Category: Healthcare Disparity

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!!!

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.