When the architects of our republic wrote the magnificent words of the Constitution and the Declaration of Independence, they were signing a promissory note to which every American was to fall heir. This note was a promise that all men — yes, Black men as well as white men — would be guaranteed the unalienable rights of life, liberty and the pursuit of happiness.

It is obvious today that America has defaulted on this promissory note insofar as her citizens of color are concerned. Instead of honoring this sacred obligation, America has given the Negro people a bad check, a check which has come back marked insufficient funds.

But we refuse to believe that the bank of justice is bankrupt.

We refuse to believe that there are insufficient funds in the great vaults of opportunity of this nation. And so we’ve come to cash this check, a check that will give us upon demand the riches of freedom and the security of justice.

This, I think, is one of the most profound lessons that Dr. King taught us and our national collective conscience: talk is cheap, and America needs to live up to her words that “all men were created equal.” America needs to live up to her words that there is “equal protection before the law.” America needs to live up to her words that there is “freedom and justice fore all.”

This is in all aspects of life in America, including in the healthcare space where, sadly, there is a great gap in healthcare equity and equality for Black and Brown Americans. We need to do better to close that gap and ensure all people are given the care that they deserve. Even that sentence is cheap; it is easy for me to write it, much harder to work to make that sentence become reality.

I pledge to do what I can. I pray we, as a field, are successful. Thank you, Dr. King, for all you did to ask America to live up to her glorious words and make them more than just words.

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Covid-19 has, in many ways, provided really useful insights into the underlying mechanics of the American healthcare system. Not only has it exposed glaring systemic inadequacies, but it has also highlighted the strength and character of the second most important tier of healthcare, the people that provide the care. They never wavered.

The first group on that healthcare tier, in any system that seeks to ensure equitable public health, is the patient. Healthcare exists to care for, treat, and to heal the patients it serves. That is, or should be, the mantra of every individual caregiver who signs up at the door of healthcare. 

Yet, for various reasons, quality-of-care disparities based on race, gender and ethnic classifications still exist within American healthcare. Covid-19 has highlighted these in ways the industry can no longer ignore. Race-based health outcomes have gone public.

The simple process of vaccine distribution, for example, has been an object lesson in the power of external forces, outside the sphere of healthcare, to dictate the quality of care certain patient groups experience. 

Harsh fact. If you’re poor, Black, Asian, Hispanic, or a member of any other minority group in modern day America, expect inferior care and poorer health outcomes. We know this to be fact. Covid data has removed any wiggle room from the argument. 

The American healthcare system is biased in favor of middle class and wealthy white patients. 

Feels uncomfortable reading that, doesn’t it? Fact though. You can’t argue with figures, only interpret them with the intent of obfuscating the truth or seeking it. 

The only question that now remains to be addressed is this. 

Is healthcare itself to blame for the bias or does the bias stem from healthcare’s dependency on external agents? Governments, politicians, agencies, and other parties linked to healthcare. In the end, the question itself is moot. Healthcare has to be accountable for what happens in healthcare. 

Only when the industry is able to assume responsibility for its failure to provide equitable care, will it be able to effectively coalesce toward solution-driven action. Allocating blame to third parties is tantamount to the indefensible ‘he made me do it’ plea. It is “our house” and we are honor-bound to ensure the safety of all who enter it.

Amplifying the ills that ail us

It’s a Rosa Parks moment for healthcare and WE, the privileged, need to stand and offer our seats. Those petitioning for change within the industry, crying out for equitable and accessible care, an end to gender bias, and seeking to bring balance to the industry, need to be heard. It is our responsibility to ensure they are. That their concerns and the demographic they speak for be placed front and center where we can shine a spotlight on the decades of shame we have enabled through our silence.

We cannot, in good conscience, move forward with an industry that is not fit for purpose. It detracts from the good we achieve and history will judge us accordingly. How can progress truly be described as progress, when we continue to contradict the very premise that led to the creation of the profession. First, do no harm. 

I know what I intend to do. I know what Medika intends to do. We have assumed our responsibility, along with the rising crescendo of voices seeking equity for the people they care for. No more. 

The world will not change to accommodate the lofty goals of healthcare. Healthcare needs to change the world. Together, one united voice and the walls of Jericho will tumble. Only, and only if, we call out in unison.

Let’s look back in pride, ten or twenty years from now, knowing that we’ve taken ownership of our profession, assumed responsibility, and empowered change. It is so simple and yet so hard. Will you join us?

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Medicine sometimes snatches away health, sometimes gives it. — Ovid

African-American patients suffer greater numbers of deaths from the COVID-19 virus than white patients. Why is that?

Racists and those who follow the teachings of people like William Shockley, the Nobel prize-winning physicist who developed the transistor, would see a damaged-from-birth individual.

