Racism

[Mark]

Posted by Catsquotl (here)
About as many, As the whites or yellows or red would.
Under the colors of our skins each and every one of us is capable of humanities best and worst.

I believe that is true, all people are capable of everything.

But I don't believe that, given our global history, if power shifted from caucasian control in the USA and the global community to melanated populations, that retribution would be taken in the form of enslavement and genocide of white people. That could happen at the individual level, but not at the collective. There are a lot of angry people on all sides.

Posted by Catsquotl (here)
I do suspect that if the tables were turned. whites would call out racism the same as blacks do now, And after the dust settled many a black person would feel ill at ease when racism becomes an excuse to call out the so the called privileged whomever is the current ruling color on perceived racism where none was intended and feel .offended by their own perception, same as is happening a lot lately.

Agreed. I hesitate to agree that the situations would be exactly reversed, though, because the nature of African civilizations has been different, historically and culturally, than European civilizations.

Posted by Catsquotl (here)
Is an "involuntairy" club membership such a bad thing per se?

I wouldn't say so. I do not place value judgments on things that we can't help.

Posted by Catsquotl (here)
When I say I thing people get way too offended these days it is exactly that they deny the very club they belong to. Sure as human beings we are all one, But within this realm of existence we do belong to a specific gender, a skin color, a social layer. And even though as individuals we may believe we are not defined by such trivial differences in our humanity they do give us some sense of who or what we are as we try to grow up and start noticing how these differences shape the way we act, behave and feel about ourselves and the clubs that are familiar to us.

Agreed without qualification. And, there are soooo many ways that we transcend these clubs and blend over into other clubs, that there are possibilities to belong and connect in ways that transcend our skin color and familial/genetic history. I believe it will only become moreso as these essential classifications become obscured beneath the increasing codification of belonging that world cultures and sub-cultures are experiencing now. So many sub-groups, so many ways to be a part of something with others that may not look like you or even come from the same culture. It is happening every minute of every day online and off. The change are happening with the youth to such an extent now that most of us who do not deal with the kids have no idea what is going on or who they are, really.

[Mark]

Posted by James Newell (here)
An interesting part of history was mentioned by David Icke on a segment of Infowars.com today. He brought up an interesting point about a satanic cult that spawned from the Jews, than infected Islam, then Christianity, and the West. Keeping people divided by race is just one part of the agenda. The end product is no more humans on this planet. It won't really matter what race you are.

Not a fan of the use of the word, "infected" to describe what could be termed cultural diffusion more accurately. I don't know when, where or how it started but I do know what its results are for the world. I also know that anyone in the world in any group could claim victim status. All people, groups, are aggrieved in some way, shape or form.

The superiority complex that comes from applied intergenerational racism, though, is a very specific form of victimization which leaves both those who practice it and those who it is practiced upon victims. Those who practice racism internalize forms of sociopathy, exemplified by a lack of compassion, dehumanization and separation from other members of the human family. This could be considered to be a result of whatever conspiracy you are talking about, but its effect upon everyday people is very real and impacts the very nature of the soul. Perhaps it can be posited that this is a way to make large groups of people more like the controllers, those who, by their nature, are separate and consider themselves better than and above all other people no matter what they look like or where they come from.

Those whom racism is practiced upon experience lowered self-esteem, stress from living in an environment which is constantly antagonistic, lower life-spans, more health problems, etc. These outcomes, for both populations, are life-denying and are perhaps also epigenetic in nature, affecting populations at the level of gene expression as environmental choices set in across generations. This perhaps means, psychopathy and empathy can be selected for based upon the experiences and lifestyles of one's ancestors.

Perhaps, the divisions we see because of racism are created for this very purpose. After all, elites always require people to serve them. Why not create a large group of people who will do your dirty work for you by attempting to eliminate populations they don't want in the world they wish to create? Shock Troops of the Apocalypse, you might say. People who have been subjected to trauma generation after generation after generation.

After all, race as a biological/political/cultural category was created in the United States in the 1600s amongst a mixture of different global populations that then coalesced in the colonies, and after the rebellions in which Irish, Africans and other indentured and poor folk rose up against the burgeoning agricultural/industrial machine. They began offering the Irish and other European-descended folk jobs on the Slave Patrol which would become the police in a later era, as Overseers, they gave away land and other "privileges" to separate these poor populations by race. Populations that had every economic reason to unite against the will of the controller population, those who sought to consolidate wealth and power at the highest echelons of society, as has been done in every pyramidal society that has ever been.

400 years, for those whose families have been in the USA that long, of having to "pretend" that you are better than other families of humanity. Perhaps, at this point, for those affected by these ways of life, it is no longer pretending, it is an inherent understanding that is as natural as breathing.

It has been a very effective strategy. As now, it has become nigh sub-conscious. And these are very shocking potentialities if they are so. Epigenetics is reminiscent of the social Darwinism of past generations and we must be careful about the kinds of conclusions we come to. The research remains pending, as doing this type of work on humans is very controversial. And do we, really, want to know the answer?

[James Newell]

If you think you are a body and the color makes a big difference than you got skin in the game of make wrong.
If you know you are a spirit that has a body a lot of this racial difference thing is a belly laugh.

It comes down to que bono(who benefits)? The elite of the planet make their bread and butter on creating differences among mankind. If the vast majority woke up we would know who to really put our attention on to handle.

[Ernie Nemeth]

So ... do y'all believe that black folks across the world will enslave, murder, rape and experiment on white people, if the tables were turned?

