THE HARLEM WISDOM TABLE INTERVIEWS NORMAN J CLEMENT RPH DDS: THE CRIMINALIZATION OF MEDICAL PAIN PROTOCOLS, EXPOSING RACIAL BIAS IN PAIN ASSESSMENT AND TREATMENT: THE UNINTENDED CONSEQUENCES OF INCREASED SUICIDE IN THE WHITE CHRONIC PAIN SUFFERERS

BY

NORMAN J CLEMENT RPH., DDS, NORMAN L.CLEMENT PHARM-TECH, MALACHI F. MACKANDAL PHARMD, BELINDA BROWN-PARKER, IN THE SPIRIT OF JOSEPH SOLVO ESQ., IN THE SPIRIT OF REV. C.T. VIVIAN, JELANI ZIMBABWE CLEMENT, BS., MBA., WILLIE GUINYARD BS., JOSEPH WEBSTER MD., MBA, BEVERLY C. PRINCE MD., FACS., LEROY BAYLOR,   JAY K. JOSHI MD., MBA, ADRIENNE EDMUNDSON, ESTER HYATT PH.D., WALTER L. SMITH BS., IN THE SPIRIT OF BRAHM FISHER ESQ., MICHELE ALEXANDER MD., CUDJOE WILDING BS, MARTIN NDJOU, BS., RPH., IN THE SPIRIT OF DEBRA LYNN SHEPHERD, BERES E. MUSCHETT, STRATEGIC ADVISORS

youarewithinthenorms.com

The Criminalization of Medical Protocols

A

DISCUSSION ON RACIAL BIAS IN PAIN ASSESSMENT AND TREATMENT RECOMMENDATIONS, AND FALSE BELIEFS ABOUT BIOLOGICAL DIFFERENCES BETWEEN BLACKS AND WHITES 

A 2016 study conducted by Kelly M. Hoffman, Sophie Trawalter, Jordan R. Axt, and M. Norman Oliver examined beliefs associated with racial bias in pain management, a critical health care domain with well-documented racial disparities. Specifically, their work reveals that a substantial number of white laypeople and medical students, and residents hold false beliefs about biological differences between blacks and whites and demonstrates that these beliefs predict racial bias in pain perception and treatment recommendation accuracy. (1)

It also provides the first evidence that racial bias in pain perception is associated with racial bias in pain treatment recommendations. Taken together, this work provides evidence that false beliefs about biological differences between blacks and whites continue to shape the way we perceive and treat black people—they are associated with racial disparities in pain assessment and treatment recommendations.

BLACK AMERICANS BEING SYSTEMATICALLY UNDERTREATED FOR PAIN

The Hoffman, Trawalter, et al., study demonstrated Black Americans are systematically undertreated for pain relative to white Americans. We examine whether this racial bias is related to false beliefs about biological differences between blacks and whites (e.g., “black people’s skin is thicker than white people’s skin”). 

Study 1 documented these beliefs among white laypersons and revealed that participants who more strongly endorsed false beliefs about biological differences reported lower pain ratings for a black (vs. white) target. 

Study 2 extended these findings to the medical context and found that half of a sample of white medical students and residents endorsed these beliefs. Moreover, participants who endorsed these beliefs rated the black (vs. white) patient’s pain as lower and made less accurate treatment recommendations. Participants who did not endorse these beliefs rated the black (vs. white) patient’s pain as higher, but showed no bias in treatment recommendations. (1)

NO AMOUNT OF PREJUDICES CAN JUSTIFY RACISM IN MEDICAL CARE

December 2, 2019, New York Times writers Austin Frakt and Toni Monkovic reported:

“Starting in the 1990s, new prescription opioids were marketed more aggressively in white rural areas, where pain drug prescriptions were already high. As a result, 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.
4. 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. 

Mary Mihal@mazsamem replying to @urwithinthenorm:

Lack of effective pain relief is harming millions of Americans. Racial bias exists in the health care field–it’s rampant. Kolodny is considered an expert. I hope the future sees him for what he is because the present values his killer instincts. War on Drugs is a war on people.

