Racial bias can seep into U.S. patients’ medical notes

When health care providers enter notes into patients’ electronic health records, they are more likely to portray Black patients negatively compared with white patients, two recent studies have found. The unfavorable descriptions may perpetuate bias and stigma and influence the care patients receive.

“The first impression is the chart,” says Gracie Himmelstein, a physician training in internal medicine at the UCLA David Geffen School of Medicine. “That narrative is going to shape your views of the patient, even if you think you’re just looking for the clinical data.”

Himmelstein and colleagues analyzed more than 48,000 hospital admission notes from a Boston medical center. Stigmatizing language overall, and about diabetes and substance use disorder in particular, was more often used in the notes of Black patients compared with white patients, the team reported January 27 in JAMA Network Open.
Another study combed through more than 40,000 medical notes from a Chicago medical center. Black patients were more likely to be described as not complying with or resistant to treatment, among other unfavorable terms, a different research group reported in the February Health Affairs.

The two studies appear to be the first to quantify racial bias in the U.S. electronic health record. Bias can drive health disparities — differences in health tied to social, environmental or economic disadvantages — that occur between different racial and ethnic groups. For example, Black infants have a higher mortality rate than white infants due to health disparities (SN: 8/25/20).

The Health Affairs study’s team designed a computer program to look for phrases with negative connotations, including “not compliant,” “not adherent” and “refused,” in medical notes written from January 2019 to October 2020 for close to 18,500 patients. Overall, 8 percent of the patients had one or more negative terms in their electronic health records.

Black patients were 2.5 times more likely to have such words in their medical notes than white patients, the researchers found. This language “has a potential for targeted harm,” says coauthor Michael Sun, a medical student at the University of Chicago’s Pritzker School of Medicine.

Himmelstein and colleagues scrutinized the electronic health record for negative language like “nonadherent” and “unwilling” along with stigmatizing words — including the verb “abuse” — that label or place blame on the patient. The team studied medical notes that were written from January to December in 2018.

Overall, around 1,200, or 2.5 percent, of the admission notes contained unfavorable language. Notes about substance use disorder and diabetes had more of that language woven in, at 3.4 percent and 7 percent, respectively. In the full sample, Black patients were nearly 1.3 times more likely to have stigmatizing terms in their notes than white patients. That factor was about the same when the researchers focused on diabetes notes, while for records about substance use disorder, Black patients were 1.7 times more likely to have negative descriptions.

The new studies didn’t assess what impact the biased notes had on patients’ medical care. But other research has found that when short descriptions of a patient include stigmatizing language, the negative terms influenced physicians’ treatment decisions, making doctors less likely to offer sufficient pain medication.

Along with potentially leading to worse care, bias in medical notes may sour patients’ perception of their providers. Patients now have the right to read their electronic health records, as mandated in the 21st Century Cures Act. Notes that include stigmatizing or biased depictions can “potentially undermine trust,” says primary care doctor and health equity adviser Leonor Fernández of Beth Israel Deaconess Medical Center in Boston.

In a survey of nearly 23,000 patients, Fernández and colleagues found that 10.5 percent felt offended or judged, or both, after reading their own notes, the team reported in the Journal of General Internal Medicine in September 2021. (The survey didn’t ask about discrimination or racial bias specifically.) Many respondents also explained what prompted their feelings. One participant wrote, “Note said I wasn’t doing everything I could to lose weight which was untrue and very upsetting to see my Dr thought of me like that.”

Researchers have written about ways to remove stigma from descriptions of substance use disorder and obesity, among other conditions. This guidance encourages language that does not identify the patient by their illness and that focuses on the efforts a patient is making.

Rather than labeling a person a “diabetic,” for example, health care providers can write that a person “has diabetes,” researchers from a diabetes care task force recommend. And instead of describing a patient as “non-compliant” with their medication, the researchers suggest explaining why, as in, the patient takes insulin “50 percent of the time because of cost concerns.”

