By Laura Blue
Black patients with diabetes do worse than white patients — even
when they're getting treatment from the same doctor. That's the message
of a new study published this week in the journal Archives of Internal Medicine.
It's not the first paper to document health disparities between black
and white diabetics, but it breaks new ground: By looking at the
outcome discrepancy among a group of patients with access to the same
health facilities — 90 Massachusetts physicians working in 14 health
centers — the new study rules out the explanation that black patients,
by virtue of being poorer, are excluded from seeing the better quality
doctors to which their white counterparts are more likely to have
access.
Even when they were being treated by the same pool of physicians,
whites were more likely than blacks to meet the commonly accepted
cut-off point for long-term control over blood pressure (30% v. 24%),
over "bad" cholesterol (57% v. 45%), and over the blood-glucose
measure, hemoglobin A1C (47% v. 39%). The researchers approached their
data mindful of the need to ensure that any discrepancies were not
simply the effects of what they term "socio-demographic factors":
Comparing apples with apples — patients of the same gender,
income-range and age — the white patients still fared far better.
The cause of the discrepancy, however, remains a mystery.
Although the researchers adjusted their data for factors such as
obesity levels, these did not affect the racial disparity. Some might
be tempted to see the data as reflecting racial discrimination among
doctors, but that would probably result in a different pattern among
different doctors. Instead, the discrepancy was common among all of the
doctors, irrespective of how many black patients they saw or how good
their overall performance rates were.
Furthermore, at least the initial patient-doctor interaction
appeared to have been similar for all patients: rates of testing for
blood-sugar control and for cholesterol, for example, were the same.
"That suggests the physicians are implementing standard treatment
plans," says Thomas Sequist, lead author of the study and an internist
at Harvard Vanguard Medical Associates. It's only later, when it comes
to treatment and, especially, outcomes, that a disparity is evident.
Sequist, for his part, has a hunch. He doesn't think most doctors
discriminate at all. "I feel like the issue may more be that the
doctors are
treating all the patients the same — and if you treat all the patients
the same you won't get the same outcomes because patients don't face
the same challenges," he says. "We're not tailoring our counseling to
the needs of our patients."
That's why Sequist did a follow-up study with the same group of
physicians, asking whether they thought racial disparities were a
problem in diabetes care. About 90% said there's a problem in the U.S.
nationally, but less than half of that number believed the problem
affects their own practices. Now, Sequist is giving those doctors
reports on their treatment performance based on the race of the
patient. He's also experimenting with what he calls "cultural
competency training": lessons designed to help doctors recognize when
patients may not share the same assumed health conditions, or when
patients may face constraints that make the standard dietary and
exercise guidance tougher to follow.
Sequist emphasizes that these
lessons are not aiming to teach doctors "what a black patient thinks,"
but to get doctors to find out what their patients actually do
think. Results of the trial won't be available until later this year.
But, if it works, it could be a huge boon to treatment for all kinds of
chronic conditions. "I think the issues are all the same," Sequist
says. "They're around medication adherence and patient engagement."
A warrior woman: fighting for life against breast cancer, brother Troy Anthony Davis’ death sentence
By Margaret Summers
Martina Correia, a 42-year-old African American from Savannah, Georgia, is a “warrior woman,” inspiring death penalty abolitionists as well as women like her struggling with breast cancer.
Guest Contributor
Courtesy of National Coalition for the Abolition of the Death Penalty (NCADP)
Correia’s brother is Troy Anthony Davis, convicted in 1991 for the shooting death of white police officer Mark MacPhail. There is no physical evidence linking Davis to the crime. No murder weapon was produced. Seven of nine witnesses who initially implicated Davis have since recanted, stating in sworn affidavits that they were pressured or coerced by police into naming him. Davis’ attorneys are appealing his case before the U.S. Supreme Court. The Court will determine whether or not to review Davis’ habeas petition on June 25, and make its decision public on June 26 or June 29. If the appeal is rejected, Davis will be executed.
