Wednesday, January 04, 2006

there's far too many of you dying

In actually quite serious news from the NYT, a study recently found significant differences in the way African-American lung cancer patients are treated in comparison to Caucasian lung cancer patients. If you have access to the Journal of Clinical Oncology, there are two excellent articles published that demonstrate the problem at hand. In some ways, many of the confounders that are often associated with these types of studies are eliminated. If you read the first sentence of this paragraph, you might shoot holes in the results with the following:
  • African-American patients may not have access to the same level of healthcare due to socioeconomic factors. True, but this study was comparing apples to apples: African-American patients with treatable lung cancer and equivalent access to healthcare.

  • Even if African-Americans have access to healthcare, due to cultural differences, they may be more reticent to undergo treatment. Again, the study cleanly sought patients that showed a willingness to be treated upon initial presentation with lung cancer.

  • Due to cultural differences, African-Americans may wait until their cancer is too advanced to be properly treated. Once more, might be true, but a companion piece in JCO by the same author shows work that was done, demonstrating that African-American patients responded just as well as Caucasian patients did to chemotherapy. Even in cases where the patients were from lower socioeconomic backgrounds than the Caucasian patients, they still had a similar survival rate. And in cancer, the survival rate is really the gold standard by which effectiveness is measured.

And here are the conclusions to the main study (emphasis mine):
    Black patients obtain surgery for lung cancer less often than whites, even after access to care has been demonstrated. They are more likely not to have surgery recommended, and more likely to refuse surgery. Additional research should focus on the physician-patient encounter as a potential source of racial disparities.

That is truly disturbing to me. If this holds water, physicians are subconsciously or consciously treating African-American patients differently. Even the observation that African-American patients are more likely to refuse surgery can, in my opinion, be partially tied back to the physician-patient relationship. If a physician is treating patients differently, it is no wonder that African-American patients might feel a sense of distrust, and choose not to undergo surgery. Furthermore, the physician may have offered surgery as an option, but less than whole-heartedly, biasing the patients' decision. Either way, it is ten kinds of all wrong, and I am surprised there is not a bigger uproar about it.

Here's something that there should be a bigger uproar about, as well, but in a much happier sense: it is the birthday of the most suitable blogger I know. It is both Anna's example and her encouragement that have fueled many, many a blogger, including this one. In a nice bit of serendipity, it appears that I will be spending the end of the month in her neck of the woods. So, if any of you are in the DC area, and feel like listening to me whine about how the west coast has turned me into a total pansy when it comes to tolerating the cold, drop a line. In the meanwhile, go over to Anna's place and drop her a birthday wish and a big hug.

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