23. Medical Bias

Besides a history of the medical community experimenting on people of color without their knowledge or consent, studies have shown that discrimination against patients of color still exists. (For some examples, see the Tuskegee experiments on black men and the refusal to treat the diseases they were infected with, how the “father of gynecology” gruesomely crafted his expertise on black women without their consent and with no anesthesia or pain medication, and how Henrietta Lack’s cells were taken without her knowledge or consent and used without compensation to her or her family for over 10,000 experiments.)

Studies have shown that medical professionals are more likely to believe white people when they describe their pain than people of color (leftover biases from the time of slavery when whites believed that black people were not fully human and either incapable of feeling pain or having an inhuman tolerance to pain). White people are more likely to receive treatment for that pain from children to the elderly with cancer. These studies have controlled for various potential causes like access to health care, insurance, socio-economic class, etc. Across the board, white people are more apt to receive quality health care than people of color.

Pharmacies are not stocking pain medication in neighborhoods of color. In a recent study in NYC, only 25% of pharmacies in neighborhoods in which less than 40% of residents were white) had opioid supplies that were sufficient to treat patients in severe pain. In neighborhoods that were 80% white, 72% of pharmacies were stocked sufficiently. Another study in Michigan showed that pharmacies in minority zip codes were 52 times less likely to carry sufficient opioid analgesics than pharmacies in white zip codes regardless of income.

In one study, doctors were given two medical cases on paper of the same man--same age, same symptoms indicating a heart attack, same background. The only difference was race. Doctors were more likely to prescribe a life-saving medication to the white man. The doctors were then given an implicit bias test. Those who were more likely to have implicit biases against black men were less likely to prescribe the medication.

I have had personal experience with this in taking KG to the ER after she had sneaked an Eggo waffle. She has a life threatening allergy to eggs. She had not yet gone into anaphylactic shock, but based on prior experience it was coming soon. I explained to the doctor the many times this has happened and the timeline of how everything plays out (her allergic reaction kicks in once the egg/egg product hits her small intestine). The doctor was first skeptical and then dismissive and left us alone for a long period of time with no monitoring. When KG slipped into shock, I had to go searching for someone to help. Even when she was in shock, the doctor would not give her epinephrine immediately. He wanted to try other things first. In case you’re wondering, that is not the protocol for anaphylaxis.

References:
Experience less pain -
http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0048546 (first 4 experiments)

Pain less adequately treated in minorities -
http://www.nejm.org/doi/full/10.1056/NEJM199403033300902
http://www.ncbi.nlm.nih.gov/pubmed/9634258
http://www.ncbi.nlm.nih.gov/pubmed/11880868
http://jama.jamanetwork.com/article.aspx?articleid=1149438

Pharmacies not stocking pain medication -
http://www.nejm.org/doi/full/10.1056/NEJM200004063421406
http://www.jpain.org/article/S1526-5900(05)00730-3/abstract?cc=y%3D

Doctors less likely to prescribe life-saving meds -
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2219763/