Your headline purports that racial discrimination has some how protected Black people from opioid addiction. Should I "feel" lucky for not having access to a drug that could drastically improve my quality of life? I don't feel lucky. I am dismayed and unfortunately proven right that doctors under treat black patients.
This is discrimination plain and simple. Having lower addiction rates is not the consolation prize you believe it to be. Black people have and will continue to suffer in pain needlessly because their physician's see their skin color before they see their pain.
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How very ironic!
This is an argument for Medicare for all, in which everyone, supposedly, would be treated the same. However, it's unlikely that such a change would get through Congress. The ACA picks winners and losers, even if it's not based on race.
One question that could answer whether there was racism or some other factor would be to look at the death rate for black patients who had black physicians and compare that to the death rate for black patients who had non-black physicians.
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I could give you a long explanation but take it from me, what you propose would be unscientific.
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@James - the same PNAS study i reference in a comment above also (as usual in academic papers) reviews the relevant research (up to 2016) regarding racial bias in medical care.
the authors summarize four papers as follows:
"Of note, this research has also shown that racial attitudes, measured both implicitly and explicitly, do not predict racial bias in pain perception or treatment (11, 15, 18), with the exception of one study showing that implicit pro-white attitudes predicted physicians’ likelihood of recommending thrombolysis treatment (19). Racial bias in perceptions of pain (and possibly treatment) does not appear to be borne out of racist attitudes. In other words, it is likely not the result of racist individuals acting in racist ways."
in any article, you need to read cited research papers to understand what they actually document.
for that matter, i take strong exception to the authors' claim in this article that the Tuskegee study was an instance of "inferior health care." it was an exploitative and racist abuse of human life, perpetrated without outrage for four decades and with a sham "informed consent" from the participants.
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@James , Hi James, there have been such studies, and black patients treated by black doctors receive better preventative care and better long term care and on average have better medical outcomes and longer life spans than black patients treated by white doctors.
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Opium derived pain killers are prescribed for pain. If taken as directed they are very effective and have less side effects then other pain medication. Other than street drugs the Dosis is always exactly the same and entirely predictable.
Therefore any overdose is the responsibility of the consumer.
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@Walter GerholdhTheOpium, if patients and doctors were accurately appraised of how addictive a given drug was, I might agree with you, but the facts say that is not correct.
For instance, Purdue Pharma downplayed the addictive nature of OxyContin when marketing to patients *and* doctors. Not only that, but they encouraged doctors to prescribe the maximum dose because it was more profitable. This behavior continued after they knew addiction was becoming a problem.
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@Walter GerholdhTheOpium you have been grossly misinformed.
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@SuzTee Anyone who has attended a public school in American has heard how addictive opioids are. Users are fully aware that “less addictive” is an empty marketing term and as meaningless as a drug pusher's promises. Those who combine multiple illegal narcotics with alcohol (the cause of the majority of overdose deaths) do so knowing the risks.
It's much easier to blame pain patients with broken bodies for the crisis and deny them access to prescribed opioids than admit the deaths are caused by illegally obtained Chinese-made fentanyl. The war on drugs is a farce and a failure. It was never designed to stop drug use, only to be a tool enabling racial discrimination.
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There was once a time when Afro-Americans were viewed as not being courageous enough for front line military combat. As a result, they were relegated to behind the lines support roles, often menial roles. Away from front line danger.
Sounds like a good deal.
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I realize this article is a short report. However, the journalist can not be irresponsible with language in absence of a critical analysis of the issue. Specifically, using the word "protection" to seemingly justify implicit bias. Furthermore, not considering the negative implications of the bias as far as illicit opioid use/abuse and subsequent death after denial of prescription opioids for pain related to serious illness. I'll rename the article: A common case where racial bias harmed Black patients
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After reading “Medical Apartheid,” I am no longer shocked by the racial disparities in healthcare that continue to this day.