In fact, I do, and history supports my view. Like in South Africa today, for one. Although they are just revisiting an insult delivered to them centuries earlier.

The indoctrinated racist attitude is not only reserved for visible minorities, however. It is equally applied to any distinctive feature of an individual that the majority has taken a dislike to. For example, intelligence on the school ground is reason enough for denigration. Or beauty. Or ugliness. Or physical deformity. Or any particularly frowned upon beliefs. Or wealth. Or lack of wealth. Color of one's car. Address. Friends. Politics. Religion. Any and all minor differences can be and are employed to mark the current distinction between an out-group and the in-group...

[Mark]

Posted by James Newell (here)
If you think you are a body and the color makes a big difference than you got skin in the game of make wrong.
If you know you are a spirit that has a body a lot of this racial difference thing is a belly laugh.

You are absolutely right. This is the "game" we play. Many believe they are a body. And the rest of us have to live with them and not tell, but show differently, even if that makes no perceptible difference. There is no agreement for a new way of being human in this world, currently. But there will be. Some are able to, truly, laugh at that reality. But most are not.

Posted by James Newell (here)
It comes down to que bono(who benefits)? The elite of the planet make their bread and butter on creating differences among mankind. If the vast majority woke up we would know who to really put our attention on to handle.

Benefit passes down through many layers.

¤=[Post Update]=¤

Posted by Ernie Nemeth (here)
In fact, I do, and history supports my view. Like in South Africa today, for one. Although they are just revisiting an insult delivered to them centuries earlier.

Your argument is invalid because whites in South Africa as a group are not being subjected to the same strictures and experiences that blacks were subjected to for hundreds of years. Nowhere near it.

Posted by Ernie Nemeth (here)
The indoctrinated racist attitude is not only reserved for visible minorities, however. It is equally applied to any distinctive feature of an individual that the majority has taken a dislike to. For example, intelligence on the school ground is reason enough for denigration. Or beauty. Or ugliness. Or physical deformity. Or any particularly frowned upon beliefs. Or wealth. Or lack of wealth. Color of one's car. Address. Friends. Politics. Religion. Any and all minor differences can be and are employed to mark the current distinction between an out-group and the in-group...

Sure. This is more than just in-group out-group dynamics. More than culture. The psychology of race has proven that over quite a long time.

[James Newell]

Slave comes from the root slav which is that area North of Greece and Turkey. So the whites up there were choice meat for the slave block for many centuries. The Roman and Arab slavers were very predominate in enslaving the Slavs and the blacks before and after Mohammand. The Arabs are still openly active slavers in Libya.

Black tribes in Africa regularly enslaved other tribes for Thousands of years. Romans enslaved the Brits, the French enslaved the Arabs and on and on.

The Spaniards enslaved most of South and Central America. Their deeds done to the Indians were horrific.

Seems the Jews were big slavers and brought many hundreds of thousands of blacks to the Americas for several hundred years. That seems to be conveniently forgotten. Seems big money was made on this human trafficking aberration. And still is.

The various American Indigenous tribes enslaved each other regularly. Who had the better army were the slavers.

I guess the point here is this racist thing is a good justifier( an excuse for doing wrong) to treat your fellow man less than a dog. You can do just about anything to another if you make him less.

How to handle all this: A good place to start is try to treat others as you would like to be treated.

[Mark]

I don't agree with everything this article says, particularly the part about banning certain forms of speech, but I think it forwards the discussion in some other aspects. The discussion itself is where the importance of conversation is, the back and forth when that back and forth is productive and not skewed by cultural conditioning, which is often the downfall of scientific research and has been historically. The possibilitiy of achieving true objectivity is another question worth asking these days, whether science can or cannot move beyond its mooring in cultural norms.

Can science rise beyond the cultures that practice it? When we study each other and ourselves, can the interpretation of incomplete data refrain from drawing conclusions that don't reflect the lived reality of those being studied? Or must science always be denigrated to the level of serving political ends that eventually end up being non life-oriented and reductive in nature rather than expansive and life affirming?

How Can We Curb the Spread of Scientific Racism?
A new book examines the insidious effects of scientific investigations into race

By John Horgan on October 17, 2019



A dozen years ago I flew to Europe to speak at a conference on science’s limits. The meeting’s organizer greeted me with a tirade about James Watson, co-discoverer of the double helix, who had just stated publicly that blacks are less intelligent than whites. “All our social policies are based on the fact that their intelligence is the same as ours,” Watson told a journalist, “whereas all the testing says not really.”

At first I thought my host, a world-famous intellectual whose work I admired, was condemning Watson. But no, he was condemning Watson’s critics, whom he saw as cowards attacking a courageous truth-teller. I wish I could say I was shocked by my host’s rant, but I have had many encounters like this over the decades. Just as scientists and other intellectuals often reveal in private that they believe in the paranormal, so many disclose that they believe in the innate inferiority of certain groups.

That 2007 incident came back to me as I read Superior: The Return of Race Science by British journalist Angela Saini (who is coming to my school Nov. 4, see Postscript). Superior is a thoroughly researched, brilliantly written and deeply disturbing book. It is an apt follow-up to Saini’s previous book, Inferior, which explores sexism in science (and which I wrote about here and here). Saini calls “intellectual racism” the “toxic little seed at the heart of academia. However dead you might think it is, it needs only a little water, and now it’s raining.”


