Tag Archives: medicine

How Bias in Medicine Affects Treatment and Outcome by Race

Google Image “Black Child and Doctor”, and the first 900 images look something like this fantasy –

Now, with only about 2.5% of all doctors being black – what do you think the statistical chance of this is? This is the first lie of many the medical profession tells itself, and the world. It also empowers a dangerous stereotype that patients are treated better racially. You find pretty much the same thing for Asian or Hispanic kids.

We know that the result of such disparate treatment results in the needless deaths of possibly several hundred thousand black patients a year. From Prenatal Mortality rates 1.5 to 2.5 times higher than white or Hispanic populations, to higher death rates among the elderly.

From the Journal of the American Medical Association

A landmark report from the Institute of Medicine (IOM) in 2003 documented that from the simplest to the most technologically advanced diagnostic and therapeutic interventions, African American (or black) individuals and those in other minority groups receive fewer procedures and poorer-quality medical care than white individuals.1 These differences existed even after statistical adjustment for variations in health insurance, stage and severity of disease, income or education, comorbid disease, and the type of health care facility. Very limited progress has been made in reducing racial/ethnic disparities in the quality and intensity of care.2

This from the prestigious New England Journal of Medicine.

Bias, Black Lives, and Academic Medicine

At noon Pacific Standard Time on December 10, 2014, thousands of students from 70 medical schools throughout the United States held silent “White Coats for Black Lives” die-ins. These demonstrations, the largest coordinated protests at U.S. medical schools since the Vietnam War era, were initiated by medical students in California and spread across the country in response to the following call to action posted online

“We feel it is essential to begin a conversation about our role in addressing the explicit and implicit discrimination and racism in our communities and reflect on the systemic biases embedded in our medical education curricula, clinical learning environments, and administrative decision-making. We believe these discussions are needed at academic medical centers nationwide.” Though the stimulus for the die-ins was the nationwide protests in response to the killing of unarmed black men by police officers, the students demanded an examination of racial bias within our country’s academic medical centers.

What are the systemic biases within academic medical centers, and what do they have to do with black lives? Two observations about health care disparities may be relevant.

First, there is evidence that doctors hold stereotypes based on patients’ race that can influence their clinical decisions.1 Implicit bias refers to unconscious racial stereotypes that grow from our personal and cultural experiences. These implicit beliefs may also stem from a lack of day-to-day interracial and intercultural interactions. Although explicit race bias is rare among physicians, an unconscious preference for whites as compared with blacks is commonly revealed on tests of implicit bias.1

Second, despite physicians’ and medical centers’ best intentions of being equitable, black–white disparities persist in patient outcomes, medical education, and faculty recruitment. In the 2002 report Unequal Treatment, the Institute of Medicine (IOM) reviewed hundreds of studies of age, sex, and racial differences in medical diagnoses, treatments, and health care outcomes.2 The IOM’s conclusion was that for almost every disease studied, black Americans received less effective care than white Americans. These disparities persisted despite matching for socioeconomic and insurance status. Minority patients received fewer recommended treatments for diseases ranging from AIDS to cancer to heart disease. And racial gaps in health care outcomes have persisted. For example, gaps in blood pressure, cholesterol, and glycated hemoglobin control between black and white members of Medicare health maintenance organizations were found throughout the period 2006 to 2011.3

The IOM found “strong but circumstantial evidence for the role of bias, stereotyping, and prejudice” in perpetuating racial health disparities.2 The finding that physicians have implicit racial bias does not prove that it affects patient–doctor relationships or changes treatment decisions. But some research suggests that there’s a direct relationship among physicians’ implicit bias, mistrust on the part of black patients, and clinical outcomes.1 Although the causes of health care disparities are certainly multifactorial, implicit bias plays some role.

Implicit bias may also influence administrative decisions at academic medical centers — decisions ranging from what services are provided, to whether to accept insurance plans that serve the most disadvantaged members of minority groups, to which neighborhoods to choose when establishing new physicians’ offices. The likelihood of such influence does not mean that bias is the only explanation for unequal treatment or administrative decisions that favor one group over another. The point is simply that there is potential for making racially biased decisions, and it generally goes unexamined.

