IN SICKNESS AND IN HEALTH: EXPOSING THE PAIN OF STRUCTURAL RACISM AND ITS MINDSET IN TREATMENT OF THE TERMINALLY ILL BLACK PATIENT AND THE NEED FOR CONGRESSIONAL OVERSIGHT

REPORTED BY

NORMAN J CLEMENT RPH., DDS, NORMAN L.CLEMENT PHARM-TECH, MALACHI F. MACKANDAL PHARMD, BELINDA BROWN-PARKER, JOSEPH SOLVO ESQ., REV. C.T. VIVIAN, JELANI ZIMBABWE CLEMENT, BS., MBA., WILLIE GUINYARD BS., JOSEPH WEBSTER MD., MBA, SHELLEY HIGHTOWER, BS., PHARMD.,  LEROY BAYLOR,  ADRIENNE EDMUNDSON, NATASHA DUVALL PHARMD., WALTER L. SMITH BS., LEROY BAYLOR, BS., MS., MS., BRAHM FISHER ESQ., MICHELE ALEXANDER, CUDJOE WILDING BS, DEBRA LYNN SHEPHERD, BERES E. MUSCHETT, STRATEGIC ADVISORS

THE PERCEIVED NEEDS AND BARRIERS TO OPTIMAL CONTROL

Journal of American Cancer Society

Cancer Pain Management Among Underserved Minority Outpatients

2002

The year is April 2002, Karen O. Anderson Ph.D. and her colleagues Stephen P. Richman M.D.Judith Hurley M.D.Guadalupe Palos R.N., Dr.PH.Vicente Valero M.D.Tito R. Mendoza Ph.D.Ibrahima Gning D.D.S.Charles S. Cleeland Ph.D. published in the Journal of American Cancer Society, an article called Cancer Pain Management Among Underserved Minority Outpatients ;Perceived Needs and Barriers to Optimal Control, examiing the role of bias and the mindset of medical clinicians in the treatment of pain in terminally ill cancer patients stating:

“Minority patients with cancer are at risk for undertreatment of cancer‐related pain. Most studies of patient‐related barriers to pain control have surveyed primarily non‐Hispanic Caucasian patients. The purpose of the current study was to explore barriers to optimal pain management among African‐American and Hispanic patients with cancer through the use of structured patient interviews. Structured interviews allowed the authors to probe for previously unidentified barriers to pain management in these populations.” (1)

Most African‐American patients (93%) and all Hispanic patients stated that they discussed their cancer pain with their doctor or nurse. However, more than half of the African‐American patients (57%) and 38% of Hispanic patients indicated that their doctor or nurse did not ask about pain prior to the patient telling them about their pain. Only 25% of African‐American patients and 29% of Hispanic patients indicated that their doctor or nurse used a pain scale for pain assessment. The pain scale was described as helpful by all patients who were asked to use one to rate their pain intensity.

Louis Ladson Pharmacy Owner___

Excellent article outlining the bias attacks against black-owned independent pharmacies doing exactly what they trained to do…….” Putting patient needs first”. Just because a pharmacy does not fall within the national average norms does NOT automatically mean illegal activity is taking place… maybe exceptional pharmacy care is taking place! Too many pharmacies are being attacked w/o cause along with assumed guilt versus assumed innocence.

Unfortunately, all of the patients indicated that they would wait until their pain was severe (≥ 7 on a 0–10 scale) before they would make a telephone call to their doctor, nurse, or oncology clinic. In addition, 88% of Hispanic patients and 82% of African‐American patients would wait until their pain intensity was a 10 before calling for assistance. Despite the apparent gaps in communication, most Hispanic patients (86%) and African‐American patients (92%) felt that their doctor understood about their pain.

LINDA CLEMENT, WIFE, MOTHER, STOMACH CANCER SUCCUMBED MARCH 13, 2019

Unfortunately, 25% of African‐American patients described physician reluctance to prescribe opioid medications for their pain. Some of these patients commented that their physicians warned them about a possible addiction to pain medication. Although no Hispanic patients reported physician reluctance to prescribe opioids, 35% of Hispanic patients were receiving analgesics that were inadequate for the severity of their pain. When opioid analgesics were prescribed, most patients did not have difficulty obtaining them from the hospital or clinic pharmacy. Lack of availability of a prescribed opioid in a neighborhood pharmacy was described as a barrier by 10% of the interviewed patients. The cost was described as a barrier to obtaining pain medication by another 10% of patients. Most patients, however, were able to obtain financial assistance with the costs of medication.