Angela Saini. Credit: Henrietta Garden

Saini argues that racism is implicit within the concept of race. “Race is at its heart the belief that we are born different, deep inside our bodies, perhaps even in character and intellect, as well as outward appearance,” she writes. “It’s the notion that groups of people have certain innate qualities” that can “define the passage of progress, the success and failure of the nations our ancestors came from.” Yes, that’s what Watson was saying.

Like sexism, racism is a personal topic for Saini, who is of Indian descent. Growing up in London, she endured abuse from white children, who hurled insults and stones at her and her sister. Racism is hardly unique to white westerners, she acknowledges. Indians, after all, have long engaged in discrimination against each other, as reflected in their notorious caste system. “Every society that happens to be dominant comes to think of itself as the best, deep down,” Saini comments.

But scientific racism--an oxymoron if ever there was one--is a relatively recent, localized phenomenon. It emerged in Europe during the so-called Enlightenment and accelerated after the publication of Darwin’s On the Origin of Species. “It is no accident that modern ideas of race were formed during the height of European colonialism,” Saini writes, “when those in power had already decided on their own superiority.”

“The Negroes of Africa have by nature no feeling that rises above the trifling.” That was Kant. Darwin came from a family of abolitionists and was progressive for his era. He nonetheless believed, as Saini puts it, that “men were above women, and white races were above all others.” Thomas Henry Huxley, Darwin’s bulldog, supported abolition but said, “The highest reaches in the hierarchy of civilization will assuredly not be within the reach of our dusky cousins.”

White, male Europeans used race science—embodied in ideologies such as social Darwinism and eugenics--to justify their nations’ conquest, enslavement and extermination of non-white people. Given this appalling history, one would think scientific racism would have vanished long ago. And after World War II it did go underground, for a while. The association of the Nazis with scientific racism complicated its marketing.

Race science has nonetheless recently re-emerged, heartening white supremacists, neo-Nazis and other bigots. Saini shows how wealthy benefactors and organizations such as the Pioneer Fund, founded in the 1930s to promote “race betterment,” have enabled this resurgence. They fund and help disseminate research—via journals such as Mankind Quarterly and websites such as Unz Review--that supposedly establishes the innate inferiority of certain races.

Those who espouse this ideology call themselves “race realists.” They insist that racial injustice and inequality “isn’t injustice or inequality at all,” Saini explains. “It’s there because the racial hierarchy is real.” Race realists claim that “they are challenging the politically correct wider world by standing up for good science and that those who oppose them are irrational science deniers.”

Race, as Saini shows, has always been an arbitrary way to categorize people, motivated primarily by political rather than scientific goals. Yes, some genetic markers and heritable diseases, like sickle cell anemia, tend to be associated with certain populations, a fact exploited by 23andMe and Ancestry.com and by scientists tracing human evolution. But numerous studies have revealed that there is far more genetic variation within than between races, however they are defined. A 2002 study found that 93-95 percent of the genetic variation occurs within rather than between geographically distinct populations.

Given this enormous variability, it is absurd to make gross generalizations, as racists do, about the character and capabilities of certain groups. “The racial categories we are used to seeing on census forms don’t map onto the true picture of human variation,” Saini writes. She herself can be categorized as black, brown or Caucasian. The concept of race “is useless, pernicious nonsense,” geneticist Mark Thomas tells her.

Not all research on race is overtly racist. In fact, many scientists doing race-related research claim that their aim is to help targets of racism. But Saini notes that even well-intentioned race science may be poorly conceived. In 2003 anthropologist Duana Fullwiley asked researchers doing race-related medical studies to define race. “None of them could answer her question confidently or clearly,” Saini says. Race-based research, she fears, can end up subtly reinforcing racist conclusions.

For example, researchers have long sought a biological basis for African-Americans’ relatively high rates of hypertension, which is associated with higher rates of heart disease, stroke and death. I had assumed this to be a case in which race science could be beneficial, because it could lead to improved medical treatments for blacks. But Saini presents evidence that environmental factors—including stress and poverty resulting from discrimination—are the primary causes of African-Americans’ elevated hypertension. Rural Africans, she points out, have low levels of hypertension.

The claim that black Americans’ hypertension stems from their genes “lays the blame for inequality at the feet of biology,” Saini writes. “If poor health today is intrinsic to black bodies and has nothing to do with racism, it’s not anyone’s fault.” Ironically, in the slavery era, scholars justified harsh treatment of blacks by claiming that they were hardier and less sensitive to pain than whites. (These myths persist among medical students, the New York Times recently reported.)

Saini also worries about the insidious effects of identity politics and of ancestry testing, which has “helped reinforce the idea that race is real.” “Have pride in where you live or where your ancestors come from if you like,” she says, but “don’t be sucked into believing that you are so different from others that your rights have more value.”

Saini seems to envision a world in which race really does not matter, in which individuals are judged, as Martin Luther King put it, by the content of their character and not the color of their skin. But race poses a paradox. Race should not matter, and yet it does, profoundly, as long as racism endures. As the case of black hypertension shows, race might not be a legitimate biological category, but in a racist society it has measurable biological as well as social consequences.

Superior left me pondering hard questions: Can scientists study race in a way that doesn’t exacerbate racism? Or does all such research, no matter how well-intentioned, subtly reinforce the idea that an individual’s race matters? If scientists do research with the explicit goal of countering racism, are they really scientists, or are they social activists? Finally, can we take pride in our ethnic heritage without being racist?