He spent the second half of his career, from the 1960s on, espousing a racist eugenics agenda, taking occasional breaks to help promote a high-IQ sperm bank. He ended up a disgraced bigot — ostracized and (as his biographer speculates) perhaps mentally ill. Shockley believed African-Americans were inferior and he would have, undoubtedly, attributed their high death rate to this inferiority.

The famed physicist wasn’t alone in his distorted beliefs about persons who trace their origin to Africa. He was one of many who clung to this belief in white exceptionalism. Often, they put their beliefs into action.

An unfortunate urban myth surrounds the eminent Black physician’s death, Dr. Charles R. Drew, who developed blood banks. While driving a car, he was involved in a serious auto accident. Despite the efforts of hospital staff, Drew died. He had been taken to a “white” hospital, and the erroneous belief that he had been denied blood transfusions was born.

Drew’s injuries were so severe and his loss of blood so great that he could not be saved. His family later wrote letters to the attending physicians thanking them for their efforts. But the belief of denial of blood survived.

Marks on the History of Medicine

The infamous Tuskegee “research” is probably the best-known study involving Black men. It was to be a study of untreated syphilis. Begun in 1932 with 600 black men, 399 with syphilis, 201 who did not have the disease, it was conducted without informed consent. The men were told it was to assess several ailments, including syphilis, anemia, and fatigue.

As is usual in some studies, participants received free medical exams, free meals, and burial insurance. The initial objective was to conduct the study for six months, but it lasted for 40 years and many men died of the horrific, debilitating disease.

Once the unethical aspects were discovered, and that the researchers failed to provide treatment for men with syphilis, the research was halted and branded as highly unethical.

A review of the study found that the subjects were never given a choice to quit even when new, highly effective treatments were available. The most likely available medication would have been penicillin, which was an accepted treatment in 1945.

A class-action lawsuit against the researchers was won in an out-of-court settlement in 1974. Participants and their families were awarded $10 million. Men and women weren’t the only Blacks involved in questionable research studies.

Children as young as three months old were, according to one researcher, used as guinea pigs in UK medical experiments to test out drugs such as those for HIV. The children in the clinical trials were either Hispanic or Black and resided at an orphanage.

Tests were performed to check for drug safety and tolerance, and the president of the Alliance for Human Research Protection said the children had been treated like “laboratory animals.”

Pain has also received new research attention as it pertains to Black patients. A belief in differences not only in the color of their skin, but the thickness of Black skin vs. white and pain tolerance persists.

…a substantial number of white laypeople and medical students and residents hold false beliefs about biological differences between blacks and whites and demonstrates that these beliefs predict racial bias in pain perception and treatment recommendation accuracy. It also provides the first evidence that racial bias in pain perception is associated with racial bias in pain treatment recommendations.

The result is that many Black patients are undermedicated for pain and do not receive the relief that a white patient would under the same circumstances.

Good Reasons for Hesitancy

What are the barriers to greater participation of Black people in Covid-19 trials? Although they are multiple, a critical factor is the deep and justified lack of trust that many Black Americans have for the health care system in general and clinical research in particular.

This distrust is often traced to the legacy of the infamous syphilis study at Tuskegee, in which investigators withheld treatment from hundreds of Black men in order to study the natural history of the disease. But the distrust is far more deeply rooted, in centuries of well-documented examples of racist exploitation by American physicians and researchers.

The unethical medical practices perpetrated against Black patients were not limited to the Tuskegee syphilis experiment. During the 19th century, the physician James Marion Sims performed gynecological surgery on enslaved Black women without anesthesia.

Defenders of his actions indicate that this was groundbreaking surgical research for which the women may have asked. But, according to articles written since that time, there was no way to know that they either gave consent or that their owners agreed to the procedures.

The owners, however, had a financial interest in their slave’s recovery and most probably would have agreed with the procedure going forward.

Considering the requirements for medical school today, Sims’ period of study was rather slim. He worked with a physician for a short period of time and took a three-month course at a medical school before starting his medical practice.

Sims, in his autobiography, indicated that once he established himself in a small hospital on a slave plantation, he operated daily and had many patients. Considered the “father of modern gynecology,” Sims worked in an area of medicine considered undesirable, if not somehow unsavory.

When any of Sims’s patients died, the blame, according to him, lay squarely with “the sloth and ignorance of their mothers and the Black midwives who attended them.”

Medical researchers have not always been forthcoming in their work. One reason they would indicate is that to do so would skew the results. But there is sufficient evidence of medical deceit and continuing bias to cause vaccine hesitation — especially in the Black communities.

An additional consideration might be found in how the studies of the vaccines have been carried out. What was the number of Black persons involved in the samples, and were genetic differences noted? When I worked in a research study of an Alzheimer’s drug, few Black patients were enrolled.

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