LINDA GALE WILKERSON CLEMENT

The African‐American patients tended to report more difficulty than the Hispanic patients discussing physical problems with other people. However, the two groups did not differ in reported difficulty with talking about having cancer or cancer‐related pain. Almost all patients in both groups stated that they discussed their pain with their physicians.

I FEEL I’M BEING STEREOTYPED

However, the majority of African‐American patients and more than one‐third of Hispanic patients indicated that they had to bring up the issue of pain management. Pain assessment reportedly was limited, with less than one‐third of patients describing some quantified measurement of their pain. Even more disturbing was the finding that more than 80% of patients in both ethnic groups would wait until their pain severity was a 10 on a 10‐point scale before calling their health care provider or oncology clinic for assistance with pain management.

Our results revealed that many of the patients in both ethnic groups used prayer and religious beliefs as complementary strategies for coping with pain. Also, about one‐third of patients were taking nonprescription analgesics that were not recommended by their physicians or nurses. Special teas, foods, vitamins, and supplements also were reported as complementary strategies. Thus, it is important to assess carefully what nonprescription medications or supplements a patient is taking.

One of the most troubling examples of research bias appeared on Fewer opioid prescriptions meant fewer deaths (possibly 14,000), but the episode also reveals how prevalent and harmful stereotypes can be, even if implicit.

THE PERCEIVED NEEDS AND BARRIERS TO OPTIMAL CONTROL

THE NEW YORK TIMES

“A Rare Case Where Racial Biases’ Protected African-Americans,”

2019

It is December 5, 2019, New York Times on “A Rare Case Where Racial Biases’ Protected African-Americans,” By Austin Frakt and Toni Monkovic 

When the opioid crisis began to escalate some 20 years ago, many African-Americans had a layer of protection against it.

But that protection didn’t come from the effectiveness of the American medical system. Instead, researchers believe, it came from racial stereotypes embedded within that system.

As unlikely as it may seem, these negative stereotypes appear to have shielded many African-Americans from fatal prescription opioid overdoses. This is not a new finding. But for the first time an analysis has put a number behind it, projecting that around 14,000 black Americans would have diedhad their mortality rates related to prescription opioids been equivalent to that of white Americans.

Starting in the 1990s, new prescription opioids were marketed more aggressively in white rural areas, where pain drug prescriptions were already high. African-Americans received fewer opioid prescriptions, some researchers think, because doctors believed, contrary to fact, that black people 1) were more likely to become addicted to the drugs 2) would be more likely to sell the drugs and 3) had a higher pain threshold than white people because they were biologically different.

I’M SO SORRY I CAN’T HELP YOU

A fourth possibility is that some white doctors were more empathetic to the pain of people who were like them, and less empathetic to those who weren’t. Some of this bias “can be unconscious,” said Dr. Andrew Kolodny, a director of opioid policy research at Brandeis University.

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. “The reason to study this further is twofold,” 

Dr. Kolodny said. “It’s easy to imagine the harm that could come to blacks in the future, and we need to know what went wrong with whites, and how they were left exposed” to overprescribing. The prescription opioid-related mortality rates of black and white Americans were relatively similar two decades ago, but researchers found that by 2010, the rate was two times higher for whites than for African-Americans.

Because African-Americans were less likely to receive those prescriptions, they were less likely to become addicted — though they were more likely to endure unnecessary and excruciating pain for illnesses like cancer.

THE PERCEIVED NEEDS AND BARRIERS TO OPTIMAL CONTROL

YOURWITHINTHENORMS.COM

“THE ENFORCERS OF JUNK SCIENCE AND THEIR BELIEFS”

2020

On December 22, 2020 Walmart Pharmacy writes in response to the United States Justice lawsuit stating:

“The Justice Department’s investigation is tainted by historical ethics violations, and this lawsuit invents a legal theory that unlawfully forces pharmacists to come between patients and their doctors, and is riddled with factual inaccuracies and cherry-picked documents taken out of context. Blaming pharmacists for not second-guessing the very doctors the Drug Enforcement Administration (DEA) approved to prescribe opioids is a transparent attempt to shift blame from DEA’s well-documented failures in keeping bad doctors from prescribing opioids in the first place. 

In contrast to DEA’s own failuresWalmart always empowered our pharmacists to refuse to fill problematic opioids prescriptions, and they refused to fill hundreds of thousands of such prescriptions. Walmart sent DEA tens of thousands of investigative leads, and we blocked thousands of questionable doctors from having their opioid prescriptions filled at our pharmacies. 

