RACIST MEDICINE
Most patients unaware of how race is used to make risk assessments, guide clinical care
New study provides an important contribution to the ongoing discussions about racism in medicine
Peer-Reviewed Publication(Boston)— Algorithms that incorporate race as a modifying factor to guide clinical decision-making have recently been criticized for propagating racial bias in medicine. The calculation of lung or kidney function are examples of equations that have different diagnostic parameters depending on an individual’s race. While these clinical measures have multiple implications for care, patients’ awareness of and their perspectives on the application of such algorithms is unknown.
To examine patients’ perspectives on race and the use of race-based algorithms in clinical decision-making, researchers from Boston University Chobanian & Avedisian School of Medicine and Boston Medical Center (BMC) undertook a study to investigate patients’ perspectives on race, racism and the use of race-based algorithms in clinical decision-making.
“We learned that patients were generally unaware of the widespread use, and misuse of race in medicine and also elicited differing perspectives on race and racial discrimination in healthcare settings,” explained corresponding author Insa Marie Schmidt, MD, MPH, assistant professor of medicine. “For example, the use of race to calculate pulmonary function can reduce the likelihood that Black patients receive disability support for lung diseases.”
To examine patients’ perspectives, the researchers conducted semi-structured, qualitative interviews. Most study participants were not cognizant of how race has been used to make risk assessments and guide clinical care. Experiences described by non-white participants ranged from micro-aggressions to overt acts of racism, including perceived racist encounters with healthcare providers. In addition, patients spoke of a deep mistrust in the healthcare system as a major barrier to equitable care.
According to the researchers these findings highlight the deleterious effects of racism on health and suggest that focusing research on patients and their lived experiences is crucial to inform the development of anti-racist policies and regulatory agendas.
“We hope this study will ultimately highlight the need to center the voices of historically marginalized and minoritized patients when designing research aimed at addressing racism in medicine,” adds Schmidt.
These findings appear online in the Journal of General Internal Medicine.
I.M.S. is supported by the American Philosophical Society Daland Fellowship in Clinical Investigation. I.M.S. and Merav S. are supported by the Social Science Research Council grant SSRC-4393. S.S.W. is supported by NIH grants UH3DK114915, U01DK085660, U01DK104308, R01DK103784, and R21DK119751.
Note to Editor:
S.S.W. reports personal fees from Public Health Advocacy Institute, CVS, Roth Capital Partners, Kantum Pharma, Mallinckrodt, Wolters Kluewer, GE Health Care, GSK, Allena Pharmaceuticals, Mass Medical International, Barron and Budd (vs. Fresenius), JNJ, Venbio, Strataca, Takeda, Cerus, Pfizer, Bunch and James, Harvard Clinical Research Institute (aka Baim), Oxidien, Sironax, Metro Biotechnology, Biomarin, and Bain. N.D.E is a full-time employee of Fresenius Medical Care. E.C.M. is also employed by the American Medical Association in the Center for Health Equity. All other authors have nothing to disclose.
JOURNAL
Journal of General Internal Medicine
METHOD OF RESEARCH
Survey
SUBJECT OF RESEARCH
People
ARTICLE TITLE
Patients’ Perspectives on Race and the Use of Race-Based Algorithms in Clinical Decision-Making: a Qualitative Study
ARTICLE PUBLICATION DATE
22-Feb-2023
COI STATEMENT
S.S.W. reports personal fees from Public Health Advocacy Institute, CVS, Roth Capital Partners, Kantum Pharma, Mallinckrodt, Wolters Kluewer, GE Health Care, GSK, Allena Pharmaceuticals, Mass Medical International, Barron and Budd (vs. Fresenius), JNJ, Venbio, Strataca, Takeda, Cerus, Pfizer, Bunch and James, Harvard Clinical Research Institute (aka Baim), Oxidien, Sironax, Metro Biotechnology, Biomarin, and Bain. N.D.E is a full-time employee of Fresenius Medical Care. E.C.M. is also employed by the American Medical Association in the Center for Health Equity. All other authors have nothing to disclose.
Black people less likely to receive dementia-related medications
MINNEAPOLIS – Black people are receiving medications for dementia less often than white people, according to a preliminary study released today, February 26, 2023, that will be presented at the American Academy of Neurology’s 75th Annual Meeting being held in person in Boston and live online from April 22-27, 2023.
“Previous research has shown that due to racial disparities, people with dementia do not always receive the same access to medications that may be beneficial in nursing homes and hospitals,” said Alice Hawkins, MD, of Mount Sinai in New York, New York, and a member of the American Academy of Neurology. “However, there is limited data for the use of dementia medications that people take at home. Our study found disparities in this area as well. We hope our findings lead to a better understanding of these disparities so that steps can be taken to eliminate this health inequity.”
The study involved 25,930 people. Of this group, 3,655 were Black and 12,885 were white. Researchers collected information on the participants including asking them about race and outpatient medications.
Researchers looked at how often participants received one or more of five medication classes typically prescribed for dementia. Cholinesterase inhibitors prevent the breakdown of a chemical messenger in the brain called acetylcholine, which is important for memory and thought. People with dementia may also use N-methyl-D-aspartate (NMDA) antagonists, which can help cognitive function. Both drug classes help facilitate communication between nerve cells. Selective serotonin reuptake inhibitors (SSRIs) are common antidepressants, antipsychotics treat psychosis and benzodiazepines can be used to treat anxiety and agitation.
Researchers found that Black people with dementia received all five medication types less often than white people.
For cholinesterase inhibitors, 20% of Black people received a prescription compared to 30% of white people. For NMDA antagonists, the numbers were 10% for Black people and 17% for white people. For SSRIs, the numbers were 24% and 40%. For antipsychotics, the numbers were 18% and 22%. For benzodiazepines, the numbers were 18% and 37%.
The differences remained after researchers controlled for factors such as age, sex, and insurance type.
“Black people who saw a neurologist were receiving cholinesterase inhibitors and NMDA antagonists at rates more comparable to white people,” said Hawkins. “Therefore, referrals to specialists such as neurologists may decrease the disparities for these prescriptions.”
A limitation of the study was that the data relied on what was present in participants’ medical records. Another limitation is that data on the actual prescription behavior of physicians could not be reliably collected. Therefore, Hawkins said it remains unclear how much of the observed disparity is due to physicians prescribing fewer medications to Black people versus other patient-related factors, such as inability to afford medications.
Hawkins noted, “More research is needed to understand the root cause of such disparities and design programs to eliminate them.”
The study was supported by the American Academy of Neurology Resident Research Scholarship, which was awarded to Hawkins.
Learn more about dementia at BrainandLife.org, home of the American Academy of Neurology’s free patient and caregiver magazine focused on the intersection of neurologic disease and brain health. Follow Brain & Life® on Facebook, Twitter and Instagram.
When posting to social media channels about this research, we encourage you to use the American Academy of Neurology’s Annual Meeting hashtag #AANAM.
The American Academy of Neurology is the world’s largest association of neurologists and neuroscience professionals, with over 38,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, concussion, Parkinson’s disease and epilepsy.
For more information about the American Academy of Neurology, visit AAN.com or find us on Facebook, Twitter, Instagram, LinkedIn and YouTube.
No comments:
Post a Comment