This is the second entry in a two-part op-ed series on institutional racism in American medicine.
A little over a year before the coronavirus pandemic reached our shores, the racism problem in U.S. health care was making big headlines.
But it wasn't doctors or nurses being accused of bias. Rather, a study published in Science concluded that a predictive health care algorithm had, itself, discriminated against Black patients.
The story originated with Optum, a subsidiary of insurance giant UnitedHealth Group, which had designed an application to identify high-risk patients with untreated chronic diseases. The company's ultimate goal was to help re-distribute medical resources to those who'd benefit most from added care. And to figure out who was most in need, Optum's algorithm assessed the cost of each patient's past treatments.
Unaccounted for in the algorithm's design was this essential fact: The average Black patient receives $1,800 less per year in total medical care than a white person with the same set of health problems. And, sure enough, when the researchers went back and re-ranked patients by their illnesses (rather than the cost of their care), the percentage of Black patients who should have been enrolled in specialized care programs jumped from 18 percent to 47 percent.
Journalists and commentators pinned the blame for racial bias on Optum's algorithm. In reality, technology wasn't the problem. At issue were the doctors who failed to provide sufficient medical care to the Black patients in the first place. Meaning, the data was faulty because humans failed to provide equitable care.
Artificial intelligence and algorithmic approaches can only be as accurate, reliable and helpful as the data they're given. If the human inputs are unreliable, the data will be, as well.
Let's use the identification of breast cancer as an example. As much as one-third of the time, two radiologists looking at the same mammogram will disagree on the diagnosis. Therefore, if AI software were programmed to act like humans, the technology would be wrong one-third of the time.
Instead, AI can store and compare tens of thousands of mammogram images — comparing examples of women with cancer and without — to detect hundreds of subtle differences that humans often overlook. It can remember all those tiny differences when reviewing new mammograms, which is why AI is already estimated to be 10 percent more accurate than the average radiologist.
What AI can't recognize is whether it's being fed biased or incorrect information. Adjusting for bias in research and data aggregation requires that humans acknowledge their faulty assumptions and decisions, and then modify the inputs accordingly.
Correcting these types of errors should be standard practice by now. After all, any research project that seeks funding and publication is required to include an analysis of potential bias, based on the study's participants. As an example, investigators who want to compare people's health in two cities would be required to modify the study's design if they failed to account for major differences in age, education or other factors that might inappropriately tilt the results.
Given how often data is flawed, the possibility of racial bias should be explicitly factored into every AI project. With universities and funding agencies increasingly focused on racial issues in medicine, this expectation has the potential to become routine in the future. Once it is, AI will force researchers to confront bias in health care. As a result, the conclusions and recommendations they provide will be more accurate and equitable.
Thirteen months into the pandemic, Covid-19 continues to kill Black individuals at a rate three times higher than white people. For years, health plans and hospital leaders have talked about the need to address health disparities like these. And yet, despite good intentions, the solutions they put forth always look a lot like the failed efforts of the past.
Addressing systemic racism in medicine requires that we analyze far more data (all at once) than we do today. AI is the perfect application for this task. What we need is a national commitment to use these types of technologies to answer medicine's most urgent questions.
There is no antidote to the problem of racism in medicine. But combining AI with a national commitment to root out bias in health care would be a good start, putting our medical system on a path toward antiracism.
Ben Droz
Ben Droz
U.S. President Donald Trump speaks during a campaign rally at Pinnacle Bank Expo Center on the Nebraska State Fairgrounds on October 05, 2026 in Grand Island, Nebraska.
The President Invited Iran to Bomb My Home
I was driving home to San Diego from Los Angeles on Monday night when I heard that the President of the United States had offered both cities up to Iran as bomb targets. At a rally in Nebraska, defending his war, Trump told the crowd, “let [Iran] take out Los Angeles, let ‘em take out San Diego.” It was, he said, “a very small price to pay.”
I was coming from a Bernie Sanders rally for Proposition 40, the one-time tax on California billionaires that would send 90% of its revenue to healthcare. We desperately need it to pass because, in order to give tax breaks to billionaires, Trump signed a law that will strip health coverage from 10 million Americans; this tax will make sure we can still cover Californians. Call me crazy, but I think taxing billionaires one time so we can make sure kids in California get to see a doctor is a very small price to pay. I also think that even if Trump were joking, it is indefensible to make jokes about the potential destruction of so many lives. Human life is never a small price to pay. Human life is priceless.
Plus, the reality is: here in San Diego, we’re already paying the price for Trump’s actions, and it’s not small at all. He has gutted FEMA, tried to kill climate resiliency programs, and destroyed public health standards, while his signature law is set to cut off health insurance and food support for hundreds of thousands of San Diegans. Like plenty of American cities, San Diego is already busy finding local solutions to respond to the problems this president has recklessly created.
