 5-point score = 0.33, P < .001 by paired t test). Meanwhile 74.8% felt that taking IATs is a worthwhile experience for physicians, and 76.1% felt that learning more about unconscious biases could improve their care of patients.
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Abstract
BACKGROUND
METHODS
RESULTS
>COMMENT
REFERENCES
COMMENT
The IAT has been used to study implicit preferences and stereotypes for over a decade. It is a new method in its application to studying health care provider bias as a potential root cause of racial/ethnic disparities in health care. This is the first study to use a sociocognitive measure of bias among physicians, and to correlate this with treatment decisions according to patient race. It also represents the first time that the IAT, first published in 1998,19 has been modified to measure and demonstrate an implicit stereotype specific to medical care (i.e., that black patients are less willing to undergo medical procedures).
Not surprisingly, most physicians did not admit to any racial biases explicitly. However, on the implicit measures of bias (IATs), most nonblack physicians demonstrated some degree of bias favoring whites over blacks. Participants’ scores on the race preference IAT showed a range of implicit race bias similar to previous experiments on nonphysicians.21,26 The new cooperativeness IATs were normally distributed and somewhat correlated with the well-studied race preference IAT, suggesting that they measure different but related components of race bias.
Findings of implicit bias and its effects on clinical decisions may surprise physicians who tend to view their work as both altruistic and evidence-based.27 Implicit race biases are prevalent in the United States in general,26 and as such it should not be surprising that they are prevalent among physicians as well. The neural and cognitive processes underlying these biases are assumed to reflect both evolutionary bases and socially acquired orientations. The content of implicit biases(e.g., that black Americans are less cooperative than white Americans) are assumed to derive from sociocultural learning (e.g., explicit instruction and implicit messages) that accumulate over time. Implicit biases are primarily unconscious and do not imply overt racism. This is supported by the strong dissociation in the average level of expressed, explicit preferences and elicited, implicit ones, as well as the low correlation between explicit and implicit preference observed in this study. Critics of implicit measure of social cognition have asserted that such preferences and beliefs may reflect messages about the state of social groups in the larger culture but cannot be said to reflect an individual’s own preferences. If that were the case, doctors’ own decisions should not have been predicted so clearly by their implicit biases. The fact that they do remind us that implicit biases may affect the behavior even of those individuals who have nothing but the best intentions,24 including those in medical professions.12,13,15 The IAT is but one method for detecting implicit social cognition and it is the first to be put to use in the present study in a medical context. As such, the meaning and significance of implicit biases in health care deserves much greater investigation.
We found no difference in the crude rate of thrombolysis between study participants assigned a black patient versus those assigned a white patient. However, this race equality in treatment occurred in the presence of greater diagnosis of CAD in black than white patients. Equal treatment in the face of unequal diagnosis between the two groups constitutes a disparity.
The result of interest did not depend on demonstrating disparities in treatment. Rather, this study was designed to determine whether physicians’ implicit biases (IAT scores) predicted different patterns of thrombolysis recommendation for black and white patients. We found that implicit bias against blacks (as measured by the race preference IAT) was negatively correlated with likelihood of recommending thrombolysis for black patients and positively correlated with likelihood of recommending thrombolysis for white patients. This finding suggests that unconscious race biases among physicians may influence their decisions about important interventions such as thrombolysis for suspected myocardial infarction. Whereas several studies have pointed to unconscious biases as one potential root cause for racial and ethnic disparities in health care,9–14 this is the first evidence directly supporting this link. We were encouraged to find most resident physicians open to the idea that unconscious biases could affect their clinical decisions, and that learning more about these biases could improve their care of patients. After completing the IATs, residents acknowledged greater vulnerability to unconscious bias than they did at the start, suggesting that the experience heightened their awareness. Also, those physicians who were aware that the study had to do with racial bias, and who had higher levels of implicit prowhite bias, were more likely to recommend thrombolysis to black patients than physicians with low bias—the opposite of the study’s main effect. This suggests that implicit bias can be recognized and modulated to counteract its effect on treatment decisions. These finding support the IAT’s value as an educational tool.
There are several limitations inherent in this study. Response rates were relatively low and the sample size smaller than ideal, making it difficult to detect smaller effects that may exist. Resident physicians, particularly those at large academic health centers in Boston and Atlanta may differ from physicians who typically make thrombolysis decisions, so it remains to be seen if those with greater experience show the same pattern. Nevertheless, our primary findings are based on an experimental manipulation involving randomized assignment of the physician to a black or white patient vignette, which provides confidence in the causal interpretations that are drawn. A second limitation derives from the use of a computerized presentation of a patient, which may, for reasons that may not be obvious, have contributed to an outcome that may not occur in a typical in-person encounter. The result of predictive validity we report may be an overestimation, but equally likely an underestimation of the role of implicit bias in clinical decision making.
