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Democrats Blast a Sunny-Side Look at U.S. Health Disparities

Reposted with permission from Science Magazine , Volume 303, Number 5657, Issue of 23 Jan 2004, p. 451.

When Congress ordered a report on racial and socioeconomic disparities in the health of U.S. citizens, it wasn't expecting a smiley face. But that is what it got, according to Representative Henry Waxman (D-CA), who last week accused the Bush Administration of whitewashing federal researchers' conclusions. Administration officials deny charges by Waxman and other Democrats that they softened the December report; they say editors emphasized "successes" in the summary only because that is the best way to encourage improvements in health care.

At issue is the 196-page National Healthcare Disparities Report, authored by three researchers at the Agency for Healthcare Research and Quality (AHRQ). It is packed with data on health care treatment and outcomes for many diseases affecting minority groups and the poor. Waxman's Democratic staff on the Government Reform Committee compared the final version with a June 2003 draft and concluded that Health and Human Services (HHS) officials scrubbed the executive summary.

The draft stated, for example, that "racial, ethnic, and socioeconomic disparities are national problems." The final version simply says that "some socioeconomic, racial, ethnic, and geographic differences exist." The final summary omits statements that inequalities are "significant" and "pervasive" and also drops some striking examples of inequalities such as higher rates of late-stage cancer and death from AIDS among minorities. New wording, however, notes that "some 'priority populations' do as well or better than the general population in some aspects of health care."

AHRQ spokesperson Karen Migdail says that "revisions were done to use successes ... as a catalyst for change" in a "glass half-full approach." She says that "this Administration has made reducing health disparities a major priority." She adds that "not a number was changed" in the body of the report.

Some health policy experts agree with Waxman that the final summary gives a distorted view. "I admire the Administration's ability to look at the positive, but it shouldn't come at the expense of the truth," says Harvard's Joseph Betancourt, who served on two Institute of Medicine panels on inequities in health care. Another member of one panel, Donald Steinwachs of the Johns Hopkins Bloomberg School of Public Health, says that his group's 2002 report, Unequal Treatment, was "very similar in tone" to the draft HHS report, emphasizing that disparities "have to be a national priority." Making the report more "upbeat," he says, "does not accomplish the goal of focusing people on the problems." The last U.S. Surgeon General during the Clinton Administration agrees: "I'm concerned that the report [has lost] a sense of urgency," says David Satcher, now at the Morehouse College of Medicine in Atlanta, Georgia.

Waxman, who maintains a Web site on this and other allegations of political meddling in science, * has asked HHS to provide details of official correspondence during the report's revisions.