I lived for two years in Mississippi, at the height of the 1960s civil rights struggle there, and in the deepest part of the Deep South - the Delta.
But I never met a bigot there.I talked with Klansmen, but none of them hated blacks, Catholics or Jews. They were merely trying to keep the natural order of humankind as they felt the Bible prescribed it.
It was the most profound learning experience of my life: Discrimination rarely goes to work without its mask.
I'm continually running into people who proclaim in hurt tones, "I'm not a racist," or "I'm no chauvinist," or "How dare they call me homophobic."
They honestly believe it, because they have no conscious feelings of hate. On the contrary, they're likely to put women on a pedestal; they profess to see and admire an innate athletic ability in black people; they have a gay friend but wish he wouldn't hurt himself by declaring his orientation.
I believe there's a Rule of Reverse Correlation here: The louder and more frequently people declare their freedom from bias, the more they're likely to be its captive.
The fact is that none of us is free of bias. And the people who seem to be most aware of the injustices in our society, and who are doing the most about them, are the ones who have been honest with themselves - recognizing and continually trying to root out their own prejudices.
Medicine is only one of many institutions where bias is subtle but deadly. But it provides good examples:
- Racism: Researchers found that blacks make up 33 percent of the patients with fatal kidney disease - but get only 21 percent of the kidney transplants.
The largest group of kidney recipients is white men from 25 to 44 years old.
Research on people already diagnosed with heart disease found in 1989 that blacks had 75 percent more heart attacks but were 50 percent less likely to have coronary angiography and 33 percent less likely to have coronary-bypass surgery.
- Sexism: The congressional General Accounting Office found that the Nation-al Institutes of Health, which funds 90 percent of health research, was making grants to projects that excluded women - in violation of its own regulations.
The assumption was that women's hormones would skew the results of research on heart disease, diabetes, cancer and every other ailment that came along.
- Ageism: A study released in January showed that older people are more likely to get more medicine than is safe for them but don't get screened for various conditions as often as they should.
- Ethnic bias: Researchers in Britain applied for residencies in response to ads placed by 23 hospitals. The biographical information was identical except for one thing: on half the applications, English names were used, and on the other half, Asian names.
The English names made the short list in many more hospitals.
Prejudice? Of course not!
Fraud, the hospitals said, and had the researchers arrested.