Paging Drs. Gupta, Shah, Sharma and Rao

When ER first came on TV, I remember thinking it looked completely unrealistic because it was too damned white. Now I finally have some numbers to back up my instincts:

Plenty more like her

From 1980 to 2004, the fraction of medical school graduates describing themselves as white fell from 85 percent to 64 percent. Over that same period, the percentage of Asians increased from 3 percent to 20 percent, with Indians and Chinese the two biggest ethnic groups. [Link]

S. Balasubramaniam … recently queried 50 medical schools and calculated that 12 percent of the class that entered in 2006 is of Indian heritage. The highest percentages are in California, Texas, New York, New Jersey and New England. [Link]

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p>While the article doesn’t indicate anything about Balasubramaniam’s sampling methodology, the numbers are consistent with my gut feelings about the number of brown faces I’ve seen amongst med students. When asked to explain why she went into medicine, one desi doctor said:

“We were never forced into medicine … But in the Indian community in Chicago, everyone was a professional. Everyone was a doctor or an engineer…” [Link]

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p>Although there have always been many desi doctors, the numbers of current brown medical students represent a sizeable increase over past years since roughly 5% of all doctors are of Indian origin, and many of them studied abroad:

In the US, Indians and Indian-Americans make up the largest non-Caucasian segment of the American medical community, where they account for one in every 20 practicing doctors. [Link]

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p>My thoughts at this point go off in two different directions. The first is about the clannishness of desi doctors. How many times have you heard a doctor say that nobody can understand what they go through unless they’re a doctor themselves? It’s as if they think that being a doctor is distinct from other professions, on a plane of its own, completely inaccessible to people who do other things for a living. They also love to boast about the hours they work, even though (post-residency) my doctor friends work both shorter and more predictable hours than friends who are lawyers, iBankers or programmers.

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p>I don’t understand why they feel this way though – I’ve never heard anything similar from engineers. Is it the combination of the long training and the high salaries? What’s at the root of this medical exceptionalism?

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My other thought has to do with how little the multicultural nature of the medical profession is reflected on TV. ER finally has a one desi doctor. To the best of my knowledge, none of the other medical shows do (although I don’t watch much TV so please correct me if I’m wrong).

This is part of a larger problem, namely that the America you see on the small screen is significantly whiter than reality. An analysis of the 2001 Fall Season found that:

White characters received 81 percent of screen time, while non-Hispanic whites make up about 70 percent of the population. [Link]

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p>An article I once read made the case that this was driven by audiences and advertisers, namely that white Americans felt most comfortable with shows that skewed whiter than what than realistic demographics, and therefore advertisers were willing to pay more to reach them. The article below makes a similar argument, but puts the blame more squarely on advertisers:

The FCC has collected plenty of … evidence, illustrating a range of racist assumptions about non-white customers openly cited by advertisers as reasons to pay less for ads in ethnic markets, or not to buy them at all. There’s the buyer for Ivory soap who refused to purchase time on a Latino-formatted station because “Hispanics don’t bathe as frequently as non-Hispanics.” (FCC study, “When Being No. 1 Is Not Enough: The Impact of Advertising Practices on Minority-Formatted Broadcast Stations,” 1/99) Companies have cited worries that “our pilferage will increase,” if they advertise on minority stations, or said simply, “Your station will bring too many black people to my place of business.” If that’s not racism, what is?… [Link]

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p>This is part of how we end up with TV shows like Friends that are set in New York City but which show a city which is whiter than Boise, Idaho. To me, that’s just bad television and I refuse to watch it.

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p>I do realize that because of stereotypes about Asians we’re likely to see Asian representation on TV increase soon, but I want more than just parity for yellows and brownz. And yes, I do also realize that TV shows are fantasy not reality, but that’s precisely what bothers me. If the absence of minority characters represents the fantasy world of white viewers, then what does that tell us about them?

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372 thoughts on “Paging Drs. Gupta, Shah, Sharma and Rao

  1. There’s a statistical defense to the over-representation of white actors and actresses.

    Firstly, at time of conception, the cast of one show is independent of the cast of another show.

    Secondly, the regular cast of one show is a small integer – the consequence of this is that with 5 regular cast members, even if attempts were made to approximate the national demographic, representation below 20% of the nation translates into below 1 person of the 5-member cast, which truncates to 0 (floor, since ceil and round may require a 6th member). By itself, this rounding is innocuous, but since, as previously stated, shows are independently casted, then each show is rounding 0.999 to 0 even when, in aggregate, those 0.999 persons add up to many, many integer persons.