Future studies might do well to examine actual patient-physician interactions, introducing such dimensions as communication, rapport, and other nonverbal behaviors that are known to be related to implicit discrimination. It may in fact be the subtleties of interracial interactions that lay the foundation for differential treatment to occur.28 IATs can be developed to provide a broader range of clinically relevant stereotypes, in addition to the tests we used. Studies should continue to obtain detailed measures of participant awareness because this did show impact on treatment decisions in our study.
In conclusion, our findings suggest that physicians, like others, may harbor unconscious preferences and stereotypes that influence clinical decisions. Further study is needed to confirm our findings, and to determine the extent to which unconscious racial biases contribute to health care disparities. Given the potential existence of these biases, new approaches to addressing disparities might include confidential feedback mechanisms to make physicians aware of disparities in their own cohort of patients, securely and privately administered IATs to increase physicians’ awareness of unconscious bias, and targeted education to mitigate its effects on clinical decision making. We cannot and do not suggest that unconscious bias among health professionals is the largest or most important factor leading to disparities in health care. However, the fact that it is, by its very nature, hidden from conscious awareness suggests that it receive explicit attention.
Acknowledgment
We are grateful to Joseph Betancourt at Massachusetts General Hospital and to Ron Walls and Tom Stair at Brigham and Women’s Hospital for support and mentorship; to Elizabeth Donahue at Massachusetts General Hospital for assistance preparing the manuscript; and to Elizabeth Mela at Harvard University for help with all stages of this research and manuscript preparation. We are also grateful to Brian Nosek and his team at University of Virginia for developing the web-based study software and implementation. We are especially grateful to those who helped us coordinate data collection at each site: Art Kellerman, Phillip Shayne, Donald Brady, Joshua Larned, and Inginia Genao at Emory University, Carlo Rosen, Nate Shapiro, Eileen Reynolds, and Janet Buccola at Beth Israel Deaconess Medical Center, Valerie Stone and Deborah Wexler at Massachusetts General Hospital, and Eric Nadel, Peter Reese, and Joel Katz at Brigham and Women’s Hospital.
Funding and Support This study was funded by the Esther B. Kahn Fund of the Department of Emergency Medicine of Brigham and Women’s Hospital. Dr. Green received support from a National Research Service Award, grant no. T32HP11001-15. Dr. Banaji and Dr.Carney received support from the Mind, Brain, and Behavior Initiative at Harvard University and Dr. Banaji received support for the development of the internet-based portion of this study from the National Institute of Mental Health Grant HL-0000013 as well as the Mind Science Foundation. The funding organizations had no role in the design and conduct of the study, including data collection and management, analysis, interpretation of the data, and preparation, review, or approval of the manuscript.
Conflict Of Interest None disclosed.
Appendix
Clinical case vignette
Mr. Thompson is a 50-year-old man with a history of well-controlled hypertension and smoking, but no other risk factors for CAD, who presents to the emergency department with chest pain. He appears to be in a lot of pain describing it as “sharp, like being stabbed with a knife” and pointing to the midsternum. He has had it about 3 hours, and it has waxed and waned, but is now an 8 out of 10 in intensity. The pain is not exacerbated by movement or deep inspiration. It does not radiate and is not accompanied by shortness of breath, nausea, or diaphoresis. His vital signs, oxygen saturation, and physical exam are normal except for some mild sternal tenderness to palpation. His EKG shows 2 mm horizontal ST elevations in the anterior leads (not J-point elevation), but there is no prior EKG for comparison and there is no time for cardiac enzymes. He did not have access to a cardiac catheterization lab. He has no absolute contraindications to thrombolysis.
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Abstract
BACKGROUND
METHODS
RESULTS
COMMENT
>REFERENCES
REFERENCES
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Smedley BD, Stith AY, Nelson, AR, eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. Washington, DC: Institute of Medicine; 2003.
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Development vs. Growth in the Global Recession
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November 18th, 2008 8:30 am
Brooks said about so-called "developing" nations but more accurately these are nations that were exploited and systematically 'underdeveloped' by colonial (example Britain) and later neo-imperial (U.S.) powers:
"Over the past decade, millions of people in these societies have climbed out of poverty. But the global recession is pushing them back down. Many seem furious with democracy and capitalism, which they believe led to their shattered dreams."
As a person born and raised in a "developing" nation, our greatest challenge is to forge economies and social justice systems that are NOT based on the U.S model of militaristic capitalism, and where the greatest freedom is the unlimited freedom to shop.