Superior provides a foundation for discussion of these urgent issues. Saini’s work won’t have any impact on social-injustice warriors, who are beyond moral or rational appeals. “Race realists” have viciously attacked her, as she disclosed in her recent Scientific American column “The Internet Is a Cesspool of Racist Pseudoscience.” (For a similar view, see this New York Times essay, “Racists Are Recruiting. Watch Your White Sons.”)

But I believe, and hope, that Superior will provoke others, including progressives, to re-evaluate their attitudes toward race. She has certainly made me re-evaluate my views. I now see research on racial differences in an even more negative light than I once did, which I didn’t think was possible. As long as racism still infects our societies, it confounds attempts to disentangle the relative contributions of genes and environment to racial inequality.

I once suggested that, given the harm done by research on alleged cognitive differences between races, it should be banned. I stand by that proposal. I also agree with Saini that online media firms should do more to curb the dissemination of racist pseudoscience. “This is not a free speech issue,” she writes in Scientific American, “it’s about improving the quality and accuracy of information that people see online, and thereby creating a fairer, kinder society.”

[AutumnW]

Rahkyt,

Thanks for that. Want to also add that Ancestry.com is an outfit that has strong ties to Mormons. And Mormons, regardless of what any individual will tell you, were overtly racist in the past and likely covertly so today. That's not exclusive to that religion.

I have had some astounding online conversations with very well educated white academics about racial issues in the U.S. For example, Ferguson Missouri riots. The media report on the few weeks of rioting and neglect to inform their viewers about the immediate history of race relations in the town (and many others like it) and forget about the deep history about the region. They won't touch that with a ten foot pole. Dude had no clue about private prisons and slave labor either.

And the alternative right media, like Breibart, surely won't fill that void with their war on "the politically correct" which subsumes many legitimate political racial concerns under the same umbrella as the most extreme nutty causes.

People are so being played, regardless of ethnicity, skin color, etc...

[Mark]

Posted by AutumnW (here)
And the alternative right media, like Breibart, surely won't fill that void with their war on "the politically correct" which subsumes many legitimate political racial concerns under the same umbrella as the most extreme nutty causes.

People are so being played, regardless of ethnicity, skin color, etc...

As is always the case isn't it, people getting played seems like a large part of the human story in general in this Age, at least. The Right does obscure some things just as the Left over-dramatizes others. The media, which is also politics, is really bad about that. Now that I am in the political arena, I see that up close and firsthand. People have assumed I am a Progressive since I ran for office, but I have some views that are waaaaaay beyond any political category as y'all know. I've been and am being attacked on the Left almost as much as I have been on the Right. Such is life when you don't fit in anybody's boxes.

[Ernie Nemeth]

Rahkyt for President!

all aboard

[Mark]

Posted by Ernie Nemeth (here)
Rahkyt for President!

Rahkyt for retirement is more like it. City government is much different from State or Local, it is non-partisan in nature, which suits me just fine. The pressures upon those who run and win are enormous, from citizens and from business interests, which is as it should be I suppose. This is not really the space to discuss local politics as, for me, race does not factor into the equation. But thanks for the vote of confidence! I'm doing my best!

[Mike]

Wait what? Rahkyt for president? I like the sound of that.

I think I'd make a good vice. Let me know if ya need me bro

[AutumnW]

Posted by Catsquotl (here)

Posted by Rahkyt (here)

So ... do y'all believe that black folks across the world will enslave, murder, rape and experiment on white people, if the tables were turned?

About as many, As the whites or yellows or red would.
Under the colors of our skins each and every one of us is capable of humanities best and worst.


I do suspect that if the tables were turned. whites would call out racism the same as blacks do now, And after the dust settled many a black person would feel ill at ease when racism becomes an excuse to call out the so the called privileged whomever is the current ruling color on perceived racism where none was intended and feel .offended by their own perception, same as is happening a lot lately.





WIth Love
Eelco

Catsquotyl,

I understand how you feel and think and don't fault you for it but here is the problem. It is really convenient for the dominant class or race, or both to comfort themselves with the "if tables were reversed, we would get the same treatment," idea. This presupposes that whites would have gotten the same treatment by others when it's not been proven in recent centuries.

The moral equivalency idea wraps something horrific in bright tissue paper tied together with the tiniest string of remorse. All this, while forcing a koombaya moment on those who are still experiencing the after shocks of past trauma.

It's okay for people whose culture, race or caste have been dominant through coercion to feel awkward and uncomfortable about it. That is really tiny price to pay for past wrongs.

¤=[Post Update]=¤

Posted by Mike (here)
Wait what? Rahkyt for president? I like the sound of that.

I think I'd make a good vice. Let me know if ya need me bro

If not him, then who? He seems to be the best person for the job. I swear he'd make the world a better place.

[Catsquotl]

Posted by AutumnW (here)

Catsquotl,

I understand how you feel and think and don't fault you for it but here is the problem. It is really convenient for the dominant class or race, or both to comfort themselves with the "if tables were reversed, we would get the same treatment," idea. This presupposes that whites would have gotten the same treatment by others when it's not been proven in recent centuries.

The moral equivalency idea wraps something horrific in bright tissue paper tied together with the tiniest string of remorse. All this, while forcing a koombaya moment on those who are still experiencing the after shocks of past trauma.

It's okay for people whose culture, race or caste have been dominant through coercion to feel awkward and uncomfortable about it. That is really tiny price to pay for past wrongs.

before the recent centuries there are accounts of afrikan's using slaves.
The presupposition as you call it is all we have to go on. But knowing how humans behave I guess it's is a save bet to assume the worst in this case. No matter which color is the ruling class. It isn't as much a racial thing as it is a power thing. Those in power feel drawn to it and will miss-use it for personal gain regardless of the consequences. Those who wouldn't usually do not want to be in power or do so very reluctantly.