    Thirdly, the distribution of ethnicities and race at the time the shows are deployed may be at parity with national figures, removing culpability from studios, and it may instead be that viewership is correlated with racially homogeneous cast, and through the business prudence of deleting lowly rated shows, television loses parity with national demographics when we focus on shows that survived past their premier or underwent intensive viewership studies to decide upon whether it even merits a premier.

    The above defense only mitigates, but does not necessarily eliminate, statistically significant bias in casting. Any research into the severity of the bias needs to normalize for the above three business practices by (i) not aggregating statistics across shows since they are independently casted, (ii) rounding to the nearest whole persons, and (iii) separating the statistics for concept shows that may or may never have passed viewership studies from statistics for shows that clearly have high viewership.

    For example, Indians constitute less than 5% under most distributions (save for employees of Silicon Valley software companies), so it’s not unusual to see absolutely no Indian faces across 30 different shows with 5 cast members each. One show with 20 cast members, such as ER, would have an Indian because 5% of 20 is one integer person, and indeed we see one on ER.

    Solutions?

    If it turns out that no intentional bias exists but bias is instead an artifact of rounding, then rounding needs to be tackled. It’s not practical to have shows coordinate with each other so that they, in aggregate, model the national demographic. Instead, I prefer how empirical sciences solves this problem. Empirical science had a huge problem with rounding 0.5 because, traditionally, 0.5 rounds up to 1. Likewise, 1.5 rounds up to 2, and so forth. Because empirical sciences are based on sigfigs, rounding to the correct sigfigs is essential, and this led to the problem that values had a 1/10 chance of being unaltered (ending with 0), 4/10 chance of being rounded down (ending with 1,2,3,4), and a 5/10 chance of being rounded up (ending with 5,6,7,8,9). This led to a net inflation in values. The solution was to round 0.5 based on something that is likely to be uncorrelated with it and have no bias – that is, round 0.5 based on whether the preceding figure was even or odd since there are 5 evens (0,2,4,6,8) and 5 odds (1,3,5,7,9) base-10, letting us round 0.5 up 50% of the time and round 0.5 down 50% of the time. A change in rounding practice for depicting America would help. The uncorrelated random variable that could facilitate unbiased rounding might be an SHA1 hash of the characters’ names. Whenever a decision between 0.2 non-white and 0.8 white persons needs to be rounded into 1 integer person, the SHA1 hash mod 10 can be tested to see if it is (0,1) = non-white or (2,3,4,5,6,7,8,9) = white. This would result in unbiased rounding.

    If it turns out that bias beyond integer-artifacts exists, then it needs to be seen whether it’s due to the studios (sample all concept shows), or due to viewership (sample surviving shows). If studios are culpable, then some sort of federally regulated measure or court mandated punitive judgment may result. If the viewership is culpable (not to the exclusion of the studios’ culpability), then no real action can be taken short of affirmative action since networks will otherwise claim the right to maximize profits.

    My 2.4999 cents.

  2. The uncorrelated random variable that could facilitate unbiased rounding might be an SHA1 hash of the characters’ names.

    I can just imagine this conversation. “You see, Brad, we couldn’t cast Ricky because the bit sequence was 0001110011110.”

  3. Great post!

    The extra-white ‘reality’ that is portrayed in movies/sitcoms/comedies is what makes most of us back in the Des think that this is what America is about… imagine our surprise when we DBDs land here and see tons of Desis, Hispanics, Chinese, and so on… it’s a bitter sweet experience really. Bitter – because you realize that a stereotype(negative most of the times) of your race has already been made by people who got here before you and it will take you time to fight it. Sweet – because diversity is always good.

    For whatever this comment is worth, I’d just like to say that I’m really happy that there seems to be a rising trend of ‘at least one desi per show’ happening – Kelly Kapoor in the Office, Suresh from Heroes, and so on… I know it is not much representation, but we are definitely getting there. I’m also happy that most of these characters aren’t your stereotypical desis with bad accents, etc ( except Sayeed from LOST, but he’s playing an Iraqi there ) . Kelly in the Office is as American as everyone else .. and Dr.Suresh from Heroes has a very respectable role as well.

    Compare this to roles Hispanics are getting – they are portrayed in most movies/sitcoms as maids ( Crash, Babel ). The Chinese and Indian representation in movie roles seems to be getting pretty good these days … and that in my opinion is something to be happy about.

  4. i also get a kick out of the fact that kelly kapoor knows very little about her culture, and that the show implies that this is not such a great thing – e.g. the diwali episode.

