THE ALGORITHMS OF MEDICAL APARTHEID: OF ROLE MODELS AND THE PEOPLE MADE TO BE INVISIBLE

BY MICHELLE ALEXANDER MD

AND SUPPORTED BY

NORMAN J. CLEMENT RPH., DDS., MALACHI F. MACKANDAL PHARMD, JOSEPH SOLVO ESQ., BEVERLY PRINCE MD., JACK FOLSON RPH., NORMAN L.CLEMENT PHARM-TECH, REV. C.T. VIVIAN, JELANI ZIMBABWE CLEMENT, BS., MBA., WILLIE GUINYARD BS., BRAHM FISHER ESQ., JOSEPH WEBSTER MD., ESTER HYATT PHD., BERES E. MUSCHETT, STRATEGIC ADVISOR

THE MANIFESTO OF THE NORTH STAR PROJECT

When you see THROUGHOUT LIFE most of your friends, colleagues, and classmates who are of degree being sanctioned, terminated, harassed, arrested, jailed, and imprisoned for the most minuscule violation of a regulation, or for just doing what they’ve been trained to do.
Then at some point, you are compelled to ask yourself when

ENOUGH IS ENOUGH

ARE WE NOT SEEN AS BEING HUMAN ???

 THE ALGORITHM

According to Heidi Ledford  in the October 24, 2019  issue of Nature Magazine, titled;

“Millions of Black People Affected by Racial Bias in Health-care Algorithms” 

“An algorithm widely used in US hospitals to allocate health care to patients has been systematically discriminating against black people, a sweeping analysis has found. (1)(2)

The study, published in Science on 24 October, concluded that the algorithm was less likely to refer black people than white people who were equally sick to programs that aim to improve care for patients with complex medical needs. Hospitals and insurers use the algorithm and others like it to help manage care for about 200 million people in the United States each year.

SOWETO, SOUTH AFRICA

“The researchers found that the algorithm assigned risk scores to patients on the basis of total health-care costs accrued in one year. They say that this assumption might have seemed reasonable because higher health-care costs are generally associated with greater health needs. The average black person in the data set that the scientists used had similar overall health-care costs to the average white person.

ARE WE NOT SEEN AS HUMAN ??

Michelle Alexander MD., a graduate of the College of Medicine University of Florida and practicing physician in New York City, writes:

  • Rampant racial bias in the health care algorithms used by hospitals and insurance companies
  • Black patients receive lesser care than white patients who are equally sick
  • Black health-care professionals are forced to spend hundreds of hours to justify treatment
  • Black patients spend more money for less care
  • Algorithms used by hospitals and insurance companies failed to account for inherent historical social injustices which are built into the systems (6)

The common man or woman has very little understanding of how so-called drug policies directly affect their daily living, until they become are diagnosed with some chronic illness or have a loved one who may be facing death. Then, the importance of chronic illness and disease states is ever so critical. 

BLACK-OWNED PHARMACIES ARE SYSTEMATICALLY RACIALLY PROFILED

Let it further be clear, patients being treated for chronic pain who travel to a Black-owned pharmacy are called “RED FLAGS” by the DEA and these pharmacies  are  classified as imminent dangers to the “Public Health.” While the same patients traveling to non-black owned pharmacies, with the same prescriptions, using the exact same payment methodology, the fictitious label of “red flags” does not truly exist.  

However, the large chain pharmacies and their parent companies clearly violate laws through false billings and even forged prescriptions on their part, while the DEA collects billions of dollars in what amounts to “extortion fines” and the large chains are given a pass. These warnings remain ever so obliterated, and one cannot ignore the functions of how race works in these types of proceedings.

In October 2019, I read an article published in Nature magazine that I was immediately struck by.  It explained what I and many of my colleagues already knew.  This was that Black patients were systematically given lesser or poorer care than white patients with similar diagnoses who were equally sick.  

LESEDI CULTURAL VILLAGE, GAUTENG, SOUTH AFRICA

The article reviewed a study published in Science, which documented what was described as rampant racial bias in the health care algorithms used by hospitals and insurance companies to determine the level of care required for patients, based on the data provided to them by the doctors treating these patients. 

ARE WE NOT SEEN AS BEING PEOPLE?