Implicit racial bias might contribute to the failure to achieve greater inclusion of black students in medical education. Though there has been progress in the recruitment of some underrepresented minority groups to medical schools, the percentage of black men among all medical school graduates has declined over the past 20 years (see graph Number of U.S. Physicians by Graduation Year, Race, Ethnic Group, and Sex, 1980–2012.). The country’s traditionally black medical colleges — Howard, Meharry, and Morehouse — continue to graduate a disproportionate number of black medical students. In 2012, there were just 517 black men among the more than 20,000 graduating students at U.S. medical schools (see graph). Black medical students are more than twice as likely as white students to express a desire to care for underserved communities of color. Our inability to recruit black men into medicine is alarming, given the urgency of racial health care disparities in the United States.

Recruitment and retention of black faculty members have also long challenged academic medicine. Only 2.9% of all faculty members at U.S. medical schools are black.4 A 2010 study showed that among faculty members who had been hired in 2000, blacks were less likely to have been retained than any other demographic group. Black faculty members are less likely than their white counterparts to be promoted, to hold senior faculty or administrative positions, and to receive research awards from the National Institutes of Health.5 Thirty-one percent of the 84,195 white faculty members at U.S. medical schools were full professors in 2011, as compared with just 11% of the 3952 black faculty members. The paucity of black faculty members contributes to a climate in which black medical students may lack accessible black role models. The IOM has defined the climate for diversity as “the perceptions, attitudes, and expectations that define the institution, particularly as seen from the perspectives of individuals of different racial or ethnic backgrounds.” Though there may be various drivers of poor recruitment, retention, and promotion of black faculty members, the role of institutional bias and the climate for black faculty at academic medical centers deserve scrutiny. By any measure, academic medicine’s persistent difficulty in developing black faculty members is a serious concern.

For the sake of not only black lives but all lives, we should heed our students’ call to examine the implicit biases in our academic medical centers. We can begin by assessing how bias contributes to the persistence of black–white disparities in health care, medical school recruitment, and faculty retention in our own institutions. We can audit the care we deliver to ensure that the right treatments are provided and the best outcomes are achieved regardless of patients’ race, class, or sex. We can assess the climate within our centers and strive to ensure that our recruitment processes, classrooms, clinics, administrations, and boardrooms are inclusive to all. But most important, we should talk about bias, with our students, our faculties, our staff, our administrations, and our patients. Maybe then we’ll have a chance to finally eliminate the racial health care disparities that persist in the United States.

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Posted by on September 26, 2015 in American Genocide, The Post-Racial Life


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Senegal is Free of Ebola

The West African country of Senegal has managed to do something the US hasn’t despite all our vaunted medical facilities, science, and training…

Clear their country of Ebola.

Of course they are probably far to intelligent to have Faux News type conservatwits whimpering and wailing to the rafters getting in the way of the people who could contain the disease.

A view of the Capital City – Dakar

Senegal is free from Ebola, WHO says

The West African nation of Senegal is free of Ebola, the World Health Organization declared Friday, congratulating the country on the diligence that enabled it to repel the threat.

Senegal had only one case, a man who had entered the country by road from Guinea, where he’d had direct contact with an Ebola patient.

The government’s response included identifying and monitoring 74 close contacts made by the man for signs of infection.

It also introduced prompt testing of all suspected cases, increased surveillance at entry points to Senegal and nationwide public awareness campaigns, the WHO statement said.

The patient recovered from Ebola and tested negative for the virus on September 5, the statement said. He’s since returned to Guinea.

Since then, 42 days have passed — double the maximum known incubation period for the virus — without another case, allowing Senegal to be declared free of Ebola.

When the case was first detected, WHO treated it as a public health emergency it said, sending a team of epidemiologists to help local health officials and international partners such as Doctors Without Borders manage the situation.

“The most important lesson for the world at large is this: An immediate, broad-based, and well-coordinated response can stop the Ebola virus, carried into a country in an infected traveler, dead in its tracks,” WHO said.

