Thursday, June 19, 2008

The legacy of Tuskegee?

I recently attended a conference on the topic of race and medical care. There were several other presentations going on at the same time, and this one was possibly the least well attended. I understood why. Topics like these make people very uncomfortable.

The issue of disparity in health care has long been documented. To put it simply, African-Americans in the US receive a significantly lower standard of health care than White Americans do.

There has much debate over why this is so. Some argue that African-Americans are less likely to seek out health care, relying instead on God and his angels to help heal their illnesses. Others maintain that Blacks in America are less likely to have better health insurance and so do not share the same level of access to health care that Whites generally do. And some attribute it to the possibility that those of a darker shade of pale are simply more likely to receive short shrift by medical systems.

More and more researchers are proving the last hypothesis to be the most accurate. And this appears to be true across a broad category of illnesses.

Researchers have found that Blacks are less likely to receive appendectomies than Whites. Imagine that – a procedure as simple and basic as removing an infected appendix is less likely to occur for Black patients. Hence the higher rate of mortality from untreated appendicitis among Blacks.

Blacks are also less likely to receive appropriate cardiac care. The delays between home to ambulance or ambulance to hospital are longer for Blacks than for Whites, regardless of where they live. And even when a Black person is already in the hospital, he or she is still more likely to experience delays in attempts at cardiac resuscitation. Finally, Blacks are more likely to be treated with older medical equipment while White patients are more likely to be offered the latest technologies and the newest drug interventions. Frightening isn’t it?

The data on disparities in pain management are even more disturbing. It is now well-established medical policy that patients should not be allowed to remain writhing in agony. Pain management has become an important focus of current medical treatment, and new and more effective drugs are currently available. The use of opiates in medical pain management has become standard practice in cases of severe injury. However, research has shown that Blacks are less likely to be prescribed opiates and are more likely to receive non-opioid forms of pain relief. And, sadly, Blacks are more likely to be accused of drug-seeking behavior when they complain of pain.

Even more unsettling, disparities in pain management seems to be especially true for children. One study looked at the effectiveness of pain management among samples of Black and White children under age 12 who had broken a limb. Black children were less likely to be offered effective pain relief. [By this point in the presentation I was in tears, and had to do some fancy covering up to hide my emotions.]

I asked the presenter if these statistics held true even for those conditions that are more prevalent among African-Americans. Her answer was “Yes”. Blacks are less likely to receive appropriate care even for conditions such as diabetes, cirrhosis, and hypertension that tend to be more common in Black communities.

A lot of research has gone into examining patient factors that explain disparities in healthcare. Researchers point especially to the mistrust of health systems by Black patients as possibly reflecting the legacy of Tuskegee. Between 1932 and 1972 in Tuskegee Alabama, 399 poor Black men diagnosed with syphilis, were deliberately left untreated so that researchers could examine the course of this disorder [see photos above & below].

Some researchers believe that this experience has left a mistrust by not only Blacks but by other racial and ethnic minorities as well, who do not believe that the Federal Government will protect them from medical harm or experimentation. Indeed, a recent study found that educated Black men were actually more likely to believe that the HIV virus was promulgated among Blacks as a form of government-sponsored genocide. Mistrust of health systems is clearly an important patient factor in health care disparities.

But my problem with the focus on patient factors is the sense that the victim is being blamed for his or her demise. I believe that the larger problem lies not with care receivers but with their caregivers. In one of the studies, physicians were asked if they practiced discriminatory methods of healthcare. A significant percent admitted that they believed that such practices existed – but they did not think that this occurred at their hospitals or in their practices. How can you fix a problem that is neither recognized nor acknowledged?

I am not necessarily saying either that physicians are all guilty of discriminatory health practices. Frankly, when individuals of color walk into a doctor’s office, they have to deal with a whole slew of individuals before they even get to see the doctor. Discrimination starts from the minute they walk through the door.


miko said...

i wonder if we're getting anywhere with this.

tennischick said...

sadly not. this is all very recent research.

tennischick said...