I am aware as a white so called privileged middle aged male I know saying what I see is convenient. It doesn't make it less true though, Assuming things would be different if some tables were reversed is equally presumptuous.


did you notice I did not say whites would be enslaved by the way, only that they would say they were discriminated against. There is no way of knowing what would have happened if things had played out differently.


feeling awkward and uncomfortable is different from feeling I have to defend my right to simply exists. Like I said I will not apologize for being white, or "privileged" or male, or straight. I will treat others with respect and expect the same in return. No race, religion, caste or clan needed or exempt.


with Love
Eelco

[Mark]

This article is a good example of how "science" in the form of statistics can create inequalities. Often, not purposefully, just as a function of the way the equations are created. Statistical problems are formulated based upon certain conditions, and lead to the creation of models. Models, just by sheer dint of the fact that we cannot ever completely know reality, are generally inadequate as descriptors of the world as we exist in it. But the process evolves over time and we do better when we know better.

Beyond Racial Bias: Rethinking Risk Stratification In Health Care

Leonard W. D’Avolio



A recent study by Ziad Obermeyer and colleagues in Science identified a racial bias in a risk stratification algorithm that is used to prioritize patients for care management. Like most algorithms currently in use, it considers past cost to identify individuals most in need of help. Because white people tend to have higher medical expenses, they are prioritized over sicker black patients. The researchers show that if the bias is corrected for, the proportion of black people prioritized for care swings from 17.7 percent to 46.0 percent.

Less than a week later, news of the study appeared in Nature, Business Insider, the Wall Street Journal, and Wired. The State of New York is investigating and threatening suit against UnitedHealthcare and others that employ such approaches.

While this recent discovery is rightfully gaining attention, it is just one of many known biases and shortcomings of the health care system’s current approach to risk stratification. Obermeyer and his colleagues’ study and the concerns it raised offer an opportunity to carefully consider unintended consequences of the prevalent approaches of stratifying risk to find a new way forward.

Flaws And Unintended Consequences
The algorithms in question are decades-old adaptations of actuarial models. They rely mostly on claims (that is, billing) data as input. With the introduction of managed care in the 1980s, health plans needed a way to prioritize their care management activities. The same approach used to estimate the “risk” of populations was applied to predict individuals’ future health care use.

Soon after these approaches were adapted to help care management teams prioritize their limited resources, researchers began publishing studies that identified deficiencies and unintended consequences. A systematic review of 30 risk stratification algorithms appearing in the Journal of the American Medical Association in 2011 concluded, “Most current readmission risk prediction models that were designed for either comparative or clinical purposes perform poorly.” Despite these findings, little has been done to address the problem in the past decade. A number of factors contribute to this poor performance:

Reliance On Claims
As the agreed-upon means of justifying reimbursement, claims data are one of the few widely available data standards in health care. However, the disease code assignments in claims files are notoriously inaccurate. While such errors may be less problematic for calculating the cost of a population over the next year, their effects can be amplified when assigning priority to individuals.

Assumption That Past Cost Equals Future Need
Hockey great Wayne Gretzky credits his success to skating to where the puck will be. In contrast, risk stratification algorithms direct care management teams to where the puck was by finding patients who already cost the most. Research has shown that for patients who use large amounts of health care services, the need often is intense yet temporary. Algorithms that prioritize those who consumed the most health services in the past are inadvertently prioritizing a number of patients nearing end of life and those whose medical needs are subsiding, thus creating a past-consumption bias.

Use Of One-Size-Fits-All Formulas
Many factors—including the nature and stage or severity of the disease, extent of social support, and number of preventable emergency department visits, hospital admissions, or readmissions—may be indicators of medical need. Yet, traditional risk scores ignore these factors, which can provide important context for prioritizing patients.

This myopic approach leads to a type of condition bias in which the diseases that generate the most health care use are prioritized by risk scores. For example, people on dialysis or with late-stage cancer are more likely to be prioritized over people with early signs of type 2 diabetes because patients suffering from the former are likely to have accrued greater medical expenses than the latter. Yet, the greatest opportunity for clinical and financial impact is often in the earlier stages of disease.

Use of one-size-fits-all formulas also introduces age bias; younger sick people are ignored by most algorithms in favor of older people with more chronic, complex conditions. For example, a child with rising risk of potentially fatal diabetic ketoacidosis is unlikely to be prioritized over a 55-year-old with a chronic condition that has led to intense spending over the past 12 months. This bias is particularly problematic for care management organizations serving high-need Medicaid and dually-eligible (Medicare plus Medicaid eligible) populations with a wide age range.

The Impetus For Change
Providers’ adoption of value-based contracts has led to significant new investments in care management. Organizations are expecting measurable returns from these investments in the form of improved outcomes and reduced medical expenditures. Different levels of care and interventions are being introduced to address specific needs at different times, often outside of the clinic. Examples include remote monitoring programs, more in-home and telemedicine programs for patients with chronic and complex needs, and community-based palliative care. These programs typically are costly to implement, thus raising the stakes for efforts to identify patients who are benefiting most and who are most likely to benefit.

New data from electronic medical records, medical devices, and new technologies such as machine learning and natural language processing are introducing more opportunities to use data to identify the patients most likely to benefit—not necessarily those who cost the most in the past.