INSIDE THE OPIOID CRISIS

The Drug Enforcement Administration lacks the ability to rationalize within the agency the distinctive difference between criminal drug dealers and licensed pharmacists.  This agency has charged known drug dealers and licenses pharmacists with the same federal violation 21 U.S.C. §§ 841(a)( 1) (possession with the intent to distribute and distribution of oxycodone and hydromorphone and 21 USC 846 (conspiracy to do the same) and 843 (fraud/deception regarding the same). 

VIVIAN MCGEE, (SINGLE) BRIAN CANCER 2016

The multidimensional levels of corrupted behavior have allowed the DEA to view themselves as enforcers of justice within their own eyes, they see no wrong.  As this agency continues on its trajectory, it will soon develop into murderous acts to protect the agency or themselves from detection.  This agency has subordinated the laws in exchange to justify their actions. Right or wrong they stand behind what they do and believe.  This deliberate drive to be has shifted a once well-known and professional agency, to accept ‘deviant, dishonest, improper, unethical or criminal behavior.  The men and women of this once well-known and respected agency would understand the impact of deception.  Today the DEA does not and cannot accept errors of their ways.  

According to research done by Dr. Richard Lawhern

“The basic premises of the 2016 CDC guidelines on the prescription of opioid analgesics to adults with chronic non-cancer pain are wrong.  And CDC KNOWS they are wrong! 

Higher overdose mortality from 2010-2020 is a direct outgrowth of socioeconomic factors and the invasion of illegal Fentanyl into US street markets. We also know from State-level analysis of Prescription Drug Monitoring Programs data that when a prescription-type opioid is found in postmortem toxicity screens, it is likely to be only one substance among several, including illegal or diverted drugs and alcohol. Our “drug crisis” is driven by illegal drugs, not prescriptions.”

THE PERCEIVED NEEDS AND BARRIERS TO OPTIMAL CONTROL

THE LAWHERN FILES

“WHEN AN ONCOLOGIST FEARS TREATING “CANCER”

2021

The year is 2021, March the article AN ONCOLOGIST WHO LIVES IN FEAR, publish by Richard “red” Lawhern written by Dr Shulman:

Dr. Lawhern, I have read some of your blogs.  I completely agree with many of the things you stated as they apply to my particular case where I lost my license.  The reluctance of so-called “pain physicians” to care for patients who are on high doses of opioids and/or who show signs of “aberrant behavior” leaves patients suffering from pain and addiction in a precarious position and at risk for suicide. It also leaves poor physicians like me (an Oncologist)  who try to provide appropriate care for patients in real pain and addiction in a terrible position. 

The patient I was caring for the middle-aged African American woman, a single parent, without adequate insurance unfortunately committed suicide by overdosing on the opioid drugs I was supplying her. I feel due to the constant fighting she experienced with the medical system including pharmacies, doctors, hospitals. I was trying as best I could to find a doctor with appropriate experience to care for her, but they are an extreme rarity. (2)

THE PAIN OF INDIFFERENCE

In her case, she was probably asking for high doses i.e. double the dose she was using, and selling some of the drugs to pay for the drugs she was using as her insurance refused to pay for her opioids. She was also doing early refills.  She was seen by three pain specialists who observed aberrant behavior and either just “dropped her” or instituted or suggested rapid tapers leaving me -a hapless oncologist – with the task of wrestling with her pain control and addiction. 

https://www.c-span.org/video/?435395-3/senator-hatch-dea-opioid-crisis

Two of these pain specialists all verbalized the fear of the DEA as the reason for tapering to “safe” levels – which I felt was inadequate to control her pain.  A fourth pain specialist wanted to give her methadone without any other referral to addiction or psychologist and also proposed a rapid taper of her opioids which the patient did not want to accept. No pain specialist she saw would say “ok you have an addiction but you also have real pain, so I was a pain specialist will take your case on knowing its high risk and work with an addiction specialist and perhaps a psychologist and we will work together to when appropriate try to taper you slowly and appropriately and improve your situation. 

 https://www.dailymotion.com/embed/video/x4456kb

DEA AGENT STATES: “THE WAR ON DRUGS…IT’S ABOUT RACE…WE DON’T ENFORCE DRUG LAWS IN WHITE AREAS”

It seems in my opinion, the medical and legal world divides patients into two categories:  

(1) Patients who show patterns of addiction: Providers are taught that these patients should be “dropped” because health care providers will be sanctioned by the DEA and state for “inappropriate prescribing of controlled substances”  under the controlled substance act and lose their license  These patients are at highest risk of overdose (according to the CDC guidelines in 2016) and hence increase the fear of prescribing to such patients.   

