Race Norming Healthcare and the NFL

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Thu, 2021-06-03 20:58

jerrym

An American judge yesterday criticized the NFL practice of race norming that the league practiced in dealing with Black players who suffered from concussions. Race norming was used by the NFL to exclude some Black players from receiving concussion benefits by assuming that Blacks have a lower level of cognitive ability than whites, and therefore could be excluded from getting concussion-related benefits unless their cognitive ability was below the lower level than the whites players allegedly had. You can't get any more racist than that. Since 58.9% of NFL players are Black this resulted in enormous savings for the league. This is not a practice carried over from the 1920s but introduced for the concussion settlement. What century do the NFL owners live in?

This was revealed only because two Black players sued the NFL over this. Furthermore, the judge only directed the league, which created the practice to negotiate a settlement with the players.

When this hit the media, the NFL said the practice would be discontinued. However, it did not even bother to apologize for this extreme act of racism.

The history of racism in the NFL has been long and tragic, from the lily white days shortly after its founding (there were a couple of Black players in the 1920s and then none till after WWII), the refusal to allow Black QBs play in the league well into the 1980s and only recently has that increased in a major way, to the blacklisting of Colin Kaepernick over simply taking a knee during the national anthem.

Judge Anita Brody of the U.S. District Court for the Eastern District of Pennsylvania, who oversees the NFL’s settlement with thousands of former NFL players regarding the league’s cavalier handling of head trauma issues for decades, has ordered the league and class counsel representing those former players to the negotiating table to address the race-norming issue, which former players say weighs settlement awards against former Black players.

On Monday, Judge Brody issued a pair of orders — one dismissing the lawsuits brought against the league by former players Kevin Henry and Najeh Davenport as “an improper attack on the Settlement Agreement.” But Judge Brody also issued an order expressing concern about the practice of race-norming, which sets a lower cognitive bar for Black players, thus preventing them from gaining equal consideration when cognitive impairment due to head trauma is determined.

“We are glad that the Court has expressed concern about the NFL Concussion Settlement program’s ‘race-norming,’ since for the last four years it has been used to discriminate against Black former players and must be changed immediately,” said Cy Smith, an attorney at Zuckerman Spaeder, who represents Henry and Davenport. “However, we are deeply concerned that the Court’s proposed solution is to order the very parties who created this discriminatory system to negotiate a fix. The class of Black former players whom we represent must have a seat at the table and a transparent process, so that we are not back in the same place four years from now dealing with another fatally flawed settlement.”

At the request of an attorney who represents several former NFL players, a neuropsychologist who has evaluated former NFL players under the concussion settlement program recently re-scored the results of cognitive tests from a group of 94 Black former players.

Nine tests were deemed “incomplete” because of “missing raw scores,” leaving a sample of 85 scores recorded by approximately 40 different clinicians between 2016 and 2020.

When the clinician interpreted the test scores as if those former players had been white, 34 of them met the criteria to receive payouts through the program. When the clinician applied the recommended demographic correction to those same scores, however, only 10 of those same players qualified.

https://touchdownwire.usatoday.com/2021/06/02/nfl-race-norming-concussio...

Thu, 2021-06-03 21:00

jerrym

Even the NFL's promise to end the race norming practice based on the racist idea that Black players has a lower level of cognitive function and therefore had to score lower on brain functions tests than whites was mealy mouthed. How institutionalized is this racism? The lawyer for the players went along with it. He should be disbarred, but at least he apologized, which the NFL still hasn't done.

“We are committed to eliminating race-based norms in the program and more broadly in the neuropsychological community,” the NFL wrote in an email. “Everyone agrees race-based norms should be replaced, but no off-the-shelf alternative exists and that’s why these experts are working to solve this decades-old issue. ...

The development comes as the lead counsel for the retirees, Chris Seeger, issued a mea culpa to ABC News for supporting race-norming. “I was wrong. I didn't have a full appreciation of the scope of the problem," Seeger said, according to a press release from ABC. "You think you know everything. Sometimes you don't. But the closer I looked, the more I realized that this had to go. I'm really sorry that anybody, any client of mine in this program has been made to feel that way," he continued. "That is a big mistake. It was a failure of the system. I'm a part of that. But I'm also a part of getting it fixed."

https://theathletic.com/news/nfl-promises-to-end-race-norming-in-concuss...

Thu, 2021-06-10 02:42

jerrym

The following article discusses how healthcare in general is involved in race norming and the problems that arise out of that, and how race norming affects much more than football players.

The NFL recently agreed to end the practice of “race norming,” which was used as part of its calculations to determine who was eligible to tap into a $1 billion settlement for former players with traumatic brain injuries. The practice meant that some Black players’ claims were denied because the NFL’s equation assumed that those players started with a lower cognitive function. As the league reverses this discriminatory practice, it’s easy to pick out a villain: the NFL.

