racial disparities

Why We Need More Minority Doctors

Updated at 1:23 PM, February 10, 2012

Dr. Alden Landry

“I’m an ER physician,” Dr. Alden Landry told me. “When I walk into patients’ rooms and start speaking to them and introduce myself as their doctor, often older black women will say, ‘Thank you for being my doctor! I’m so proud of you. I’m glad you’re going to be taking care of me.’ They say they feel more comfortable with me as their physician.”

Dr. Alden Landry practices emergency medicine at Beth Israel Deaconess Medical Center, but he’s more than just a doctor — he’s helping lead the movement to diversify medicine. He heads up projects on the issue at Beth Israel, Massachusetts General Hospital, and Harvard Medical School

“It’s not always a rosy picture talking to my patients,” he explained. “Early in my career, there was a patient — an older black man — [who] had been in the emergency department for a number of hours, and they’d placed him in the hallway to wait. I went over to talk to him and ask him if he needed anything. ‘Why do they always put the black patients in the hallway?’ he asked me.” I can’t necessarily say he was placed there because of his race – but when you hear comments like that, it shows that patients don’t feel appreciated when they’re receiving medical care, that they feel like second- or even third-class citizens, that their concerns are being overlooked.”

Dr. Landry, among many in the medical field, feels there’s a way to help solve this problem: recruit more African-Americans and Hispanics to be doctors. That’s why he’s heading up the Tour for Diversity as its co-director. The tour is a new initiative funded by the Aetna Foundation – and, yes, it is an actual tour. Continue reading →

FILED UNDER: Medicine/Science, practicing medicine, racial disparities

November 30, 2011 | 4:24 PM | Carey Goldberg

‘Health Of Boston’ Mixes Good News And Bad: Teen Births Down, Racial Gaps Loom

This just in from the Boston Public Health Commission: The new “Health of Boston report is out, and mixes the good news with the bad:

Fewer Boston teens are having babies, fewer Boston public high school students are smoking, and fewer city children have elevated blood lead levels, according to the 2011 Health of Boston report released today by Mayor Thomas M. Menino.

But amid the good news about the health of Boston residents in the 398-page report prepared by the Boston Public Health Commission were troubling signs that racial disparities persist. In 2009, the asthma hospitalization rate for black children ages 3 to 5 was four times the rate for white children; the tuberculosis rate for Asians was three times the rate for Boston residents overall; and the heart disease hospitalization rate for Latino males was more than twice the rate for white males. In 2010, a higher percentage of black and Latino adult residents were obese compared to white and Asian adult residents, while a higher percentage of adult smokers were white compared to other racial and ethnic groups.

“The Health of Boston report is always a sobering reminder that our work is far from finished, though every year we continue to see areas of progress,’’ Mayor Menino said. “This report will help us set our public health priorities so that we align resources where they are most needed.’’

Among the bright spots for Boston residents: Continue reading →

FILED UNDER: Personal Health, Politics, Boston PUblic Health Commission, public health, racial disparities

September 19, 2011 | 10:30 AM | Carey Goldberg

10 Things About ObamaCare You May Not Know But Should

Harvard professor and author John E. McDonough

Let us be clear. John McDonough is a Democrat down to his DNA. Though he’s a professor at the Harvard School of Public Health, he makes no pretense of being dispassionate about the Affordable Care Act of 2010, better known as ObamaCare. He calls it a landmark of the magnitude of the creation of Social Security or Medicare.

John also knows the law inside and out, and shares his knowledge — both of what’s in the 18-month-old law and how it politically came to be — in a new book, “Inside National Health Reform.” Thankfully, he’s a great sport about turning esoteric knowledge into soundbites. On Friday, he took our “3-minute challenge” here, and below, he offers the top 10 things people probably don’t know about ObamaCare but should:

1. 32 million newly covered
Beginning in 2014, an estimated 32 million people who today are uninsured will begin to be enrolled in affordable coverage. About 16 million will be enrolled through expansions of Medicaid, and 16 million through insurance “exchanges.” That will leave about 23 million uninsured.

Who are those 23 million? The Urban Institute estimates about 40% of them will be eligible for Medicaid and just not sign up. We’d like those people to get signed up but the truth is, if they get sick and get health care, the clinic or hospital will be able to — or in fact, be required — to sign them up on the spot.

‘If it gets repealed, which could happen depending on what happens on Nov. 6, 2012, it will be a couple of generations before our federal government may find the political will to go at this again in such a significant way.’

So then about a quarter of them are undocumented, and the rest include some — like about 30,000 in Massachusetts — who say, ‘I’m going to pay the penalty and not get covered.’

2. It’s not really a ‘mandate’

The individual mandate is not really a mandate; it is a financial penalty if you can afford to buy health insurance and don’t do so. Switzerland actually has a real mandate — the law requires you to buy health insurance and the government will make you buy it — versus what we have in Massachusetts and the Affordable Care Act, which is just a financial penalty for not purchasing coverage if you can afford to do so.

