While no one could argue that racial inequity is gone in the United States, there are important ways in which a far greater level of equality is being achieved today. One of these is the increasing equality of the provision of peripheral medical services, such as dentistry and optometry, between historically white neighborhoods and historically ethnic neighborhoods. Today in St. Louis eye surgery will likely have similar patient outcomes in the North and South parts of the city, whereas this would not have been the cast twenty years ago.

The strides forward are the primarily the result of three different changes in the delivery of peripheral medical services. First, the outreach organizations of each of these professions has become more vocal, creating more supportive economic conditions in traditionally Black and Latino communities. Second, the emergence of branded surgical techniques are creating greater uniformity. Third, the level to which we are connected is raising awareness and reducing abuses.

Medical care has always been worse in poor neighborhoods than in affluent ones, and the delivery of peripheral medical services has for the most part followed that trend. Since race has been an unfortunate predictor of economic stratum, the difference between a rich man's medicine and a poor man's medicine has mirrored the experience of White patients versus Black ones. Practicing in a poor neighborhood wasn't as lucrative, and doctors followed the money.

One of the principal effects of the increasing activity of professional organizations, however, has been to lobby lawmakers to allocate money to improve patient outcomes in poorer neighborhoods. Another has been to raise awareness within those neighborhoods of the importance of certain services. With more money available and more patients interested, lower-income neighborhoods are more attractive places to set up shop.

Over the same period of time, there has been an increase in branded therapeutic advances such as laser eye surgery, invisible orthotic devices, and others. These have become popular at all levels of society, and they are provided in low income neighborhoods as well as in the rich parts of town.

For the companies that own the brands, maintaining their good name is essential. When patients have negative outcomes, it casts a shadow over the procedure itself, which can cost tens or hundreds of millions of dollars. Consequently, the brands tend to guard their therapies very well, delivering them through their own clinics or demanding standardized delivery through individual doctors' practices. Adhering to the requirements of these brands has had a dramatic effect on standardization of care overall.

One of the key advantages of these branded therapies is that, like any franchise-type business, there is a considerable amount of built-in oversight up the line of the company that owns the technology. The doctor isn't on his own when he delivers one of these services. He has the companies that own the brands looking over his shoulder, making sure he does a good job. Consequently, just about every doctor providing a branded therapy does it the same way, whether the patient is rich or poor, and regardless of race.

Patients themselves are also playing an increasing role in forging a more equitable landscape through social media. Social media defies racial, cultural, geographical, and economic barriers by allowing people to connect across them with ease. Consequently, patients in poorer neighborhoods are more aware of the experience of patients in wealthier neighborhoods, and they demand the same experience of their doctors.

In St. Louis eye surgery patients on the South Side, which is historically more white and more affluent than the North Side, may have experienced a higher quality of care. But now, patients on the North side who don't receive the same quality of care have tools to punish their doctors' reputations.