(Please note that the dates refer to the time we transferred the news topics to our archives)
March 10, 2002
Blacks Patients Less Likely to Get Life-Saving Heart Procedure
Black patients who have had heart attack patients are far less likely than whites to receive the common and potentially life-saving procedure known as cardiac catheterization, regardless of the race of their doctors, conclude researchers at Yale University.
The researchers examined hospital records of about 40,000 Medicare beneficiaries — 35,676 whites and 4,039 blacks — who had been treated for heart attacks around the U.S.. After taking socioeconomic status and the patient's medical condition into account, they found that doctors of both races referred white patients for catheterization about 40 percent more often than blacks.
This study is not the first to document striking racial disparities in care delivered to whites and blacks. But it is the first to examine the effect of the doctor's race on differences in care, and its authors say it debunks the notion that discrimination by white doctors against black patients is the sole source of the disparity. "We do find disturbing differences in patterns of care, but whatever accounts for this is likely to be pervasive throughout the system."
The Yale study looked at records of patients 65 or older who had been hospitalized for heart attacks in 1994 and 1995 to see if they had been offered cardiac catheterization within 60 days after the attack. White doctors offered cardiac catheterization to 45.7 percent of their white patients but only 38.4 percent of blacks. Black doctors offered the procedure to 49.6 percent of white patients and 38.2 percent of blacks.
Cardiac catheterization, in which doctors insert a tube into a vein and then inject a dye to detect blockages in blood vessels, is important because it is the first step in determining whether patients need other life- saving treatments, like heart bypass surgery.
Experts say a combination of factors is probably behind this difference in care, such as quality of medical care, patients preference, doctors' attitude to be more aggressive in treating white patients who would then receive at times unnecessary procedures. At the same time, experts who study racial disparities in health say unconscious or subtle discrimination is almost certainly at work.
The Yale study adds to a growing body of medical literature that suggests blacks receive less care, and less sophisticated care, than whites. "We shouldn't be surprised that biases that are prevalent in the larger society also appear in medicine," said Dr. H. Jack Geiger, professor of community medicine at City University of New York. "We should be deeply concerned, but not surprised." Perhaps, experts like Dr. Geiger say, there is something about going through medical school that creates, or reinforces, stereotypes, like some people's not wanting certain kinds of care or being less able to comply with doctors' instructions.
David Williams, a sociologist at the University of Michigan who has studied disparities in health, said doctors of all races might be "socialized within the same professional context to view certain patients as undesirable." Those views may have more to do with class than race, Dr. Williams said. It was apparently impossible to draw conclusions about how the disparity ultimately affected the health of the patients studied. "The study doesn't provide important evidence that this has hurt blacks," said Dr. Epstein, the Harvard Health Policy professor, who also wrote an editorial about the study. "On the other hand, it doesn't provide important evidence that it doesn't hurt blacks."
Sources: New England Journal of Medicine; New York Times
(Reviewed by Carl Gilbert, MD)
February 4, 2002
More Ghanaian teenagers in sex trade
ACCRA, October 04, 2001 -- Ghanaian health authorities fear an AIDS explosion could be looming in the country following the growing number of teenagers, as young as 13 years, in the sex trade.
The young girls, some of whom are still in basic schools, and citing several reasons including economic difficulties for their decision to enter the sex trade, are pushing their older colleagues out of the business.
"If you need something and your boyfriend cannot give you but someone would (have sex with you) and give you, why not go in for it?" declared an 18-year-old girl, who asked not to be named.
The older women, from an apparent frustration of failing to stop their "daughters" from displacing them, have come to accept them and are said to be coaching them.
According to a survey, fees charged for sex vary depending on whether condom is used, the duration of the act, and the status of the client.
A one-hour session with condom could be as low as 20,000 cedis (less than three US dollars) while sex with a high-class client without a condom could be as high as one million cedis (about 140 dollars), the monthly salary of a senior civil servant.