By noting the barriers to a patient’s ability to follow medical advice, says Himmelstein, a health care provider can “engage with that in a way that’s actually helpful in promoting health.” Instead of using terms like “non-compliant,” Sun hopes health care providers “think about what other context and what other story” can be told about the patient.

Accounting for the challenges a patient faces “actually makes you more effective” as a health care provider, says Fernández, and makes the patient less likely to feel blamed.

In the Health Affairs study, Sun and his colleagues observed an unexpected and encouraging change in the electronic health record over time. For notes written during the second half of the study, from March to October of 2020, it was no longer more likely that Black patients’ notes had negative terms compared with white patients. That time period coincided with the start of the COVID-19 pandemic and Black Lives Matter protests.

More work is needed to sort out what’s behind the drop, says Sun. He and his coauthors note that health care providers may have considered patients with COVID-19 less responsible for their illness, in contrast to other conditions. But perhaps it has something to do with how “impactful” that period was, Sun says, in raising awareness of racial health disparities. Perhaps the shift was “out of empathy.”

The W boson might be extra hefty. If so, it could hint at new physics

There’s something amiss with a mass.

A new measurement of the mass of an elementary particle, the W boson, has defied expectations. The result hints at a possible flaw in physicists’ otherwise stalwart theory of the fundamental bits and bobs of our world, known as the standard model.

That theory predicts a W boson with a mass of about 80,357 million electron volts, or MeV. But the new measured mass is larger, at 80,433.5 MeV, physicists with the Collider Detector at Fermilab, or CDF, collaboration report in the April 8 Science.

The finding could hint at new particles or other mysteries of physics yet to be discovered. “If confirmed, this would clearly mean very interesting new physics that we can explore,” says theoretical physicist Sven Heinemeyer of the Institute for Theoretical Physics in Madrid.

Still, several earlier, less precise measurements found W boson masses more closely aligned with the standard model, including one from the ATLAS experiment at the Large Hadron Collider at CERN near Geneva. So physicists are awaiting further confirmation before declaring their prized theory incorrect.
“CDF’s new result seems barely compatible with the previous ones, including its own previous result, which prompts questions,” says ATLAS physicist Maarten Boonekamp of the Institute of Research into the Fundamental Laws of the Universe at Université Paris-Saclay.

Discovered in 1983, the W boson plays an important role in the standard model (SN: 2/5/83). The particle comes in two varieties, with either positive or negative electric charge. Together with their uncharged partner, the Z boson, the particles carry the weak nuclear force, which is responsible for certain types of radioactive decay and plays an important role in the nuclear reactions that power the sun.

Using data that CDF collected from 2002 to 2011, the team looked for W bosons produced in collisions of protons and their antimatter counterparts, antiprotons, in the now-shuttered Tevatron particle collider at Fermilab in Batavia, Ill. (SN: 9/9/11). The analysis was designed so that researchers couldn’t tell what the end result was until they were done.

The moment of the unveiling was striking, says experimental particle physicist Ashutosh Kotwal of Duke University. “When the answer popped up … we were awestruck about what we might have just learned.”

With a precision of 0.01 percent, the new W boson mass measurement is about twice as precise as the previous record. “This is a very special measurement; this is a true legacy,” says experimental particle physicist Rafael Coelho Lopes de Sá of the University of Massachusetts Amherst, who worked on measuring the W boson mass for another Tevatron experiment. “The level of dedication and care and detail … is amazing.”

The new measurement disagrees with the standard model expectation by 7 sigma, a measure of the statistical significance of a result. That’s well above the 5 sigma that physicists usually require to claim a discovery.

Still, “before getting too excited,” says ATLAS physicist Guillaume Unal of CERN, “I would like to see an independent measurement that confirms the CDF measurement.” In addition to the ATLAS measurement, described in 2018 in the European Physical Journal C, another measurement of the W boson’s mass from the CERN experiment LHCb was also in line with the standard model prediction, researchers reported in the January Journal of High Energy Physics.

