170-year-old report promoting racial discrimination in healthcare continues to negatively affect outcomes

Racism is alive and well in healthcare. More than 150 years after the Medical Association of Louisiana tasked Samuel Cartwright, MD, with providing scientific and biologic support for racial discrimination, many of the myths he created persist. A 2016 survey of American medicine residents found that 58% of participants agreed the skin of Black people is thicker than that of white people, 39% agreed Black people’s blood coagulates faster, 20% agreed the nerve endings of Black individuals are less sensitive than their white counterparts, and 12% agreed white people have larger brains.

“These ideas linking race to biology to support the racial caste system in the antebellum South and justify what abolitionists called human rights abuses don’t go away,” said Ashira D. Blazer, MD, Assistant Professor of Rheumatology, New York University Langone Medical Center. “We know they are false, but they still affect the ways we deal with race in medicine.”

Dr. Blazer discussed the origins and realities of racism and racial disparities in healthcare during Microaggressions & Gaslighting: Navigating Negative Behaviors in the Healthcare Setting. The session, which was originally presented Tuesday, Nov. 9, can be viewed by registered meeting participants through March 11, 2022.

Biologic myths — beliefs that the brains of Black individuals are smaller and less intelligent, that this population has less efficient respiration, feels less pain, has thicker skin and stronger bones, is less prone to bleeding, and is less able to care for themselves than white individuals — are part of what Dr. Blazer termed “willful ignorance” of racism. And it continues today.

She noted that current assessment of spirometry results includes a 20% “correction” for Black patients that first appeared in Dr. Cartwright’s “Report on the Diseases and Physical Peculiarities of the Negro Race,” published in The New Orleans Medical and Surgical Journal in May 1851.

“You can imagine what overestimating respiratory function by 20% means for the diagnosis and treatment of conditions like asthma,” she said. “Willful ignorance of racism continues to affect the ways we deliver care, including rheumatology care.”

Early diagnosis is among the most important factors in reducing flares and comorbidities, including renal disease and congestive heart failure, Dr. Blazer continued. Yet self-reported experiences of racism have strong negative associations with healthcare utilization, including delay in seeking care (OR=0.43), treatment uptake and adherence (OR=0.70), and negative patient experiences (OR=0.35).

“Racism is affecting how our patients trust us,” Dr. Blazer said. “We don’t tend to think about racism when we talk about treatment uptake and adherence, but we should. It is very difficult to trust someone who is actively denying your reality.”

About 80% of health outcomes are due to social determinants of health. This includes socioeconomic factors such as education, job status, family support, and income; the physical environment, including housing, crowding, and pollution; and health behaviors such as tobacco use, diet and exercise, alcohol and other drug use, and sexual activity. Healthcare, including access and quality of care, is responsible for just 20% of health outcomes.

“The reality is that racism, historic and current, is a major determinant of the social determinants of health,” Dr. Blazer said. “When we see and measure racial differences in medicine, we are largely seeing and measuring the effects of racism. We should be asking how racism is operating to produce this disparity, when too often we are looking for a gene. When you realize that all humans and all human genetic diversity came out of Africa, looking for an African-American gene to blame does not make scientific sense.”