The Way Forward
As pointed out by Obermeyer and colleagues, the way forward is not as simple as swapping out one variable for another. Neither is the answer to simply apply new data and new math to the traditional method of risk stratification. To meet the evolving needs of care management and capitalize on access to new data and technology, we need to rethink our approach. The next generation of risk stratification approaches should:

Use All Relevant Data, Not Just The Data That Everyone Else Has
It’s no longer necessary or even appropriate to limit models to the same common denominator data that all institutions have access to (for example, claims). Just as companies such as Amazon and Google use all of the data at their disposal to tailor their approaches to selling books and advertisements to individual consumers, health care can use data to move beyond one-size-fits-all approaches to risk stratification.

For example, Cyft, the analytics company I work for, recently collaborated with a care management organization responsible for the health of a Medicaid population. The care management organization cared for all ages of people with behavioral health needs. However, the state offered a special program for people younger than age 18 with behavioral health needs. Unfortunately, the organization’s risk scoring system did not consider age nor was it designed to detect patterns that would indicate behavioral health need. Without the support of customized risk stratification, referrals to the younger than-18 program were limited to patients already engaged with clinicians who happened to be aware of the state program.

To help the team identify and prioritize those likely to benefit, we built two risk stratification models, one that was trained with (that is, learned from) the data of people younger than 18 years old and one trained on patients 18 and older. This approach prevented the younger people from being crowded out by older people with more health care use. Rather than prioritize based on cost, both models were designed to predict inpatient psychiatric admissions as a proxy for impending behavioral health need. The results of the two age- and condition-sensitive models were used to match individuals with interventions tailored to address their age- and condition-sensitive needs.

As organizations capture more data—including clinical data in electronic medical records and care management systems, as well as survey data on topics such as activities of daily living and social determinants of health—this information can be used to prioritize patients, not just for care management but for the programs or interventions best suited to their unique characteristics and needs.

Include Clinicians Throughout The Design Process
Most risk stratification algorithms are licensed and installed with little feedback and even less design input from the clinical team they are intended to support. As a result, interventions may not adequately account for limitations in the clinical team’s capacity or workflows, and they may fail to achieve optimal outcomes. To maximize the potential for algorithms to advance positive results, models should be designed with a collaborative approach in which clinicians lead the discussion about intended use. In the state behavioral health intervention described above, the decisions to model by age and focus on inpatient psychiatric admissions were the result of a design process that included clinicians from the start.

Evaluate Performance With Your Own Population
Clinicians should not be asked to “trust” the results of models that were not evaluated within their own population. Importantly, a local evaluation means that the results of each model can be checked for inadvertent bias by analyzing the distributions of various subpopulations by age, sex, race, and disease.

Use Appropriate Measures
There is not a single “best statistic” for all stratification applications. Understanding which is the right tool for the job is critical for teams planning and evaluating their efforts. Unfortunately, clinical research has a tradition of measuring model performance with diagnostic accuracy measures that indicate how good a model is at predicting which people do not need help (negative predictive value). The commonly used area-under-receiver-operator characteristic (AU-ROC or c-stat), which relies on specificity, measures how well an algorithm predicts true negatives. Both risk stratification vendors and researchers benefit from this type of accounting, which favors correctly identifying the hundreds of thousands of people who are not the most in need versus their ability to identify the hundreds who are. However, these measures offer little insight to teams hoping to allocate limited resources to those most in need.

The metric that matters for effective care management is how good the algorithm is at prioritizing people who do need help (true positives), or the positive predictive value (PPV) of the algorithm. Even more relevant is the PPV for the number of people the team can possibly reach within a given period of time. In other words, measuring the PPV of an algorithm applied to all 100,000 people in a population is less relevant than the PPV of the first 100 predictions per week if that’s the volume and frequency of outreach the care management program can achieve.

Once Models Are Deployed, Conduct Ongoing Monitoring Of Performance And Output
Most risk stratification models are static, yet they are deployed in evolving and complex environments. The introduction of new data sources, changes in reimbursement contracts and policies, and the redesign of care management programs are not uncommon. Without a system of monitoring and periodic assessment to determine whether the model is meeting the clinical teams’ needs, clinical end users may not notice that models are producing irrelevant or inaccurate results.

Measure What Happens Next
The best predictions are merely suggestions. To have impact, a care management program must lead to a series of cascading activities, from outreach to enrollment to intervention. Today, surprisingly few care management teams measure the activities or the outcomes of their programs. Those that do often rely on annual assessments and biased pre- versus post-evaluations.

Moving forward, organizations that use stratification algorithms should do so as part of a system of ongoing measurement and improvement. Clinical teams should participate in the design of what’s measured to be sure that metrics are useful for advancing program goals. While an institution’s leadership may believe it is important to measure admission rates on an annual basis, care management is more likely to benefit from monitoring key metrics on a monthly basis, such as how many people identified as “at risk” received outreach from care managers, the number and method of outreach attempts, and enrollment rates. Measures of improvement should be compared against a control group with similar characteristics. Such information can be used to make incremental improvements that can help reduce admission rates over time.

Obermeyer and team have done health care an important service. By diagnosing a major shortcoming of the current approach to prioritizing patients for care management, this research should help prompt organizations to think more carefully about the use of algorithms. In doing so, it is important to recognize racial bias as one of several unintended consequences—along with past-consumption bias, condition bias, and age bias.