The case has generated global attention. Former President Jimmy Carter, Pope Benedict XVI, South African Bishop Desmond Tutu, the NAACP, and human rights organization Amnesty International, have called for Georgia Governor Sonny Purdue to grant Davis clemency. Former U.S. Representative Bob Barr, former FBI Director William Sessions, and several former prosecutors and judges, have filed an amicus brief supporting Davis’ plea.
Long before her brother’s involvement in the criminal justice system, Correia opposed the death penalty. An Amnesty International member since age 13, she resigned her U.S. Army nurse position when told she couldn’t express “political opinions” against capital punishment. Since her brother’s conviction, “I speak at universities, high schools and before community groups. I talk about the injustices that lead to arrests of innocent people, why so many people of color get the death penalty, and how and why prosecutors select people for death sentences. I don’t just talk about my brother on death row, but the system that put him there.”
She didn’t know what to expect when Davis was tried. “I anticipated that my brother would get his day in court,” she explains. “But our judicial system is fraught with biases. Until my brother was accused of killing a white police officer, I didn’t realize just how black I was.”
Watching Davis’ trial, “I felt like people were angry that my brother had attorneys from out of town,” says Correia. “I thought he would have more time in the courtroom to argue his case, but he only got 20 minutes, and then a bell rang when he ran out of time.” Alarmed, Correia stepped up her fight for Davis’ exoneration.
Then in 2001, Correia was diagnosed with breast cancer. When chemotherapy treatments resulted in hair loss, she shaved her head and wore hats or scarves. The prison initially barred Correia from wearing head coverings during visits with Davis for “security reasons”; weapons could be hidden in headgear. Davis intervened. Correia was made an exception, “but whenever I wore a scarf the prison guards made me take it off to search it.”
Determinedly working through exhaustion, Correia’s only concession to debilitating chemotherapy is to request airfare from sponsors of appearances located more than five hours from her home. Otherwise, she drives herself, although chemotherapy makes her sleepy. “I have to try to stay awake while driving. When a speaking engagement’s over, I go home and rest, ”she says.
Correia serves on the boards of death penalty abolition organizations like Georgians for Alternatives to the Death Penalty and New Hope House. She also participates in efforts to increase federal funding for breast cancer research. She is a lobby delegation team leader in the National Breast Cancer Coalition. She teaches health maintenance classes to women with cancer in Savannah’s St. Joseph’s/Candler Health System.
Somehow Correia balances her advocacy with raising her 14-year-old son Antone, an Honor Roll middle school student, whose winning social studies project in a state competition last year was entitled: “How Does the Troy Anthony Davis Death Penalty Case Impact Georgia?” Antone, who considers “Uncle Troy” a role model, wants to be a medical researcher when he grows up, and find the cure for breast cancer that has stricken his mother and thousands of women.
Correia says her brother’s confinement on death row and her illness are difficult for her and their family but “I trust God, I have faith. It’s like Troy said when he was minutes away from execution (before the current U.S. Supreme Court appeal), ‘God didn’t take me this far to leave me.’ I pray for Troy and for Mark MacPhail’s family. I ask God to let me live to see my brother freed and my son graduate from school. My biggest prayer is that my mother doesn’t continue to suffer. If Troy is executed it will break her heart.
“I’m going to fight this system until somebody says, ‘We made a mistake,’ she adds. “I know that the name Troy Anthony Davis is a name known all over the world by people who believe in truth, justice and fairness. That’s all I’m asking for, fairness.”
The NAACP and Amnesty International U.S.A. are co-sponsoring a “Week of Witness” for Troy Anthony Davis, June 19-26 2009. Faith communities are asked to pray for the Davis and MacPhail families during that week, sign a petition, ask their religious leaders to sign a clergy letter, or discuss Davis’ case during regular weekend worship services. Additional information, please visit the “Week of Witness”.
Chrisrabb! on Wednesday, June 17, 2009 at 09:53 AM in Commentary/Opinion, Community & Consumer Activism, Crime & Punishment, Family, Health, Public Policy, Race, Culture & History, The Law | Permalink | Comments (0) | TrackBack (0)
Technorati Tags: Afro-Netizen, Amnesty International, capital punishment, clemency, commutation, criminal justice, death penalty, death row, NAACP, NCADP, poverty, race, SCOTUS, Troy Anthony Davis
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