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What is next for these researchers? To find out how many African lives were saved from cobra snakes, lions, etc. when they were brought over to America as slaves? Oh, and they'll acknowledge that the lives saved from African wildlife does not outweigh the atrocity of the slave trade.... so noble of them. Why make this report in the first place. Strikes me as being an incredibly contorted attempt to justify denying legitimate pain medications to African Americans or anybody, for that matter, which is exactly what you might expect from someone like Andrew Kolodny, infamous anti-opioid crusader, whose expertise is not pain management but testifying for large sums of money ($500-$700 K for the J&J Oklahoma trial). Possibly feeling the threat of evidence-based science breathing down his neck as presented by such agencies as the CDC, FDA, HHS, AMA and Human Rights Watch, he is desperately trying to find some justification i.e. saving African Americans from addiction by denying them pain meds. That kind of insanity is, unfortunately, spreading even into the care of terminal cancer patients with more reported cases of denial of opioid pain meds, even in the last stages of life, for fear that "they might get addicted". With legions of weak-minded, compliant news reporters marching in lock step, there is no shortage of assistance Kolodny and his ilk can summon for a public platform to continue spreading the false but popular notions of opioids.
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@tritone inversion,
The headline of this article may be injudicious, but the cited study traces a specific impact of racism on both African-Americans and our nation. It in no way deprecates other harmful impacts. The individuals whose selfish behavior exacerbates racism are outside the scope of the study. Should it not be reported nonetheless?
They may have avoided addition or worse, but they were certainly not offered other forms of relief, I bet. They were more likely just told to "move along" - which is a far cry from good treatment. I can't read this as anything positive.
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I don't think we should in any way celebrate that people were denied access to needed pain medication. The vast majority of people who use pain medication for medical issues never have any issue with addiction. Untreated pain can cause severe problems. I have had pain all of my life due to a birth defect. I'm a white female with a long medical history to back up my claims and I still struggled to get proper pain treatment, even immediately after surgeries. I now have PTSD from extreme, undertreared pain after a horrible surgery. That makes it very hard for me to access medical care and because of my underlying issues I HAVE to see doctors freqeuntly. I am so, so saddened that people were left without pain medication due to the color of their skin. There is no excuse for this failure.
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Much is lost without the framework of "racial capitalism"
http://bostonreview.net/forum/donna-murch-how-race-made-opioid-crisis
"... some researchers think.."
And the answer is (as always)...'racism'.
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@Ami
Some researchers find that one's status in life is determined by the intersection of one's social privileges (en.wikipedia.org/wiki/Intersectionality). There's no escaping the racism embedded in American society, along with prejudice based on gender, sexual preference, religion, economic class etc. I suggest you examine your own privileges.
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The authors, it seems, lack any understanding of what the words "protection" and "discrimination" mean. To contend the under-recognition and under-treatment of Black pain is a form of "protection from discrimination" requires ignoring the pains that resulted in disproportionate losses, declining productivity, diminishing physical mobility, and avoidable death. It requires overlooking the humans who were demeaned as drug seeking, faking, or incompetent and turned away, untreated, and their underlying malady potentially unaddressed. Rather than framing the opioid epidemic, and its deaths, as a "good example" of where discrimination doesn't live, perhaps times such as these should be marked as harrowing reminders of just how white supremacy discriminates. Because while disproportionately offering white patients an opioid may disproportionately offer them death, disproportionately neglecting Black pain, and the underlying etiologies of that pain, also offers them death. Because not every patient who received an opiate prescription becomes an addict. But every patient whose pain is under-appreciated risks concurrent and continued suffering, from the pain itself and whatever it stems from. This too is a form of discrimination and its toll is deeply palpable.
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@Dr. Boyd: You seem to have misread the article. The authors of the NY Times article do not say that the undertreatment of Black pain is a form of protection from discrimination. The premise of their article, which they clearly state, is that undertreatment has been a result of discrimination. Also, the authors do not claim that Blacks were protected from discrimination but that they were protected from higher numbers of overdose deaths. And the authors do describe the negative consequences of underprescribing pain medication for Blacks (and other non-White groups), including needless suffering.