But race norming isn’t just used by the league. It’s used throughout medicine in a number of tests and equations to help doctors tell how sick you are. A physician takes some measurements, inputs them into a computer, and then punches in some other information: your gender, your age—and, a lot of times, your race. On Monday’s episode of What Next, I talked with Darshali Vyas, a resident physician at Massachusetts General Hospital, about why what looks like a victory for football players might be part of something much bigger: a reassessment of how all of us are seen when we go to the doctor. Our conversation has been edited and condensed for clarity. ...

The NFL recently agreed to end the practice of “race norming,” which was used as part of its calculations to determine who was eligible to tap into a $1 billion settlement for former players with traumatic brain injuries. The practice meant that some Black players’ claims were denied because the NFL’s equation assumed that those players started with a lower cognitive function. As the league reverses this discriminatory practice, it’s easy to pick out a villain: the NFL.

But race norming isn’t just used by the league. It’s used throughout medicine in a number of tests and equations to help doctors tell how sick you are. A physician takes some measurements, inputs them into a computer, and then punches in some other information: your gender, your age—and, a lot of times, your race. On Monday’s episode of What Next, I talked with Darshali Vyas, a resident physician at Massachusetts General Hospital, about why what looks like a victory for football players might be part of something much bigger: a reassessment of how all of us are seen when we go to the doctor. Our conversation has been edited and condensed for clarity.

Darshali Vyas: More and more, as our technology improves and increases, there is a movement to move toward an online calculator, or an algorithm, or a risk score, that helps doctors make difficult decisions. There are some decisions that are clear-cut and some decisions that are more in a gray area. And when we’re trying to make decisions like that—it could be when to start a patient on a certain kind of medication or how to counsel a patient toward or away from a procedure or when to seek additional testing or imaging—it can be helpful to have a tool that helps us individualize a patient’s risk factors and guide decision-making. And in some ways, it’s helpful to have that because it helps doctors be more objective. ...

But when race is a factor, how do you decide whether to plug that data in or leave it out? Especially when there isn’t a clear answer on what the patient’s race is.

There are no clear guidelines on how to answer that question. And there’s a lot of room for error in judgment to go into that decision. These tools that ask for race, typically they’ll ask for very constrained categories of race. They’ll say Black, white, Asian. The patients I take care of, their racial identities don’t fall neatly into those categories. So clinicians often will have to make an assumption based on skin color, what you think they’re identified as, or if the patient’s in front of you, you can ask them what race they identify as. ...

When I was on my obstetrics rotation, there was an example of race correction right in front of me through the vaginal birth after caesarean section tool, or the VBAC tool, that also corrects by race.

This VBAC tool is another one of those calculators for doctors. For women who have given birth once by C-section but want to try for a vaginal birth next time–a VBAC—this tool lets you plug in all kinds of information, and then you get a score that tells you how successful a vaginal birth is likely to be. The thing is telling the tool you were Black or Hispanic lowered your score.

Anecdotally, we heard from practitioners who would use the tool and have a cutoff in their mind. Like, if this calculator gives me a percentage that’s less than 50 percent, I’m not going to offer a VBAC.

And that could mean a more dangerous birth for a Black or Hispanic mom. A successful VBAC has far fewer complications than a repeat C-section, but the tool wasn’t able to factor that in.

The equity concern there is that it may be directing clinicians to steer women of color toward repeat caesarean sections. ...

So you and a couple colleagues wrote a paper urging your peers to reconsider the use of race in this tool. And you’ve seen some progress recently, right?

Just a couple of weeks ago, actually, that feedback calculator online is officially changed to a version of the same tool that does not use race. And what’s really interesting and exciting is that the same group that validated the original VBAC calculator revalidated the tool removing race....

The VBAC calculator has officially become the first instance of race correction in a clinical algorithm that’s been systematically reconsidered, revalidated, and abandoned with an explicit concern for equity. But also, it’s a powerful demonstration that equity work can look like: this willingness to respond and incorporate critique and to reconsider old practices. ...

In general, patients often don’t know when they’re being race-normed. Some of the tools are ones that maybe a doctor will do in front of the patient. But other calculations happen at the lab. So there are a lot of examples of race norming that patients wouldn’t be aware of. And even the VBAC calculator, sometimes clinicians will maybe pull up the calculator and do it with the patient in front of them, but often it’s done before the visit even starts. And so there is an element of this that’s patient advocacy and empowering patients to ask about scores that are being used to help guide decisions about their care.

https://slate.com/technology/2021/06/race-norming-nfl-medicine-racism-di...

Thu, 2021-06-10 20:30

laine lowe laine lowe's picture

I heard about the VBAC calculator on a medical procedural I watch on TV, "New Amsterdam". I found it shocking and racist. Hearing about it being used to determine compensation for concussion injuries among NFL players is also shocking and so freaking racist in the most insulting of ways (lower cognitive level starting point if you're Black). Damn, that is awful and should be illegal.