Each formerly oppressed nation-state will have to find its own economic and social justice trajectory. For example Gandhian-type (India) self reliance or Nyerere-type (Tanzania) Ujamaa African socialism is a more apt and necessary alternative. The elites in our Global South countries are the biggest roadblocks to this alternative because they have joined with the dominant economic order that we now see, justifiably, turned upside down.
The U.S.-initiated global recession offers an opportunity to THE PEOPLE of Global South nation-states to build self-reliant, interdependent and yes, innovative green, social-justice economies to primarily benefit their peoples, not serve as sweatshops to produce shoddy, ever-cheaper goods for the consuming West.
Development is not the same thing as growth.
Chithra KarunaKaran
http://www.EthicalDemocracy.blogpost.com
— EthicalDemocracy, http://www.EthicalDemocracy.blogspot.com
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November 18th, 2008 8:30 am
Brooks said about so-called "developing" nations but more accurately these are nations that were exploited and systematically 'underdeveloped' by colonial (example Britain) and later neo-imperial (U.S.) powers:
"Over the past decade, millions of people in these societies have climbed out of poverty. But the global recession is pushing them back down. Many seem furious with democracy and capitalism, which they believe led to their shattered dreams."
As a person born and raised in a "developing" nation, our greatest challenge is to forge economies and social justice systems that are NOT based on the U.S model of militaristic capitalism, and where the greatest freedom is the unlimited freedom to shop.
Each formerly oppressed nation-state will have to find its own economic and social justice trajectory. For example Gandhian-type (India) self reliance or Nyerere-type (Tanzania) Ujamaa African socialism is a more apt and necessary alternative. The elites in our Global South countries are the biggest roadblocks to this alternative because they have joined with the dominant economic order that we now see, justifiably, turned upside down.
The U.S.-initiated global recession offers an opportunity to THE PEOPLE of Global South nation-states to build self-reliant, interdependent and yes, innovative green, social-justice economies to primarily benefit their peoples, not serve as sweatshops to produce shoddy, ever-cheaper goods for the consuming West.
Development is not the same thing as growth.
Chithra KarunaKaran
http://www.EthicalDemocracy.blogpost.com
— EthicalDemocracy, http://www.EthicalDemocracy.blogspot.com
Back to Article »
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1. Dick Cavett: The Wild Wordsmith of Wasilla
2. Big City: 12-Year-Old’s a Food Critic, and the Chef Loves It
3. Op-Ed Contributor: Our Home-Grown Melamine Problem
4. Architecture: Saving Buffalo’s Untold Beauty
5. The Vampire of the Mall
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1. Dick Cavett: The Wild Wordsmith of Wasilla
2. Big City: 12-Year-Old’s a Food Critic, and the Chef Loves It
3. Op-Ed Contributor: Our Home-Grown Melamine Problem
4. Architecture: Saving Buffalo’s Untold Beauty
5. The Vampire of the Mall
6. Some See Big Problem in Wisconsin Drinking
7. The Reckoning: Deregulator Looks Back, Unswayed
8. For More of Mexico’s Wealthy, Cost of Living Includes Guards
9. Digital Domain: What Has Driven Women Out of Computer Science?
10. Editorial: Who Should Take a Statin?
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1. Iraqi Cabinet Approves Security Pact With U.S.
2. Rather's Lawsuit Shows Role of G.O.P. in Inquiry
3. At National Review, a Threat to Its Reputation for Erudition
4. Clinton Vetting Includes Look at Mr. Clinton
5. If Detroit Falls, Foreign Makers Could Be Buffer
6. A Deregulator Looks Back, Unswayed
7. George W. Hoover?
8. Facing Deficits, States Get Out Sharper Knives
9. Many Dealings of Bill Clinton Under Review
10. China's Navy May Be Seeking Carrier
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1. obama
2. modern love
3. november 5, 2008
4. all apologies
5. sarah palin
6. paul krugman
7. crossword
8. china
9. henry alford
10. october 3, 2008
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Sunday, November 16, 2008
Hillary for State? What would Change?
Comment # 115. NYTimes
November 16, 2008 10:52 am
Link:
http://community.nytimes.com/article/comments/2008/11/16/opinion/16dowd.html?permid=115#comment115
Hillary has a higher profile and proven capability in international affairs and has more credentials in foreign policy than Barack Obama or ANY of her colleagues in Congress.
Hillary would be an invaluable asset to the Obama cabinet and she would probably, given her energy, drive, ambition, political astuteness, prove to be a great Secretary of State.
