JAYE K JOSHI, MD, MBA, NORMAN J CLEMENT RPH., DDS
Jay K Joshi MD, MBA
“An honest discussion of where we are going in the humanity of health care in America”
discussing racial bias in Pain Assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites
In a 2015 study by Kelly M. Hoffman, Sophie Trawalter, Jordan R. Axt, and M. Norman Oliver, Black Americans are systematically undertreated for pain relative to white Americans. They examined 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.
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 Opioid War Against Patients in Pain review of Helen Borel’s book:
“Managing pain with opioids is a science…overzealous law enforcement are denying American patients the relief they so desperately need…demonizing the best pain reliever we have leads to needless suffering, even suicides, and it drives the rise in deadly street drugs…
Helen Borel gathers and presents the evidence, the intimidation, the raids of clinics, the chilling effect on those very professionals we trust to care for our loved ones and ourselves. She looks hard at the Veterans Administration, Drug Enforcement Agency, Department of Justice, and the Centers for Disease Control and Prevention.”
The Criminalization of Pain Care
“The misguided emphasis on purported red flags conflates an elemental analysis with an essential analysis, allowing individual actions, taken out of context, to constitute the full understanding of the term, “prescribing outside of the scope of professional practice”, without incorporating the full context of clinical behavior – a logical fallacy that has allowed certain individuals to pass investigational fraud as inductive legal arguments, and to retroactively redefine interpretations of hopelessly vague statutes.”
Interpretations became legal arguments, and accusations served as the basis for convictions, ushering in an era of Medical McCarthyism in which the fear of prosecution defines the quality of patient care.
Based on their actions the DOJ-DEA used fraudulent and bogus data to target doctors pharmacist and their patients around the country particularly Blacks and Asian providers and went so far to the illegal use of google maps to track patients.
DEA-DOJ CORRUPT ORGANIZATIONS AND 2 CENTURIES OF WRONGDOING
The seizing of Journalists and Congress personnel records and the reporting of attacks on Black-Owned pharmacies by the United States Justice Department and the United States Drug Enforcement Administration under the Attorney General William Barr of the Trump administration are one and the same; these attacks included everything and everyone of every hue
in public healthcare. The data used has been based on a foundation of junk science where figures who lie ( Richard Alpert, Donald Sullivan, John Beerbower, Tom Muzzing) and who are liars figured.
They’ve used and are using fraudulent unscientific bogus data which they knew and have known to be flawed/suspect to target and arrest doctors and falsified search warrants by redefining medical procedures and protocols.
Even though much of the data DOJ-DEA had generated was erroneous they further were able to get away with it through a rigged Kangaroo Court System which the agency created and that operates outside the rules of Federal Civil Procedures.
In some cases, healthcare providers found themselves forced to plea responsible to fictitious DEA medical protocols, DEA investigators, Supervisors, and Judges created which are contrary to the practitioners training and licensure.
Skilled Attorneys found themselves powerless to rules which made it impossible to present evidence. Innocent Dr’s also found themselves handcuffed and some went to prison.
In essence, the DOJ-DEA has engaged in wholesale prosecutorial misconduct and corruption in order to promote their war on medically prescribed narcotic analgesic (opioids) pain medications by extorting both medical practitioners, drug manufacturers and by concocted search warrants, immediate suspension orders(ISO), that lacked any semblances of probable cause.
Politically ambitious, morally ambiguous, these individuals used the pretense of law to unleash lawlessness throughout the land, from the general public to the courts of law.
Nowhere was this more manifest than in the investigation and adjudication of statutes around the opioid epidemic – in which extreme, medically inappropriate interpretations of the laws created a disparity between the laws’ intention and its implementation.
ONE PATIENT Jklingenhofer WROTE:
“Thank you for speaking up on behalf of chronic pain patients, and also acute pain patients. Another important side effect of this war on opioids is that surgical and post surgical pain is being under medicated by our doctors no hospitals, including some of our best hospitals in the country.
