Or you can save you sanity by jumping ahead and reading the report by Democratic members of the House Committee on Government Reform:
UNITED STATES HOUSE OF REPRESENTATIVES
COMMITTEE ON GOVERNMENT REFORM — MINORITY STAFF
SPECIAL INVESTIGATIONS DIVISION
JANUARY 2004
A CASE STUDY IN POLITICS AND SCIENCE--CHANGES TO THE NATIONAL HEALTHCARE DISPARITIES REPORT (PDF, 252 Kb)
I found this story via Atrios and Calpundit.EXECUTIVE SUMMARY
In March 2002, the Institute of Medicine found “overwhelming” evidence that racial and ethnic minorities suffer disparities in healthcare and concluded that “the real challenge lies not in debating whether disparities exist . . . but in developing and implementing strategies to reduce and eliminate them.” In the months that followed, the U.S. Department of Health and Human Services (HHS) was faulted for not pursuing many of the strategies recommended by the Institute of Medicine to counter healthcare disparities.On December 23, 2003, HHS released its own long-awaited National Healthcare Disparities Report. Unlike the Institute of Medicine, however, HHS did not describe healthcare disparities as a national problem. In fact, the HHS report emphasized that in some ways racial and ethnic minorities are in better health than the general population.
At the request of Rep. Henry A. Waxman, Rep. Elijah E. Cummings, Rep. Ciro D. Rodriguez, Rep. Michael M. Honda, Del. Donna M. Christensen, Rep. Hilda L. Solis, Rep. Danny K. Davis, and Rep. Dale E. Kildee, this report investigates why HHS reached conclusions on healthcare disparities that differ from those of the Institute of Medicine. The investigation is based on a comparison of two versions of the healthcare disparities report: (1) the final version that was released by HHS on December 23 after review by political appointees in the Department; and (2) the draft executive summary that was prepared by HHS scientists and widely circulated in the Department.
The investigation finds that HHS substantially altered the conclusions of its scientists on healthcare disparities. In the June draft, the Department’s scientists found “significant inequality” in health care in the United States, called healthcare disparities “national problems,” emphasized that these disparities are “pervasive in our health care system,” and found that the disparities carry a significant “personal and societal price.” The final version of the report, however, contains none of these conclusions.
This investigation finds:
• The final version of the National Healthcare Disparities Report deletes most uses of the word “disparity.” The scientists’ draft defined “disparity” as “the condition or fact of being unequal, as in age, rank, or degree” and included the term over 30 times in the “key findings” section of the executive summary. By contrast, the final version leaves “disparity” undefined and includes it in the “key findings” section just twice.
• The final version eliminates the conclusion that healthcare disparities are “national problems.” The scientists’ draft found that “racial, ethnic, and socioeconomic disparities are national problems that affect health care at all points in the process, at all sites of care, and for all medical conditions — in fact, disparities are pervasive in our health care system.” The final version states only that “some socioeconomic, racial, ethnic, and geographic differences exist.”
• The final version drops findings on the social costs of disparities and replaces them with a discussion of “successes.” The scientists’ draft concluded that “disparities come at a personal and societal price,” including lost productivity, needless disability, and early death. The final version drops this conclusion and replaces it with the finding that “some ‘priority populations’ do as well or better than the general population in some aspects of health care.” As an example, the executive summary highlights that “American Indians/Alaska Natives have a lower death rate from all cancers.” The executive summary does not mention that overall life expectancies for American Indians and Alaska Natives are significantly shorter than for other Americans or that their infant mortality rates are substantially higher.
• The final version omits key examples of healthcare disparities. The scientists’ draft concluded that racial and ethnic minorities are more likely to be diagnosed with late-stage cancer, die of HIV, be subjected to physical restraints in nursing homes, and receive suboptimal cardiac care for heart attacks. The final version drops these examples. The report instead highlights milder examples of healthcare disparities, such as the finding that “Hispanics and American Indians or Alaska Natives are less likely to have their cholesterol checked.”A previous report for Rep. Waxman by the Special Investigations Division documented a growing pattern of political interference with science at HHS and other science-based federal agencies. [see Politics and Science in the Bush Administration (Aug. 2003) (Minority Staff, Government Reform Committee)] The alterations made by HHS in the National Healthcare Disparities Report provide another example of the increasing politicization of science under the Bush Administration. In this case, the changes to the National Healthcare Disparities Report minimize the scope and extent of racial and ethnic disparities in healthcare, undermining efforts to address these problems.
In whatever earthly state You will have me be
Not from sorrow, pain, or care Freedom dare I claim;
This alone shall be my prayer: Glorify Your name.
--from New Year's Hymn by Lawrence Tuttiett, 1864 (alt.)
