USA: One reason the push for diversity in medicine is lagging

2023/04/21 Leave a comment

Of interest:

Sabina Spigner says she’s always known she wanted to be a doctor. But, as a premed student at the University of Pennsylvania, she found herself struggling to balance a heavy class load while also working as much as 20 hours a week.

“I was always working, because I didn’t have money and I was a work-study student,” says Spigner.

Her grades suffered as a result. In her junior year, she turned to her pre-med adviser for help. “She was like, well, you know, you’re just not going to get into med school with that GPA. so I think you should consider something else. And she didn’t really present me with many resources or options other than just giving up,” Spigner says.

That conversation happened nearly eight years ago. Spigner — who is Black and Southeast Asian-American — says when she recalled the experience on Twitter last month, “unfortunately, a lot of people shared similar stories.”

“You know, this is something that’s happening across the country and it’s very, very common, especially for students of color, to experience discouragement,” she says.

For decades, leading medical organizations have been trying to diversify the ranks of physicians, where Black and Hispanic doctors remain vastly underrepresented relative to their proportion of the U.S. population. That matters, because research has shown that people from underrepresented racial and ethnic groups can have better health outcomes when their doctors look like them.

But a recent study in the journal JAMA Health Forum highlights the factors, including financial pressures and discrimination, that can keep determined students of color from actually making it to medical school.

The study looked at responses from more than 81,000 students who took the Medical College Admission Test. The standardized exam is grueling: People study for it for months, if not years, says the study’s first author, Dr. Jessica Faiz of the University of California Los Angeles.

“You paid for the test. You took all that time to study. You are definitely quite committed to applying” to med school, says Faiz, an emergency physician and fellow with the National Clinician Scholars Program at UCLA.

Even so, Faiz and her colleagues found that Black and Hispanic test takers were significantly less likely to go on to apply and enroll in med school than white test takers. Not only that, but Black, Hispanic and Native American students were more likely to say they faced financial barriers, such as difficulty affording test prep materials and already having large student loans.

“Even further, they’re more likely to face discouragement from advisors when applying to medical school compared to their white counterparts,” says study co-author Dr. Utibe Essien, an assistant professor of medicine and health equity researcher at UCLA.

Another key finding: Black, Hispanic and Native American students were more likely to have parents without a college degree and more likely to go to a low-resourced college, which the researchers defined as a college with a less-selective admissions process and a majority of students living off campus.

Those factors “really trickle down to your social networks that are really integral in succeeding as a medical student,” Faiz says. For instance, the study found that students of color were less likely to have shadowed a physician – an experience that can burnish a med school application. Faiz says that likely reflects a lack of the kinds of connections that make it easier to set up that kind of experience.

Essien notes that decades of research have found that patients of color can benefit from having a doctor of their own racial or ethnic background. For example, studies have found they were more likely to have received preventative care in the prior year and more likely to be satisfied with the health care they receive.

For minorities, says Essien, “Having a doctor who looks like you makes you more likely to accept flu vaccination, to have a colonoscopy, to consider having a more invasive heart procedure.”

There’s even striking new evidence that Black people live longer if they reside in counties with more Black physicians. But that new study came with a sobering discovery: A little over half of U.S. counties were excluded from the national analysis because they didn’t have a single Black primary care physician. Faiz says that finding, which was published on the same day as the study she led, underscores why it’s so critical to better understand the factors that keep students of color from med school.

Adds Essien: “We’re not just advocating diversity out of the goodness of our hearts. It really, literally is saving lives.”

Dr. Jaya Aysola is executive director of Penn Medicine’s Center for Health Equity Advancement. She wrote a commentary that accompanied the study in JAMA Health Forum. Aysola says the study sheds much-needed light on the financial barriers and unconscious biases that can block the path to med school for students of color.

“From who advises you to submit an application to who then eventually helps select your application, to those who interview you, there’s bias all along those processes,” Aysola says.

As for Sabina Spigner? She didn’t let her premed adviser’s discouragement stop her from pursuing her med school dreams. She decided to pursue graduate school first. She ended up with two master’s degrees — in science and public health — before heading to the University of Pittsburgh School of Medicine. When she graduates next month, she’ll officially be Dr. Spigner at last.

She says she lives by the philosophy that “only you can tell you if you can succeed or not. It’s not somebody else’s job to say that.”

“I’m proof that there’s a way,” she adds.

She’ll start her OB/GYN residency at Northwestern University in June.

