The focus for the Black Lives Matter campaign has, of course, been on the demonstrable violence and racism carried out by police against Black people. However, you will probably not be shocked to learn that racism is rife elsewhere. America has a racism problem that presents in just about all sectors of society, and science – thought by many to be unbiased – is far from free of it.
One example that has gone viral over the last few days is a page from a medical textbook that was published way back in 2017. It was a different time back then, I guess?*
The textbook, Nursing: A Concept-Based Approach to Learning (winner of the 2018 American Journal of Nursing Book of the Year award), has a chapter on "Cultural Differences in Response to Pain" that perpetuates a lot of untrue beliefs about how different ethnicities react to pain – white is conspicuously missing – as well as blatantly racist falsehoods and stereotypes. For ease of reading, here are some of the points below:
- May not request pain medicine but instead, thank Allah for pain if it is the result of the healing medical process.
- Pain is considered a test of faith. Muslim clients must endure pain as a sign of faith in return for forgiveness and mercy.
- Chinese clients may not ask for medication because they do not want to take the nurse away from a more important task.
- Indians who follow Hindu practices believe that pain must be endured in preparation for a better life in the next cycle.
- Blacks often report higher pain intensity than other cultures.
- They believe suffering and pain are inevitable.
- Jews may be vocal and demand assistance.
- They believe pain must be shared and validated by others.
- Hispanics may believe that pain is a form of punishment and that suffering must be endured if they are to enter heaven.
- They vary in their expression of pain. Some are stoic and some are expressive.
- Native Americans may prefer to receive medications that have been blessed by a tribal shaman.
- They may pick a sacred number when asked to rate pain on a numerical pain scale.
As well as having a lot of obviously racist nonsense in there, it contains stereotypes that could lead to patients not getting the pain relief that they need. If you think Jewish people are more vocal and demanding, for instance, you may end up taking their requests for pain relief less seriously, or just assume Black people don't need it.
"If a patient tells you their pain level, believe them – because they are the expert on their body," a child and welfare specialist wrote when the page first went viral in 2017. "As a medical professional, your job is to provide medical care, the patient's job is to convey their symptoms; when in doubt err on the side of better treatment, not disbelief."
The publishers apologized for the page after the uproar, and removed it from subsequent editions. The textbook is far from an isolated incident, however, and more of a symptom of a wider problem in medicine. Research has consistently found, for example, that black Americans are systematically undertreated for pain.
A study in 2016 found that a large number of white medical students held false beliefs about biological differences between Black and white people, including Black people have thicker skin, their blood coagulates more quickly than white people, and Black people have less sensitive nerve endings.
After a survey of the medical students' beliefs, they were given simulated patients to evaluate – a kidney stone and a leg fracture in Black and white patients – and asked to recommend pain relief based on the levels of pain they thought the patients were experiencing. The students that held false biological beliefs about the differences between Black and white people were more likely to report lower pain ratings for Black patients, as well as give less accurate treatment recommendations.
“The good news is that individuals who do not endorse these false beliefs do not show any evidence of racial bias in treatment recommendations," the authors wrote in a statement. "Future work will need to test whether challenging these beliefs could lead to better treatment and outcomes for Black patients.”
Getting rid of racist textbooks used to teach people in-built bias is a start.
*Since America also has a sarcasm problem, this was sarcasm.