“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.”

DISCUSSING REALITY, THE TARGETING OF BLACK-OWNED PHARMACIES BY UNITED STATES DRUG ENFORCEMENT WHERE ABSOLUTELY NO INVESTIGATIONS ARE EVER PERFORMED

THE DRUG WAR ON BLACK-OWNED PHARMACIES AND THE UNINTENDED CONSEQUENCES

These unwarranted targetings of Black-Own Pharmacies by DEA law enforcement are likely precipitating one grave unintended consequence. A dramatic increase in the rate of suicides in pain patients who had been stopped by unscientific CDC guidelines from seeking proper medical care. Most of the percentage of the patients being cared for by these Black-owned pharmacies are White.

Sally Satel a psychiatrist wrote:

” Some patients have become so desperate for relief that they’ve moved to inherently riskier drugs after losing access to prescription opioids. “The VA cut my pain meds cold turkey after over 25 years,” a veteran told Fox News. “I now buy heroin on the street.” 

Though the percentage of such patients is small (perhaps 5% over five years, according to estimates from SAMHSA), turning to street pills has proven dangerous. The Drug Enforcement Administration warns that sales of counterfeit pills — consisting of fentanyl pressed into pill shapes with familiar tablet markings — have been linked to overdose deaths nationwide.

Suicide is perhaps the most devastating consequence of the crackdown on opioid prescriptions. Case studies documented by physicians and personal tragedies memorialized on social media give the strong impression that poorly treated pain has pushed some patients into taking their own lives. Since 2011 Anne Fuqua, a retired nurse, and chronic pain patient, and Terri Lewis, a doctor of rehabilitation medicine with Southern Illinois University, has maintained a registry of people who took their own lives following physician-initiated changes or cuts in their doses.

To date, they have confirmed 584 suicides, the majority of which included people under age 59. About half were women, and almost all were white. Self-inflicted gunshot wounds were the most common cause of death, followed by hanging, carbon-monoxide poisoning, and jumping off a bridge. One veteran in New Jersey set himself on fire.”

CONCLUSION FOR THOUGHT

The study of Kelly M. Hoffman, Sophie Trawalter, et al., sheds light on a heretofore unexplored source of racial bias in pain assessment and treatment recommendations within a relevant population (i.e., medical students and residents), in a context where racial disparities are well documented (i.e., pain management). It demonstrates that beliefs about biological differences between blacks and whites—beliefs dating back to slavery—are associated with the perception that black people feel less pain than do white people and with inadequate treatment recommendations for black patients’ pain. (2)

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 unfortunately shaped United States drug policy as well that found in academia. However, they are seriously flawed.  

FOR NOW

YOU ARE WITHIN THE NORMS

REFERENCE:

1. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites – PubMed Kelly M Hoffman, Sophie Trawalter, Jordan R Axt, M Norman Oliver PMCID: PMC4843483 DOI: 10.1073/ pnas.1516047113 Affiliations PMID: 27044069

Abstract FOLLOW NCBI

2. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites https://pubmed.ncbi.nlm.nih.gov/27044069/

a,1 a a b,c Kelly M. Hoffman, Sophie Trawalter, Jordan R. Axt, and M. Norman Oliver

aDepartment of Psychology, University of Virginia, Charlottesville, VA, 22904;
bDepartment of Family Medicine, University of Virginia, Charlottesville, VA, 22908;
cDepartment of Public Health Sciences, University of Virginia, Charlottesville, VA, 22908
1To whom correspondence should be addressed. Email: khoffman@virginia.edu.
Edited by Susan T. Fiske, Princeton University, Princeton, NJ, and approved March 1, 2016 (received for review August 18, 2015)

Author contributions: K.M.H., S.T., J.R.A., and M.N.O. designed research; K.M.H. and M.N.O. performed research; K.M.H. and S.T. analyzed data; and K.M.H., S.T., J.R.A., and M.N.O. wrote the paper