Essay by Corrine Kola-Balogun
Myths are an age-old phenomenon that have existed since ancient times. Often described as outlandish ideas, tales or stories, these myths have been highly pervasive through human civilisations and cultures.
Having amassed huge swathes of believers, regardless of how outrageous or ridiculous they seemed to the dissenting minority, one cannot underestimate the power of mythology in driving human beliefs and actions, especially in pre-industrial, and pre-scientific societies, where people were more prone to hysteria and non-factual belief. At their best, these myths serve as points of humour or flattery for individuals or groups. At their worst, they intentionally or unintentionally fan the flames of xenophobia, and help to facilitate discrimination against specific groups of people in society.
In the medical field, myths can be highly damaging to the long-term health and life expectancy of people of colour. These medical myths can also help reinforce existing prejudices people of colour experience in wider society. Although commendable for its seemingly ceaseless advancement in understanding, treating various conditions that arise in the human body (genetic engineering and cloning to name a few recent extraordinary advances), medicine is still overrun by racial misconceptions and biases that specifically harm the health of non-white patients. Through an exploration of some key medical myths that plague the medical field, both in theory and in practice, this article seeks to enhance awareness surrounding these detrimental myths, and to propose solutions for these confronting issues in modern medicine.
1. "DEFAULT HUMAN CONCEPT"
One such myth is the "default human concept". This is a blanket approach whereby all procedure, medical research, and general knowledge is modelled from white men, then universally applied to all humans. According to an article from Medical New Today, barriers to entry for black medical professionals, who represent a mere 8% of UK doctors, has led to the field being characterised by professional, pedagogical and physical dominance of white voices and perspectives. This has, over time, led to major gaps in the medial curriculum, as universities and other educational institutions fail to accurately acknowledge or identify how symptoms present themselves on non-white patients.
Conditions such as jaundice and even muscle strains have a tendency to be first identified through physiological factors such as skin colour. These physical changes are, however, most evident among white medical patients, textbooks failing all too often to remind medical students to be more vigilant for other kinds of physical change present on bodies of colour. Therefore, the default human concept leads to gaps in the quality of care received from medical professionals on the basis of race, whilst also allowing these same professionals to retain unconscious biases, consequently negatively impacting their professional capabilities.
2. PAIN, OR "RACE AS A MEDICAL CONDITION"
A 2016 study published by PNAS revealed that black patients in America receive pain treatment less frequently than their white counterparts. More specifically, while 57% of black patients receive 'analgesics' (painkillers) for fractures in situations of emergency, this is 17% lower than the 74% of white patients' course of treatment in the exact same circumstances. The same study further suggests a 15% gap (35-50%) in adequate medical treatment being provided for different forms of cancer, again to the detriment of patients from ethnic and racial minorities. This discrepancy in pain treatment is rooted in the medical misconception that black people are 'less sensitive to pain' than white people. This false perception is not new, however, with numerous historical antecedents within the medical community.
One example is the 1932-1972 Tuskegee syphilis study, with black male patients who should have been included in the study sample excluded as a result of the false belief that 'thicker skin' was a barrier to pain sensitivity. Years later, Alicia A. Wallace found that 50% of over 400 medical students interviewed for a Harvard study believed at least one medical myth about black patients, for example the notion that black patients' nerve endings are "less sensitive". This was later reflected in a similar Virginia study, with 60% of medical students believing black patients had 'thicker skin'. These students not only obviously reveal the inevitable discrepancy of pain treatment on the basis of race, but also highlight, on a deeper level, how blackness can be a proxy for bias and poor medical treatment within the field. There's a lot of work to be done to overturn these disparities, one example being to reform the medical curriculum into one which is not only more sensitive to issues of racial diversity, but also dismantles the demonstrably false notion that race does, or should, dictate health outcomes
3. SOCIALLY DETERMINISTIC IDEAS OF RACE, AND THEIR CONSEQUENCES
Gunjan Mhapandahr, a paediatrician, argues that race is discussed as a social determinant in medical school. This indirectly pushes forward the idea that race in itself is some sort of "medical condition", as opposed to a "social construct". Accountability, or the consignment of characteristics and outcomes to arbitrary and often outdated ideas of race and racial identity becomes distorted. As Kate Raphael outlines, writing a piece about racial bias in medicine, blackness is unfairly and singularly cast as the 'architect of its own destruction.' When viewed together with societal links between minority status and economic inequality, affecting access to healthcare in countries where services are privatised in particular, real consequences are evident. A 2013 AMA report demonstrates how bias and misconceptions around an increased likelihood of drug addiction on the basis of race has a direct impact on pain treatment - good example of these 'real consequences', particularly for people from Black and Hispanic backgrounds, a lack of trust in their ability to follow dosage instructions resulting in them being prescribed less than their white peers.
One final example of a misconception or myth with a net negative impact is that 'a large proportion of Black patients suffer from Vitamin D deficiency'. Though darker skin does require more sun exposure, this is not the same thing as a 'deficiency', often leaving to over-testing and unnecessary supplementation, weakening trust in healthcare advice and services within minority communities (and, in some cases, myths in minority groups themselves). This is all aside from the obvious dangers these pose: risks of skin damage, cancer, and countless other serious medical problems.
In terms of solutions, one obvious example would be to increase the number of non-white people going into the medical field - only 4.2% of dermatologists in the UK are from an ethnic minority, an increased diversity in medical fields of practice, particularly dermatology, evidently of high importance. The COVID-19 pandemic, now almost infamous for the amount of misinformation and bad advice being passed around, equally gave rise to the myth that black people were somehow immune to the virus: despite male black patients being twice as likely to die from COVID in pandemic's first few months, compared to their male counterparts. Additionally, black aid and keyworkers made up a large portion of the country's frontline response, occupying increasingly cramped conditions and rapidly increasing rates of exposure. Once again, history repeats itself: see yellow fever (1792), or smallpox (-1870).
"There is not an intentional bias within the curriculum... however I do feel the examples given to us, for example in dissection, are usually based on white bodies, on top of the fact that most of our donors are white. I'm not sure whether this changes during clinical years, but more definitely needs to be done about unconscious bias, including diverse bodies in our study." (Henry, 1st year Medic)
CONCLUDING THOUGHTS All in all, despite some of the misconceptions, myths and biases that exist both on the level of practice and, to some degree, curriculum, there is still huge progress being made in medicine today to bridge this gap, and enhance awareness around these issues. The mere fact that articles are being written and studies being conducted around this topic creates room for hope, and is indicative of strides being made in the right direction. This is a testament to medical professionals and patients taking notice to these discrepancies, and working to understand and alleviate their associated causes.
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