WHO sounded a note of caution, however, given that Senegal shares a border with Guinea, a hotspot for the disease along with Sierra Leone and Liberia.

“While the outbreak is now officially over, Senegal’s geographical position makes the country vulnerable to additional imported cases of Ebola virus disease,” it said.

Wrestling is the National Sport of Senegal

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Posted by on October 17, 2014 in Africa


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A Cure for the Common Conservative?

Looks like the cure for conservatism will actually beat a cure for cancer… Yup – “There’s a pill for that!”

Blood pressure drug ‘reduces in-built racism’

A common heart disease drug may have the unusual side-effect of combating racism, a new study suggests.

The beta-blocker drug can reduce ‘subconscious’ racism, the Oxford University study found.

Researchers found that people who took propranolol scored significantly lower on a standard test used to detect subconscious racial attitudes, than those who took a placebo.

Propranolol is most often used to reduce high blood pressure by lowering the heart rate, as well as angina and irregular heartbeat. It is also used to manage the physical symptoms of anxiety, and control migraine.

It is thought to work by blocking activation of the peripheral ‘autonomic’ nervous system, and in areas of the brain involved with formulating emotional responses, including fear, called the amygdalae.

The researchers believe propranolol reduces racial bias because such subconscious thoughts are triggered by that autonomic nervous system.

Their small study took 36 white student volunteers, gave half a single 40mg dose of propranolol and half a placebo, and asked them all to undertake the Implicit Association Test – designed to test “subtle and spontaneous biased behaviour” – two hours later.

The test requires participants to visually sort particular words like ‘joy’ ,’evil’, ‘happy’ and ‘glorious’, as well as black and white faces, into the correct categories.

Sylvia Terbeck, lead author of the study, published in the journalPsychopharmacology, said: “Our results offer new evidence about the processes in the brain that shape implicit racial bias.

“Implicit racial bias can occur even in people with a sincere belief in equality.

“Given the key role that such implicit attitudes appear to play in discrimination against other ethnic groups, and the widespread use of propranolol for medical purposes, our findings are also of considerable ethical interest.”

Professor Julian Savulescu, of the university’s Faculty of Philosophy, and a co-author of the study, said: “Such research raises the tantalising possibility that our unconscious racial attitudes could be modulated using drugs, a possibility that requires careful ethical analysis.

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Posted by on March 8, 2012 in The Post-Racial Life


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A Vaccine for Heroin Addiction?

Wow – this could be  major game changer.

And you thought there were only Zombies in the movies..

Mexican scientists successfully test vaccine that could cut heroin addiction

A group of Mexican scientists is working on a vaccine that could reduce addiction to one of the world’s most notorious narcotics: heroin.

Researchers at the country’s National Institute of Psychiatry say they have successfully tested the vaccine on mice and are preparing to test it on humans.

The vaccine, which has been patented in the US, makes the body resistant to the effects of heroin, so users would no longer get a rush of pleasure when they smoked or injected it.

“It would be a vaccine for people who are serious addicts, who have not had success with other treatments and decide to use this application to get away from drugs,” the institute’s director Maria Elena Medina said on Thursday.

Scientists worldwide have been searching for drug addiction vaccines for several years, but none have yet been fully developed. A group at the US National Institute on Drug Abuse has reported significant progress in a vaccine for cocaine.

However, the Mexican scientists appear to be close to making a breakthrough on a heroin vaccine and have received funds from the US institute as well as the Mexican government.

During the tests, mice were given access to deposits of heroin over an extended period of time. Those given the vaccine showed a huge drop in heroin consumption, giving the institute hope that it could also work on people, Medina said.

Kim Janda, a scientist working on his own narcotics vaccines at the Scripps Research Institute in La Jolla, California, said that the Mexican vaccine could function but with some shortcomings.

“It could be reasonably effective, but maybe too general and affect too many different types of opioids as well as heroin,” Janda said.