If Hillary is appointed Secretary of State, it would then be up to informed and progressive members of the U.S.electorate, NOT to support the 60-year policy of the U.S. State Department to meddle, with disastrous consequences, in the internal affairs and foreign policy priorities of sovereign states.
To name a few:
Pakistan is trying its best to deal with its own extremist threat within its own borders. The U.S. better not conduct so-called counterterrorist incursions (with loss of civilian life)into Pakistan because the U.S. will undoubtedly unleash a long-term backlash against itself in both Pakistan and Afghanistan.
Russia has a right to reconfigure relationships with republics of the erstwhile Soviet Union without a Cheney-type threat to Putin and Medvedev.
Iran, like every sovereign nation-state has every right to develop its nuclear capability. It is NOT for the U.S. (which has the MOST nuclear warheads and is the ONLY nation-state that has used nuclear against another nation-state) to decide who should or should not develop nuclear capability.
The U.S. can certainly boost humanitarian aid (with no-strings attached) in Africa. That would be a beneficial use of the State Department's resources.
No matter who is appointed to lead State, that individual will likely continue to follow an unfair, unethical, undemocratic pro-Zionist policy in the so-called Middle East (it is West Asia).
The people of the nation-states of West Asia, especially the Palestinian people have long suffered the consequences of first British/French and now U.S. neo-imperial greed and manipulation.
So, I have only modest hopes about the Hillary candidacy for Secretary of State. I am pragmatically aware that the US under Barack Obama will NOT be progressive, but neoliberal and militaristic.
The U.S. will continue to DOMINATE instead of PARTICIPATE in international initiatives and alliances to build a more equitable world order. The U.S. will continue to distort international politics with its direct interventions and its self-serving, supremacist divide-and-rule strategy.
In my view the U.S. has proven to be the greatest threat to world peace, stability and an equitable world economic order, in the last 60 years. This is not going to change in any substantive way, no matter who becomes the U.S. Secretary of State.
Much of the world is moving in the direction of new multi-polar alliances and reconfigurations but the U.S. continues to be uni-polar.
How 20th century!
An ethical electorate (can this admittedly small section of the U.S. electorate coalesce around progressive goals?) that places the Greater Collective Good(GCG) of ALL of the world's peoples, over the aggressive and destructive stance of the Cheney-Bush U.S. State Department can attempt to make a difference.
Will the "change" at State really mean, in practice, no change at all? Just hype, no change?
The burden of proof is on the incoming Obama administration.
Chithra KarunaKaran
http://www.EthicalDemocracy.blogspot.com
— EthicalDemocracy, http://www.EthicalDemocracy.blogspot.com
Recommend Recommended by 0 Readers
November 16, 2008 10:52 am
Link:
http://community.nytimes.com/article/comments/2008/11/16/opinion/16dowd.html?permid=115#comment115
Hillary has a higher profile and proven capability in international affairs and has more credentials in foreign policy than Barack Obama or ANY of her colleagues in Congress.
Hillary would be an invaluable asset to the Obama cabinet and she would probably, given her energy, drive, ambition, political astuteness, prove to be a great Secretary of State.
If Hillary is appointed Secretary of State, it would then be up to informed and progressive members of the U.S.electorate, NOT to support the 60-year policy of the U.S. State Department to meddle, with disastrous consequences, in the internal affairs and foreign policy priorities of sovereign states.
To name a few:
Pakistan is trying its best to deal with its own extremist threat within its own borders. The U.S. better not conduct so-called counterterrorist incursions (with loss of civilian life)into Pakistan because the U.S. will undoubtedly unleash a long-term backlash against itself in both Pakistan and Afghanistan.
Russia has a right to reconfigure relationships with republics of the erstwhile Soviet Union without a Cheney-type threat to Putin and Medvedev.
Iran, like every sovereign nation-state has every right to develop its nuclear capability. It is NOT for the U.S. (which has the MOST nuclear warheads and is the ONLY nation-state that has used nuclear against another nation-state) to decide who should or should not develop nuclear capability.
The U.S. can certainly boost humanitarian aid (with no-strings attached) in Africa. That would be a beneficial use of the State Department's resources.
No matter who is appointed to lead State, that individual will likely continue to follow an unfair, unethical, undemocratic pro-Zionist policy in the so-called Middle East (it is West Asia).
The people of the nation-states of West Asia, especially the Palestinian people have long suffered the consequences of first British/French and now U.S. neo-imperial greed and manipulation.
So, I have only modest hopes about the Hillary candidacy for Secretary of State. I am pragmatically aware that the US under Barack Obama will NOT be progressive, but neoliberal and militaristic.
