Discussion: inital draft of equity concerns (work in progress) #552
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| ### Concerns about Equity in Healthcare | |||
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| Scientific and medical research broadly is shaped by a number of biases. | |||
| Some concerns include how clinical trials recruit and operate. | |||
| The objective of the paper is to compile and synthesis literature on the disease COVID-19. | |||
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| The objective of the paper is to compile and synthesis literature on the disease COVID-19. | |
| The objective of the paper is to compile and synthesize literature on the disease COVID-19. |
| Some concerns include how clinical trials recruit and operate. | ||
| The objective of the paper is to compile and synthesis literature on the disease COVID-19. | ||
| To accurately and completely discuss this pandemic, health disparities and bias need to be addressed, so that the information is applicable to all. | ||
| Bias in medicine can be characterized as when a physician and/or patient “others” an individual in a healthcare setting, oftentimes this occurs when a person looks or acts differently. |
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| Bias in medicine can be characterized as when a physician and/or patient “others” an individual in a healthcare setting, oftentimes this occurs when a person looks or acts differently. | |
| Bias in medicine can be characterized as when a physician and/or patient “others” an individual in a healthcare setting. | |
| Oftentimes this occurs when a person looks or acts differently. |
For "looks or acts differently," is there a specific definition for differently that they use in the literature you looked at? Otherwise, I actually think you could stick with just the first sentence.
| The objective of the paper is to compile and synthesis literature on the disease COVID-19. | ||
| To accurately and completely discuss this pandemic, health disparities and bias need to be addressed, so that the information is applicable to all. | ||
| Bias in medicine can be characterized as when a physician and/or patient “others” an individual in a healthcare setting, oftentimes this occurs when a person looks or acts differently. | ||
| By being self-aware of our own implicit biases, one can work towards equality. |
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This is definitely a good point (because it applies to science as well as clinical trials and medical treatments), but I would suggest maybe reframing a little to bring it back to the context of this review (e.g., COVID-19 outcomes and medical research).
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I agree about the reframing -- these are good points, but they sound like a letter to the editor rather than a research paper. Discussing racial bias in a review about COVID-19 is necessary because of the differential death rates observed, but putting a complete discussion of bias in the medical profession in a review about COVID-19 isn't feasible -- it just sounds like a digression.
| The population of the inhabitants or humans on Earth is approximately 7.8 billion people. | ||
| The myriad of cultures, languages, and environments differentiate the population into subpopulations with varying beliefs, values, and point of views. | ||
| However, the preponderance of the academic discourse made public is produced by western, educated, industrialized, rich and democratic, or WIERD, individuals, which comprise 12 percent of world occupants. | ||
| While there is not much empirical data on the representativeness of WEIRD individuals within mankind, this blatant disparity brings forth the notion of bias in science, for researchers generalize their discoveries to the entire human population. |
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Let's try to figure out what the clinical trials terminology for this is -- I think WEIRD is mostly used in psych. This seems like it might be helpful: https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.23157
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I have a hard time seeing how some of this applies to COVID-19 specifically. Are you concerned that there aren't enough COVID-19 trials in some regions of the world? If so, it would be much more informative in this context to support that claim with data or citations, instead of just making sweeping and unsupported statements about how science in general is biased. I'm not saying that you are wrong in what you're saying, but I think that in a review written by many people it's necessary to work extra hard to keep from becoming a collection of forty brief essays by forty different people. And most importantly, I think that it is very important that these claims need to have citations to back them up.
| There is a misconception that African-American individuals have thicker skin and exorbitant pain tolerance in comparison to other demographics. | ||
| As a result, African-Americans can be misdiagnosed and be given incorrect prescriptions. | ||
| The glomerular filtration rate (GFR) is a tool used to measure a specific protein in the blood, which is an indicator of kidney function. | ||
| This sophisicalted equation inputs data, such as, weight, age, sex, serum levels of creatinine, and race, to obtain a result. |
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| This sophisicalted equation inputs data, such as, weight, age, sex, serum levels of creatinine, and race, to obtain a result. | |
| This sophisticated equation inputs data, such as, weight, age, sex, serum levels of creatinine, and race, to obtain a result. |
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I think that it is important to have citations for these statements, in the context of a review article. I also would recommend changing the word "exorbitant" because I don't think it actually means "high" in general; I think it means "overly expensive" which doesn't make sense here. Maybe you mean "extreme" or just "unusually high"?
I'm not sure how pain perception in particular fits in with COVID-19 though. It might make sense to talk about discrimination in the medical system as a whole, but it would be important to structure the text in such a way that it's easy to see the point you're making ("there's been bias on other topics in the past, so maybe there will be bias on this topic now").
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Yes, I forgot to add citations.
I was attempting to provide some examples to the extent of discrimination in the medical field, however, I understand they do not relate to covid. Thus, I will try to speak more to the medical field as a whole. One of my concerns is due to the lack of info on covid,, much of what i would be saying would be inferences, correct?
| This sophisicalted equation inputs data, such as, weight, age, sex, serum levels of creatinine, and race, to obtain a result. | ||
| Black individuals have a higher racial adjustment factor than that of other races. | ||
| Thus, with similar factors as a white person, for instance, a Black person would have greater kidney function, leading to more kidney complications to reach the threshold of kidney disease. | ||
| In addition to misdiagnosis, participation in clinical trials by African-Americans is disproportionately lower than that of caucasians, even in diseases which [African-Americans] are more susceptible.When there is equal opportunity to participate in clinical trials, there is an insignificant difference between racial groups. |
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| In addition to misdiagnosis, participation in clinical trials by African-Americans is disproportionately lower than that of caucasians, even in diseases which [African-Americans] are more susceptible.When there is equal opportunity to participate in clinical trials, there is an insignificant difference between racial groups. | |
| In addition to misdiagnosis, participation in clinical trials by African-Americans is disproportionately lower than that of caucasians, even in diseases which [African-Americans] are more susceptible. | |
| When there is equal opportunity to participate in clinical trials, there is an insignificant difference between racial groups. |
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I think these claims need to be made a little clearer, and definitely need to be supported with citations.
