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InvisibleDiploidM
Cuban


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Registered: 01/09/03
Posts: 19,274
Loc: Rabbit Hole
Minorities Prescribed Fewer Opiates
    #7822577 - 01/02/08 04:15 AM (16 years, 30 days ago)

It's a fucked up system when social stigma over a drug influences doctors to prescribe fewer pain relieving medicines based on patient race. :sad:

--

CHICAGO, Jan 1 (Reuters) - Black and Hispanic patients in pain are less likely than whites to get powerful painkillers from U.S. hospital emergency departments, but the reasons may go beyond sheer racial bias, researchers said on Tuesday.

In a look at 375,000 emergency room visits over 13 years, a study found 31 percent of whites in pain received opioid drugs

-- a broad class of narcotic painkillers dispensed only by -- a broad class of narcotic painkillers dispensed only by prescription -- compared to 23 percent of blacks and 24 percent of Hispanics.

In contrast, 36 percent of minority patients received less-potent, non-opioid pain relievers such as acetaminophen and ibuprofen during emergency room visits, compared to 26 percent of white patients.

There may several reasons behind the racial disparity, Dr. Mark Pletcher, the study's author, wrote in this week's issue of the Journal of the American Medical Association.

Pain relief received more attention in the late 1990s, and formal U.S. guidelines issued in 2001 called for improved monitoring and control of patient pain. Overall, use of opioids in hospital emergency departments increased from 23 percent of patients in 1993 to 37 percent in 2005, the researchers said.

"Studies in the 1990s showed a disturbing racial or ethnic disparity in the use of these potent pain relievers, but we had hoped that the recent national efforts at improving pain management in emergency departments would shrink this disparity," Pletcher, of the University of California at San Francisco, said in a statement.

"Unfortunately, this is not the case," he said.

While health care providers would be loathe to admit it, they may show racial bias in assessing whether a patient is exaggerating symptoms to obtain powerful painkillers to either sell or abuse, the report said.

But the study found the largest racial disparity in providing stronger medications was found among patients in the most pain and those aged 12 or younger who are unlikely to be drug abusers.

"There is no evidence that nonwhites have less severe or different types of pain when they arrive in the emergency department," Pletcher said. "We think our data indicate that opioids are being underprescribed to minority emergency department patients, especially black and Hispanic patients."

A factor may be that white patients are more likely to expect and demand relief from pain and better convey their symptoms in comparison to minority patients, the report said. Whites -- who are more likely to have health insurance -- may also be overprescribed the drugs, it said.

But the persistent racial disparity suggested changes are needed in emergency room protocols for pain management, it concluded.

reuters.com


--------------------
Republican Values:

1) You can't get married to your spouse who is the same sex as you.
2) You can't have an abortion no matter how much you don't want a child.
3) You can't have a certain plant in your possession or you'll get locked up with a rapist and a murderer.

4) We need a smaller, less-intrusive government.


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OfflineSheerTerror
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Male

Registered: 11/28/03
Posts: 2,348
Last seen: 9 years, 2 months
Re: Minorities Prescribed Fewer Opiates [Re: Diploid]
    #7822596 - 01/02/08 04:30 AM (16 years, 30 days ago)

eh, the whole bureaucratic corporate drug system is all fucked. The cuban drug rings should all unite and manufacture, supply, and profit on with better narcotics.


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Invisiblefastfred
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Registered: 05/17/04
Posts: 6,899
Loc: Dark side of the moon
Re: Minorities Prescribed Fewer Opiates [Re: Diploid]
    #7822625 - 01/02/08 04:53 AM (16 years, 30 days ago)

Quote:

Diploid said:
Whites -- who are more likely to have health insurance -- may also be overprescribed the drugs, it said.




Nice to see an article that acknowledges that it's main point may be completely reversed from the truth.

Unlike the other news story on the same study, this one points out what should be the obvious conclusion.

Whites generally have more and better health insurance + more money to pay for pills. More insurance also almost always = more treatment, including painkillers. Nothing new there.


-FF


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InvisibleDiploidM
Cuban


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Registered: 01/09/03
Posts: 19,274
Loc: Rabbit Hole
Re: Minorities Prescribed Fewer Opiates [Re: fastfred]
    #7822647 - 01/02/08 05:08 AM (16 years, 30 days ago)

I don't think insurance had much influence on these numbers.

The report covers only emergency rooms where the doctors do not even know if the patient has insurance or not. That information is irrelevant to medical care and so isn't in any of the paperwork the doctor sees.

The only information the doctor has when deciding whether to administer an opiate is the medical facts in front of him and the face on the patient.


--------------------
Republican Values:

1) You can't get married to your spouse who is the same sex as you.
2) You can't have an abortion no matter how much you don't want a child.
3) You can't have a certain plant in your possession or you'll get locked up with a rapist and a murderer.

4) We need a smaller, less-intrusive government.


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Invisiblefastfred
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Registered: 05/17/04
Posts: 6,899
Loc: Dark side of the moon
Re: Minorities Prescribed Fewer Opiates [Re: Diploid]
    #7822672 - 01/02/08 05:30 AM (16 years, 30 days ago)

I'm not so sure about that. Insurance info is usually provided on the forms you fill out as soon as you enter the ER. Unless you're unconscious you pretty much have to fill out the forms if you want any treatment at all.

