Understanding racism in health care

HOUSTON - As the George Floyd case drew national attention in 2020 to inequalities facing the black community, the COVID-19 Pandemic simultaneously highlighted what Dr. Anthony Fauci called the "undeniable ways racism has driver disparities in public health."

"Racism is not just police brutality," says Dr. Rechina Bicette, a Black doctor who's currently Associate Medical Director of Emergency Medicine for Baylor St. Lukes in the Houston Medical Center. "It’s not just unfair housing practices, but those systematic injustices filter down to the medical field as well."

To fix this, many believe we must start by acknowledging the deep roots of mistrust between Black Americans and public health projects.

"There's been a long-standing hesitancy and lack of trust in the Black community about medical intervention," explains Dr. Vida Robertson, Director for the Center for Critical Race Studies at University of Houston Downtown.

Perhaps the most widely cited example of the roots of this mistrust is the Tuskegee Study. It began in the 1930s with researchers recruiting African-American men who were understood to have syphilis.

"Rather than offering them to penicillin that would later be discovered, they withheld it, and rather were more interested in studying the effects of syphilis over long periods of time," says Dr. Robertson.

The study ran from the 1930s up through the 1970s. Many participants died from lack of treatment.

"They stepped out on faith to get better and to cure what they had," recalls Lillie Head, a descendant of a Tuskegee study participant. She recently spoke publicly to encourage the Black community against letting the Tuskegee experiment keep them from trusting COVID-19 vaccines.

"If we deny ourselves the vaccine, we are doing misjustice to what the men were trying to do," Head says.

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The Tuskegee Study was only one way trust between the Black community and medicine has been violated over the years.

"Slaves were dug up from the graves in order for people to perform autopsies on them in the name of medicine," recalls Dr. Bicette.

"Equally, the sterilization campaigns that were part of eugenics program sponsored by the government in the 1930s, the 1970s," says Dr. Robertson.

It's been documented by U.S. Congress that hundreds of women were sterilized without their consent or knowledge in government-funded surgeries. Many claim they were told their welfare payments would be compromised if they did not comply.

Even the roots of reproductive care have a dark past. Dr. Bicette explains that, "the father of obstetrics and gynecology, Dr. Sims, gained most of his knowledge by performing inhumane experiments on slave women without anesthesia at a time one anesthesia did exist."

Some examples of violating Black trust in medicine can be found more recently.

"We take the incredible, the phenomenal tennis player, Serena Williams. She has all the economic resources available to us in the country, but because she resides in a Black female body she was not taken seriously when she was complaining of the issues she was having after her pregnancy," says Dr. Robertson, explaining that it was only after persistent complaint that doctors realized Serena was suffering a pulmonary embolism and hematoma.

According to the American Association of Medical Colleges, as many as 40% of medical students believe Black women have different sensitivity to pain, and are thus less likely to treat that pain appropriately.

Many think we could fix the medical treatment and trust in the Black community, if we had more Black healthcare providers. An estimated 5% of active physicians identify as Black. Census data shows those numbers haven't changed much in the past 100 years.

As top-ranking doctor in Houston's globally recognized medical community, Dr Bicette points out many Black doctors are first-generation in their field. "There isn’t anyone before us who is blazing a path, so you’re kind of having to figuring it out on your own."

"I remember meeting with my pre-med advisor for the first time," recalls Dr. Bicette. "She took a look at my file. She told me that I likely wouldn't be able to get into a traditional medical school; that I might have to look at alternative paths. Not only did I get into a top-tier medical school but I got in with an academic scholarship, so obviously there is a disconnect."

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Dr. Bicette does not believe the advisor was being knowingly racist, but she worries even unconscious bias can still lead Black students to face unnecessary discouragement.

"Talking to some of my peers, who I went to school with at the time, none of the rest of them got that advice. But, none of them look like me," she explains.

Dr. Bicette says she's eager to see more Black medical mentors for minority students.

In addition to improving the pipeline by which Black Americans enter the medical ranks, many hope doctors of all races will consider opening more facilities in minority neighborhoods. The hope is that improvements to access and participation in medical care can help rebuild trust, and thus improve medical outcomes, for our Black neighbors and friends.

"We must all, whole-heartedly and passionately, seek out the kind of equity that our country wonderfully prescribes, That if we really are going to be the United States of all Americans, then we have to strive to do much better. The only way we can do that is together," says Dr. Robertson.