Category: Healthcare Inequity

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 Impact of “Full Ride” Medical School

Want a good smack in the face with some good old-fashioned common sense? Check this out. What you will see is an article that reviews the impact of NYU’s Grossman Medical School giving, starting in 2018, all current and future medical students free tuition. A generous move for sure, and one likely to attract medical students who otherwise might have gone to the Harvard’s and Georgetown’s of the world. But how about the expressed purpose of the move, i.e., to attract more students who will feed into primary care, and to attract a more ethnically and socially diverse student body? 

Read the piece and think about it. A free ride looks just as good to me if I am going into one of the lucrative specialties, like dermatology or radiology, as it does if I am headed for primary care. Free tuition did nothing to shape the direction of NYU graduates’ specialty choice. Zero. Nada.

Similarly, as long as metrics like GPA and MCAT scores are the primary selection criteria used nationwide, and minority applicant pools remain stagnant, free tuition does little to increase the diversity of the medical profession overall. Sure, more minority students may be drawn to the free tuition at NYU, but only at the expense of other schools. 

Bottom Line. Much talk is heard about “unintended consequences.” Civilians killed in air raids on military installations, etc. But how about “intended consequences?” Shouldn’t somebody be looking at a generous but expensive program like free medical school at NYU and ask the question, “How is that going to make happen what we want it to make happen?” 

How indeed?

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.