One of the authors of the study that is described in the article did say “First, it’s a good example of how more medical care is not necessarily a good thing,” and “Second, it’s an extremely rare case where racial biases actually protected the population being discriminated against.” First, he sees the result as a good example regarding the use of medicine, not on the occurrence of discrimination. Second, he clearly states that the effect results from racial bias (living discrimination, if you want). This study author does mention protection from being discriminated against, which I agree may seem inappropriate, but I understand him to mean that discrimination had some beneficial effects for Blacks, in this case perhaps 14,000 fewer deaths. Even considering all of the other factors, I can't think of an argument to support 14,000 additional deaths as the better outcome.
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Sam Quinones's award-winning book "Dreamland" reports that the Mexican heroin gangs who cleaned up after prescription opioids started being cracked down upon tended to avoid big cities with black drug gangs in favor of whiter parts of the country like southern Ohio and Kentucky.
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Studies like this treat the black community as monolithic and you get one undifferentiated number that ignores the fact that there are rich and poor, Latin and ancestral American, urban and rural and on and on. Any study that compares blacks to others should include multiple distinct black populations. A wealthy Southern black and a poor Northerner get little useful information if the results reported are the average of everyone of the same skin color.
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@michjas
Racism makes no class distinction. Serena Williams is a wealthy well-known black woman who Almost died in a hospital because white medical professionals refused to take her concerns seriously. God only knows what is happening to blacks who lack wealth and a public platform.
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In my undergraduate nursing clinical rotations, I cared for African American patients who suffered from and endured sickle cell crises. This was decades before the use of opioids for chronic pain, and these crises were treated with morphine until the patients were able to tolerate the pain. We mostly erred on the side of not enough pain medication in acutely injured or ill patients, but we were there to encourage, and cajole patients to ambulate, to breathe deeply (before disposable incentive spirometers), and to use daytime mobilization out of bed to help with rest and sleep (no beeping technology to awaken patients). Before DRGs and "managed care" in the mid 80s, professional nursing was a days-weeks long presence helping patients to recover from dependency and pain to independence and comfort.
Professional nursing has been stripped from US healthcare. We don't allow patients to recover fully before discharging them to wherever, not knowing or caring who is there to help them in the absence of the professionals whose expertise lies exactly with pain management, comfort and recovery
Nursing has been left out of health policy analysis, planning and allocation of healthcare dollars and resources. Until this profession is given seats at the decision-making table, expect these terrible, but foreseeable, crises and awful outcomes to continue.
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This may be a rare case, but the consequences of this positive discrimination in favor of white patients have been devastating. The outsized death rates from opioid epidemics are part of the "deaths of despair" concentrated in some white communities. This in turn, in terms of the change in the average life expectancy for the entire nation, is the biggest health care crisis in 100 years, since the influenza pandemic. And yet this is not worth mentioning in this article. I wonder why.
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@John
The article presumes readers are informed about the opioid crisis and don’t need to have it explained as though they are four years old.
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And Wanda Sykes said what, please?
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@Miss B
Ms Sykes is a under appreciated national treasure.
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i am increasingly intrigued by the difference between personal, structural and notional racism. racism in medicine illustrates the difficulty.
the study cited on physicians showed that physicians were more likely to "underestimate" patient pain (39%) than "overestimate" pain (15%), but got it right half the time (47%).
pain was judged on a 0 to 10 scale, and i could "underestimate" your pain by rating it at 4 rather than your 5.
the article argues that this must mean lower opioid prescriptions and 14,000 lives saved. but does it?
it's possible that patients responding to a questionnaire were more candid than they were to physicians with patient quotas, who can appear brusque or intimidating -- especially when only 6% of them are black.
i won't get into all the health and legal regulations that dictate care against doctors' better judgment, which my sister (an anesthesiologist) recounts to me through many examples.
but there's who has health insurance, whether the patient presents in routine care or an emergency room, and the pain diagnosis. who is likely to sue because of inadequate pain treatment -- the rich or the poor?
as for incarceration: we're not looking at opioids vs. crack, but at corporate executives and doctors (all lawyered up) vs. street dealers.
as for regulation: the FDA heeled big pharma's leash for many years. it wasn't the change from rural to urban, but the accumulating body count, that finally turned the tide.
is it all just racism?