And thinking that info on intake forms is unavailable to the doctor is naive. Doctors can and do take everything into account when prescribing drugs. That includes medical history and past treatment. While it's not usually quite so plainly spelled out on the chart it is pretty apparent weather the patient has insurance from even a cursory look. If you haven't been in for regular checkups and other minor medical issues, then you probably don't have insurance. If your history is blank then you almost certainly have no insurance.

And that's just from what the doctor should know about you. I guarantee that few things travel faster than gossip amongst staff about patients at a hospital. I guarantee that they almost always know insurance status about patients weather it's on their chart or not. Some hospitals straight up refer to hypochondriacs and the uninsured as GOMER's, meaning Get Out of My Emergency Room.

Insurance and ability to pay is also a legit concern for both doctor and patient. The uninsured often discuss that with their doctor and seek less expensive treatment options. Often there are a number of options and no clear "best for the patient" situation. I wonder if the study took that into account at all? People that can't pay will often refuse non-essential treatment like pain killers.

Doctors certainly take economic factors into account. Adding $200 onto somebody's bill, who probably can't pay in the first place, for drugs that don't really have much effect on a patient's health is in nobody's best interest. Sure you might feel a bit better from taking the pills, but it's not worth it for a lot of people that will later end up having to pull extra shifts at a minimum wage job to pay for the pills.

Quality of life issues, pain management, and quality of care are rarely as straightforward as they first seem. When economic factors are factored in things get grey pretty quickly.

I think it's wrong to start screaming racism at the drop of a hat when there are plenty of confounding factors that quite likely play a bigger role than any actual racism.


-FF


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OfflineSheerTerror
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Registered: 11/28/03
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Last seen: 9 years, 2 months
Re: Minorities Prescribed Fewer Opiates [Re: fastfred]
    #7822677 - 01/02/08 05:33 AM (16 years, 30 days ago)

yeah, it just shows how some serious hypocrisy is going on. Thats why i just chose to boycott it all :shitstorm: Here there is a state health care reform act. By last month everybody here had to have health insurance or there will be penalties and fines later on.


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InvisibleDiploidM
Cuban


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Registered: 01/09/03
Posts: 19,274
Loc: Rabbit Hole
Re: Minorities Prescribed Fewer Opiates [Re: fastfred]
    #7822685 - 01/02/08 05:42 AM (16 years, 30 days ago)

Well, I've never seen anything like that and I've had uninsured friends need emergency treatment. I'm not talking office visits or optional shit like plastic surgery. Other than having to share a room with three other hospital beds, the treatment seemed to be the same as with insured patients.

Also, I think it would be unethical for a doctor to allow 'ability to pay' to in any way influence his decisions over medically needed treatment in an ER.

If I were a smart ambulance chaser layer, I'd camp out in the ER looking for a poor-looking black guy to use as fodder for a malpractice suit based on treatment statistics and race and my poor mistreated client.

Seems like a slam-dunk case. I dunno...


--------------------
Republican Values:

1) You can't get married to your spouse who is the same sex as you.
2) You can't have an abortion no matter how much you don't want a child.
3) You can't have a certain plant in your possession or you'll get locked up with a rapist and a murderer.

4) We need a smaller, less-intrusive government.


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Invisiblefastfred
Old Hand
Male User Gallery

Folding@home Statistics
Registered: 05/17/04
Posts: 6,899
Loc: Dark side of the moon
Re: Minorities Prescribed Fewer Opiates [Re: Diploid]
    #7822718 - 01/02/08 06:07 AM (16 years, 30 days ago)

If you're in the ER for something straightforward you're going to get pretty much the same treatment no matter what your payment status.

Painkillers are one area though were people get treated differently. The are optional and don't usually have any effect on the outcome. So when you get into optional treatments things definitely go in different directions.

"Medically needed treatment" vs. the exact type of care you get are different issues. I'm sure that painkillers and expensive rehab options vary a lot based on if you have good insurance.

Also when an insured person is offered pills they'll almost always take them, whereas somebody who's going to have to pay a crazily inflated cost for each and every pill they take will likely try to get off as cheaply as they can. Doctors do often discuss the costs of different treatment options with patients and I assume that the pained look on some people's faces when they hear the price tag has a lot of influence. When a doctor knows it will be a hardship to pay medical bills it's only reasonable that the doctor will try to minimize costs and avoid overtreating the patient. I'm sure well insured people also demand a lot more treatment, knowing that they aren't going to have to pay for it.

Another thing is that if you look at the numbers it seems that only 37% of ER visits are getting pain killers, meaning that the large majority of people are being denied opiate painkillers. In a situation like this, where many people are denied painkillers, it would be hard to imagine insurance not playing a factor. If you're denying a large portion of people painkillers one would assume that the uninsured would mostly fall into the denied category before the insured. In most cases I'd bet that the treatment is pretty fair, but with a large grey area like there is I'd think that in most of those cases ability to pay would be taken into account.


-FF


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