Do no harm … to some

How have we allowed medicine, one of our most respected industries, to be tainted by racist prejudice?

Medicine: the selfless industry with the sole purpose of helping people get better, mentally and physically. Surely this is the one part of our society untainted by the horrendous implications of racism? Yes, pharmaceutical companies may have some bad connotations. And the accessibility of healthcare insurance. But racism? In doctors? Surely not! After all, the oath which they all swear to proves their selfless and giving intent. But how can the medical education, the prejudices and stereotypes in society, the state of technology (which we praise so much) be contributing to the inequalities exposed by the Covid-19 pandemic? And how can we change our systems for the better?

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The world was unequally affected by the Covid-19 pandemic. Yes, it was difficult for everyone, but where for some it was a time of minor inconveniences (which would be considered luxuries in the lives of others), racial prejudice within the healthcare system ensured that there were 60% more deaths in black people than white people during the first surge, not accounted for by age or measures of sociodemographic disparity. Previous suggestions of the role of vitamin D in infection rates have been disproven, leaving us with the explanation that the ridiculous metric of black people being 3.57 times more likely to die from Covid-19 than white people (in a May 2020 study), must be purely from financial, societal and healthcare-related structural racism.

The distribution of vaccines is a classic example of the lack of moral integrity within the decision-making bodies in the developed world. The growth mindset that has shaped our economy and workplace, making us wealthier, and ‘happier’ (or at least, raised our level of consumption), is also having severely detrimental consequences to both the natural world, and the rest of humanity. Although large pharmaceutical companies such as Pfizer were willing to spend hundreds of millions on development of the vaccine (to make $81.3 billion in revenues in 2021 alone), when it came to distributing them to other countries, those that could not pay the price had to suffer. The hypocrisy of hoarding vaccines within North American and Western European countries, whilst focussing conversations around the issue of “anti-vaccers” is astounding. Should we not focus on delivering them to those who want and need them, not trying to force vaccines on people who do not want them? Perhaps unvaccinated people being in so close proximity feels threatening - more threatening than whole nations of unvaccinated populations, across the sea. It was only to be expected then, that the Western world paid for its greed, with variants to the virus emerging out of less developed countries (both Delta and Omicron being examples of these), to infect populations pumped full of new mRNA technology. Desperation for medicine drives money making potential, leading to greed, selfishness and inequity, which comes back to bite. The concept of profiting off of the illness of others is flawed, because it shifts our focus from helping people, to helping those who will pay us well.

Many of the inequities in healthcare are a result of the medical education system, and technologies. Certain symptoms for conditions which are taught in medical school include ‘blue lips’, to show low levels of blood oxygen, which is easy to recognise in white people, but harder in darker skin. This has become a particular issue with the introduction of telemedicine, where clients are asked to diagnose themselves, or family members, under oral instruction. The pulse oximeter has also shown a bias, being less effective in picking up hypoxia in darker skin. In 2016, a study was conducted, which revealed that 73% of medical students (in the study) had biases in opinions about the biological implications of race, believing wrongly that black people have a higher pain tolerance. Geographical implications also come into play, with a 67% increased likelihood of a shortage of primary care physicians in predominantly Black zip codes. In an industry promising medical aid, where the technology, training, and placement of medical personnel is prejudiced, how can we consider our systems (in the US and UK) democratic? How, when we have fought for capitalism and democracy, believe that our system is superior? It is not a matter of the ‘right’ system, but the values that underpin it, and in a system founded on colonialism, we must make further effort to remodel our incentives and goals towards equality - it is the least that we owe the victims of the past. 

Social stereotypes and financial biases, although not explicitly part of the healthcare system, have a seriously underestimated effect on the mental and physical wellbeing of ethnically diverse populations. The perception about pain tolerance in medical students is a product of social ideas, such stereotypes also being responsible for black males being four times more likely to receive a schizophrenia diagnosis than white males, with doctors tending to focus on psychotic, over depressive symptoms, in black people. The ‘model minority’ stereotype, modelling Asian Americans as successful and prosperous has led to clinicians being less likely to diagnose alcohol addiction in Asian Americans, compared to white Americans, in spite of displaying identical symptoms. Societal ideas can not only hinder the capacity of doctors, but stigmatisation of mental health issues within communities can magnify the consequences of racism in marginalised populations. This may be part of the reason why “African Americans, Latinx, and Asian Americans receive treatment of mental health challenges at 50-70% lower rates than white Americans”. Economic unfairness is another seemingly unrelated factor, but when it impacts healthcare insurance, and therefore access to healthcare for people and families, it is evident that this is a serious issue, causing many to forego healthcare in a country which has the capacity to care for them.

Recent concerns over the teaching of black history have shed light on some of the lack of diversity within our education system, and view of the past. But a general overview of the North Atlantic Slave Trade in history class is by no means sufficient for nurturing a more aware and caring generation. Darwin’s theory of evolution by natural selection in the Origin of Species was used by eugenicists to support their argument for selectively breeding humans. University College London (a respectable and distinguished institution of learning) was where Francis Galton and Karl Pearson developed methods of categorising traits, leading to work such as the forced sterilisation of those believed to have unfavourable genes, often considering race. Not only was this work completely inaccurate, prejudiced and racist, but it is not taught alongside the teaching of Mendelian principles (the method used by Francis Galton to eliminate traits), or the theory of natural selection, causing generations to be unaware of possible misuses for these scientific methods which they are learning about. As we are constantly saying, in reference to the Holocaust, we must learn about past atrocities, so as not to repeat those mistakes. But we should also remember to research methods and situations that perpetuated injustices in less obvious ways, because it is these which we are more likely to repeat unknowingly.

According to the Collins English Dictionary, racism is the ‘the aspects of a society which prevent people of some racial groups from having the same privileges and opportunities as people from other races’. The question is; how did we arrive at such a way of seeing the world; a way of thinking which has hindered progress for ourselves as well as others (proved in the effects of biased vaccine distribution), and has resulted in suffering within a system based on the pledge to ‘do no harm’. Why would a species be capable of such selfishness? Surely our tendency is to preserve and protect ourselves and communities? Perhaps structural racism is a result of a self and family-preservation mechanism, which prioritises those closest to you, over communities living in another family, country or continent. This, when combined with our modern technologies, globalisation, weapons, political systems, and power, creates the appalling inequalities we face now. Greed has clouded our ability to consider the impacts of the technologies and systems we are creating, and education is a key part of unlearning this unfounded prejudice. Institutions such as medical schools have a remarkable amount of power over our society; the biased teaching, equipment and societal ideas within the community leading to systemic racism in the profession, impacting the healthcare of millions. From this pandemic, we cannot simply sigh over the inequities, and read a couple of books on slavery: we must consider every aspect of our curriculum, the way we perceive others, and our access to healthcare, and prioritise change in favour of equity - the industry that profits off of helping others and not doing harm must reassess how they teach and allocate resources in order to truly ‘do no harm’ to anyone. 

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Bibliography:

https://www.medicalnewstoday.com/articles/why-racism-is-a-public-health-threat-expert-perspectives

https://www.medicalnewstoday.com/articles/racism-in-healthcare

https://www.medicalnewstoday.com/articles/racism-in-mental-healthcare-an-invisible-barrier

https://archpublichealth.biomedcentral.com/articles/10.1186/s13690-021-00722-0

https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-8124-z

https://khn.org/news/article/pfizer-pandemic-vaccine-market-paxlovid-outsize-profit-influence/