Sitting in front of a webcam as I attended my Zoom medical school interview, I adjusted my hair, quickly looked into the mirror, and asked myself, “am I pretty enough to make a good impression?” The stress of the interview prevented me from thinking about why I thought this at that moment, but later on, I was reminded of an incident that subconsciously made me think this. A friend in college told me how her parents were persistent about her losing weight before interviewing for medical school. When I asked her why they were doing that, she told me the following story which changed how I viewed the world. Her parents were both physicians who were also responsible for picking residents. They told my friend that appearance is a crucial factor that influences which residents they end up hiring. This story brought me to the question I asked my medical school peers.
“How do you think your appearance will affect future opportunities?”
The majority responded in agreement to the statement: “I think my appearance will be an advantage for getting future opportunities.”
Out of 68 responses, 47% agreed with this choice.

The neutral option was the second popular choice. A few felt that their appearance would be a disadvantage, so it was very interesting to see that many people felt they had an upper hand due to the way they looked. Perhaps, appearance played a role in getting into medical school, but I would need to know more about the scientific basis of this social phenomenon colloquially known as ‘pretty privilege.’
I thought I’d start by looking into the Halo effect. Simply put, it is when people think that an attractive person is a good person. To expand, it is when people assume that someone has other good qualities (e.g. a moral compass) based on one good quality (in this case attractiveness) that they’ve observed. Evolutionarily speaking, what is considered attractive? Well, good thing we have an article that tells us. In the article titled, “Facial attractiveness: evolutionary based research,” their research concludes that symmetry, averageness, secondary sexual characteristics, skin health and color, facial cues, age, weight, height, hair color, and possibly other factors that may have not been mentioned in the article (Little et al.) contribute to attractiveness. Averageness may seem peculiar but basically, it says that people favor faces that are representative of the average population. That makes sense because people’s preferences are determined by what they see. The other physical characteristics like secondary sexual characteristics, skin health, and symmetry seem to almost be instinctual observations to determine if someone is a suitable mate for reproducing.
In regards to symmetry, there is something in nature called the golden ratio which is about 1.618. Because of its recurrence in the natural world, it is thought to be the ideal proportion. This ideal has also been discussed in regards to an individual’s beauty. So according to the golden ratio, an ideal person’s face would be 1.5 times longer than its width. However, one study done in 2010 (“New “Golden” Ratios for Facial Beauty”) concluded that “although different faces have varying attractiveness, individual attractiveness is optimized when the face’s vertical distance between the eyes and the mouth is approximately 36% of its length, and the horizontal distance between the eyes is approximately 46% of the face’s width. These “new” golden ratios match those of an average face,” (Pallet et al.). The golden ratio evolutionarily provides people with a baseline on perceiving symmetry for survival, but maybe the ratios for facial preferences have changed with globalization and a less threatening living situation compared to pre-modern times.