The U.S. will continue to DOMINATE instead of PARTICIPATE in international initiatives and alliances to build a more equitable world order. The U.S. will continue to distort international politics with its direct interventions and its self-serving, supremacist divide-and-rule strategy.
In my view the U.S. has proven to be the greatest threat to world peace, stability and an equitable world economic order, in the last 60 years. This is not going to change in any substantive way, no matter who becomes the U.S. Secretary of State.
Much of the world is moving in the direction of new multi-polar alliances and reconfigurations but the U.S. continues to be uni-polar.
How 20th century!
An ethical electorate (can this admittedly small section of the U.S. electorate coalesce around progressive goals?) that places the Greater Collective Good(GCG) of ALL of the world's peoples, over the aggressive and destructive stance of the Cheney-Bush U.S. State Department can attempt to make a difference.
Will the "change" at State really mean, in practice, no change at all? Just hype, no change?
The burden of proof is on the incoming Obama administration.
Chithra KarunaKaran
http://www.EthicalDemocracy.blogspot.com
— EthicalDemocracy, http://www.EthicalDemocracy.blogspot.com
Recommend Recommended by 0 Readers
Friday, November 14, 2008
An Obama "Transition" to Public Education?
My post is Recommended by the NYTimes editors, well sometimes they do that!
http://community.nytimes.com/article/comments/2008/11/14/us/politics/14obama.html?s=1&pg=2
Post #42.
November 14, 2008 9:50 am
The pic accompanying a story in the NY Times today on the Obama family's "transition" since he became the President-elect, shows Obama's daughters arriving at school.
Private school.
During his almost-two-year campaign, Obama repeatedly promised to "fix" education. By that he and everybody else means PUBLIC education. Even though we have an unequal two-tier system of private/elite vs. public/mass education, it is always public education that apparently needs fixing. The elite private education system goes unexamined, unregulated.
Obama is no Jimmy Carter. When Carter was President, he sent his daughter Amy to a public elementary school in Washington DC. It was a predominantly Black school. When Obama becomes President, he will send his two daughters to an elite private predominantly white school. Like the Clintons, Obama will choose an elite (which also means predominantly upper middle class, white) private school for his daughters.
The real "transition" would be if the Obama parents sent their daughters to public school. But then, that would make Obama what we need in a leader -- a social, economic and political PROGRESSIVE, rather than a NEOLIBERAL who maintains and enforces the political, economic and social status quo while gaining immediate benefits for themselves, to the detriment of the Greater Collective Good in civil society.
Chithra KarunaKaran
City University of New York (a public education institution)
http://www.EthicalDemocracy.blogspot.com
— EthicalDemocracy, http://www.EthicalDemocracy.blogspot.com
====================================================================================
http://community.nytimes.com/article/comments/2008/11/14/us/politics/14obama.html?s=1&pg=2
Post #42.
November 14, 2008 9:50 am
The pic accompanying a story in the NY Times today on the Obama family's "transition" since he became the President-elect, shows Obama's daughters arriving at school.
Private school.
During his almost-two-year campaign, Obama repeatedly promised to "fix" education. By that he and everybody else means PUBLIC education. Even though we have an unequal two-tier system of private/elite vs. public/mass education, it is always public education that apparently needs fixing. The elite private education system goes unexamined, unregulated.
Obama is no Jimmy Carter. When Carter was President, he sent his daughter Amy to a public elementary school in Washington DC. It was a predominantly Black school. When Obama becomes President, he will send his two daughters to an elite private predominantly white school. Like the Clintons, Obama will choose an elite (which also means predominantly upper middle class, white) private school for his daughters.
The real "transition" would be if the Obama parents sent their daughters to public school. But then, that would make Obama what we need in a leader -- a social, economic and political PROGRESSIVE, rather than a NEOLIBERAL who maintains and enforces the political, economic and social status quo while gaining immediate benefits for themselves, to the detriment of the Greater Collective Good in civil society.
Chithra KarunaKaran
City University of New York (a public education institution)
http://www.EthicalDemocracy.blogspot.com
— EthicalDemocracy, http://www.EthicalDemocracy.blogspot.com
====================================================================================
Monday, November 10, 2008
Covert Aggression Under the Guise of Counterterrorism
Today, the NYTimes reported that a 2004 secret order had been issued authorizing U.S. attacks on suspected "terrorists" in 20 sovereign nation-states.
The New York Times published my comment on this report:
NYTimes blog
The U.S. has a right to defend its own territory against attacks.
But wait. What gives the U.S. the right to carry out attacks (which frequently end in the death of innocent civilians), into sovereign states that are themselves trying to curb extremist elements within their own borders?