“The W boson mass is notoriously difficult to measure,” says LHCb physicist Mika Vesterinen of the University of Warwick in Coventry, England. That explains why it took CDF so long to wrap up this analysis, published more than 10 years after the experiment ended.

Hopefully, scientists won’t have to wait that long for another measurement. The ATLAS and LHCb collaborations are already working on improved W boson mass analyses. CMS, another experiment at CERN, could also size up the particle.

If the new measurement holds up, it’s not yet clear what secrets of physics might be at play. New particles — such as those predicted by the theory of supersymmetry, which posits that each known particle has a heavier partner — could help shift the W boson mass upward (SN: 9/6/16). Intriguingly, Heinemeyer points out, those same particles might also help explain another recent physics mystery — the magnetic gyrations of muons reported by the Muon g−2 experiment (SN: 4/7/21).

Whatever physicists uncover, they’ll gain a new grasp on the particulars of this crucial particle, says theoretical physicist Nathaniel Craig of the University of California, Santa Barbara. “At the end of the day, the added energy and attention devoted to the W mass measurement … will be an immensely positive thing.”

The Large Hadron Collider has restarted with upgraded proton-smashing potential

After a hiatus of more than three years, the Large Hadron Collider is back.

Scientists shut down the particle accelerator in 2018 to allow for upgrades (SN: 12/3/18). On April 22, protons once again careened around the 27-kilometer-long ring of the Large Hadron Collider, or LHC, located at the particle physics laboratory CERN in Geneva.

The LHC is coming out of hibernation gradually. Researchers started the accelerator’s proton beams out at relatively low energy, but will ramp up to slam protons together at a planned record-high energy of 13.6 trillion electron volts. Previously, LHC collisions reached 13 trillion electron volts. Likewise, the beams are starting out wimpy, with relatively few protons, but will build to higher intensity. And when fully up to speed, the upgraded accelerator will pump out proton collisions more quickly than in previous runs. Experiments at the LHC will start taking data this summer.

Physicists will use this data to further characterize the Higgs boson, the particle discovered at the LHC in 2012 that reveals the source of mass for elementary particles (SN: 7/4/12). And researchers will be keeping an eye out for new particles or anything else that clashes with the standard model, the theory of the known particles and their interactions. For example, researchers will continue the hunt for dark matter, a mysterious substance that so far can be observed only by its gravitational effects on the cosmos (SN: 10/25/16).

After several years of operations, the LHC will shut down again to prepare the High-Luminosity LHC (SN: 6/15/18), which will further boost the rate of proton collisions and allow for even more detailed studies of the fundamental constituents of matter.

Scientists made a Möbius strip out of a tiny carbon nanobelt

From cylindrical nanotubes to the hollow spheres known as buckyballs, carbon is famous for forming tiny, complex nanostructures (SN: 8/15/19). Now, scientists have added a new geometry to the list: a twisted strip called a Möbius carbon nanobelt.

Möbius strips are twisted bands that are famous in mathematics for their weird properties. A rubber band, for example, has an inside and an outside. But if you cut the rubber band crosswise, twist one end and glue it back together, you get a Möbius strip, which has only one face (SN: 7/24/07).

In 2017, researchers created carbon nanobelts, thin loops of carbon that are like tiny slices of a carbon nanotube. That feat suggested it might be possible to create a nanobelt with a twist, a Möbius carbon nanobelt. To make the itsy-bitsy twisty carbon, some of the same researchers stitched together individual smaller molecules using a series of 14 chemical reactions, chemist Yasutomo Segawa of the Institute for Molecular Science in Okazaki, Japan, and colleagues report May 19 in Nature Synthesis.

While carbon nanotubes can be used to make new types of computer chips and added to textiles to create fabric with unusual properties, scientists don’t yet know of any practical applications for the twisty nanobelts (SN: 8/28/19; SN: 2/8/19). But, Segawa says, the work improves scientists’ ability to make tiny carbon structures, especially complicated ones.