We now have a unique opportunity to modernize care management. It is time to replace the traditional, one-size-fits-all approach with models that are customized to local populations, informed by clinician expertise, and designed to prioritize those most in need. Deployment of these models should not be viewed as a one-time endeavor but rather as an evolving process aligned with a system of continuous quality improvement.

Author’s Note
The author is the founder and CEO of Cyft, a company that focuses on exactly this issue. He is also an adviser to other companies (Datalogue, Firefly Health) and philanthropies (the Helmsley Charitable Trust Foundation) that are responsible for using data to get the right care to the right people at the right time.

[Praxis]

I just wanted to jump in with a personal anecdote.

I dont experience racism, at least not in America( I did in Japan), but my wife does. She is Indonesian.

I dont think that most people realize this is an issue because it is never pointed at them.

One could easily think it is not an issue because the water signs no longer say "Whites only".

I got a text from her telling me that she went out to lunch at a Korean BBQ place while she is in LA.

She is first in line to be served, but is served last by the waiter(Koreans).

This is in California. How do you imagine this goes in other parts of the country?

She told me one time "The way I get treated with I am with you is different than when I am alone"

This boils my blood.

I do not have much to add here sorry.

I would hope that other people on here who experience racism, big and small, please add your anecdotes to start to show the people on this forum what kinds of things they dont have to deal with.

p.s.

We went shoe shopping as a family this Christmas. Went to a shoe store we have been to tons of times. We walk in and I head to the mens area and start looking. Am approached at least two of three times by sales people. Find shoes. Buy leave the store to take niece and nephews to park while shopping continues.

In talking to my wife about her experience, she was not approached once by sales person. My mother had to go get someone to help her.

[James Newell]

One of the most racist countries I have ever been in was in S. Korea I think around 1971, the kids happily or was it anger, threw rocks at me as a was riding a bicycle and called me White monkey. I later found out the Koreans think they were evolved from bears and the rest of the world was evolved from monkeys. Luckily for me they didn't know how to throw rocks very well.

I actually observed a lot of racist asian barbs especially to White women. All over asia when I was stationed there, eg, Thailand, korea, Japan.

It appears S Africa has it much worse now especially since the commie gov has got into power. Of course one can justify it all away with retributions needed against the whites, for their many years in power.

https://concit.org/media-silence-on-...rican-farmers/

[Hym]

Race ism. Race schism. There must be many anecdotal views written on this thread, so I will add a small amount of mine. However, on this date being a reminder of Martin Luther King Jr.'s Birth, actually Jan. 15, I remember deeper truths.

I remember the highest likelihood of agency hit squads, one of which did the shooting itself. I remember the King family, knowing full well the truth, searching for the truth in court of an agency of the u.s. gov't's guilt in the assassination and not any guilt of james earl ray, after they had lengthly conversations with him.

I would ask any black man why he would work for an agency that has never been held culpable for the death of Martin, providing the weapons that were used in Malcolm's murder, for inserting provocateurs as operatives in any empowerment movement, all done primarily for opposition to the profiteering war in Vietnam, the one step over the line in the most personal of self-sacrifices against evil. In this all I see no disconnect from economic and racial equality.

I find it hard to listen to the many obfuscations of the truths this great man shared with us, even while understanding the mechanisms of manipulation within academia, the media and the profiteers. I remember the turn to truths, from those that live far beyond hate, that Malcolm shared when he realized the common values we all share. Medgar Evers and millions of those as worthy as any other that ever lived who were victimized by the hatred, the greed and the fear. At the same time I hold no white guilt for the sins of other souls, as I know the temporary time limit of this human skin and the illusion of any value it does and does not have. I'll be working in the fields while others waste time blaming.

I also remember the abject stupidity of racism within those with their culturally embedded predispositions to self-destruction, given life through those same hate and fear based habituations. They are just too dumb to not know the great value and soulful nourishment that diversity creates.

I also rail at the ignorance of those who simply do not allow all to be as human as each other, just as good, just as f***ed up, just as normal, just as pre-occupied, just as brilliant, just as prejudiced, just as self-destructive, as capable and as culpable as any.

And, unless you have stepped up and in for others who are not of the majority wherever you live, when these challenges have threatened your income, your financial security, your personal freedom and your physical health...you do not know what it takes to be here and be of any worth. Your discussions about equality hold no merit with me. For me it has often been a matter of the rights of opportunity given as the duty of anyone in any government. It has almost always been the direct reality of economic equality not being given and even searched for when it is not present.

Being a member of the film world I am aware of how challenging it is at times to just be me and try to get work. The reality is that until the b.s. of discrimination, in it's many guises, is at hand I'm just enjoying the work and the company I keep. You'd never know who I was beyond my work unless the toilet stopped working.

Being different is not a skill set we put on our resumes. If it wasn't for having a depth of respect from others for my work ethic and my skills I would have had no work at all.

I say this as it is very odd being a person of no color at all, so say the blind, bringing up the fact that not one hispanic has ever held the highest position of those in construction, as a major coordinator, in the state with the highest percentage of hispanics in the country.

I even suggested to a good friend that the next time I am hired on in this position, one I've held before, that after I hire him as a general foreman I'd switch positions with him, making him the first hispanic high end coordinator. The only problem with that is he refused the offer since he loves to work as much as I do and, as he noted, I'm the one with the gift and love of this communication and the intense juggling the job requires.