Is this "secret order" an act consistent with ethical democracy or are these actions illegal, arrogant, futile, counter-productive and likely to unleash a backlash?
The perilous Cheney-Bush Ideology of Exceptionalism (" we are so special, there's nobody in the entire world quite like us so we can do whatever we want, invade, occupy, kill, threaten, impose sanctions, etc. etc."), has led the U.S. headlong into a dangerous and futile engagement OUTSIDE its own territory and WITHIN the territory of sovereign states.
This covert aggression has clearly inflamed civilian sentiment especially when local residents lose a family member who is not involved in any extremist activity.
Don't we by now know about the failures of U.S. "intelligence"? This lose-lose strategy will hopefully be halted, beginning in January 2009. Otherwise it will signal a continuation of the same failed policy of the Cheney-Bush regime.
Regime change, Bush-Cheney to Obama-Biden, cannot afford to be merely symbolic.
Chithra KarunaKaran
— EthicalDemocracy, http://www.EthicalDemocracy.blogspot.com
The New York Times published my comment on this report:
NYTimes blog
The U.S. has a right to defend its own territory against attacks.
But wait. What gives the U.S. the right to carry out attacks (which frequently end in the death of innocent civilians), into sovereign states that are themselves trying to curb extremist elements within their own borders?
Is this "secret order" an act consistent with ethical democracy or are these actions illegal, arrogant, futile, counter-productive and likely to unleash a backlash?
The perilous Cheney-Bush Ideology of Exceptionalism (" we are so special, there's nobody in the entire world quite like us so we can do whatever we want, invade, occupy, kill, threaten, impose sanctions, etc. etc."), has led the U.S. headlong into a dangerous and futile engagement OUTSIDE its own territory and WITHIN the territory of sovereign states.
This covert aggression has clearly inflamed civilian sentiment especially when local residents lose a family member who is not involved in any extremist activity.
Don't we by now know about the failures of U.S. "intelligence"? This lose-lose strategy will hopefully be halted, beginning in January 2009. Otherwise it will signal a continuation of the same failed policy of the Cheney-Bush regime.
Regime change, Bush-Cheney to Obama-Biden, cannot afford to be merely symbolic.
Chithra KarunaKaran
— EthicalDemocracy, http://www.EthicalDemocracy.blogspot.com
Sunday, November 9, 2008
Democracy on Wheels, Corruption on Wheels
Democracy on Wheels, Corruption on Wheels
TTE corruption is rampant on IR. Train Ticket Examiners (TTEs) are stealing from the Indian riding public.
Yeah sure, going green on train toilets is fantastic provided they work.If they don't work (wanna bet?) they'll STINK worse than ever. Green toilets are a welcome, long overdue innovation that will be kind to the environment and generate savings to the public. It will contribute to the Greater Collective Good, my qualitative/quantitative measure of Ethical Democracy.
But what really stinks is flagrant bribe-taking by train ticket examiners and almost equally flagrant bribe-giving by the public.
When I am in India which is at least five months every year, I use ONLY PUBLIC MASS TRANSIT. Buses, trains. No, not even autorickshaws. No dumb SUVs and private cars for me. I ride our wonderful always-in-need-of-improvement Indian Railways all the time. From Kolkata to Kochi and all points in between. This is DEMOCRACY ON WHEELS.
But what is completely unacceptable and damaging is corruption by Train Ticket Examiners. TTEs collect cash payments on every shift, from everybody they can squeeze money out of. Remember, TTEs are already paid wages out of taxpayer money and have secure lifetime jobs and healthcare, with pensions and benefits upon retirement.
I have NEVER given TTE's a paisa, and never will. Many of my friends and relatives regularly offer bribes to TTE's. They complain they cannot 'get anything done' unless they proffer a bribe, whether to a TTE or a municipal bureaucrat or a constable who issues them a ticket for a traffic violation.
What distorted, undemocratic, unethical thinking and action.
Many Indians, especially middle and upper class Indians (of course they also belong to the privileged dominant castes) degrade democracy, abuse their civic rights as well as their privileges and responsibilities as lawful citizens in India -- an unprecedented democratic nation-state, the world's most populous democracy.
The TTE's "sell" berths to passengers who have not paid their full fare to the IR. In fact the TTEs run a PARALLEL ECONOMY. The TTE's run an underground illegal economy that drains money from the Indian Railways. The TTEs steal money from taxpayers and line their own pockets, to the detriment of a public sector service -- rail transport for everybody.
I have seen this happen right in front of my eyes whenever I ride the trains (second class of course, I am no elitist), of the Indian Railways.
