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**Dill** · 11-15-2017, 07:23 PM

(11-15-2017, 03:21 PM)michaelsean Wrote: I'm curious about the studies that say black people are under-prescribed pain killers. Maybe as a whole, black people rely on them less. They may refuse the prescription.

Here are a couple which control for multiple variables to establish the differential and assess grounds for it.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3111792/

Racial/ethnic minorities consistently receive less adequate treatment for acute and chronic pain than non-Hispanic whites, even after controlling for age, gender, and pain intensity. Pain intensity underreporting appears to be a major contribution of minority individuals to pain management disparities. The major contribution by physicians to such disparities appears to reflect limited awareness of their own cultural beliefs and stereotypes regarding pain, minority individuals, and use of narcotic analgesics.

http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0159224
Abstract

Prescription drug abuse is a growing problem nationally. In an effort to curb this problem, emergency physicians might rely on subjective cues such as race-ethnicity, often unknowingly, when prescribing opioids for pain-related complaints, especially for conditions that are often associated with drug-seeking behavior. Previous studies that examined racial-ethnic disparities in opioid dispensing at emergency departments (EDs) did not differentiate between prescriptions at discharge and drug administration in the ED. We examined racial-ethnic disparities in opioid prescription at ED visits for pain-related complaints often associated with drug-seeking behavior and contrasted them with conditions objectively associated with pain. We hypothesized a priori that racial-ethnic disparities will be present among opioid prescriptions for conditions associated with non-medical use, but not for objective pain-related conditions. Using data from the National Hospital Ambulatory Medical Care Survey for 5 years (2007–2011), the odds of opioid prescription during ED visits made by non-elderly adults aged 18–65 for ‘non-definitive’ conditions (toothache, back pain and abdominal pain) or ‘definitive’ conditions (long-bone fracture and kidney stones) were modeled. Opioid prescription at discharge and opioid administration at the ED were the primary outcomes. We found significant racial-ethnic disparities, with non-Hispanic Blacks being less likely (adjusted odds ratio ranging from 0.56–0.67, p-value < 0.05) to receive opioid prescription at discharge during ED visits for back pain and abdominal pain, but not for toothache, fractures and kidney stones, compared to non-Hispanic whites after adjusting for other covariates. Differential prescription of opioids by race-ethnicity could lead to widening of existing disparities in health, and may have implications for disproportionate burden of opioid abuse among whites. The findings have important implications for medical provider education to include sensitization exercises towards their inherent biases, to enable them to consciously avoid these biases from defining their practice behavior.

NO DISPARITIES for definitive conditions, however.

**Dill** · 11-15-2017, 07:55 PM

(11-15-2017, 07:18 PM)bfine32 Wrote: Answer this one question: Why did he begin the article with his kid asking him how many people he could have as his best friend; if the kid was concerned about images from Charlottesville?

I have no problem discussing race relations with anyone and to think racism does not exist in modern society is ridiculous; however, when a father turns a question asked by his 4-year old son as to how many best friends he has into a racial issue, he is looking to bring race into any conversation. As do those in this forum that are applauding his words.

When the child is asking the questions about friendship, he is only exploring the question/definition of friendship with the open, innocent mind of a child, as yet unclouded by racism and hate outside the home. That is what we are all like before we hear about the history of racism, before the first time a white kid calls us the n-word or a black kid takes our lunch money. Friendship--the possibility thereof-- is thus raised in this pristine form to set the theme of the essay.

It's not clear that, and doesn't seem to be the point, that child or parent shifted a discussion of friendship to Charlottesville in mid-discussion.

"But even a child’s joy is not immune to this ominous political period. This summer’s images of violence in Charlottesville, Va., prompted an array of questions."

So Yankah begins with the image of innocent questions about friendship, then changes the topic, not in the discussion with his son but in the essay, to what complicates the questions--the racism in the outside world. But the questions about Charlottesville "last summer" could have come before or after, the friendship questions, on different days, weeks or months apart.

The sets of questions are juxtaposed here 1) to produce the contrast between everyone's original innocence and curiosity about "friends" and that postlapsarian state in which we suddenly find out there are people who don't like us for who we are, something we didn't choose and can't change. (That is also why whites feel anger hearing about some "white privilege" which doesn't seem to be benefiting them.)

And 2) to introduce the question of how racism, history, and the present figure into black families and parental relations at the current juncture.

So as far as I can tell, Yankah and his sons have not yet had the necessary "discussion" about race and friendship with whites. That he thinks it necessary at some point is what frustrated him into writing the OpEd.

I value the OpEd for the insight it gives into how some blacks are responding to the Trump phenomenon, what they believe it means for them and their future.