We Are Hopelessly Racist

This is inaccurate reporting–you should have entitled this “Speculation About Something I Know Nothing About”. I do not mean offense here but it is dangerous to make these kind of statements and then fail to support them.

The critical sentence in this article you linked to is this:
“Doctors in accredited hospitals must ask patients about pain,…”
I am a clinical social worker and have worked in hospital management ,Quality Assurance, Utilization Management as well as being a practitioner delivering care myself. The first thing that comes to mind for me in reading this study is that there is a tremendous disparity in THE SELF REPORTED LEVELS OF PAIN by race and culture. And that is not breaking news. Any decent entry level nursing, social work or other medical course will cover that in the first semester.

When a doc or RN assesses for pain management, they ask the patient for a self assessment of the pain, usually on a numerical scale. My personal experience in delivering care, and in reviewing many thousands of charts is that this is very culturally dependent. African Americans–especially males, are less likely to report high levels of pain than are white males, and who report pain less than white females. In some cultures,like with Hispanic males for instance, they are considered weinies if they report any pain at all. This study does not report that it controlled for any of these factors. Yes, the gross numbers will support that there is different narcotic pain management by race and culture. You make a mistake when you attribute that to racism. Cultural differences in self-reported pain are a massive confounding variable.

In short, if the patient reports little pain, that is what is charted, and that is what the administration of meds is based on. To attribute this to RACISM is inaccurate and irresponsible.

What are the racial disparities? In presenting for treatment? Or are patients denied treatment? Is it in the diagnostic process? The socioeconomic factors are not as salient in my experience of pain management assessment, documentation, treatment etc. as are the cultural factors. I would not deny that there are racists in every shape and color and profession. This article asserts that it is practitioner racism at fault and not institutional racism.

One could make the same argument about the disparities by gender regarding pain control and most certainly in medical research itself. Many docs won’t even think about prescribing narcotics to a woman who is very verbal or assertive about the pain level for they interpret that as “drug seeking” behavior and so become suspicious. So should we also start the hue and cry of SEXISM and link it to the wonders of a Hillary presidency? There are also disparities by age. Should Fred Thompson get the ballyhoo?

While I am not dismissing the relevancies of this article, I am getting very tired of the microscopic search for proof of racism in every utterance, look, gesture, ADL etc in the service of furthering someone’s political career or agenda in the current political discourse. It is getting ridiculous. As guerrilla theatre, the ginning up of the racist talk is brilliant. But it is bad science and even worse politics for it will eventually alienate allies in its overkill. The Democratic party can easily shatter over this and then we will have a President McCain. Be careful about overplaying that “racism” hand.

The study is very interesting, I wish it had more of its methodology available to really look at the sample and its controls.

I am not marginalizing racial disparities, I am however pointing up confounding factors in this study and asking pointed questions about which point in the service provision process accounts for the failure of equal treatment. No answers are forthcoming.

I am suspect of the charges of the title of this article that “We Are Hopelessly Racist” because I see it as being guilty of tremendous bias and of fixing the facts around a preconceived notion to support a political agenda. Let’s talk about healthcare–not Obama. There are many disparities in the provision of healthcare but ya’ll only seem to be interested in race. There is no evidence that this study adjusted for confounding cultural factors in the self reporting mechanism of pain assessment which is the Occam’s Razor here. Controlling for socioeconomic status alone does not cut it. Unless that is accounted for, this study is crap for the observed disparity can be attributed to other causative factors.

Lots of published research can be picked apart as crap that is published to support a political agenda and could be rightly renamed “propaganda”. Just look at some of the garbage studies published that blame the veterans for the development of PTSD due to a) their outright lying about it to game the system or b) pre-existing personality disorders that make them “think” they have it–all in the service of denying them disability benefits, rationing care, controlling costs and to control the fallout from the negative press generated by a generation of vets who are psychologically shattered so an unpopular war can be perpetuated. All published in medical journals and all crap that can be systematically picked apart in a review of the methodology– but that rarely gets done by mainstream media who lurch for the sexy headline and leave it at that.

I have been horrified by the “racism” rhetoric I have been reading lately because it clearly demonstrates an affinity by some for searching the environment for any evidence of behavior that can be spun into offenses in the service of a political agenda. To say that some are quick to take offense is an understatement–to say that they are looking for a fight is more like it. This keeps the race card right in the fore and is nothing more than very effective guerrilla theater. There is nothing like a rumble to grab the attention of the masses. This is a political strategy and utilizes an “offense offensive” which is quite effective for keeping Hillary and Edwards on the ropes but does not indicate to me that Obama will do anything other than guarantee a President Huckabee or McCain. As long as the political discourse is largely about charges of racism, other substantive issues do not get addressed. It is a smoke screen. And just like this medical study, to point out that racial disparities exist does nothing to account for the WHY and HOW of their existence. And didn’t you say that we knew this already???

To quote President Clinton:GIVE ME A BREAK!! The race card is being overplayed. To suggest that Obama can unite people by being some kind of Kumbaya healer is not empirically supported by his campaign which is, indeed, on a “microscopic search for proof of racism” and is so quick to take offense that it is alienating even long time allies and champions of racial equality.

“Yet, you persisist in looking for “confounding factors,” “service provision process,” “cultural factors,” “socioeconomic factors,” “causative factors,”…everything but the “most likely factor”…racism.”
You don’t get this –the simplest explanation here is that there are cultural differences in how each patient is predisposed to answer a question. You are in effect comparing elephants to oranges by suggesting that you will get as valid an answer to pain level experienced from Patient A as you would from Patient B, despite the fact that A and B are not likely to give an accurate and candid answer due to cultural prohibitions. But in your world view, it seems that there is only ONE EXPLANATION for this phenomenon and that is the unscientifically defined construct of “racism”. There was no measure of the variable “racism” defined in this study. But you assert that it is the only explanation.

The very- difficult to operationally define variable of “racism” is not science– that is OPINION. You seem to misunderstand the very basics of Research Methods 101. In science you have to empirically prove that A CAUSES B. Not that A & B occur at the same time– which does not necessarily imply causation. Or in this case that B occurs (less pain meds by race) and A (racism) caused it. B could easily have been caused by C=That patient X gives his pain rating a “1″ because it is his cultural heritage to under-report pain for fear of looking like a wus, and patient Y gives the same subjective level of pain a “9″ because there is less shame in his culture for reporting pain most certainly would cause the same effect as seen in this study. And there is a tremendous body of research which provides empirical evidence of this very phenomenon. All variables are given operational definitions and it is clearly shown that cultural prohibitions on the self report of pain experienced will have a significant impact on the level of care provided. Occam’s Razor.

My question that you so deride is “Where in the service provision process is this so-called “racism” intervening and resulting in the failure to provide adequate pain management to African Americans and Hispanics”? Is it at intake? Triage? Initial assessment and diagnosis by the tech? RN? Doc? Anesthesiologist? Where? and Who?