Source: One reason the push for diversity in medicine is lagging

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Canadian medical journal acknowledges its role in perpetuating anti-Black racism in health care

2022/10/26 Leave a comment

Of note:

Canada’s premier medical journal says it’s eager to address the role it plays in perpetuating anti-Black racism in health care and spark the broader change needed to dismantle structural barriers to equitable care.

The Canadian Medical Association Journal says a special edition released Monday is the first of two spotlighting papers by Black authors, examining system-wide failures and urging change.

Editor-in-chief Kirsten Patrick says the peer-reviewed publication is also working on ways to ensure future issues better represent the work of Black experts and the needs of Black patients, many of whom routinely face overt and subconscious biases that compromise their care.

She credits a working group of Black academics and medical professionals with helping her and the staff confront harmful practices, noting: “I really see things that I didn’t see before.”

“I’m a white woman, I think of myself as progressive and feminist,” she said from Ottawa.

“And I learned new things about my own internalized anti-Black racism from doing this special issue and definitely have reflected on the way that CMAJ’s processes undermine minority engagements, I would say, and put barriers sometimes to people who are not white.”

The two special editions follow years of advocacy by a group known as the Black Health Education Collaborative, co-led by OmiSoore Dryden, an associate professor in the Faculty of Medicine at Dalhousie University who specializes in medical anti-Black racism, and Dr. Onye Nnorom, a family doctor and public health specialist with the University of Toronto.

Barriers to understanding

Dryden says work on the special issues began more than a year ago when discussions began on how anti-Black racism manifests in structural and systemic ways that ultimately prevent research from being shared. They hope the editions can help the journal’s audience — largely educators and practitioners — understand the vast scope of the problem.

“In some ways, Canada very much is a welcoming place. However, that can act as a barrier in understanding how racism manifests — it’s not just the racial slur. It’s not just the racist targeting. But it is in the very systems of continuing to practice race-based medicine,” she said, noting racial stereotypes could lead practitioners to make false assumptions about what’s making a Black patient sick.

“Even if we had more funding and even if we had more Black physicians and practitioners, if we do not address the very real reality of anti-Black racism — in structures and in practice — we will continue to see poor health outcomes from Black communities.”

One of the articles in Monday’s edition examines the difficulties many Black patients face in getting cancer screening, molecular testing, breakthrough therapies and enrolment in clinical trials. One of the examples given is a study of immigrant women in Ontario, which found that lack of cervical cancer screening was linked to systemic barriers such as not having a female physician or coming from low-income households

Monday’s CMAJ paper also notes mortality from breast, colorectal, prostate and pancreatic cancers is higher in Black patients than in white patients, citing data from the Canadian Cancer Registry that was linked to census data on race and ethnicity. But it notes the impact of race on cancer incidence and mortality is not often studied because Canadian registries don’t regularly collect race and ethnicity data, unlike those in the United Kingdom and the United States.

Other pieces in Monday’s edition examine youth mental health and prostate cancer in Black Canadian men.

Same thinking reinforced, editor says

The second edition, set for release on Oct. 31, explores topics including gaslighting in academic medicine and Afrocentric approaches to promoting Black health.

The two issues were developed with guidance from the advocacy collaborative as well as a guest editorial committee comprised of Black experts in health equity: Notisha Massaquoi, assistant professor, department of health and society at the University of Toronto; Dr. Mojola Omole, surgical oncologist and journalist in Ontario; Camille Orridge, a senior fellow at the Toronto health policy charity the Wellesley Institute and Bukola Salami, associate editor at CMAJ and associate professor of nursing at the University of Alberta.

Massaquoi says their work went far beyond preparing the two issues; it included reviewing all processes the journal uses throughout the year that hinder diversity on its pages.

She says articles submitted for academic publishing are most often reviewed by editorial committees that don’t include Black researchers. As a result, reviewers don’t fully grasp the context of the article or question the credibility of the research and dismiss the pitch.

Patrick estimates the journal has published six to seven articles and a few blog posts by Black authors in the last 18 months amid a concerted effort to boost representation. Actual data is unavailable because the CMAJ does not ask submitting authors about their race or ethnicity, however this is being considered, she says.

Patrick acknowledges that minority authors are “super-rare” when looking at the 111-year history of the journal, which publishes 50 online issues per year and a selection of articles in a monthly print version.

“We just keep on getting the same kind of thinking reinforced over and over and over again from a small subsection of our medical population,” she said.

Massaquoi says that’s why it’s important for the CMAJ to work on methods used to recruit writers familiar with Black issues and improve the diversity of its pool of reviewers. She says she’s “absolutely confident” these steps can make a difference.