I am a chronic pain patient with a life long disease requiring many surgeries in my lifetime. I remember when pain wasn’t managed well, the short period when it was given the importance of a vital sign, back to being under medicated. I live in terror if having to have another surgery, and have put off a needed surgery for well over a year now.“
The Criminalization of Medical Protocols
To convict a person of a crime, a prosecutor must prove beyond a reasonable doubt that the accused exhibited criminal intent – a translation of an originally latin phrase, ‘mens rea’. A phrase which appeared first in religious canon, in the teachings of the Roman Christian philosopher, St. Augustine, who stated, “the act is not guilty unless the mind is guilty”, implying that guilt, or immoral acts were as much a mental failure as a physical failure.
That the physical act resulting in a crime is an extension of the mental state that led the person to commit the crime – that the two are inseparable.
Forming a connection that serves as a foundation for the common law system – and subsequently the Constitution – canonized in the mid-seventeenth century by British lawyer-philosopher Sir Edward Coke, who expanded upon the various definitions of mens rea, while providing case studies to substantiate his writings.
The common law system integrates elements of morality and virtue into law and order, often insinuating that a crime is defined by someone willing to transgress the social framework of morality and virtue. An obvious definition when examining more crimes such as stealing livestock from a neighboring farm.
But the definition becomes more convoluted when dealing with morality ambiguous topics – particularly those in healthcare – such as abortion or euthanasia. Fortunately, the common law framework is built upon frameworks that help us navigate through such complex topics.
So it should come as no surprise that the Supreme Court referenced Sir Edward Coke when ruling in favor of permitting abortion as a “personal liberty” in accordance with the 14th Amendment.
The Common law system has a certain logic to it, which goes beyond the rigidity of the statutory laws we have today – codified laws that are effectively self-explanatory definitions.
There is no ambiguity as to what the speed limit is when driving on the highway – it is posted frequently and the speed at which most drive is both generally assumed and well-known.
We do not need to reference common law frameworks to justify through logic the particular statutes around driving speeds. We know that driving too fast increases the risk of an accident, that there is a balance to be maintained in driving expediently and safely. A speed limit serves to maintain that balance.
While no one will dispute the balance between individual speed and overall safety in operating a motor vehicle, healthcare does not share that same level of uniformity. In fact, healthcare is quite the opposite – the field is rife with diverging opinions and contrasting facts.
THE LOGIC OF HEALTHCARE LAW
At any given hospital, any two physicians may produce different working diagnoses for a patient who presents initially with the same set of symptoms. And neither physician may necessarily be wrong, as healthcare is complex, and concepts that are fundamentally complex have substantial uncertainty within it.
It is precisely within this uncertainty that diverging opinions may form within medicine. A patient who presents with elevated blood pressure, dizziness, and fatigue could be evaluated for a cerebrovascular accident, such as a bleeding or hemorrhagic stroke, or could be evaluated for myocardial infarction, a heart attack.
The diagnosis may not be immediately known, but the steps to ascertain the diagnosis are – meaning a physician can order a series of tests and images to glean the probable cause of the symptoms. But even within these standard steps, different opinions or conclusions can form – some correct and some incorrect.
Healthcare laws instead should be based upon positive rights. Laws designed to balance the complex relationships inherent to healthcare behavior, which obligate individuals to work in a coordinated manner to improve overall public health.
But attempting to design healthcare laws based upon positive rights in a culture that values negative rights creates a contradiction – that can be solved by incorporating a deeper understanding of healthcare behavior into healthcare law, by developing laws that better represent the dynamic nature of patient behavior.
“Each man is a sliding scale”, Emerson wrote, referencing that patients can present with both different symptoms and different degrees of awareness for those symptoms, emphasizing that both the changing symptoms and the changing awareness of those symptoms should go into treating patients.
Healthcare was never intended to be distilled down to just the facts. It is an experience, to be viewed in its entirety. With the facts and data viewed relative to the whole experience.
A sentiment Justice Oliver Wendell Holmes, Jr. agreed with when he said, “the life of the law has not been logic; it has been experience.”
Healthcare natural rights should similarly be defined through the experience of healthcare, incorporating the complex array of medical conditions, interactions, and patient behaviors – into the laws themselves.
Laws that do not simply restrict healthcare behavior, but assert healthcare natural rights.
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