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April 04, 2016

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Myths of black toughness contribute to pain undertreatment, study suggests

April 4, 2016
Courtesy of PNAS
and World Science staff

Per­va­sive myths about black peo­ple be­ing tougher than whites may be one rea­son why doc­tors tend to of­fer less pain re­lief to blacks, a study sug­gests.

Some whites—even med­ic­ally trained peo­ple—wrongly be­lieve blacks have thicker skin or less sen­si­tive nerve end­ings, for in­stance, the Un­ivers­ity of Vir­gin­ia study found.

Not all white peo­ple who hold these views are racists, but the be­liefs are “nonethe­less con­se­quen­tial,” the re­search­ers wrote, re­port­ing the find­ings in this week’s early on­line edi­tion of the jour­nal Pro­ceed­ings of the Na­tio­n­al Aca­de­my of Sci­en­ces.

For ex­am­ple, they found that in a sam­ple of 222 white med­ical stu­dents and res­i­dents, half en­dorsed at least one false be­lief out of a list of 11 false be­liefs that they were asked to re­mark on. Four true state­ments were mixed in­to the list as well.

Those who en­dorsed false be­liefs, the in­ves­ti­ga­tors found, made less ac­cu­rate pain treat­ment rec­om­menda­t­ions for a black pa­tient, com­pared with a white pa­tient.

Some av­er­age dif­fer­ences be­tween blacks and whites do ex­ist, ac­cord­ing to the re­search­ers: for instance blacks on av­er­age have stronger bones and are more at risk for heart dis­ease and stroke, but less at risk for spi­nal cord dis­ease.

False be­liefs, how­ev­er, run the gam­ut, the sci­en­tists said. These in­clude myths that black peo­ple have stronger im­mune sys­tems, a bet­ter sense of smell, slow­er ag­ing, and smaller brains. The lat­ter was the least wide­spread false be­lief on the list, ac­cord­ing to the study—but still, one or two per­cent of first- or second-year med­ical stu­dents en­dorsed it, as did 12 per­cent of peo­ple with­out med­ical train­ing.

The most wide­spread false be­lief was that blacks have thicker skin: over 40 per­cent of first-and-second year med­ical stu­dents sam­pled thought so, as did fully a quar­ter of med­ical res­i­dents and 58 per­cent of peo­ple with­out med­ical train­ing.

Some of these myths date back to slav­ery times, when doc­tors and oth­ers jus­ti­fied slav­ery by claim­ing that blacks could with­stand harder work and harsher pun­ish­ments than whites.

As for pain treat­ment, “re­search has shown that, rel­a­tive to white pa­tients, black pa­tients are less likely to be giv­en pain med­ica­t­ions and, if giv­en pain med­ica­t­ions, they re­ceive low­er quan­tities,” the re­search­ers, Kelly M. Hoff­man and col­leagues, wrote.

“These dis­par­i­ties in pain treat­ment could re­flect an over-prescription of med­ica­t­ions for white pa­tients, un­der­pre­scrip­tion of med­ica­t­ions for black pa­tients, or, more like­ly, both,” they added.

One study “found that black pa­tients were sig­nif­i­cantly less likely than white pa­tients to re­ceive anal­gesics for ex­trem­ity frac­tures in the emer­gen­cy room (57 per­cent vs. 74 per­cent), de­spite hav­ing si­m­i­lar self-reports of pain,” they not­ed.

This dis­par­ity “is true even among young chil­dren,” they went on. “A study of nearly one mil­lion chil­dren di­ag­nosed with ap­pen­di­ci­tis re­vealed that, rel­a­tive to white pa­tients, black pa­tients were less likely to re­ceive any pain med­ica­t­ion for mod­er­ate pain and were less likely to re­ceive opi­oids—the ap­pro­pri­ate treat­ment—for se­vere pain.”


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Some pervasive myths about black people being tougher than white people may be one reason why doctors tend to offer significantly less pain relief to blacks, a study suggests. Some whites—even medically trained people—wrongly believe that blacks have thicker skin or less sensitive nerve endings, for instance, the University of Virginia study found. Not all white people who hold these views are racists, but the beliefs are “nonetheless consequential,” the researchers wrote, reporting the findings in this week’s early online edition of the journal pnas. For example, they found that in a sample of 222 white medical students and residents, half endorsed at least one false belief out of a list of 11 false beliefs that they were asked to remark on. Four true statements were mixed into the list as well. Those who endorsed false beliefs, the investigators found, made less accurate pain treatment recommendations for a black patient, compared with a white patient. Some average differences between blacks and whites do exist, according to the researchers: for existence blacks on average have stronger bones and are more at risk for heart disease and stroke, but less at risk for spinal cord disease. False beliefs, however, run the gamut, the scientists said. These include myths that black people have stronger immune systems, a better sense of smell, slower aging, and smaller brains. The latter was the least widespread false belief, according to the study results—but still, one or two percent of first- or second-year medical students endorsed it, as did 12 percent of people without medical training. The most widespread false belief was that blacks have thicker skin: over 40 percent of first-and-second year medical students sampled thought so, as did fully a quarter of medical residents and 58 percent of people without medical training. Some of these myths date back to slavery times, when doctors and others justified slavery by claiming that blacks could withstand harder work and harsher punishments than whites. As for pain treatment, “research has shown that, relative to white patients, black patients are less likely to be given pain medications and, if given pain medications, they receive lower quantities,” the researchers, Kelly M. Hoffman and colleagues, wrote. “These disparities in pain treatment could reflect an over-prescription of medications for white patients, underprescription of medications for black patients, or, more likely, both,” they added. One study “found that black patients were significantly less likely than white patients to receive analgesics for extremity fractures in the emergency room (57% vs. 74%), despite having similar self-reports of pain,” they noted. This disparity “is true even among young children,” they went on. “A study of nearly one million children diagnosed with appendicitis revealed that, relative to white patients, black patients were less likely to receive any pain medication for moderate pain and were less likely to receive opioids—the appropriate treatment—for severe pain.” suggests