“This is the premier journal that our medical professionals are using so that they understand the newest and the most innovative, up-to-date information on health care in Canada,” Massaquoi said.

“And if it’s absolutely devoid of any material that’s going to help them understand working with Black communities, then we’re doing our profession a disservice.”

Patrick says the CMAJ is consulting outside experts to look at equity issues and interview staff and people who submit to the journal, as well as members of the anti-Black racism special issue working group.

“We’re not just putting out a statement that’s meaningless. We’ve committed to real work in this area.”

Source: Canadian medical journal acknowledges its role in perpetuating anti-Black racism in health care

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In China’s Xinjiang, Forced Medication Accompanies Coronavirus Lockdown

2020/09/03 Leave a comment

News from China and the Uighurs gets worse and worse:

When police arrested the middle-aged Uighur woman at the height of China’s coronavirus outbreak, she was crammed into a cell with dozens of other women in a detention center.

There, she said, she was forced to drink a medicine that made her feel weak and nauseous, guards watching as she gulped. She and the others also had to strip naked once a week and cover their faces as guards hosed them and their cells down with disinfectant “like firemen,” she said.

“It was scalding,” recounted the woman by phone from Xinjiang, declining to be named out of fear of retribution. “My hands were ruined, my skin was peeling.”

The government in China’s far northwest Xinjiang region is resorting to draconian measures to combat the coronavirus, including physically locking residents in homes, imposing quarantines of more than 40 days and arresting those who do not comply. Furthermore, in what experts call a breach of medical ethics, some residents are being coerced into swallowing traditional Chinese medicine, according to government notices, social media posts and interviews with three people in quarantine in Xinjiang.

There is a lack of rigorous clinical data showing traditional Chinese medicine works against the virus, and one of the herbal remedies used in Xinjiang, Qingfei Paidu, includes ingredients banned in Germany, Switzerland, the U.S. and other countries for high levels of toxins and carcinogens.

The latest grueling lockdown, now in its 45th day, comes in response to 826 cases reported in Xinjiang since mid-July, China’s largest caseload since the initial outbreak. But the Xinjiang lockdown is especially striking because of its severity, and because there hasn’t been a single new case of local transmission in over a week.

Harsh lockdowns have been imposed elsewhere in China, most notably in Wuhan in Hubei province, where the virus was first detected. But though Wuhan grappled with over 50,000 cases and Hubei with 68,000 in all, many more than in Xinjiang, residents there weren’t forced to take traditional medicine and were generally allowed outdoors within their compounds for exercise or grocery deliveries.

The response to an outbreak of more than 300 cases in Beijing in early June was milder still, with a few select neighborhoods locked down for a few weeks. In contrast, more than half of Xinjiang’s 25 million people are under a lockdown that extends hundreds of miles from the center of the outbreak in the capital, Urumqi, according to an AP review of government notices and state media reports.

Even as Wuhan and the rest of China has mostly returned to ordinary life, Xinjiang’s lockdown is backed by a vast surveillance apparatus that has turned the region into a digital police state. Over the past three years, Xinjiang authorities have swept a million or more Uighurs, Kazakhs and other ethnic minorities into various forms of detention, including extrajudicial internment camps, under a widespread security crackdown.

After being detained for over a month, the Uighur woman was released and locked into her home. Conditions are now better, she told the AP, but she is still under lockdown, despite regular tests showing she is free of the virus.

Once a day, she says, community workers force traditional medicine in white unmarked bottles on her, saying she’ll be detained if she doesn’t drink them. The AP saw photos of the bottles, which match those in images from another Xinjiang resident and others circulating on Chinese social media.

Authorities say the measures taken are for the well-being of all residents, though they haven’t commented on why they are harsher than those taken elsewhere. The Chinese government has struggled for decades to control Xinjiang, at times clashing violently with many of the region’s native Uighurs, who resent Beijing’s heavy-handed rule.

“The Xinjiang Autonomous Region upheld the principle of people and life first….and guaranteed the safety and health of local people of all ethnic groups,” Chinese Ministry of Foreign Affairs spokesman Zhao Lijian said at a press briefing Friday.

Xinjiang authorities can carry out the harsh measures, experts say, because of its lavishly funded security apparatus, which by some estimates deploys the most police per capita of anywhere on the planet.

“Xinjiang is a police state, so it’s basically martial law,” says Darren Byler, a researcher on the Uighurs at the University of Colorado. “They think Uighurs can’t really police themselves, they have to be forced to comply in order for a quarantine to be effective.”

