Same Biology, Different Results: Bias in Medicine

Authored by: Suri Wang

Art by: Carla Hu

"Of all the forms of inequality, injustice in health is the most shocking and most inhuman because it often results in physical death." — Dr. Martin Luther King Jr. (1966)

While healthcare is seen as a benevolent and nonjudgemental field, health professionals often exhibit implicit biases (unconscious biases based on perceptions and stereotypes) against patients that are part of marginalized groups based on race, economic status, and gender. 

Medical bias has existed for hundreds of years. In the third century BCE, Aristotle described the female body as faulty, defective, and deficient. The illnesses of female patients were commonly related back to the reproductive organs [1]. In the 1800s, physicians followed the advice of Benjamin Rush, who believed that Indigenous Americans and Africans did not suffer from insanity and tuberculosis due to their “uncivilized” and active lifestyle and diets. It was instead believed that the cultivation of civilization and abolition of slavery left these populations vulnerable to disease [2]. 

As time went on, minority groups were excluded from medical education, exacerbating the prevalence of bias within medical schools with a lack of diversity within the student population. After the 1910 Flexner Report, which standardized resources for medical schools, medical schools for Black students faced closures. Continuing from this, medical school was seen as a privilege reserved for wealthy males. Those from lower economic classes, often minority races, were diverted into public health and sanitation careers [3]. These historical barriers laid the foundation for biases that persist in modern-day healthcare. 

Bias in Healthcare Today 

Modern day society is often viewed as progressive, especially when it comes to understanding various biases. However, implicit biases are still prevalent. A study conducted in 2007 found that physicians underestimate the pain of Black patients by twice as much across different care settings, even when education and insurance status were controlled for [4]. Moreover, Black patients are less likely to be prescribed medications, and when they are, tend to receive lower dosages. Black patients are also 17% less likely to receive analgesics for fractures in the emergency room. In a study done on white medical students, it was found that half held false beliefs about African Americans, including 60% believing that the skin of Black individuals is thicker or have nerve endings that are less sensitive [5].

Moreover, the opioid crisis began largely with poor, rural white citizens in Appalachia, many of whom participated in manual labor to make a living and were thus prescribed such medications. As the epidemic grew, it was largely overlooked until opioid use rose in affluent suburban communities [6]. The discrepancy in public attention highlights how socioeconomic status influences which populations receive medical attention and policy responses, highlighting bias in healthcare systems. 

In the case of gender, men are presented as stoic and holding high pain tolerance. Meanwhile, women are pictured as sensitive, hysterical, and said to be fabricators. Additionally, women are often judged by their physical appearances and encouraged by healthcare providers to put their family and household foremost, even when suffering from pain. They also face more ineffective healthcare, including being recommended coping strategies, reduced pain medication (including opioids), increased antidepressant prescriptions, and more frequent mental health referrals [7]. 

The Feedback Loop 

In the Tuskegee study which began in 1932 and lasted forty years, 399 black men were unwillingly subjected to an experiment on syphilis by the United States Public Health Service. Officials forced them to suffer, with no treatment, with the supposed goal to observe the natural history of untreated syphilis. Its most prominent result, however, was a heavy amount of medical distrust in African American communities [8]. 

Patient mistrust in physicians leads to barriers in equitable participation in clinical trials, amplifying bias. Inclusive clinical research is essential for generalizable and applicable data, promoting health equality. However, incidents such as the Tuskegee study have led to low participation from minority groups including Black and Latinx individuals, averaging 4%-6% per study [9]. Additionally, those with lower financial resources face barriers to participation, often due to lack of invitation from physicians, who hold implicit biases. 

Many of these individuals hold high levels of mistrust in the medical system and feel as if they will not benefit from research or as if their communities are being exploited. For instance, it was found that those in rural Appalachia (with a majority low-income, white population) feel high levels of medical mistrust due to lack of interaction with healthcare organizations. This leads to a feedback loop, in which a lack of available data results in continued implicit bias [10]. 

What Can Be Done?