THE VILLAGE PHARMACIST OF QUILLLUBO KATENGA, CACHOEIRA BAHIA, BRAZIL

These hospitals and insurance companies used these algorithms to help manage care for ~200 million people in the US.  The article went on to explain that smaller studies have also documented racial bias in decision-making algorithms in everything from the criminal justice system to education.  

CAPE TOWN SOUTH AFRICA

It also explained the countless hours spent by my colleagues on telephones and emails to justify the care that they were providing to their patients (Black doctors and Black patients).  In many cases, doctors would be forced to provide care that was never reimbursed or to provide lesser care because of these algorithms. Black patients were often sicker with co-morbidities such as diabetes, hypertension, kidney disease, which often would require a greater level of care but did not receive it because of such algorithms. 

GAUTENG SOUTH AFRICA

This was also confirmed by the data in which Black patients received care at a cost of $1,800 less than given to a white person with the same number of chronic problems. Needless to say, if doctors did not diligently pursue the necessary treatment, patients suffered.  Not all health care providers are so diligent in this pursuit.  We already know of the health care biases of humans due to racism and white supremacy.

LESEDI CULTURAL VILLAGE, GAUTENG, SOUTH AFRICA

The researchers of the study (Obermeyer et all) collaborated with the developers of the algorithm (Optum of Eden Prairie, Minnesota) to improve the algorithm to reduce racial bias. Changes were made to reduce bias by 84%.  Optum said in a statement that the researcher’s findings were “misleading” because this was only one of the data points used for managing care.  It stated that the doctor’s expertise was the most important.  However, what Optum failed to understand is the time consumption spent by the doctors of Black patients justifying such care, and often these many hours that would be unnecessary to receive such care. (4)(5)

AMERICAN IN CAPE TOWN

The researcher points out that changing the variables to correct such bias is not straight forward. Racism and injustice is built into the systems and therefore is not easily fixed.  It is also in part because of the lack of diversity among the algorithm designers and knowledge and training to these designers about the inherent social and political injustices historically in our systems.  

As Black doctors, dentists, nurse practitioners, pharmacists, and ultimately patients we deserved fair and equitable treatment and reimbursement for such care. This is a failure of the systems and must be rectified. These algorithms have been in place for decades.  It boggles the mind about the cost to life and health due to such algorithms.

FOR NOW YOU ARE WITHIN THE NORMS

END NOTES

  1. https://www.nature.com/articles/d41586-019-03228-6
  2. https://www.nature.com/articles/d41586-018-05469-3
  3. The Algorithmic Justice League’s mission is to raise awareness about the impacts of AI, equip advocates with empirical research, build the voice and choice of the most impacted communities, and galvanize researchers, policymakers, and industry practitioners to mitigate AI harms and biases. We’re building a movement to shift the AI ecosystem towards equitable and accountable AI.
  4. Actionable Auditing: Investigating the Impact of Publicly Naming Biased Performance Results of Commercial AI Products, Inioluwa Deborah Raji University of Toronto 27 King’s College Cir Toronto, Ontario, Canada, M5S 3H7 deborah.raji@mail.utoronto.com, Joy Buolamwini Massachusetts Institute of Technology 77 Massachusetts Ave Cambridge, Massachusetts, 02139 joyab@mit.edu

5. https://www.fastcompany.com/90525023/most-creative-people-2020-joy-buolamwini EXPOSING

6. https://www.walgreens.com/rx-healthanswer/health/p2/a/3200001/how-systemic-racism-affects-public-health-part-1-health-disparities-among-black-people/2449079?ec=hncx1328345_Standard_hero&%24web_only=true&~campaign=hncx1328345_Standard_hero&mi_u=AJeqrs&%243p=e_cheetahmail&%24original_url=https%3A%2F%2Fwww.walgreens.com%2Frx-healthanswer%2Fhealth%2Fp2%2Fa%2F3200001%2Fhow-systemic-racism-affects-public-health-part-1-health-disparities-among-black-people%2F2449079%3Fec%3Dhncx1328345_Standard_hero%26%24web_only%3Dtrue%26~campaign%3Dhncx1328345_Standard_hero%26mi_u%3DAJeqrs&_branch_match_id=825407215207560675

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