Not all the recent outbreak measures in Xinjiang are targeted at the Uighurs and other largely Muslim minorities. Some are being enforced on China’s majority Han residents in Xinjiang as well, though they are generally spared the extrajudicial detention used against minorities. This month, thousands of Xinjiang residents took to social media to complain about what they called excessive measures against the virus in posts that are often censored, some with images of residents handcuffed to railings and front doors sealed with metal bars.

One Han Chinese woman with the last name of Wang posted photos of herself drinking traditional Chinese medicine in front of a medical worker in full protective gear.

“Why are you forcing us to drink medicine when we’re not sick!” she asked in a Aug. 18 post that was swiftly deleted. “Who will take responsibility if there’s problems after drinking so much medicine? Why don’t we even have the right to protect our own health?”

A few days later she simply wrote: “I’ve lost all hope. I cry when I think about it.”

After the heavy criticism, the authorities eased some restrictions last week, now allowing some residents to walk in their compounds, and a limited few to leave the region after a bureaucratic approval process.

Wang did not respond to a request for interviews. But her account is in line with many others posted on social media, as well as those interviewed by the AP.

One Han businessman working between Urumqi and Beijing told the AP he was put in quarantine in mid-July. Despite having taken coronavirus tests five times and testing negative each time, he said, the authorities still haven’t let him out – not for so much as a walk. When he’s complained about his condition online, he said, he’s had his posts deleted and been told to stay silent.

“The most terrible thing is silence,” he wrote on Chinese social media site Weibo in mid-August. “After a long silence, you will fall into the abyss of hopelessness.”

“I’ve been in this room for so long, I don’t remember how long. I just want to forget,” he wrote again, days later. “I’m writing out my feelings to reassure myself I still exist. I fear I’ll be forgotten by the world.”

“I’m falling apart,” he told the AP more recently, declining to be named out of fear of retribution.

He, too, is being forced to take Chinese traditional medicine, he said, including liquid from the same unmarked white bottles as the Uighur woman. He is also forced to take Lianhua Qingwen, a herbal remedy seized regularly by U.S. Customs and Border patrol for violating FDA laws by falsely claiming to be effective against COVID-19.

Since the start of the outbreak, the Chinese government has pushed traditional medicine on its population. The remedies are touted by President Xi Jinping, China’s nationalist, authoritarian leader, who has advocated a revival of traditional Chinese culture. Although some state-backed doctors say they have conducted trials showing the medicine works against the virus, no rigorous clinical data supporting that claim has been published in international scientific journals.

“None of these medicines have been scientifically proven to be effective and safe,” said Fang Shimin, a former biochemist and writer known for his investigations of scientific fraud in China who now lives in the United States. “It’s unethical to force people, sick or healthy, to take unproven medicines.”

When the virus first started spreading, thousands flooded pharmacies in Hubei province searching for traditional remedies after state media promoted their effectiveness against the virus. Packs of pills were tucked into care packages sent to Chinese workers and students overseas, some emblazoned with the Chinese flag, others reading: “The motherland will forever firmly back you up”.

But the new measures in Xinjiang forcing some residents to take the medicine is unprecedented, experts say. The government says that the participation rate in traditional Chinese medicine treatment in the region has “reached 100%”, according to a state media report. When asked about resident complaints that they were being forced to take Chinese medicine, one local official said it was being done “according to expert opinion.”

“We’re helping resolve the problems of ordinary people,” said Liu Haijiang, the head of Dabancheng district in Urumqi, “like getting their children to school, delivering them medicine or getting them a doctor.”

With Xi’s ascent, critics of Chinese traditional medicine have fallen silent. In April, an influential Hubei doctor, Yu Xiangdong, was removed from a hospital management position for questioning the efficacy of the remedies, an acquittance confirmed. A government notice online said Yu “openly published inappropriate remarks slandering the nation’s epidemic prevention policy and traditional Chinese medicine.”

In March, the World Health Organization removed guidance on its site saying that herbal remedies were not effective against the virus and could be harmful, saying it was “too broad”. And in May, the Beijing city government announced a draft law that would criminalize speech “defaming or slandering” traditional Chinese medicine. Now, the government is pushing traditional Chinese remedies as a treatment for COVID-19 overseas, sending pills and specialists to countries such as Iran, Italy, and the Philippines.