Not to mention, at least 19 American service members have been killed in this war already. Human rights monitors have documented more than 3,600 dead in Iran by April alone. Here at home, gas is sitting just pennies below its all-time record. Taxpayers have already spent more than $45 billion on the war, while Trump’s oil and gas portfolio has grown by roughly $15.5 million this year alone. Of course anything is a “small price” to someone paying free.99 for this war, and profiting from it. Meanwhile, We the People are paying twice: first for the war, and then for the consequences of that war. But now he wants San Diego to pay a third time, flippantly offering us up to Iran.
It is worth noticing which cities he thought to name. Were San Diego and Los Angeles strategically chosen to signify something to his audience, or were they simply the first cities that came to mind as expendable places? Either way, the effect is to normalize—-and to gauge a crowd’s reaction to–the idea of massive violence in major California cities, suitable targets because of their perceived liberal lean. So what if Iran needs to bomb a little bit of America before the war can be over? Who cares, says Trump, if they target Los Angeles and San Diego?
By the way, why didn’t he offer up San Francisco, the free-love hippie-town MAGA loves to hate (and also my birthplace)? Could it be because that’s where the tech titans live? The same ones who joined Trump for Xi Jinping’s state dinner, a guest list worth a combined $2.4 trillion?
San Diego may have fewer billionaires, but it is home to more than 115,000 active-duty service members and 230,000 veterans. One in six active-duty sailors–in the entire Navy–is stationed here. So is one in four Marines. You cannot throw a rock in this county without hitting a military family: brats and spouses and veterans are among us. I got out of the Navy last year after ten years, and eight of those were here in San Diego. When Trump says “let ‘em take out San Diego,” he’s talking about the backbone of the United States military. He’s also talking about the people fighting his war.
San Diego has not been watching this war from the sidelines. Today, the USS Abraham Lincoln returns to North Island after an almost yearlong deployment to the Middle East that featured food shortages, broken toilets, and mold in the showers after 286 days at sea without a single port call. Eight sailors in the Lincoln’s strike group attempted suicide, but in August, when a reporter asked whether the deployment had gone on too long, Trump said “not nearly long enough.” Now he has told a crowd in Nebraska that we should let Iran take out the city those sailors call home. These are sociopathic sentiments.
Last week at Quantico, Pete Hegseth closed his address to the force by telling them, “President Trump has your back and so do I.” To the contrary, President Trump has put one of the biggest military towns in the country forward as a target for our adversaries. With friends like these, the “domestic” in “against all enemies, foreign and domestic” starts to sound a lot less hypothetical.
San Diego is home to Naval Air Station North Island, Naval Base San Diego, Naval Amphibious Base Coronado, the Point Loma submarine base, Camp Pendleton, and Miramar (and I have been permanently stationed at or trained at all of them). If Iran bombed San Diego and Los Angeles, aside from the devastating loss of life, it would cripple an immense share of our national security readiness.
And for what, exactly? Trump says the war is “essentially almost over with.” This is the same man who claimed in June 2025 that Iran’s nuclear program had been “obliterated,” then launched a war over it anyway on February 28. More than seven months later, he wants us to believe two things at once: that we’ve basically won, and that we might need to sacrifice an American city or two to finish winning. If the war is almost over, why does anybody need to take out San Diego?
I wonder if Trump’s endorsed candidate for California’s 48th District here in San Diego County will respond to these remarks. He recently said “no pain, no gain,” when referring to the gas prices San Diegans are paying. Jim Desmond, would you apply that same mindset if we were bombed? Or do you have the moral courage to stand up for the people you’re running to represent?
Last November, six Democratic members of Congress, all veterans, including Senator Mark Kelly, recorded a video reminding troops of their duty to disobey unlawful orders, restating the law that says so. Trump called it “SEDITIOUS BEHAVIOR, punishable by DEATH,” and then his Justice Department went looking for an indictment, which a grand jury refused. The president treated reading the law out loud to the troops as a capital offense, but then he himself invited a foreign enemy to destroy two American cities, possibly as a punchline. Is anyone calling the latter sedition? Who is demanding accountability?
Calling our lives a small price to pay affirms a moral bankruptcy, as well as an obvious dereliction of duty to the office he holds. While we can’t impeach him or invoke the 25th Amendment ourselves, we must stop being so quiet about what we’re paying already. We can make our voices heard by calling our representatives, writing op-eds, knocking doors, phone banking, and voting in defiance of the man who threatens the safety of our city. Ballots are already arriving in mailboxes. Vote, and vote yes on 40 (and no on 41 and 42).
Trump has been harming our cities for a while, but now he is inviting our military adversaries to join him in the harm. If we have any self-respect as Americans, we must not tolerate our leaders disregarding the dignity of lives in this way. We must fight for our home.
Julie Roland was a Naval Officer for ten years, deploying to both the South China Sea and the Persian Gulf as a helicopter pilot before separating in June 2025 as a Lieutenant Commander. She has a law degree from the University of San Diego, a Master of Laws from Columbia University, and is a member of the Truman National Security Project.