Authorities are worried that the desired behavioral change is yet to result from the national anti-AIDS campaign.
Commercial sex workers, too, do not appear to be scared of
the disease even though the prevalence rate among them is as high as 75
percent in Accra and 82 percent in Kumasi, the second largest city, according
to available figures. - PANA
Former U.S. Secretary of Health & Human Services,
Dr. Louis Sullivan (pictured
on the left), was honored for his
accomplishments during the 2001 Africare Bishop John T. Walker Memorial Dinner
on Nov. 6, 2001 at the Washington Hilton in Washington, D.C.
In receiving the honor, Dr. Sullivan joined past
recipients of the award, including Archbishop Desmond M. Tutu, the 1984 Nobel
Peace Prize winner; Sargent Shriver, the first director of the Peace Corps;
Nelson Mandela, former president of South Africa; and former President Jimmy
Carter. During his acceptance speech, Dr. Sullivan said his parents taught him
that "a relevant life is one that includes serving others, especially those
less fortunate."
Guests present at the
honoring ceremony included Secretary of State Colin Powell, former Rep. Ronald
V. Dellums; Bruce Alberts, president of the National Academy of Sciences; Rep.
Eva M. Clayton; Ahmedou Ould Abdallah, executive secretary of the Global
Coalition for Africa.
During the keynote address, Mr. Powell emphasized
the need for solutions to the human rights atrocities of Sudan and the AIDS
crisis on the African continent.
Source: The Washington Times
Race Bias in Stroke Treatment Found
By Jean F. Gibbs
Whites are five times more likely than blacks to receive emergency clot-busting treatment for stroke, researchers found.
Only 1.1 percent of blacks received the drug tPA in a study of the nation's top hospitals, compared with 5.3 percent of whites. Researchers said a large racial disparity persisted even after they took into account age, gender, type of insurance and severity of the stroke.
The study is published in the May issue of the American Heart Association journal Stroke.
``We have to consider the possibility that racism is contributing,'' said Dr. S Claiborn Johnston, assistant professor of neurology at the University of California at San Francisco, and a co-author of the study.
In general, researchers found low overall use of tPA - the only Food and Drug Administration approved clot-buster for strokes caused by blood clots. Among all patients who arrived at the hospital within two hours of the onset of symptoms, fewer than a quarter received the drug.
A stroke is a lack of blood flow that damages or kills brain tissue. Strokes are sometimes caused by a burst blood vessel, causing bleeding in the brain. But the vast majority strokes (cerebrovascular accidents or CVA's) are ischemic. Ischemic CVA happens when arteries feeding the brain are blocked by a blood clot.
tPA has revolutionized ischemic stroke care. The drug must be given within three hours of the first symptoms.
In the new study, researchers reviewed records at 42 U.S. academic medical centers of 1,195 ischemic stroke patients treated in 1999.
Even among the 189 patients considered good candidates for tPA - those who arrived at the hospital within three hours and had no other conditions that made treatment unsafe - whites were three times more likely than blacks to get the drug. No blacks were documented as having refused the drug, while three whites were.
Johnston said that if race is a factor, it is a subtle one. Some researchers urged caution in interpreting the results. Dr. Larry Goldstein, director of the Center for Cerebral Vascular Disease at Duke University, noted that the study looked at medical records after the fact and said that could obscure some explanations. For example, he said, tPA may have been offered and declined without the records reflecting that.
``Some people might write that down in their notes,'' Goldstein said. ``Other people may just say, `They don't want it. Let's move on,' and not take the time to write it all down.''
Dr. Mark Alberts, professor of neurology at Northwestern University Medical School, said various factors that were not statistically significant on their own could have combined to create at least some of the disparity. He noted, for example, that blacks tended to arrive later at the hospital after symptoms began and more frequently had conditions that made treatment unsafe. (Sources: AP and Stroke)
Reviewed by Carl Gilbert, M.D.
