Friday, July 7, 2017

JAMA: Racism in medicine?

Poverty kills... or maybe racism kills. JAMA explains why black babies have a higher death rate but notes it is going down.

A lot of the deaths are related to maternal complications or prematurity.

 No comparisons of black children with immigrants (including immigrants from Africa or the West Indies)  or Hispanics, so we don't know if it is racism per se, or poverty, or the barriers to access medical care.

and if it is an access problem, we don't know if it is urban (where long lines in huge clinics where you see the doc of the day discourage folks) or if it is rural (where no docs at all).

Yes there is racism in medicine: I saw a lot when I worked for the IHS.

There are also programs to recruit docs for inner city and rural "underserved areas"... alas like the IHS often it is short term stuff, and the worst one was where they subsidized you for two years then you were on your own (and left with huge numbers of patients who didn't or couldn't pay their bills, or waiting for months to get paid a pittance for Medicaid, provided they didn't turn you down for not dotting your "i's" or crossing your "t's" correctly... hmm.. wonder if Obamacare improved this).

The dirty little secret behind high childhood mortality in the black community is Sickle cell disease, which if it hit cute blond kids would have TV marathons raising money for a cure.

However, Sickle cell disease usually doesn't kick in for a couple months after birth (when the fetal Hemoglobin is replaced with adult hemoglobin).

But I wonder about things like high blood pressure complicating the mix.

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