Category: Health Equity

Tackling Racial Disparity in Cancer Care

Check this out. What you will see is a necessarily long article on a complicated topic. Article after article I perused in the last week speaks to different aspects of racial inequality encountered in healthcare. I read one by a Black ER doctor describing the myriad different kinds of racism he faces daily in his job. Another article cried out for racial bias reduction training in medical schools. Etc. Etc.

But this article grabbed me because of its specificity to the treatment of cancer patients. This piece doesn’t talk about undoing prejudice that is deeply rooted in history. Not exactly a quick fix. Nope! It talks about the importance of attaining a singular pragmatic endpoint, completion of therapy, and the benefits of interventions like providing patients, like the woman pictured above, with transportation to get to the therapy site, and nurse navigators and computer systems being employed to help in the effort. 

Bottom Line. Over the past several years that I have been examining paths toward racial equity in healthcare, I have become increasingly impressed with pragmatic interventions like this that can make a real difference and do it now! Sure, there are loftier goals, like eliminating racial prejudice. But think about it this way. Which is the more certain path, with quicker benefits? Eliminating racism to eliminate healthcare disparity or reducing healthcare disparity and having the effects of that pragmatic shift start to whittle away at prejudicial attitudes? 

As this article clearly points out, option B is going to start to save cancer patients’ lives far more quickly. Let’s learn from studies like this one, which identified practical barriers getting in the way of health equity in cancer care, and start to eliminate them! Now!!!

The Ethics of “Placebo-Controlled” Studies

Funny thing. When we hear the term “placebo-controlled study,” the methodological purists amongst us generally think that is a good thing. After all, without a placebo control arm, how would we know whether benefits apparently produced by a therapy were, in fact, actually placebo effects. But check this out. What you will see is a situation in which the circumstances of “placebo control” raise significant ethical questions. Why? Several reasons. Most tellingly, because the study participants were disproportionately “disadvantaged” inner city children of color.  AND. Because the placebo control involved withholding a standard treatment for patients with Vitamin D deficiency. AND. Because the study lasted almost a whole year, with standard therapy being withheld for this entire time for the control group. 

Bottom Line. Think about this one for a couple of minutes. The real kicker here is that this research could have been done without the placebo control arm. The reason it wasn’t?  It would have taken longer and been more expensive. 

The right question, as posed at the end of this piece, deals with how the heck institutional review boards at several major institutions signed off on this research. Exactly the kind of unethical research such boards are intended to prevent. 

How indeed!!!

There’s $$$ in Serving the Underserved!!!

Check this out. What you will see is that substantial funding is being captured by Cityblock Health, a company that specializes in providing care for “marginalized patients with complex needs.” Keep reading and you will see an interesting strategy. While many organizations are attempting to “disrupt primary care,” most of them focus on more well-to-do patients. Going where the money is makes sense, but so does Cityblock’s strategy of shooting at the other end of the financial spectrum where there is less competition and plenty of Government funding.

Bottom Line. This is another one for us to keep our eyes on. If Cityblock Health can deliver on its vision to serve 10 million patients by 2030, they will become a major force to be reckoned with in Primary Care. What impact will this have on other models, like Federally Qualified Health Centers and Free and Charitable Clinics, that are currently serving the underserved? And how will we promote to this new practice model?

It may be time to start thinking about the answers to these and other important, related questions!

Pope Francis and the COVID-19 Vaccine

We have an interesting situation here on Hilton Head Island, SC. Reported statistics indicate that about 70% of Caucasians here are fully vaccinated.  And 40% is the number being bandied about for Blacks, while the estimated number for our LatinX citizenry is 20%. 

A couple of points here. First, the explanation for the White vs. Black disparity has been heard many times. From the Tuskegee Experiment (In which Black men were purposefully injected with syphilis and left untreated to “see what would happen”) on forward, Blacks have unfortunately been provided with many “good” reasons to distrust medicine, doctors, etc.

But what’s with the LatinX number? The marketing researcher in me would love to know what’s going on here, but there are likely many factors at work, and we are desperately short on time.  Since talking science has not made much of a change in this number or overcome whatever factors are at work, maybe a campaign based on the Pope’s recent PSA, in which he declared that receiving the vaccine is an “Act of Love,” might be more effective in persuading the largely Catholic LatinX population to get vaccinated. If the Pope and these bishops say they should do it, with many of them speaking in Spanish, some probably will.

Bottom Line. Over the decades I have been studying health psychology, I haven’t seen religion pop up very frequently in health-related conversations. Now might be a good time to use religion to support vaccination, especially since anti-vaxxers’ “religious objections” are heard frequently!

Healthcare Inequity is Still Alive and Well

Pardon the tongue-in-cheek title for this post, but if you check this out you will see a very disturbing NYT article. Disturbing in that it summarizes recently reported metanalyses, demonstrating that in the first twenty years of this century, there has been virtually no narrowing of the healthcare disparity gap in the United States. That is unacceptable! That is a disgrace!!!

As many of you know, I spend a lot of time thinking about and working on healthcare disparity. Economic, racial, or any combination thereof. As Vice Chair of the Board at Hilton Head Island’s Volunteers in Medicine Clinic, serving over 10,000 patients who otherwise would be “unserved,” I am presented daily with the stark reality of this situation, which has been brought into even greater clarity by the pandemic. For example, I was recently informed that on Hilton Head, 70% of Caucasians are fully inoculated. That number is 40% for Blacks and 20% for LatinX. Why? Is this about access or attitude? Probably both, and a lot of other causes thrown in at no extra charge. Whatever the reasons, guess what COVID patients are filling the ICU beds at Hilton Head Hospital.