CDC Expands Global AIDS Program
to the Caribbean and Latin America
WASHINGTON, June 7 /U.S. Newswire/ -- HHS Secretary Tommy G. Thompson today announced that the Centers for Disease Control and Prevention will expand its Global AIDS Program to address the HIV/AIDS epidemic in the Caribbean and Latin America. Secretary Thompson made the announcement following a meeting today with Sir George
Alleyne, director of the Pan American Health Organization (PAHO).
"In the Caribbean, where HIV rates are the highest in the world outside Africa, we are committed to reducing HIV transmission through prevention," said Secretary Thompson. "We also will work to improve the care and treatment of people living with HIV/AIDS and related infections."
CDC will work in partnership with the Caribbean Epidemiology Center (CAREC), assisting them with their HIV prevention efforts throughout the Caribbean. CAREC is one of eight scientific centers within PAHO and is a leading public health institution in the region.
"The AIDS epidemic has reached alarming proportions. In the Region of the Americas, one in every 200 persons between 15 and 49 years of age is HIV-infected. In the Caribbean, one in every 50 people has the infection, and we must intensify our fight against this deadly threat to health and development," said Sir
Alleyne. "Combating the epidemic in the region requires a strong focus on prevention and access to quality, humane care and treatment, while maintaining the dignity of those infected and living with HIV/AIDS."
In June 2001, CDC will initiate technical assistance to CAREC, which will help improve the health status of Caribbean countries by supporting HIV prevention programs and care and treatment programs for HIV-infected individuals. This is not the first joint partnership with
CAREC. In 1996, CAREC established the Caribbean AIDS Telecommunications and Information Network with resources from
CDC. The network helps to increase awareness about the impact and prevention of sexually transmitted diseases, including HIV.
CDC is committed to supporting those countries most in need in Latin America as well, where more than 50,000 people died from AIDS last year. CDC representatives will begin working directly with public health officials from Brazil, Guyana and Haiti, where more than three-quarters of a million people were living with HIV/AIDS in 1999.
Since 1999, CDC has established Global AIDS Programs in India and 14 countries in Africa. In 2001, CDC will support programs not only in the Caribbean, but also in countries in Asia and in additional nations in Africa. CDC's fiscal year 2001 appropriations for its global HIV/AIDS programs is more than $104 million. An additional $11 million funds ongoing research at CDC related to international HIV/AIDS activities.
Other HHS agencies, including the National Institutes of Health (NIH) and the Health Resources and Services Administration
(HRSA), are contributing to the AIDS fight in the Americas. Since the early days of the epidemic, NIH has supported research efforts in countries affected by AIDS. Beginning in 1984 with a research project in Haiti, NIH has expanded its efforts to encompass more than 50 countries in Africa, Asia, Europe and Latin America. In fiscal year 2001, NIH will spend more than $100 million on AIDS research conducted with international partners.
HRSA is working with Mexico on the cross-border problems of HIV/AIDS and is targeting $13 million dollars over five years in grant funds for people with HIV disease and AIDS who live in the U.S. area of the U.S.-Mexico border.
Other federal agencies -- including the U.S. Agency for International Development, the Department of Defense, and the Department of Labor -- as well as non-governmental organizations -- including
PAHO, UNAIDS and UNICEF -- also work with HHS to implement programs worldwide that help halt the spread of the HIV/AIDS pandemic.
CAREC provides laboratory reference and epidemiology services to 21 member countries, including
Anguilla, Aruba, Antigua, Barbuda, Bahamas, Barbados, Belize, Bermuda, British Virgin Islands, Cayman Islands, Dominica, Grenada, Guyana, Jamaica,
Montserrat, Netherlands Antilles, St. Kitts and Nevis, St. Lucia, St. Vincent and the Grenadines, Suriname and the Turks and
Caicos. CAREC is located in the Republic of Trinidad and Tobago and was founded in 1975.