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@drollere
Yes, it is racism.
Why contort yourself to explain away the numbers? Why search feverishly for an explanation counter to what drives many, if not most, of the racial disparities played out in our nation during your lifetime and centuries before? Time wasted that would be better spent figuring out how to counter and offset the bias and unnecessary pain and death of African-Americans and Hispanics.
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@Just me - i'm not contorting anything. look, for example, at the PNAS study that examines "medical students and residents who endorsed false beliefs":
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4843483/
look specifically at the graph showing rated pain among med students as a function of "false beliefs" (FB, a 15 item scale) by race (Figure 2 of the article).
if FB is high, then white pain is rated higher than blacks; if FB is low, then black pain is rated higher than whites. racism, right?
the problem: that reasoning uses whites as the benchmark. as you will see if you examine the graph, the rated pain in blacks is EXACTLY THE SAME whether the FB score is high or low.
instead, as FB scores go up, so does the rated pain of whites -- by a whole point. and as the authors explicitly note, the FB scale is constructed so that most of the false belief items imply that whites are weaker than blacks.
also, if you look at the tabulation of false beliefs by year of medical training, you find that false beliefs as a whole decline with medical training. doctors are not trained in racism.
this study only asked med students to rate medical files, not diagnose actual people. but the obvious inference -- that whites were overprescribed opioids because doctors believe they are weaker -- is equally plausible.
i only have to get on reddit to see racism is real. i'm resisting the impulse to call every racial disparity an instance of racism against blacks. it's just not that simple.
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@drollere
Why does "it" have to be just one thing? Racism is a known fact of daily life for everyone, especially in the USA where so many of our people are the descendants of captive African slaves. Yet so is discrimination based on gender, religion, socio-economic class, education, age etc. The term for their combined impacts on individuals and society is "intersectionality" (en.wikipedia.org/wiki/Intersectionality).
As a male, Protestant, well-educated, affluent, senior American citizen of Northern European ancestry, I'm uncomfortably aware of my own intersecting privileges. They undermine my well-meaning efforts to treat everyone with the same respect. I respectfully suggest you examine your own biases.
“Several years ago, researchers at the University of Virginia, including Dr. Oliver, probed the beliefs of 222 white medical students and residents and published results in the Proceedings of the National Academy of Science. Half held false physiological beliefs about African-Americans. Nearly 60 percent thought their skins were thicker, and 12 percent thought their nerve endings were less sensitive than those of white people”.
I am no longer surprised.
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Wanda Sykes called it.
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@Mario313 You beat me to it! I was just going to write that.
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Hmm. What did Wanda Sykes Say? Not familiar with her comments relating to this....if you don’t mind sharing
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@Patrice
A full transcript of Wanda Sykes' "Not Normal" is available online. You'll want to read the section that says, "Because of racism, black people, we don’t even get our hands on opioids."
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This headline frames the issue irresponsibly.
Because of the same prejudicial medical attention, black Americans are more likely to have serious illnesses that go undiagnosed and black Americans are more likely to die or have major complications during childbirth. Etc. etc. etc.
Maybe a few thousand lives were accidentally saved in this one instance, but how does that stack up against all of the other evidence that being black in America is inherently bad for your health?
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@Rachel Hardy It very clearly says in the headline that it is "rare". Also - as it says right in the article:
"This accidental benefit for African-Americans is far outweighed by the long history of harm they have endured from inferior health care, including infamous episodes like the Tuskegee study. And it doesn’t remedy the way damaging stereotypes continue to influence aspects of medical practice today."
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