3. It’s projected to lower the deficit

According to the Congressional Budget Office, the law, over 10 years, is fully paid for and is estimated to lower the federal budget deficit by over $70 billion.

The costs are more than compensated for by new taxes, savings in the system and other revenue enhancements. Continue reading →

FILED UNDER: Insurance, Medicine/Science, Politics, affordable care act, medicaid, medicare, obamacare, obesity, racial disparities

August 17, 2011 | 1:42 PM | Carey Goldberg

Multiple Babies, Not Breastfed: Link To Aggressive Cancer In African-Americans

This just in from Boston University:

RESEARCHERS IDENTIFY POSSIBLE CONTRIBUTORS TO THE HIGHER INCIDENCE OF AGGRESSIVE BREAST CANCERS IN AFRICAN AMERICAN WOMEN

(Boston) – Investigators from the Boston University’s Slone Epidemiology Center have reported findings that may shed light on why African American women have a disproportionately higher risk of developing more aggressive and difficult-to-treat breast cancers, specifically estrogen and progesterone receptor negative (ER-/PR-) cancers.

The study, which appears online in Cancer Epidemiology, Biomarkers & Prevention, found that high parity (giving birth to two or more children) was associated with an increased risk of ER-/PR- cancer, but only among women who had not breastfed.

The findings were based on the ongoing Black Women’s Health Study, which has followed 59,000 African American women by biennial questionnaire since 1995.

In 14 years of follow-up, 318 women developed breast cancers negative for estrogen and progesterone receptors (ER-/PR-), while 457 developed breast cancers with estrogen and progesterone receptors (ER+/PR+). Giving birth to two or more children was associated with a 50 percent increase in the incidence of ER-/PR- breast cancer, but the association was not present among women who had breastfed.

The release also quotes researcher Julie Palmer:

“Our results, taken together with recent results from studies of triple negative and basal-like breast cancer, suggest that breastfeeding can reduce risk of developing the aggressive, difficult-to-treat breast cancers that disproportionately affect African American women,” she said.

FILED UNDER: Medicine/Science, boston university, breast cancer, breast feeding, racial disparities

March 14, 2011 | 5:10 PM | Carey Goldberg

Why An Emergency Medic Might Ask About Your Race

In his column yesterday, The Boston Herald’s Howie Carr makes it sound like Massachusetts medics are so busy these days filling out forms about their patients’ race that they may ignore the medical emergency at hand.

Howie’s rants are often enjoyable to read for their inflamed wrath, but this one struck me as so oddly lopsided that I asked the Department of Public Health what was up. Howie included just this from the Department of Public Health statement: “Patient health and safety must always be an EMT’s highest priority. Collecting this information must not delay nor prevent patient assessment or the provision of care.”

Here’s the whole statement, which makes clear that this sort of collection of patient data is a national norm, not a PC liberal plot:

Patient health and safety must always be an EMT’s highest priority. Collecting this information must not delay nor prevent patient assessment or the provision of care. State regulations (105 CMR 170.347) require EMTs to collect a variety of background information from patients, including their name, address, age, race and ethnicity, past health history, and medications that they are currently taking. Of course, if a person objects to responding, they have the option not to respond.

For years, more than 25 states — representing every region of the country — have been collecting this data and submitting it to the National EMS Information System (NEMSIS), and the other 25 states have committed to doing so.

NEMSIS is funded by the U.S. National Highway Transportation Safety Administration (NHTSA) in order to standardize collection of EMS data by creating a uniform data set that is used to compare and assess the quality of provision of EMS across the country. Similar data is collected in other areas of the health care system, such as hospitals and nursing homes. The NEMSIS system will catch the EMS sector up to the rest of health care in terms of having data-driven assessment available, and provide a valid way for looking at what EMS is doing, what are patient outcomes, and how EMS can be improved. Massachusetts is in the early stages of data collection and has not yet begun submitting data to NEMSIS.

Clearly, collecting data on race is a way of detecting disparities in how patients of different races are treated. Howie writes: “This is about a sick obsession by the liberals with somehow proving “disparities,” which there certainly are in this country, only they’re exactly the reverse of what the moonbats would have you believe they are.”

In actual fact, the data on disparities suggest that they’re not only real, they’re deeper than many of us might suspect. Here’s a post of ours on a national Massachusetts General Hospital study that found black and Hispanic patients were treated differently for chest pain. And here’s an overview of racial disparities in health from the CDC, an institution not generally considered a bastion of political correctness.

FILED UNDER: Medicine/Science, Personal Health, ambulance, emergency care, racial disparities

February 18, 2011 | 3:00 PM | Keosha Johnson

Study: Healthy Waist Size May Be Bigger For Black Women

By Keosha Johnson

A new study finds that the 'healthy' waistline threshold may be slightly larger for African-American women than for white women.