Struggling to get work in that same position I suggested to another film union friend that I state in my resume that I look for work on film projects that have a moral base, an inspiring storyline and an insight into the human condition. My friend said I might as well ask not to be hired and he reminded me that our work does not function on morality and that, especially in this 3rd world state, it has a long way to go until it treats it's workers well, without having to be litigated into some semblance of human decency, even as it has now turned anew to a focus on adhering to federal labor laws and ASA contract guidelines.

With new leadership in a key role, that is balls to the wall about enforcing equality and focussed on harassment prevention, at least it is on the map now. Despite the newness, the old white guard, that, thru blackballing as it's defense to being exposed on it's endless pay to play criminality, had deliberately forced many to move onto new careers, or move to another state. That crap has had a long lasting negative effect on those keys, leads, scenics, and foremen all now in upper hiring positions.

In this case and in this state equality cannot be legislated or ruled into being, especially where the union is not a hiring hall, thus making seniority, skill, compatibility and ethics only the personal choice of those doing the hiring. It is not merit based though the union always claims that to be it's moral charter on a national scale. Again, attacking racism seems to be central to gaining equality on many levels. But Hey....tilting at windmills and giving an energetic series of F**ks doesn't work when you're alone. It has never given me work.

Of course I would expect my skills to be the only determining criteria, just as it would be rare for a production to know that I demand equality along with safety, on time progress and pro-active dispute resolution and then use that as a determinate factor in choosing me. I still just want to work. I move on.

By the way, and central to the racism between whomever here, the racist views of the new mexican hispanics against Mexican immigrants is in stark contrast to the less overt racism of the Californian mexican-americans against Mexican immigrants living in that state. It seems to aggravate me much more than the hard working Mexican immigrants here. The Spanish "citizens" here, sometimes from centuries old lineage, are shocked when i bring it up to them, but they don't deny it. Idiots.

Not for me. I may have to move to another state, or another country, or create work in another field for my future. We'll see. In my life I really don't have time for the prejudiced. I live in the color and the challenge of the personalities I work with.

Listening to my son and his stays in south america I see a stark contrast in the lives of those who are discriminated against, yet live in "democracies". It is always those who, like Lula, raise the common economic lives of the poor who are attacked. It is no coincidence that those being uplifted, who most often only want the opportunity to work for a humane wage, and not to gain some welfare, are of color not shared by those in control. It may be that overt racism can be dealt with much easier than living in any place where lip service pretends to equally provide opportunity. It is never a difficult thing to see, even as the lives of many are complex.

[Mark]

Posted by Praxis (here)
I do not have much to add here sorry.

I would hope that other people on here who experience racism, big and small, please add your anecdotes to start to show the people on this forum what kinds of things they dont have to deal with.

You have added MUCH value. Thank you so much.

These are the kind of anecdotes that make it real for folks. I also have had to go find folks to wait on me at stores, have received my food after a number of other folks of different persuasions have come into the restaurant and ordered, am passed over to be helped in different contexts. Because these kinds of experiences are so common, it makes folks subject to them hyper-sensitive and we watch carefully. It is a form of paranoia that isn't good for you, and I'm speaking from personal experience here. It is sometimes hard to see the best in folks when you have to experience these kinds of things as a common occurrence. And, sometimes, you make an accusation about a perceived action or lack thereof in these situations that the person accused does not even realize they've done or not done. And so, they take offense and you're off to the races.

It is so tiring. And stressful.

I think you made a good point about people of the majority population in the USA and Europe not really being familiar with these types of experiences because they are not subjected to them. All of the examples you mention are familiar to me, for instance and yes, it happens to all minority groups, perhaps in all countries where there are minority groups. I cannot speak to the reality of that because I cannot know it, but I do admit that it is a possibility.

¤=[Post Update]=¤

Posted by James Newell (here)
One of the most racist countries I have ever been in was in S. Korea I think around 1971, the kids happily or was it anger, threw rocks at me as a was riding a bicycle and called me White monkey.

How did that experience make you feel at the time? How old were you and is it a formative memory for you, if I may ask?

Posted by James Newell (here)
I actually observed a lot of racist asian barbs especially to White women. All over asia when I was stationed there, eg, Thailand, korea, Japan.

What do you mean when you say a lot and what do you mean when you say "barbs"?

Posted by James Newell (here)
It appears S Africa has it much worse now especially since the commie gov has got into power. Of course one can justify it all away with retributions needed against the whites, for their many years in power.

I agree, it is not possible to justify retribution as anything other than what it is. Revenge. How do you justify oppression in the first place? And is it your belief that the white farmers are being oppressed in South Africa?

[James Newell]

Posted by Praxis (here)
I do not have much to add here sorry.

I would hope that other people on here who experience racism, big and small, please add your anecdotes to start to show the people on this forum what kinds of things they don't have to deal with.

I can totally agree with the above comment. While we all have probably experienced some kind of racist slur or incident of some kind in a lifetime. I don't see it as very important.
Martin Luther Kings statement of " Judge a person by his character and not by his skin color" is probably one of the best summations of living with your fellow man.

I might add to that, don't judge a person by his politics or religious beliefs either.

I think we have to be aware as Mankind as a group that there are some people or groups that love to create differences to sow discord. How many wars and death have been caused by mocked up "differences"? Divide and conquer is a time tested technique of conquering a group, nation and even a planet.

My prior post re S. Korea and Asia was probably to open up an Asian side to all this. Not to incite. The Asians back then were having new worlds opened up, and my comments were simply observations. It was an interesting feeling to be the only blond guy walking among the masses there, I kinda liked being a minority. The white women would get far more stares than me.