(2) Patients who have legitimate need meds for pain control (with or without dependence). These patients can continue to take their opioids safely as long as they are in low doses continued to be prescribed opioids.

“OUR SYSTEM OF JUSTICE IS THREATENING THE LIVES OF A LOT OF INNOCENT PEOPLE,” BRYAN STEVENSON ESQ. EQUAL JUSTICE INTIATIVE

THE CONCLUSION DRAWN BY THESE STUDIES:

2002 THRU 2021

NO AMOUNT OF PREJUDICES CAN JUSTIFY RACISM IN MEDICAL CARE 

There is absolutely no amount of prejudice, that can be justified, in any form of medical care treatment to support racism. Andrew Kolodny MD, has worked as an adviser to DEA, NIH, CDC, and has testified numerous times before the United States House and Senate. Dr. Kolodny’s opinions have shaped United States drug policy as well that found in academia, however, they are seriously flawed.  (3)(4)

CHRISTINA DENT: “END THE WAR ON DRUGS”

EXAMINING HOW DRUGS LAWS ARE ENFORCED AND THE NEED TO RE-EXAMINE POLICY

Dr. Kolodny’s thinkings allow for the withholding and or the denial of medical care, based upon a preconceived racial bias, supported by a foundation of erroneous science. The assertions and conclusions drawn by Dr. Andrew Kolodny and those who conducted this research are seriously flawed and further demonstrates how bias undermines healthcare for all Black people. These misconceptions are ingrained in people at a young age, too, according to Dore, Hoffman, Trawalter et. al., Researchers who asked black and white children to rate each other’s pain determined they’d adopted a“weak racial bias” by 7 years old and a“strong and reliable” bias by 10 years old.

Yet, more disturbingly, there has been very little push-back from Black professional medical organizations, academia, journal, and media debunking these medical stereotypes Dr. Andrew Kolodny et al., have been promoting. The utter silence upon those who profess to represent the concerns of people of color further highlights the saying, “silence is interpreted as consent” and“when one is not present at the table then one is on the menu.

DON’T GET CANCER IF YOU ARE BLACK OR HISPANIC

The barriers to pain management reported by each patient group indicate that socioeconomically disadvantaged African‐American and Hispanic patients can benefit from educational interventions on cancer pain that dispel myths about opioids and that teach patients to communicate assertively about their pain with their physicians and nurses. In addition, some patients need education regarding realistic expectations for pain treatment. Although most patients expected pain reduction to a mild level of pain intensity, over one‐third of the total sample expected the complete elimination of pain. If this is not a realistic goal for a patient, then additional education is required.

WHAT A MAN LOOKS LIKE 1 YEAR LATTER 2017, DIAGNOSED CANCER FREE, NORMAN J CLEMENT, INVASIVE SUB MUCOSAL ADENOCARCINOMA, COLON CANCER 2016

The same is true about the War on Drugs.  The efforts of the DEA, shutting down legitimate operating pharmacies are providing drug cartels a major boost.  The arrogance of their wrong is perpetrated, with each pharmacy that is closed, the sales of illegal pain medication are increasing in the community.  Such an aggressive act clearly displays that this government agency has lost its way.  It is difficult to draw conclusions about prohibition’s impact on crime at the national level, as there were no uniform national statistics gathered about crime prior to 1930.  It has been argued that organized crime received a major boost from Prohibition.(5)

FOR NOW, YOU ARE WITHIN

YOUAREWITHINTHENORMS.COM , (WYNTON MARSALIS CONCERTO FOR TRUMPET AND 2 OBOES, 1984)

THE NORMS

endnotes

  1. https://doi.org/10.1002/cncr.10414
  2. https://youarewithinthenorms.com/2021/04/03/cancer-patient-pain-suicide-and-dea-policywhen-an-oncologist-fears-treating-cancer/

3. https://youarewithinthenorms.com/2021/03/10/how-perpetual-racial-stereotyping-in-of-pain-control-prescribing-is-used-by-by-the-united-states-department-of-justice-and-the-united-states-drug-enforcement-administration-promotes-and-enforced-r/

4. https://www.painnewsnetwork.org/stories/2021/5/12/americans-reporting-more-pain-than-ever

5. https://youarewithinthenorms.com/2021/03/28/the-war-on-drugs-the-targeting-of-black-owned-pharmacies-stratification-economics-opium-money-and-the-rape-of-china/

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