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Chapter 11: African Americans and Medicine. Introduction. Chapter 10 defined “sexism” as the unjustified discrimination against a person because of the person’s gender.
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Introduction • Chapter 10 defined “sexism” as the unjustified discrimination against a person because of the person’s gender. • It examined, in a medical context, how sexist attitudes can affect everything from level of individual medical care and the availability of medical resources to the kinds and extent of gender-focused research. • This chapter examines similar forms of discrimination based on race (racism), specifically racism towards African Americans.
Introduction • But it also touches on a perhaps broader category that might be called “classism” discrimination based on some inappropriate social category. (This possibility is raised in the section “The Oscar Advantage”) • As with sexism, the key ethical questions are: when, if ever, should the race of an individual make a difference to medical treatment, research or medical policy? • On the one hand, are those who say that race should not be used in medicine because of the abuse it can lead to such as in the infamous Tuskegee syphilis Study (which is summarized in this chapter). • Patricia King in “The Dangers of Difference: The Legacy of the Tuskegee Syphilis Study” develops this perspective in Section 1 of the readings.
Introduction • The idea of “race” has been rightly stigmatized because it has often been used as a method of classifying people with the aim of then showing that one race is morally inferior or superior to the other without any ethical justification. The idea has been a deep part of America’s history, exemplified by slavery. • Because of this stigma, it may seem that race should never be used as an acceptable category in discussing bioethical issues. But, as the readings in this chapter suggest, this represents an over-simple perspective. • First, the discredited notion of race based on ethical superiority or inferiority has given way to an ethically neutral, evolutionary-geographic definition of race that can potentially benefit people of whatever “race” they belong to. This idea is developed in the reading by Armand Leroi “A Family Tree in Every Gene”.
Introduction • Second, ignoring race can lead to forms of exclusion. As Annette Dula argues in “The Need for a Dialogue with African Americans”, people of different races and ethnicities can bring unique perspectives to medicine that would be missed if race is not considered. • Additionally, as H. Jack Geiger observes in “The Demise of Affirmative Action and the Future of Health Care”, by 2050 minority groups will make up the majority of the US population. Geiger argues that addressing the medical needs of these diverse groups will require “a diverse culturally competent physician workforce”. This goal cannot be achieved without acknowledging racial and ethnic differences. • Third, it can happen that by not taking one’s race (however vaguely defined) into account, individuals of a particular race may receive inferior medical care or lose out on a medical discovery. This possibility is illustrated by the BiDil heart drug study discussed in this chapter.
Some facts about African American health • Although African Americans no longer constitute the largest minority in the United States, they have the highest death rate of any group. • African-Americans enjoy eight fewer years of relatively good health than do white people or Hispanic Americans. • The death rate for African Americans from stroke, cancer, respiratory disease, influenza, pneumonia, and HIV/AIDS is higher than that for whites.
Some facts about African American health • African-Americans are 2.2 times more likely than whites to develop diabetes, are 30% more likely to have a foot or leg amputated because of the disease, and 2.2 times more likely to die from the disease. • Black men are 20% more likely than white men to suffer from heart disease and 1.5 times more likely to be diagnosed with lung or prostate cancer. Their five-year survival rate is lower than that of whites for lung, prostate, and pancreatic cancer. • Black women are almost twice as likely to be obese than white women, and this makes them more likely to develop diabetes and heart disease.
Some facts about African American health • Lupus, the chronic and potentially fatal autoimmune disease, is three times more common in black women than in white women. • Black women, beginning in their 20s and extending into their 50s, develop breast cancer earlier than white women. • Although African-Americans make up only 13% of the population, they account for more than 52% of new HIV/AIDS cases.
Some facts about African American health • Black women account for 72% of all new cases of HIV/AIDS among women, and black women are 11 times more likely than white women to become HIV positive. • Almost twice the number of blacks die of AIDS compared with whites, a gap that has been increasing since 1998. • A 2006 study found that African Americans with treatable lung cancers are less likely to get the best diagnostic tests and less likely to get the optimum treatment than whites. • African-Americans who have a heart attack are less likely than whites to undergo diagnostic cardiac catheterization, regardless of the race of their physicians.
Reading: A Family Tree in Every GeneArmand Marie Leroi • Armand Leroi rejects the idea that race is an exclusively social construct. If we look at correlations of genetic variants instead of single variants, he argues, populations sort into groups deriving from the five inhabited continents. • When larger numbers of variants are considered, further subdivisions show up. Race is thus a shorthand way of talking about differences that are genetic rather than political or cultural.
Reading: A Family Tree in Every GeneArmand Marie Leroi • The notion of an “ethnic group,” by contrast, conflates genetic, cultural, and political differences. Leroi believes that, until individual genome sequencing becomes possible, the best way to improve medical care is by employing the concept of race. • It offers a more accurate way to assess a patient’s risk for certain diseases and serves as a guide to select the best therapy.
Reading: The Dangers of Difference: The Legacy of the Tuskegee Syphilis StudyPatricia A. King • Patricia King claims that recognizing racial differences in medicine poses a dilemma. Even when the intention is to help a stigmatized group or person, the result may be to cause harm. • King proposes that research always begin with the presumption that, with respect to disease, blacks and whites are biologically identical. • While the presumption may be shown to be wrong in the course of the study, it acknowledges that, historically speaking, more harm has come from imputing racial differences than from ignoring them.
Reading: Bioethics: The Need for a Dialogue with African AmericansAnnette Dula • Annette Dula argues for the importance of expanding bioethics to include the perspectives of various racial and ethnic groups. • While she focuses on African Americans, she sees the points she makes as also applying to Hispanics, Native Americans, Asians, and other groups that have had health care experiences out of the mainstream. • The African American perspective, according to Dula, has been shaped by the experience of receiving poor-quality care (a situation mostly ignored as a problem by bioethics) and by the emphasis on action and social justice found in the work of black philosophers.
Reading: Bioethics: The Need for a Dialogue with African AmericansAnnette Dula • By reviewing the history of the birth control movement and the Tuskegee experiment, Dula illustrates the need for an African American perspective on health care. • She then use the entrance of blacks into professional psychology and the “white women’s movement” to illustrate how the introduction of a new perspective can change social perceptions of a group, weaken stereotypes, and promote justice.
Reading: Bioethics: The Need for a Dialogue with African AmericansAnnette Dula • Dula asks that bioethics recognize access to health care as a serious bioethical problem requiring debate and action. • She ends by calling for the formation of a community of scholars who will “conduct research and articulate the perspectives of African Americans and other poor and underserved peoples.”
The Demise of Affirmative Action and the Future of Health CareH. Jack Geiger • Jack Geiger argues that the drop in medical school admissions of African Americans and other minorities, due to factors like the rollback of affirmative action and the underfunding of public schools, is the beginning of a “potential public health disaster.” • By 2050, minority groups will make up the majority of the population, but who will be their physicians? • A diverse population, Geiger says, “requires a diverse, culturally competent physician workforce” able to meet people’s needs.
The Demise of Affirmative Action and the Future of Health CareH. Jack Geiger • Developing such a workforce requires recognizing that medical education is a social good and not merely a prize awarded to favored individuals. • Yet our policies appear to be taking our society in the opposite direction. In 1998, two years after California voters outlawed the use of race in educational policies, minority enrollment in state medical schools had declined by 32 percent.