The PEOPLE have the power to change business-as-usual in the IR, by NOT giving bribes to TTEs. But will they? Will they practice Ethical Democracy?
Dr. Chithra KarunaKaran
City University of New York (CUNY)
http://www.EthicalDemocracy.blogspot.com
TTE corruption is rampant on IR. Train Ticket Examiners (TTEs) are stealing from the Indian riding public.
Yeah sure, going green on train toilets is fantastic provided they work.If they don't work (wanna bet?) they'll STINK worse than ever. Green toilets are a welcome, long overdue innovation that will be kind to the environment and generate savings to the public. It will contribute to the Greater Collective Good, my qualitative/quantitative measure of Ethical Democracy.
But what really stinks is flagrant bribe-taking by train ticket examiners and almost equally flagrant bribe-giving by the public.
When I am in India which is at least five months every year, I use ONLY PUBLIC MASS TRANSIT. Buses, trains. No, not even autorickshaws. No dumb SUVs and private cars for me. I ride our wonderful always-in-need-of-improvement Indian Railways all the time. From Kolkata to Kochi and all points in between. This is DEMOCRACY ON WHEELS.
But what is completely unacceptable and damaging is corruption by Train Ticket Examiners. TTEs collect cash payments on every shift, from everybody they can squeeze money out of. Remember, TTEs are already paid wages out of taxpayer money and have secure lifetime jobs and healthcare, with pensions and benefits upon retirement.
I have NEVER given TTE's a paisa, and never will. Many of my friends and relatives regularly offer bribes to TTE's. They complain they cannot 'get anything done' unless they proffer a bribe, whether to a TTE or a municipal bureaucrat or a constable who issues them a ticket for a traffic violation.
What distorted, undemocratic, unethical thinking and action.
Many Indians, especially middle and upper class Indians (of course they also belong to the privileged dominant castes) degrade democracy, abuse their civic rights as well as their privileges and responsibilities as lawful citizens in India -- an unprecedented democratic nation-state, the world's most populous democracy.
The TTE's "sell" berths to passengers who have not paid their full fare to the IR. In fact the TTEs run a PARALLEL ECONOMY. The TTE's run an underground illegal economy that drains money from the Indian Railways. The TTEs steal money from taxpayers and line their own pockets, to the detriment of a public sector service -- rail transport for everybody.
I have seen this happen right in front of my eyes whenever I ride the trains (second class of course, I am no elitist), of the Indian Railways.
The PEOPLE have the power to change business-as-usual in the IR, by NOT giving bribes to TTEs. But will they? Will they practice Ethical Democracy?
Dr. Chithra KarunaKaran
City University of New York (CUNY)
http://www.EthicalDemocracy.blogspot.com
Saturday, November 8, 2008
Choosing a U.S. President in the Corporate Bailout era
TrackBack URL for this entry:
http://www.pbs.org/moyers/mt3/mt-tb.cgi/1722
Obama is the president- elect. I voted for Barack Obama. This is a momentous, historic, powerfully symbolic, unprecedented election result.
When I went into my voting booth in my election district in Manhattan, I voted Obama, not on the Democrat line, but on the Working Families Party line. I rejected a chance to also vote for Charles Rangel, the longterm Harlem Democrat for whom I had voted several times before, who is Chairman of the House Ways and Means Committee, because Rangel failed to pay taxes. I also refused to cast a vote for my local NYS Assemblyman who is a donor to landlords, against the rights of tenants.
Now let me submit some qualifiers:
I refused to contribute one penny to either the Obama or McCain campaigns, instead holding out for long overdue campaign finance reform. Unfortunately, campaign financing reform will not be enacted by the majority Democrats anytime soon, because their product (Obama) sold well this election cycle. Large sections of the U.S. consuming electorate bought Obama, fewer U.S. consumers bought McCain.
In US-style advanced capitalism, most recently in its corporate bailout phase, all discourses, (from slavery onwards), are commodified. Brand Obama prevailed (for now) against Brand McCain, in a Coke vs. Pepsi contest. This does not imply that there are no differences between Barack Obama and John McCain. But, no matter who is elected, entrenched multinational corporatism and a multinational weapons industry will trump democracy and civil society in the U.S.
Barack Obama was elected because he can best satisfy the American electorate's need to continue to engage in the commodified discourse of U.S. exceptionalism "we are the best" "we are the greatest" "there's no one quite like us so we can do whatever we want, invade, occupy threaten, whatever..." etc. etc. ad nauseum.
