Looking Beneath the Surface: Racial Bias in the Treatment and Management of Pain

Schoenthaler, Antoinette; Williams, Natasha D.

doi:10.1001/jamanetworkopen.2022.16281

Cited by 22 publications

(11 citation statements)

References 7 publications

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“…Several disparities identified in this dataset are well-documented in patient populations not specific to endometriosis (e.g. prescriptions of antidepressants 28,29 , select anxiolytics 30 , and pain medication [8][9][10][11] ). Prior studies have also observed racial disparities in endometriosis diagnosis 6 and surgical treatments 7 ; therefore, it becomes important to consider how lack of treatment and lack of diagnosis may collectively impact patients' healthcare experiences.…”

Section: Results In the Context Of What Is Knownmentioning

confidence: 96%

Investigating Racial Disparities in Drug Prescriptions for Patients with Endometriosis

Kashyap,

Aziz,

Sun

et al. 2023

Preprint

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BackgroundEndometriosis is a chronic disease with a long time to diagnosis and several known comorbidities that requires a range of treatments including of pain management and hormone-based medications. Racial disparities specific to endometriosis treatments are unknown.ObjectiveWe aim to investigate differences in patterns of drug prescriptions specific to endometriosis management in Black and White patients prior to diagnosis and after diagnosis of endometriosis and compare these differences to racial disparities established in the general population.Study DesignWe conduct a retrospective cohort study using observational health data from the IBM MarketScan® Multi-state Medicaid dataset. We identify a cohort of endometriosis patients consisting of women between the ages of 15 and 49 with an endometriosis-related surgical procedure and a diagnosis code for endometriosis within 30 days of this procedure. Cohort is further restricted to patients with at least 3 years of continuous observation prior to diagnosis.We identify a non-endometriosis cohort of women between the ages of 15 and 49 with no endometriosis diagnosis and at least 1 year of continuous observation. We compare prevalence of prescriptions across selected drug classes for Black vs. White endometriosis patients. We further examine prevalence differences in the non-endometriosis cohort and prevalence differences pre- and post-diagnosis in the endometriosis cohort.ResultsThe endometriosis cohort comprised 16,372 endometriosis patients (23.3% Black, 66.0% White). Of the 28 drug classes examined, 17 were prescribed significantly less in Black patients compared to 21 in non-endometriosis cohort (n=3,663,904), and 4 were prescribed significantly more in Black patients compared to 6 in the non-endometriosis cohort. Of the 17 drugs prescribed more often in White patients, 16 have larger disparities pre-diagnosis than post-diagnosis.ConclusionsOur analysis identified significant differences in medication prescriptions between White and Black patients with endometriosis, notably in hormonal treatments, pain management, and treatments for common endometriosis co-morbidities. Racial disparities in drug prescriptions are well established in healthcare, and better understanding these disparities in the specific context of chronic reproductive conditions and chronic pain is important for increasing equity in drug prescription practices.

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Section: Results In the Context Of What Is Knownmentioning

confidence: 96%

Investigating Racial Disparities in Drug Prescriptions for Patients with Endometriosis

Kashyap,

Aziz,

Sun

et al. 2023

Preprint

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“…Such approaches implicitly treat that clinical assessment as the ground truth, and in so doing establish contemporary clinician-level performance as a ceiling. This is problematic given the well-documented fallibility of human clinicians [87], and the pervasive biases which further worsen the quality of care for underserved patients [88,89]. While learning from clinicians (particularly ensembles of clinicians) is important, MLHC should strive where possible to surpass the quality and accuracy of existing clinical practice.…”

Section: Moving Past the Status Quomentioning

confidence: 99%

Machine learning for healthcare that matters: Reorienting from technical novelty to equitable impact

Balagopalan,

Baldini,

Celi

et al. 2024

PLOS Digit Health

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Despite significant technical advances in machine learning (ML) over the past several years, the tangible impact of this technology in healthcare has been limited. This is due not only to the particular complexities of healthcare, but also due to structural issues in the machine learning for healthcare (MLHC) community which broadly reward technical novelty over tangible, equitable impact. We structure our work as a healthcare-focused echo of the 2012 paper “Machine Learning that Matters”, which highlighted such structural issues in the ML community at large, and offered a series of clearly defined “Impact Challenges” to which the field should orient itself. Drawing on the expertise of a diverse and international group of authors, we engage in a narrative review and examine issues in the research background environment, training processes, evaluation metrics, and deployment protocols which act to limit the real-world applicability of MLHC. Broadly, we seek to distinguish between machine learning ON healthcare data and machine learning FOR healthcare—the former of which sees healthcare as merely a source of interesting technical challenges, and the latter of which regards ML as a tool in service of meeting tangible clinical needs. We offer specific recommendations for a series of stakeholders in the field, from ML researchers and clinicians, to the institutions in which they work, and the governments which regulate their data access.

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“…Many still think Black people feel less pain than they do (Akinlade 2020; Anderson, Green, and Payne 2009; Schoenthaler and Williams 2022). Through an intersectional lens, Black women often suffer exponential harm.…”

Section: The Middle Fingermentioning

confidence: 99%

Finding Black Joy in a World Where We Are Not Safe

Combs

2023

Sociology of Race and Ethnicity

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In this essay, I reflect on my lived experience as a Black, female scholar doing critical scholarship on racism in the vein of Critical Race Theory (CRT). I am particularly attentive to the ways that the current backlash against those who use critical perspectives that center the experience of marginalized persons to illuminate continuing racial oppression in society is meant to silence and frighten scholars through challenging our very livelihoods and even our sanity. Amid widespread legislative attacks in numerous states across the nation, I comment on both the emancipatory power of using the agency of Black joy to speak truth to power in a White supremacist world and the constancy of its companion-pain. I do this to better answer the question: in a place where race scholarship is under attack or heavy scrutiny, what are your experiences with leaving or staying and why?

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Looking Beneath the Surface: Racial Bias in the Treatment and Management of Pain

Cited by 22 publications

References 7 publications

Investigating Racial Disparities in Drug Prescriptions for Patients with Endometriosis

Investigating Racial Disparities in Drug Prescriptions for Patients with Endometriosis

Machine learning for healthcare that matters: Reorienting from technical novelty to equitable impact

Finding Black Joy in a World Where We Are Not Safe

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