Mexico has a growing drug addiction problem. Health secretary Jose Cordoba recently said the country now has about 450,000 hard drug addicts, particularly along the trafficking corridors of the US-Mexico border.

Mexican gangsters grow opium poppies in the Sierra Madre mountains and convert them into heroin known as Black Tar and Mexican Mud, which are smuggled over the Rio Grande.


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Ancient Nubians Knew Value of Antibiotics

Turns out Nubians discovered the benefit of antibiotics over 2000 years ago.


People have been using antibiotics for nearly 2,000 years, suggests a new study, which found large doses of tetracycline embedded in the bones of ancient African mummies.

What’s more, they probably got it through beer, and just about everyone appears to have drank it consistently throughout their lifetimes, beginning early in childhood.

While the modern age of antibiotics began in 1928 with the discovery of penicillin, the new findings suggest that people knew how to fight infections much earlier than that — even if they didn’t actually know what bacteria were.

Some of the first people to use antibiotics, according to the research, may have lived along the shores of the Nile in Sudanese Nubia, which spans the border of modern Egypt and Sudan.

“Given the amount of tetracycline there, they had to know what they were doing,” said lead author George Armelagos, a biological anthropologist at Emory University in Atlanta. “They may not have known what tetracycline was, but they certainly knew something was making them feel better.”

Armelagos was part of a group of anthropologists that excavated the mummies in 1963. His original goal was to study osteoporosis in the Nubians, who lived between about 350 and 550 A.D. But while looking through a microscope at samples of the ancient bone under ultraviolet light, he saw what looked like tetracycline — an antibiotic that was not officially patented in modern times until 1950.

At first, he assumed that some kind of contamination had occurred.

“Imagine if you’re unwrapping a mummy, and all of a sudden, you see a pair of Ray Ban sunglasses on it,” Armelagos said. “Initially, we thought it was a product of modern technology.”

His team’s first report about the finding, bolstered by even more evidence and published in Science in 1980, was met with lots of skepticism. For the new study, he got help dissolving bone samples and extracting tetracycline from them, clearly showing that the antibiotic was deposited into and embedded within the bone, not a result of contamination from the environment.

The analyses also showed that ancient Nubians were consuming large doses of tetracycline — more than is commonly prescribed today as a daily dose for controlling infections from bad acne. The team reported their results in theAmerican Journal of Physical Anthropology.

They were also able to trace the antibiotic to its source: Grain that was contaminated with a type of mold-like bacteria called Streptomyces. Common in soil, Strep bacteria produce tetracycline antibiotics to kill off other, competing bacteria.

Grains that are stored underground can easily become moldy with Streptomycescontamination, though these bacteria would only produce small amounts of tetracycline on their own when left to sit or baked into bread. Only when people fermented the grain would tetracycline production explode. Nubians both ate the fermented grains as gruel and used it to make beer.

The scientists are working now to figure out exactly how much tetracycline Nubians were getting, but it appears that doses were high that consumption was consistent, and that drinking started early. Analyses of the bones showed that babies got some tetracycline through their mother’s milk.

Then, between ages two and six, there was a big spike in antibiotics deposited in the bone, Armelagos said, suggesting that fermented grains were used as a weaning food.

Today, most beer is pasteurized to kill Strep and other bacteria, so there should be no antibiotics in the ale you order at a bar, said Dennis Vangerven, an anthropologist at the University of Colorado, Boulder.

But Armelagos has challenged his students to home-brew beer like the Nubians did, including the addition of Strep bacteria. The resulting brew contains tetracycline, tastes sour but drinkable, and gives off a greenish hue.

There’s still a possibility that ancient antibiotic use was an accident that the Nubians never knew about, though Armelagos has also found tetracycline in the bones of another population that lived in Jordan. And VanGerven has found the antibiotic in a group that lived further south in Egypt during the same period.

Finding tetracycline in these mummies, said VanGerven, was “surprising and unexpected. And at the very least, it gives us a very different time frame in which to understand the dynamic interaction between the bacterial world and the world of antibiotics.”


Posted by on September 3, 2010 in Black History


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