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For Black Americans specifically, you can find some citations in the links from this paper:
https://www.propublica.org/article/black-patients-miss-out-on-promising-cancer-drugs
They talk both about why increasing diversity in clinical trial enrollment is important for ethical and scientific reasons, but also about why it is not very simple to achieve.
| Thus, with similar factors as a white person, for instance, a Black person would have greater kidney function, leading to more kidney complications to reach the threshold of kidney disease. | ||
| In addition to misdiagnosis, participation in clinical trials by African-Americans is disproportionately lower than that of caucasians, even in diseases which [African-Americans] are more susceptible.When there is equal opportunity to participate in clinical trials, there is an insignificant difference between racial groups. | ||
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| Why are certain racial groups disproportionately being infected with Covid-19. |
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It sounded like this might be a section heading? Apologies if I misunderstood!
| Why are certain racial groups disproportionately being infected with Covid-19. | |
| #### Why are certain racial groups disproportionately being infected with Covid-19 |
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I think I understand your point. In the question I posed affected would be better than infected?
| There is little to no data on the ongoing clinical trials for COVID-19, however, one can presume that African-Americans and other racial minorities are not obtaining equitable access to clinical trials for a disease that research has shown disproportionately affects them. | ||
| While much of the research on health disparities and bias are inconclusive, humans, specifically scientists in medicine, need to make an effort to think more global and be more inclusive with their clinical trials to aid the health outcomes of all demographics. | ||
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| <!--From #460: Risk of comorbid health conditions associated with more severe outcomes may be influenced by long-term damage caused by chronic stress related to traumatic social experiences [@doi:10.1007/s12170-013-0338-5], perhaps mediated by cardiovascular risk factors [@doi:10.1101/2020.05.10.20097253], although the effects of chronic stress have not yet been researched in the specific case of COVID-19 disparities.--> |
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@tlukan, this was suggested previously by another contributor. Do you think it would be an interesting topic to expand on alongside what you are developing? Previously I wanted to study allostatic load (long-term effects of chronic stress), so I have definitely got some materials I put together that I could use to make an outline in case it would be helpful. I do think your clinical trial participation point probably has the most direct effect on what we're analyzing, though.
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I do agree that we should say that it's important to make sure that people in racial minorities and people in lower-income jobs have ample opportunity to be represented in trials, especially since they are at the highest risk. But I think it would be better to present this specifically in the context of the implications for COVID-19, because the paper as a whole isn't about the sociology of medicine.
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Thank you @dziakj1 I will make the point more specific to covid-19. But much information about racial bias in covid-19 clinical trails isn't available to my knowledge, so should I present prior research on other diseases and allude to the fact that covid-19 is applicable to these issues? Since the paper is about covid I should be general in discussing prior research?
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Hey @tlukan, I thought you might be interested to know about this study: https://doi.org/10.1016/j.chest.2020.06.006 They examined the charts for all of the patients admitted for COVID-19 at a hospital in New Haven, CT over a period of time. They analyzed ethnicity and race and found that Black and Hispanic patients were actually more likely to survive than white patients when controlling for age. They hypothesize that this might be caused by the fact that the treatments were determined by a computer, which only used the symptoms and therefore was less likely to be influenced by its perception of the patients (e.g., implicit racism like you were talking about). I'm not so convinced that they have enough data to really make this stick, but it is really interesting that a study looked at patients treated in the same way in the same place and found the opposite trend as what has been widely reported, so I definitely thought I should let you know about this paper. |
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Hello @tlukan! One thing that might be helpful is to read a few articles from folks who have been studying this problem, and summarize what they say in your own words. A review article is a bit like a Wikipedia article in that you don't need to have anything fundamentally new to say, you just have to bring together what is already there. And that isn't necessarily just robotic or automatic -- you can mention what you think they got right or what they missed. |
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If you have a particular example from COVID-19 that you think is especially relevant (maybe the kidney function example) you could mention it as an analogy. As a caution, if you want to do that, then it's important to be extra clear about what you're saying and what lesson you think we need to apply from it to COVID-19. Otherwise it may just come across as switching to another topic before you finished the first topic. |
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It seems like there are quite a lot of suggestions on the text here. Should we give the author a chance to revise before we continue to add comments? It seems like the text may change a lot. |
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This text is not really ready for comment yet, which is why it's marked as a draft. @tlukan is an undergraduate student in psych and we are working on how to write a section of the discussion based on some of his interests (which are highly relevant to COVID-19, but COVID-19 is a bit outside of his experience area). |
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This might be helpful -- it came out very recently: |
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Hey @tlukan, I am working on making you the figure, but I need some packages I don't have installed on this computer and so far it's slow going. I probably won't be able to create something locally until tomorrow. In the meantime, I have two questions for you:
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Superseded by #600 |
Description of the proposed additions or changes
This is @tlukan's initial draft of the discussion! He is an undergraduate contributor who is interested in healthcare inequity and how that can affect research on COVID-19.
(The PR says "@rando2 wants to merge", but I just helped get the PR set up with @tlukan's text)
This is a work in progress so right now it's better to focus on the ideas that @tlukan proposed rather than specifics of the writing
Related issues
#460
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