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False Beliefs About Blacks' Biology May Lead Doctors to Underprescribe for Pain

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Despite what that uncle of yours may opine every time you get stuck next to him at Thanksgiving, there is a fair amount of evidence that racism still exists in the United States. For example, we know about racial disparities in policing, unemployment, housing wealth, temp hiring, home loans, pay, the Oscars , and of course, health care.

One way bias has manifested in the practice of medicine is in the treatment of pain. A study published in 2000, for example, found white patients were significantly more likely than black patients to receive pain medication for bone fractures in an emergency room. Further research has borne out unequal pain treatment -- even in children.

So why does this happen?

Researchers who have published a new study in the Proceedings of the National Academy of Sciences say they may have found the answer. And it's not pretty.

Some doctors may under-treat the pain of African-Americans because they believe there are biological differences between black and white people that result in blacks feeling less pain.


"Our findings show that beliefs about black-white differences in biology may contribute to this disparity,” Kelly Hoffman, a sixth-year doctoral candidate in the University of Virginia's social psychology program, said in a press release.

Researchers conducted two separate surveys among white, native English speakers: one group that had no medical training, and one group of medical students and residents. In both groups, they found that the more false beliefs participants held about biological differences between black and white people, the more they minimized the pain of black people.

The first study was conducted among 92 people with no medical training. These individuals were asked to rate the level of pain a randomly assigned black or white hypothetical patient would feel in various situations, such as getting a hand slammed in a car door.

The group then was asked to what extent 15 statements about biological differences between blacks and whites were true.  Eleven of the statements, such as "Black people’s skin has more collagen (i.e. it’s thicker) than White people’s skin," were false, and four, such as "Whites are less susceptible to heart disease," were true.

The researchers found that participants who believed more of these false statements rated the pain experienced by black patients lower than the pain experienced by white patients.

"In other words, relative to participants low in false beliefs, they seemed to assume that the black body is stronger and that the white body is weaker," wrote the study's authors.

Now here's where it gets especially alarming. Having found that false beliefs about biological differences between blacks and whites correlates with racial bias in pain perception among laypeople, the researchers moved on to doctors in training.

They asked 222 medical students and residents -- again white, native English speakers -- to rate the degree of truth of the same beliefs about biological differences between black and white people.

The results: The doctors-in-training believed nearly 12 percent of the false statements, and half believed at least one.

"These percentages are noticeably lower compared with those in study 1," the researchers wrote, "however, given this sample (medical students and residents), the percentages for false beliefs are surprisingly high."

The medical students and residents were also asked to rate on a scale of zero to 10 the pain levels experienced in two mock medical cases, involving a kidney stone and a leg fracture, for both a white and a black patient.

And again, the participants who endorsed more false beliefs about biological differences also rated black patients as feeling less pain than white patients.

When asked to recommend pain medication for each scenario, the students and residents with more false beliefs underprescribed pain medication for the black patients, as determined by 10 experienced physicians. These participants recommended Tylenol, anti-inflammatory medication or an ice pack, as opposed to a narcotic like hydrocodone or morphine, which would be in line with World Health Organization guidelines, according to the researchers.

Interestingly enough, those medical students who either did not believe the false statements, or believed fewer of them, showed an opposite bias in terms of their perceptions of pain -- meaning they thought white patients feel less pain. Importantly, however, this bias was not associated with insufficient treatment recommendations.

"It thus seems that racial bias in pain perception has pernicious consequences for accuracy in treatment recommendations for black patients and not for white patients," the authors wrote.

Beyond that, the authors specifically remarked on the markedly outdated nature of the false beliefs in question.

"(A) substantial number of white people -- laypersons with no medical training and medical students and residents -- hold beliefs about biological differences between blacks and whites, many of which are false and even fantastical in nature." (And which go back to the era of slavery, the authors note.)

"To our knowledge, this is the first demonstration of medical personnel (students and residents) with at least some medical training) endorsing such beliefs in modern times."

I have yet to get a hold of lead researcher Kelly Hoffman on the phone.  "I apologize for the delay," she wrote in an email. "I have been inundated with requests."

One can imagine.

And how many of these statements about biological differences between black and white people do you think are true?








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