In a 2016 study published in the Proceedings of the National Academy of Sciences, 222 white medical students and residents at the University of Virginia were shown a list of statements claiming biological differences between Black and white people. About half of the trainees marked at least one of the false statements as possibly, probably, or definitely true (Hoffman et al., PNAS 2016; PMID 27044069, PMC4843483). The same trainees rated mock Black patients' pain as lower than white patients' pain in matched clinical scenarios, and they recommended less accurate pain treatment for those Black patients.
The false statements included claims that Black people have thicker skin than white people, that Black people's nerve endings are less sensitive than white people's, and that Black people's blood coagulates more quickly than white people's. None of these are biologically true. They are remnants of nineteenth-century race science. They were endorsed in 2016 by trainees in their first year of medical school through their first years of residency.
What the paper actually shows
The Hoffman team ran two studies. The first surveyed 92 white laypersons; about 73 percent endorsed at least one false belief. The second surveyed 222 white medical students and residents at the University of Virginia (first-years n=63, second-years n=72, third-years n=59, residents n=28). About 50 percent endorsed at least one false belief.
The trainees were then shown two clinical vignettes, one in which the patient was a Black woman with a kidney stone and one in which the patient was a white woman with a leg fracture. They rated each patient's pain on a 0-to-10 scale and selected a recommended treatment from a standard list. Trainees who endorsed more false beliefs rated the Black patient's pain as lower than the white patient's pain by a meaningful margin and were less likely to choose accurate pain treatment for the Black patient. Trainees who endorsed zero false beliefs showed no racial bias in their pain ratings.
The paper's headline finding is the link between false-belief endorsement and clinical decision-making. Endorsement of the false biology predicted how the trainee would treat a Black patient in a clinical scenario.
Why the result still matters in 2026
The medical-education response to Hoffman 2016 includes new curricular content on race and medicine at many US medical schools. The trainees the 2016 study sampled (medical students and residents in 2014 to 2015) are now in practicing residency or attending positions. They are seeing patients today.
The pain-bias literature broader than Hoffman 2016 documents the downstream pattern: Black patients are systematically undertreated for pain across emergency department settings, postoperative care, sickle cell disease management, cancer pain, and chronic pain. The Hoffman result is the upstream mechanism the downstream pain-treatment-gap data has been documenting for decades.
What the paper does not say
The Hoffman study sampled white medical students and residents at one university (UVA) in 2014 to 2015; it is not a national probability sample, and it does not test whether the same endorsement rates hold for Black trainees, for non-UVA trainees, or for the 2026 cohort. The result is a strong signal at one institution at one time, with a clear mechanism linking belief to clinical decision-making, cited more than 3,500 times on Google Scholar as of May 2026 and replicated in spirit across the pain-bias literature.
How a Black patient prepares for a pain-care visit
Three concrete steps before a pain-care visit.
First, write down the pain: location, character (sharp, dull, throbbing, burning), severity on a 0-to-10 scale, what makes it better, what makes it worse, when it started, and how it has changed. The written record gives the clinician a structured account that is harder to under-rate than a verbal description. The pain-bias literature shows that subjective verbal pain reports from Black patients are the ones most often discounted; a dated, time-stamped log shifts the conversation toward objective documentation.
Second, ask the clinician to record your pain rating in the chart. The Joint Commission and most US hospital systems require pain assessment as a documented vital sign for many visits. Ask the clinician to note your 0-to-10 score and the time of assessment. If the clinician under-rates your stated pain in their note, the medical record will not reflect your reported severity, and any subsequent treatment decision is built on an under-rated baseline.
Third, ask the clinician what they would prescribe for a white patient with the same complaint. The question is direct and verifiable. The clinician can answer it honestly or refuse to. Either response gives you information you did not have before. The Hoffman study's mechanism (under-treatment when bias is present) is most preventable when the patient explicitly names the comparator.
The Black Health provider directory lists clinicians with verified active licenses; a patient routinely under-treated for pain has the option to switch to a directory-listed clinician with documented practice focus on Black patient care.
Update plan
We will update this piece if a new replication of Hoffman 2016 is published with national US medical-trainee data, if a national medical-school curricular evaluation publishes false-belief endorsement rates post-curricular reform, or if a major pain-management guideline update changes the prescribing standards relevant to this piece.
Citations
- Hoffman KM, Trawalter S, Axt JR, Oliver MN. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. Proceedings of the National Academy of Sciences USA. 2016;113(16):4296-4301. PMID 27044069. Full text: PMC4843483.