  5. ha ha , its funny that Dwight Shrute knows the whole mythology behind Diwali and is eager to explain it when Michael cuts him short :) . The Office = best comedy ever !

    I like the fact that they don’t particularly make Kelly stick out because of her ethnicity… she fits in flawlessly, and now if you were to describe her you’d probably say ‘that talkative, celebrity-gossip hungry lady on the Office’, rather than ‘the Indian’…

    Even in the ‘Beer Fest’ movie, the desi guy has got such an AWESOME role ! :D

  6. I think this is why I’ve felt of all the medical shows to be pumped out to TV, Nip/Tuck was probably the realistic, despite plot-holes, blatantly bad writing, silly serial killers, sillier clients, Rosie O’Donnell, etc. Because the others were dancing around the notion of South Asian doctors in a hospital setting like it was some kind of taboo, when they were just too lazy to do the casting. If you’re going to be soapy and over-the-top and unrealistic, at least don’t insult your audience.

  7. The desi guy in Beerfest wrote and directed the movie, as well as Club Dredd and Super Troopers. That’s why his role is so good. His name is Jay Chandrasekhar

    I am surprised no one has mentioned Sir Ben Kingsley or M. Night Shyamalan, both Indians who have managed to have a consistent presence. As for the Indian doctor thing, I can’t believe that anyone thinks that is a negative. Do I detect a few people that failed orgo?

    In all seriousness, Physicians provide a valuable service to the country. You can’t even begin to compare their contribution to a lawyer or I banker. They save lives, people, and sacrifice most of their youth in order to do so. They deserve every cent.

  8. Also I haven’t read all the comments, but I know Sanjay Gupta personally from the time he spent in our town as a practicing Neurosurgeon, and you’d be hardpressed to find a more genuine, likeable or talented person than himself. He’s a neurosurgeon, brilliant and was writing for the WSJ while still in med school. Rather than taking pot shots, he should be held up as the role model he is; it was a conversation I had with him that first opened me to the possibility of being a writer, something he encouraged even as he admitted he wished he had pursued his own writing further. Luckily for him, he was hired by CNN less than a year after.

  9. But since it is the professional, upper class Indians you guys are disparaging, I am responding on their behalf, of which I am a part.

    here come the cavalry!

  10. Gautam,

    Good post.

    I would appreciate it if you could provide any tips or direct me to a blog that’s useful for budding/aspiring writers. I prefer “real world” advice – there’s plenty of stuff out there giving false hopes and promises.

    M. Nam

  11. You can’t even begin to compare their contribution to a lawyer, engineer or I banker

    Ok, this is where I part ways with the “doctors do a wonderful service to the community” crowd. I have no disagreement with the idea that doctors provide a valuable and even noble service. But why discount the equally valuable services provided by lawyers and engineers? For what it’s worth, lawyers do save lives, and not just if for the criminal defendant. Toxic/mass tort suit saves lives, at least indirectly. The drug-eluting stent a surgeon puts in to a patient was probably developed and designed by an engineer.

    So while I agree that a physician’s services shouldn’t be discounted, I don’t particularly think their services should be put so far above the services provided by other professionals who work just as hard.

  12. In all seriousness, Physicians provide a valuable service to the country. You can’t even begin to compare their contribution to a lawyer, engineer or I banker. They save lives, people, and sacrifice most of their youth in order to do so. They deserve every cent.

    And these desi’s choose the medical profession for these very noble reasons you speak of, right? If anything I think the medical profession has actually declined, though not necessarily the doctors fault, but the HMOs and pharma companies companies have simply made it impossible to treat people on an individual basis. Each doctor, it seems follows some rote “if then” logic like “if between 25 and 30 then prescribe antibiotic oxygloburlin” I’m sure Michael Moore’s SICKo will shed more light on this.

    By the way. Without engineers to develop TCP/IP, you and I wouldn’t be having this discussion right now.

  13. In all seriousness, Physicians provide a valuable service to the country. You can’t even begin to compare their contribution to a lawyer, engineer or I banker. They save lives, people, and sacrifice most of their youth in order to do so. They deserve every cent.
    And these desi’s choose the medical profession for these very noble reasons you speak of, right?

    I think the above is an important point.

    To me, my “family” doctors (a couple who lived at the end of the street) back home in India, who still treat patients asking them to pay “as much as they can afford” are noble. They have this weird religious thing (starts with Tirupathi and I never really got the rest of the story) which makes them do that. But I really like that couple, I will call them noble. They are not alone, there are many like them—but none of them call themselves “noble”.