However, in modern times, the other factors (i.e. weight and hair color) mentioned seem to be more influential as they are informed by social norms. Of course, attractiveness is in some ways subjective, but there is such a thing as conventional beauty, which is greatly influenced by popular media and culture. This bias can also affect how we perceive one’s capabilities in academic and other professional settings.
For example, in the review article “Blinded by Beauty: Attractiveness Bias and Accurate Perceptions of Academic Performance,” researchers found that, “while there are various seemingly logical explanations for why attractiveness could be a valid cue to academic performance, the empirical evidence for a link between the two is extremely weak and perhaps only existing in the lower half of the distribution (i.e. driven by potential outliers with genetic or developmental problems affecting both appearance and cognitive ability),” (Talamas et al). Essentially, attractiveness acts as a “suppressor” when assessing actual academic performance or skill levels. This means that while attractiveness is not a good predictor of academic performance, it contributes to people’s perceptions of whether a person has the attributes of someone they believe to be “intelligent.” In this way, the halo effect potentially detracts employers or educators from objectively assessing one’s actual skill level.
Of course, there are situations where attractiveness can be a disadvantage. When asking friends whether they’ve experienced ‘pretty privilege,’ a couple said that although they may be treated well, sometimes they are underestimated or harassed because of how they look. It is distressing to hear because you see how appearance can be advantageous at one end but then knowing that the same person can face disadvantages, reminds me of how primitive our judgements can be. And in an age where social media paints a very glamorous picture of people’s lives, we get sucked into the behavior of ‘judging a book by its cover.’ There is much more to a person than the way they look, but oftentimes several biases get in the way, including racial biases.
To understand how racial biases can negatively affect people’s judgments, it’s imperative that we talk about the Horn effect.
The Horn effect is when an individual makes a sudden judgment about another person based on a trait that the individual considers negative. For instance, say that your parents made you believe that wearing revealing clothing is not okay. When you see someone who wears such clothing, your experience may make you think that person is flawed in other ways because your perception of their clothing choices is negative. From a survivalist point of view, the Horn effect makes sense. When you know that a spider with long legs can be poisonous, you stay away. It can be protective in some cases, but in a social sense, it can be harmful. It may be difficult to see the positive traits of an individual once one has made such a strong initial judgment. Eventually, this behavior perpetuates prejudice. When it comes to race-based discrimination, we see the impact of the Horn effect in the workplace. In one study conducted by the University of Chicago and MIT, researchers found that certain resumes were overlooked or excluded based on the possible race suggested by their name. Before skills and experience were considered, internal bias became a barrier to making a fair judgment.
While this does not address appearance, one other example may address the Horn effect and racism.



Colorism.
The basis of colorism is racially motivated. In colonial times, the oppression by the British monarchy and other European monarchies created this idea that whiteness equates to power. The oppressed were usually people of color as seen in the colonies in India, Australia, and Africa. The trauma from this experience carries onwards through many generations. Time blurs the original story and what happens? Individuals are excluded because they’re “too dark” or “not fair enough.”
I have seen this happen way too often during family gatherings and trips to India. My aunt called my mom in concern when she saw “how dark I’d become” in my high school’s tennis team picture and was worried about what people would think. We laughed it off then, but associating superficial traits with certain personality traits is problematic. People are not given the chance to show who they are, and may or may not get certain opportunities based on things they can’t control. It is important to look at an individual’s work ethic, experience, emotional intelligence, and conflict resolution skills, especially when hiring a physician. Ultimately, patients deserve doctors who can empathize and support them. That’s not to say that attractive people cannot do that, but everyone should be judged fairly, and level of attractiveness should not be a factor when determining who is best for the job. Hopefully, as future physicians, we can change this dialogue and promote fair evaluations of people’s abilities. It’ll be a necessary change for our future patients.
Citations:
Talamas, Sean N et al. “Blinded by Beauty: Attractiveness Bias and Accurate Perceptions of Academic Performance.” PloS one vol. 11,2 e0148284. 17 Feb. 2016, doi:10.1371/journal.pone.0148284
Little, Anthony C et al. “Facial attractiveness: evolutionary based research.” Philosophical transactions of the Royal Society of London. Series B, Biological sciences vol. 366,1571 (2011): 1638-59. doi:10.1098/rstb.2010.0404
“Halo Effect – Biases & Heuristics: The Decision Lab.” Decision Lab, https://thedecisionlab.com/biases/halo-effect.
National Geographic Society. “The Golden Ratio.” National Geographic Society, 16 Nov. 2012, https://www.nationalgeographic.org/media/golden-ratio/.
Person. “Horn Effect: Definition, Examples, and More.” Healthline, Healthline Media, 28 Oct. 2020, https://www.healthline.com/health/horn-effect.
Pallett, Pamela M et al. “New “golden” ratios for facial beauty.” Vision research vol. 50,2 (2010): 149-54. doi:10.1016/j.visres.2009.11.003
Leonard, Bill. “Study Suggests Bias against ‘Black’ Names on Resumes.” SHRM, SHRM, 11 Apr. 2018, https://www.shrm.org/hr-today/news/hr-magazine/pages/0203hrnews2.aspx#:~:text=Employers%20may%20be%20selecting%20or,Institute%20of%20Technology%20(MIT).