“Healthy” waist may be a bit bigger for black women.…When I saw this Reuters story my first thought was one of intense skepticism (full disclosure — I am a black woman).

Allow me to give a brief explainer on all things fat-related:

Waistline circumference measures the amount of fat around one’s abdomen. High levels of fat around the abdomen increase the risk of type 2 diabetes, hypertension and heart disease. Women with waist sizes above 35 inches and men with waist sizes above 40 inches are considered to be abdominally obese.
Non-Hispanic black women have higher rates of abdominal obesity than Non-Hispanic white women.
Body Mass Index (BMI) measures the amount of body fat relative to a person’s weight and height, and is typically used to diagnose whether someone is obese. African-American women have the highest rates of obesity and, in general, being overweight, in the U.S.

So you can imagine my cynicism after reading that a new study finds that the BMI threshold for black women in the study was 32.6 — the highest BMI among blacks and whites of both genders in the study — while the threshold for white women was 29.6.

Here’s an excerpt of the study, which was published in the journal Obesity:

Several studies that have included both AA [African-American] and white women have shown a racial difference in the relationship between BMI and mortality. In these studies, a significant relationship was found for white women, but the association was much weaker or nonexistent in African-American women. The weighted evidence suggests that the relationship between BMI and mortality may be less strong in AA than white women. The degree to which racial differences in the relationship between BMI and mortality may be explained by differences in the association between BMI and adiposity or risk factors is not known.

Regardless of my skepticism of the study’s findings, the issue of obesity itself remains unchanged, says Dr. Paula Johnson, Chief of the Division of Women’s Health at Brigham & Women’s Hospital, and Executive Director for the Connors Center for Women’s Health and Gender Biology.

“We still have an absolute epidemic of obesity in our country…certain populations of women, including black women, are at very high risk and have significantly higher rates,” Johnson said. “We need to recalculate those rates if in fact we see that these findings are accurate and can be replicated.” Continue reading →

FILED UNDER: Personal Health, obesity, racial disparities

October 11, 2010 | 12:33 PM |

Daily Rounds: Don’t Bogart The Joint, Mom; Obesity Genes ID’d; Persistent Racial Disparities In Breast Cancer; Seeking Natural Immunity

Marijuana, Once Divisive, Brings Some Families Closer – NYTimes.com “Bryan…began making [his parents] brownies and ginger snaps laced with the drug…At their age, his mother said, they were not concerned about it leading to harder drugs, which had been one of their worries with Bryan. ‘We have concerns about the law, but I would not go back to not taking the cookie and going through what I went through,’ she said, adding that her dizzy spells and nausea had receded. ‘Of course, if they catch me, I’ll have to quit taking it.’” (The New York Times)

Health News: Gene Sites Linked to Obesity Found – WSJ.com “An international research consortium says it has identified 18 new gene sites linked to obesity and 13 others associated with how fat is distributed in the body, advances that shed new light on the complex biology underlying one of the world’s most pressing public-health problems. The findings are based on studies involving nearly 250,000 people, making the effort the largest so far to unravel the genetic basis of common human traits, researchers said. They were published online Sunday in two papers by the journal Nature Genetics.” (Wall Street Journal)

Insurance, income don’t explain racial gaps in breast cancer care – White Coat Notes (Boston.com)

Lifelong Immunity? With Vaccines, It Depends (npr.org) “The moms at the get-together wonder if it would be easier on babies’ brand-new immune systems to spread those shots out. And they wonder if vaccines for diseases like chicken pox, which usually causes mild illness, are really necessary. ‘I think natural immunity for non-serious illnesses like chicken pox may be better than getting the vaccines,’ says Katie Combs, mother of 6 1/2-month-old Charlotte.’”

FILED UNDER: Insurance, Medicine/Science, Personal Health, Round-Up, breast cancer, medical marijuana, obesity, racial disparities, research, vaccines

September 9, 2010 | 8:47 PM | Rachel Zimmerman

Dartmouth Data: Primary Care Alone Won’t Fix Nation’s Health Woes

So today we learn from the Medicare number-crunchers up in Hanover, NH that simply gaining access to primary care doctors isn’t good enough — you’ve got to find high-quality care, and an integrated system that offers support from a range of other providers (see my post on a Boston non-profit that deploys an intense primary care network to reduce hospitalizations among the chronically ill and elderly.)

McAllen, Texas leads U.S in leg amputations

Still, new research from the influential and sometimes controversial Dartmouth Atlas Project paints a troubling picture of racial and care disparities across the country.

NPR’s health blog sums up the key findings succinctly:

Leg amputation capital of the country: McAllen, Texas (3.29 per 1,000 — paging Dr. Gawande!).

Lowest rate of seeing a primary care clinician at least once a year: Bronx, N.Y. (60.2 percent).

Blacks least likely to see a primary care clinician: Olympia, Wash. (42.9 percent, half the rate of whites there).

Lowest mammogram rate: Chicago. (50.1 percent — potential campaign issue for a mayoral candidate?)