Racial Inequalities in the Use of Procedures for Ischemic Heart Disease

To the Editor. —  We commend the study by Drs Wenneker and Epstein¹ entitled "Racial Inequalities in the Use of Procedures for Patients With Ischemic Heart Disease in Massachusetts" in the January 13 issue of JAMA.However, both the authors and the subsequent media coverage obscured the most important point: the most likely reason for these inequalities is that physicians value black lives less than white lives.We are physician-researchers. We recognize that in scientific studies, the cause of a finding is rarely established beyond a shadow of a doubt. We also recognize the need to consider alternative hypotheses, usually in decreasing order of likelihood, that would explain the observed effect.The authors stress the hypothesis that black patients are less likely to accept surgery and other technological interventions when offered. They refer to this as a "cultural difference."This comes dangerously close to blaming the victim. The cultural