Bottom Line. As this NYT piece reasonably concludes, whatever we have been doing as a nation to move toward healthcare equity clearly is not working. We need to do something else. Something different. Something way bigger. 

Thus, while I laud the programs that healthcare companies are mounting to reduce disparity, I am afraid that the problem transcends the ability of these programs to eradicate the underlying problems here. 

We need to figure this out! And to make a difference so that 20 years from now, metanalyses will not once again be demonstrating no improvement on, perhaps, one of the most important metrics in existence today.

Understanding Black Americans

Check this out. What you will see is a piece on the importance of gaining a better understanding of the 13% of Americans who are black. You will also see the author observe that many brands and companies have not done a very good job in gaining this understanding, or even in trying to do so, and are increasingly being called out for their ignorance.  

This got me to thinking as usual. Three thoughts come to mind. First, having been actively involved in pharmaceutical marketing research for the last 40 (or more!!) years, I can’t recall ever being asked to conduct a study related to understanding Black Americans. That’s not a good thing.

Next thought. It is generally understood that in order to break down healthcare disparity, we need to do three things. First, we need to understand medical differences across segments of the population. For example, our gastroenterologist at Volunteers In Medicine on Hilton Head Island recently explained to our board that H. pylori is present in about 33% of Caucasians, 66% of African Americans and about 77% of Latinx patients. Given that 90% of our 10,000 patients are of color, that’s pretty important stuff for him, and for us, to know to ensure proper testing protocols for GI cases.

Second, and this is where marketing researchers come in, we need to understand the cultural differences alluded to in this article. Blacks’ hesitancy to get vaccinated for COVID, and the relationship of this reluctance to the Tuskegee experiment and numerous other situations in which Blacks were medically abused, has significant explanatory power if we take the time to understand such issues. 

And finally, mindful of the above, we need to find creative ways to actually deliver health care to the underserved. VIM is a clear example of such a delivery mechanism.

Bottom Line. Things are changing. Health care companies are mounting significant programs to reduce health care disparity. J&J’s “Race to Equity”, The Novartis “Beyond Words” program, etc.  AND.  The ThinkGen team is starting to research relevant issues. Like doing ethnographic research with “free clinics” to find out how they work, learn about their patient segments, etc. Such knowledge is clearly necessary to guide the disparity reduction programs that pharmaceutical companies are mounting.

Exciting new times!!!

Health Care Inequity

Check this out. What you will see, as I increasingly find myself saying, is something that will not surprise you but will shock you. An extremely well written piece on how racial discrimination leads to health care inequity in the diagnosis, treatment and prognosis of cancer. Big time!!!

BUT. There are, however, geographic “bright spots.” Areas of the US where the disparities in cancer outcomes between blacks and whites are significantly smaller than the national averages.  Here’s a question. Why???

Here’s the more important question. How do we get these health equity bright spots’ characteristics to spread to other areas of the US? 

Across the pharmaceutical industry, we are increasingly, and gratefully, seeing a genuine commitment to helping to reduce racial health inequity. Here at ThinkGen, we are joining in that effort. We have partnered with Volunteers In Medicine (VIM) on Hilton Head Island, SC, and as a board member at that organization, I have the opportunity to be a “participant observer” in an organization that serves over 10,000 previously underserved patients, 90% of them being of color.  Using ethnographic methods over the next few months, I am going to increasingly focus on getting an understanding of the innermost workings of such an organization, and then go on to study a series of Federally Qualified Health Centers to find out their “backstories.” How they work, how are they different from other medical settings and how pharmaceutical companies can help. I will be sharing my findings with you here.

Bottom Line.  As demonstrated at today’s referenced URL, racial health inequity can be reduced. But we need to know more about “how” so that we can develop appropriate strategies and tactics to go beyond lip service.

What can you do today to help in the effort to make that happen?

The ACP And Social Determinants

Check this out. It is not new news. It was written in 2018. But it is still important. Relevant. Actionable.  

This piece is a “Position Paper” from the American College of Physicians on Social Determinants of Health, which are defined as “the conditions in which people are born, grow, work, live, age, and the wider set of forces and systems shaping the conditions of daily life.”

Spend a couple of minutes looking at the amazing impacts of social determinants. Everything from their causing 15 year variations in life expectancy to “low social support” causing about the same number of deaths as lung cancer.

Again, this is nothing new here. The importance of physicians employing a biopsychosocial model rather than a simply biological model in their approach to healthcare was first discussed in the literature over 40 years ago. Position papers forty years later are “nice,” but don’t accomplish much to eliminate the disparity in healthcare.  

As we have discussed in previous posts, healthcare industry programs like Johnson and Johnson’s “Race to Health Equity” program, committing $100 Million over the next five years to actually doing something about the healthcare inequity which has been highlighted by COVID-19 sickness and death rates, is an important step in the right direction. Bottom Line. People, we are moving too slowly on this! We can’t wait another 40 years to eliminate the horrific impacts of health inequities. Let’s all get our companies in line with J&J, put our shoulders to the wheel, and do something!