Racism can kill you, and a new medical study proves that racial discrimination is causing Black children extreme pain in the ER.
A study from JAMA Pediatrics that examined the pain management of children in hospital emergency departments found that Black and Latino children being treated for acute appendicitis, a painful inflammation of the appendix, are less likely to receive painkillers than white children.
The authors, Dr. Monika Goyal of the Children’s National Health System in Washington and colleagues, based their findings on data from the National Hospital Ambulatory Medical Care Survey from 2003 to 2010 to analyze the administration of opioid medications (a synthetic narcotic derived from opium) such as morphine and Percocet, and nonopioids available over the counter such as Tylenol.
Of an estimated 1 million children diagnosed with appendicitis, only 56.8 percent of patients received any analgesia, although these painkillers are highly recommended for appendicitis cases, and only 41.3 percent received any opioid analgesia. However, the study found that Black children were less likely to receive any pain medication at all for moderate pain, and less likely to receive opioids for severe pain than their white counterparts.
“Our findings suggest that there are racial disparities in opioid administration to children with appendicitis, even after adjustment for potential confounders. More research is needed to understand why such disparities exist. This could help inform the design of interventions to address and eliminate these disparities and to improve pain management for all youths,” the study said. “Our findings suggest that although clinicians may recognize pain equally across racial groups, they may be reacting to the pain differently by treating black patients with nonopioid analgesia, such as ibuprofen and acetaminophen, while treating white patients with opioid analgesia for similar pain.”
Dr. Eric Fleegler and Dr. Neil Schechter of Boston Children’s Hospital and Harvard Medical School also noted in a related editorial that without any physiological explanation for the difference in treatment, “we are left with the notion that subtle biases, implicit and explicit, conscious and unconscious, influence the clinician’s judgment.”
Possible explanations for the results include an unconscious racial bias against African-American children, an unwarranted fear of opioids, or a notion that Black children have a higher threshold and tolerance for pain. Perhaps some physicians harbor a racist belief, given the criminalization of Black people and the war on drugs, that Black children are more prone to addiction. And even worse, perhaps some doctors even feel that Black and Latino children are less worthy of receiving the medications in the first place.
Although controlling pain in medical patients is widely viewed as a cornerstone of compassionate care, the authors recognize, “significant disparities remain in our approach to pain management among different populations.” Further, they conclude that as strategies exist to solve this problem, more can and should be done.
Previous studies have addressed the racial disparities in treatment, including painkillers, among adults over the past three decades, but fewer studies have examined the differences in care given to Black children. It is particularly unsettling that our most vulnerable members of society, both as children and as those who are already exposed to racism in their daily life, are also victimized by the medical profession in such a blatant manner.
The results are shocking, though not surprising to those who understand that this latest study is part of a longstanding pattern. Racism is not merely the Klansman who wears a hooded sheet, or the white person who uses the n-word. Rather, racism is a system of exploitation that acts to the detriment of Black people, by design and with purpose, often yielding life-threatening and painful results.
There are years of medical experiments, of using Black people as human guinea pigs, including the Tuskegee experiment, in which the federal government left Black men infected with syphilis untreated for decades. In the past, medical knowledge was sought based on torture and unethical experimentation on Black prisoners, pregnant women, and other unsuspecting victims.
Unfortunately, this sad legacy lives to this day.