New training practices and direct community partnerships may help mitigate these outcomes. Structural inequalities inside the healthcare system, including racism, sex, and gender discrimination, must be addressed through core training for public health officials and healthcare providers. Additionally, diverse student bodies and greater gender equality among medical school faculty can help mitigate implicit biases. Physicians should focus on ensuring that participation in clinical trials is suggested to individuals of a variety of socioeconomic backgrounds. Regardless, it is clear that implicit bias in medicine is detrimental to patient outcomes, and the goals of medicine itself [11]. If systemic changes are not made to address medical biases in the healthcare system, we risk perpetuating disparities in patient care, further eroding trust between patients and providers. However, with intentional reform, increased awareness, and a commitment to equity, meaningful change is possible. 

References: 

1. Cleghorn, E. (2021, June 17). Medical myths about gender roles go back to Ancient Greece. Women are still paying the price today. Time. https://time.com/6074224/gender-medicine-history/

2. Jones, D. S., Hammonds, E., Gone, J. P., & Williams, D. (2024). Explaining Health Inequities — The Enduring Legacy of Historical Biases. The New England Journal of Medicine, 390(5). https://doi.org/10.1056/nejmp2307312

3. Science, in, Laurencin, C. T., Morgan, R. C., & Bright, C. M. (2025, January 21). Historical Roots of Medical Mistrust. Nih.gov; National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK611595/

4. Staton, L. J., Panda, M., Chen, I., Genao, I., Kurz, J., Pasanen, M., Mechaber, A. J., Menon, M., O’Rorke, J., Wood, J., Rosenberg, E., Faeslis, C., Carey, T., Calleson, D., & Cykert, S. (2007). When race matters: disagreement in pain perception between patients and their physicians in primary care. Journal of the National Medical Association, 99(5), 532. https://pmc.ncbi.nlm.nih.gov/articles/PMC2576060/?page=5

5. Hoffman, K. M., Trawalter, S., Axt, J. R., & Oliver, M. N. (2016). Racial Bias in Pain Assessment and Treatment recommendations, and False Beliefs about Biological Differences between Blacks and Whites. Proceedings of the National Academy of Sciences, 113(16), 4296–4301. https://doi.org/10.1073/pnas.1516047113

6. Frakt, A., & Monkovic, T. (2019, November 25). A “Rare Case Where Racial Biases” Protected African-Americans. The New York Times. https://www.nytimes.com/2019/11/25/upshot/opioid-epidemic-blacks.html

7. Samulowitz, A., Gremyr, I., Eriksson, E., & Hensing, G. (2018). “Brave Men” and “Emotional Women”: A Theory-Guided Literature Review on Gender Bias in Health Care and Gendered Norms towards Patients with Chronic Pain. Pain Research and Management, 2018(1), 1–14. https://doi.org/10.1155/2018/6358624

8. McVean, A. (2019, January 25). 40 Years of Human Experimentation in America: The Tuskegee Study. Office for Science and Society; McGill University. https://www.mcgill.ca/oss/article/history/40-years-human-experimentation-america-tuskegee-study

9. Oyer, R. A., Hurley, P., Boehmer, L., Bruinooge, S. S., Levit, K., Barrett, N., Benson, A., Bernick, L. A., Byatt, L., Charlot, M., Crews, J., DeLeon, K., Fashoyin-Aje, L., Garrett-Mayer, E., Gralow, J. R., Green, S., Guerra, C. E., Hamroun, L., Hardy, C. M., & Hempstead, B. (2022). Increasing Racial and Ethnic Diversity in Cancer Clinical Trials: An American Society of Clinical Oncology and Association of Community Cancer Centers Joint Research Statement. Journal of Clinical Oncology, 40(19), 2163–2171. https://doi.org/10.1200/jco.22.00754

10. Thomas, M., Amstutz, C., Orr-Roderick, D., Horter, J., & Holben, D. H. (2023). Medical Mistrust Among Food Insecure Individuals in Appalachia. Family & Community Health, 46(3), 192–202. https://doi.org/10.1097/fch.0000000000000362

11. Vela, M. B., Erondu, A. I., Smith, N. A., Peek, M. E., Woodruff, J. N., & Chin, M. H. (2022). Eliminating explicit and implicit biases in health care: Evidence and research needs. Annual Review of Public Health, 43(1), 477–501. https://doi.org/10.1146/annurev-publhealth-052620-103528