The US public wants to consume at ever cheaper rates, without producing what they consume (the Walmart model); wants a "tough" President and Congress and Supreme Court (which means the US does not want to be a co-equal player in the world community of nations), but instead will continue to try to dominate, interfere and distort global politics and the globalized economy even though the U.S. has a failed foreign policy and a failed economy; violate human rights in Iraq and elsewhere which it invaded and continues to occupy; make threats to invade Iran; continue to support illegal Israeli settlements in Palestine; continue to operate in Afghanistan inflicting a high civilian toll; enter Pakistan allegedly to kill "insurgents"; send Cheney to threaten Putin; consume energy resources in a wasteful and harmful manner.
Barack Obama is a neoliberal rather than a radical progressive. He is no FDR.
He is not even a Carter.
He is a Clintocrat without a zipper problem.
He will maintain the status quo while appearing to be progressive. That's the neoliberal spin tactic.
Obama is certainly no Mandela, no Kenyatta, no Nkrumah, no Nyerere and most certainly he is no Gandhi in-the-making, even though Gandhiji's portrait supposedly hangs in his Senate office.
His life is not his message.
I voted for Obama because he (possibly) is likely to be able to do less harm than McCain, in the U.S. and in the world.
The U.S. is still a long, long way from Ethical Democracy as we embark upon an Obama Presidency.
Still, I am cautiously joyful for the remotest hint of ethical progress towards democracy in the U.S.
Chithra Karunakaran
http://www.EthicalDemocracy.blogspot.com
Posted by: Chithra KarunaKaran | November 8, 2008 7:55 AM
http://www.pbs.org/moyers/mt3/mt-tb.cgi/1722
Obama is the president- elect. I voted for Barack Obama. This is a momentous, historic, powerfully symbolic, unprecedented election result.
When I went into my voting booth in my election district in Manhattan, I voted Obama, not on the Democrat line, but on the Working Families Party line. I rejected a chance to also vote for Charles Rangel, the longterm Harlem Democrat for whom I had voted several times before, who is Chairman of the House Ways and Means Committee, because Rangel failed to pay taxes. I also refused to cast a vote for my local NYS Assemblyman who is a donor to landlords, against the rights of tenants.
Now let me submit some qualifiers:
I refused to contribute one penny to either the Obama or McCain campaigns, instead holding out for long overdue campaign finance reform. Unfortunately, campaign financing reform will not be enacted by the majority Democrats anytime soon, because their product (Obama) sold well this election cycle. Large sections of the U.S. consuming electorate bought Obama, fewer U.S. consumers bought McCain.
In US-style advanced capitalism, most recently in its corporate bailout phase, all discourses, (from slavery onwards), are commodified. Brand Obama prevailed (for now) against Brand McCain, in a Coke vs. Pepsi contest. This does not imply that there are no differences between Barack Obama and John McCain. But, no matter who is elected, entrenched multinational corporatism and a multinational weapons industry will trump democracy and civil society in the U.S.
Barack Obama was elected because he can best satisfy the American electorate's need to continue to engage in the commodified discourse of U.S. exceptionalism "we are the best" "we are the greatest" "there's no one quite like us so we can do whatever we want, invade, occupy threaten, whatever..." etc. etc. ad nauseum.
The US public wants to consume at ever cheaper rates, without producing what they consume (the Walmart model); wants a "tough" President and Congress and Supreme Court (which means the US does not want to be a co-equal player in the world community of nations), but instead will continue to try to dominate, interfere and distort global politics and the globalized economy even though the U.S. has a failed foreign policy and a failed economy; violate human rights in Iraq and elsewhere which it invaded and continues to occupy; make threats to invade Iran; continue to support illegal Israeli settlements in Palestine; continue to operate in Afghanistan inflicting a high civilian toll; enter Pakistan allegedly to kill "insurgents"; send Cheney to threaten Putin; consume energy resources in a wasteful and harmful manner.
Barack Obama is a neoliberal rather than a radical progressive. He is no FDR.
He is not even a Carter.
He is a Clintocrat without a zipper problem.
He will maintain the status quo while appearing to be progressive. That's the neoliberal spin tactic.
Obama is certainly no Mandela, no Kenyatta, no Nkrumah, no Nyerere and most certainly he is no Gandhi in-the-making, even though Gandhiji's portrait supposedly hangs in his Senate office.
His life is not his message.
I voted for Obama because he (possibly) is likely to be able to do less harm than McCain, in the U.S. and in the world.
The U.S. is still a long, long way from Ethical Democracy as we embark upon an Obama Presidency.
Still, I am cautiously joyful for the remotest hint of ethical progress towards democracy in the U.S.
Chithra Karunakaran
http://www.EthicalDemocracy.blogspot.com
Posted by: Chithra KarunaKaran | November 8, 2008 7:55 AM
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