    I also like doctors who see patients as puzzles to be solved—they like the job if not the people. I understand that and I always appreciate people who like what they do. They are the ones I trust the most. For their ego (not exactly ego, but those of you who are in jobs not because it pays the bills will get it), they will try their best.

    The ones I can’t stand are the ones who think themselves noble—more often than not they are mediocre and mercenaries trying to convince themselves otherwise. Usually plastic surgeons as well. The truly noble, or the ones who like what they do and are good at it don’t speak of nobility.

  14. Folks, every little job (and sperm) is precious. I-bankers need to make a lot of money so they can afford good doctors. And if you didn’t have engineers to build ambulances, what would lawyers chase?

  15. Ok, this is where I part ways with the “doctors do a wonderful service to the community” crowd. I have no disagreement with the idea that doctors provide a valuable and even noble service. But why discount the equally valuable services provided by lawyers and engineers? For what it’s worth, lawyers do save lives, and not just if for the criminal defendant. Toxic/mass tort suit saves lives, at least indirectly. The drug-eluting stent a surgeon puts in to a patient was probably developed and designed by an engineer.

    Just for the record, I agree with Hema. But it was so nice to finally read something good about doctors on this site I disregarded that part.

  16. moornam, i don’t know about writing blogging fora in general, but there are a few publications that are open to submissions from fledgling writers. i have a friend who submitted quite a good amount of articles on slate, aurora review, switchback, and somalit, as well as to local newspapers. for a desi journal, desilit also accepts submissions.

  17. My implication was that Doctors deserved their compensation,

    See, i’m all on board with you here

    in a way that perhaps corporate lawyers and I bankers do not.

    This is where you lose me …

  18. I haven’t read the entire comment thread, but I would like to comment on the clannish nature that seems to dominate the medical profession. Specifically, I would like to expand on the comparison between docs and academics. I’ve had the chance to experience the training for both…..a PhD + postdoc and then I went to medical school. The training for a prof these days can be longer than the training for a post residency doc, but there is a difference in the character of that training. When I was in grad school and in my post doc, I was all on my own. I had my projects and I did my best to get some hot results and become famous in my chosen field (with some success). In the medical community, there is a common goal (to some extent)…..let’s get this guy better, or at least off my service. More important than that is the way the people involved are organized. There is a very strong motivation to look out for the people on your team….as a med student I did my best to cover as many asses as I could (first priority given to other med students). What I mean by covering asses is catching mistakes, backing up the people I cared about (first patitnts, second med students). This team environment is one of the aspects of medicine that I love…and prolly leads to the clannish (or TEAM!!!!!!!) nature of docs.

    My 2 cents

  19. I was not arguing that his statistics were not correct, but that they had been subtly manipulated to provide more “shock value.” My full quote reads: Just because he thinks women are more empowered or that people are better fed/nourished in sub-Saharan Africa doesn’t make it fact. I think his analyses are interesting and generally spot on, but sometimes I think he overgeneralizes to get in a little “shock factor.” [emphasis mine]>

    How does the rest of your quote change the fact that you were questioning his statement that “people are better fed/nourished in sub-Saharan Africa” which he based on reliable figures that he quoted?

    And how the heck does your personal experience in Africa change the data that shows that there is significantly more hunger and malnourishment in India? Thats the usual desi irrational reasoning in which anecdotes trump statistics. There are parts of India that do better than others: the northeastern states and Kerala have significantly lower malnutrition rates than Gujarat and Maharashtra for example. The generalized point remains: India as a whole does worse than subsaharan Africa in feeding its children.

    I must have completely imagined the sociopolitical hierarchy of the regions I worked in as well. Oh, silly me — because Amartya Sen has said it is worse in India, it must not be bad anywhere else. The last sentence was sarcasm, by the way. Would hate to have someone think I was “implying” anything different from that.

    You cant seem to think rationally. Sen does not say that things arent bad in Africa or denies that it has occasional cases of famines etc in some regions. But when it comes to endemic hunger India’s record is far worse. Even within the subcontinent only Bangladesh compares to India’s abysmal record. Yet you keep callously insisting that the poor in India arent any worse off than the poor in China!

    Also, with respect to Chicago, there is little to no empirical evidence (government-wise) of how many desis were employed in “non professional” fields in 1970 because they weren’t tracked. I checked.

    That does not stop you from claiming that every desi in Chicago was a doctor or engineer. You have no evidence for claiming that.

  20. Prema, what’s your deal? Did your desi husband leave you for a white chick or something? Why do you hate your own race so much?