Other leaders have also spearheaded unproven and potentially risky remedies – notably U.S. President Donald Trump, who stumped for the malaria drug hydroxychloroquine, which can cause heart rhythm problems, despite no evidence that it’s effective against COVID-19. But China appears to be the first to force citizens – at least in Xinjiang – to take them.

The Chinese government’s push for traditional medicine is bolstering the fortunes of billionaires and padding state coffers. The family of Wu Yiling, the founder of the company that makes Lianhua Qingwen, has seen the value of their stake more than double in the past six months, netting them over a billion dollars. Also profiting: the Guangdong government, which owns a stake in Wu’s company.

“It’s a huge waste of money, these companies are making millions,” said a public health expert who works closely with the Chinese government, declining to be identified out of fear of retribution. “But then again – why not take it? There’s a placebo effect, it’s not that harmful. Why bother? There’s no point in fighting on this.”

Measures vary widely by city and neighborhood, and not all residents are taking the medication. The Uighur woman says that despite the threats against her, she’s flushing the liquid and pills down the toilet. A Han man whose parents are in Xinjiang told the AP that for them, the remedies are voluntary.

Though the measures are “extreme,” he says, they’re understandable.

“There’s no other way if the government wants to control this epidemic,” he said, declining to be named to avoid retribution. “We don’t want our outbreak to become like Europe or America.”

Source: In China’s Xinjiang, Forced Medication Accompanies Coronavirus Lockdown

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Wary of Mainstream Medicine, Immigrants Seek Remedies From Home – The New York Times

2015/11/16 Leave a comment

Likely similar in Canada and some readers may be more familiar with any comparable initiatives here:

With the help of a $130,000 grant from the Cigna Foundation, the Botanical Garden offers training for doctors to help them better understand their patients’ cultural beliefs. So far, 740 medical students and practicing physicians have gone to the garden’s tropical conservatory to learn about medicinal plants and to participate in role-playing exercises. “It is all about promoting increased trust between health care providers and their patients,” Dr. Vandebroek said.

Issues of trust and culture are not the only things that have made some immigrants leery of mainstream medicine. Doctors’ visits are expensive, and herbs, selling for a few dollars a bag, are cheaper than prescription drugs.

According to a study by the Commonwealth Fund, 43 percent of Hispanics in the United States do not have a primary personal care physician or health provider. More than one-third lack health insurance, nearly double the rate for blacks and triple that for white Americans.

High costs and cultural differences have created a troubling disconnect between many Hispanics and the health care system. It is a rift that Dr. Roger Chirurgi, program director for the emergency medicine residency for the New York Medical College at Metropolitan Hospital Center in Manhattan, would like to heal.

“There’s a lot of people who we’ll see at repeat visits, and they’ve never taken their medicine,” Dr. Chirurgi said. “That’s why I’ve been taking my residents to the Botanical Garden for the past three years, to try to become more culturally sensitive and to be able to break through that barrier.”

Dr. Chirurgi now routinely asks patients if they are using herbals when he takes their medical history. He worries about the dangers of unregulated remedies that lack dosage guidelines and scientific evidence of their efficacy. “I want to make sure that they are safe, and don’t interact with the drug that I am prescribing,” he said. Still, he conceded that herbals may be helpful, if only as placebos. “If you believe that something will work,” he said, “it may actually work in some cases.”

Source: Wary of Mainstream Medicine, Immigrants Seek Remedies From Home – The New York Times

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Do the name and ethnicity of your doctor matter?

2013/08/31 Leave a comment

On the practical side of multiculturalism and diversity, choice of doctors.

While most of the long-standing members of my cancer medical team are Caucasian, the newer group of doctors, fellows, interns and nurses are much more diverse. Issues that sometimes comes up, not with the Canadian-born but with some foreign-born doctors, include language fluency and experience in how to discuss difficult medical issues, but both are a matter of learning through doing, not issues of medical competence. And generally, the newbies spend more time with you as part of their development, which can be helpful.

Do the name and ethnicity of your doctor matter?.

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When the Patient Is Racist – NYTimes.com

2013/07/26 Leave a comment

A more open discussion than one normally sees on racism and discrimination on the front lines of healthcare. While our hospital has an appropriate code of  on rights and responsibilities, Your rights and responsibilities,  it is a challenge to implement given the number and variety if people being seen, time pressures, the health and psychological pressure on patients, and the normal human wish to avoid conflict.

No excuse for bad behaviour of any sort but understand why doctors and other medical staff may prefer to duck and move on to the next patient.

When the Patient Is Racist – NYTimes.com.

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