Racial profiling of sickle cell patients

8/21/2014 03:22:00 PM
Scientists have identified four separate evolutionary origins of the sickle cell characteristic. Three of them were in Africa.
A news report from Seattle suggests that black sickle cell patients that go to emergency departments (EDs) for pain are often discriminated against because of their race:
"Karim Assalaam and Joehayward Wilson are both living with sickle-cell anemia. This genetic blood disorder is most common among people of African and Mediterranean descent. It can create intense internal pain. But when these two 24 year-old African-American go to emergency rooms for help, they are often met with suspicion.

"'I think it is because of being a young adult and African-American,' Wilson told us.

"The pair are among the 12,000 people in Washington State who carry the genetic trait for Sickle Cell Anemia. Wilson and Karim Assalaam are among the 450 living with the disease.

"'It's hard, people assume you're only out for the drugs or that's the only thing you're coming to there for,' Assalaam said.

"Sickle-cell sufferers frequently use Oxycontin for the pain. The drug is a narcotic that’s often abused by addicts who crush the slow-acting pills and then use the powder for a quick high."
There's now a fair amount of research establishing that medical staff tend to underestimate pain levels of black patients relative to white ones and that while this bias is larger for white doctors, black doctors also underestimate pain of black patients relative to white patients. Hence, it is not terribly surprising that ED staff--who do not specialize in sickle cell--would suspect black patients of abusing drugs, because they probably underestimate the amount of pain in black patients.

Sickle cell disease is not particularly common, affecting less than 3 in every 10,000 Americans. This means dedicated 24 hour sickle cell clinics staffed with doctors with experience with sickle cell are not financially viable, even though sickle cell patients could have severe episodes of pain or even life-threatening complications at any hour of the day. As a result many sickle cell patients rely at least in part on non-specialists in EDs to help manage their chronic condition, which is why this discrimination in pain prescriptions can be particularly problematic in this population.