Shortage Of Black Doctors Is Rooted In Racist History − A $600M Gift Will Help Historically Black Medical Schools Address The Gap

Medical student John Muthama gets his white coat during a ceremony at the University of Minnesota Medical School in August 2022. Anthony Souffle/Star Tribune via Getty Images

BY BENJAMIN CHRISINGER

ASSOCIATE PROFESSOR OF COMMUNITY

HEALTH, TUFTS UNIVERSITY

Fueled by the Supreme Court’s June 2023 ruling that bans affirmative action in higher education, conservative lawmakers across the country have advanced their own state bans on diversity initiatives, especially those that might make students feel shame or guilt for past harms against people of color.

This effort encompasses medical schools.

Despite clear and persistent gaps between white and Black doctors – and recent efforts to reckon with racial disparities within the medical profession – lawmakers have tried to advance policies to prohibit diversity initiatives in medicine.

U.S. Rep. Greg Murphy of North Carolina introduced one such bill to restrict diversity initiatives. “American medical schools are no place for discrimination,” said Murphy, a Republican, in March 2024. “Diversity strengthens medicine, but not if it’s achieved through exclusionary practices … of prejudice and divisive ideology.”

But the gaps in racial representation in medicine go beyond a professional numbers game. Modern research shows that the lack of Black doctors helps explain why about 70% of Black people don’t trust their doctors, and why Black people tend to die younger than their white peers.

The evidence is clear: America needs more Black doctors.

To that end, former New York City Mayor Mike Bloomberg pledged on Aug. 6, 2024, to donate US$600 million to four historically Black medical schools. The gifts to Howard University College of Medicine, Meharry Medical College, Morehouse School of Medicine and Charles Drew University of Medicine & Science are among the largest donations to any historically Black college or university. Xavier University, located in Louisiana, will also receive a $5 million grant to support its new medical school.

“This gift will empower new generations of Black doctors to create a healthier and more equitable future for our country,” Bloomberg said in a statement before the annual convention of the National Medical Association, an organization that advocates for Black physicians.

A limited landscape

According to a 2022 survey of 950,000 doctors by the Association of American Medical Colleges, 63.9% reported their ethnicity as white, and just 5.7% Black or African American. But according to 2023 estimates by the U.S. Census Bureau, Black people make up 13.6% of the population, while white people represent 58.9%.

These modern inequalities in medicine have deep roots. As a community health professor, I am always curious how today’s racial health disparities formed in the first place. One window into this history is through the official physician directories published by the American Medical Association.

Starting in 1906, the AMA has published directories of all qualified physicians in the U.S. These directories were created to be comprehensive records that excluded “quack” physicians and unqualified graduates of fraudulent medical schools.

Each physician’s record included a variety of details, including their place of practice and when and where they completed medical training.

Between 1906 and 1940, the AMA also insisted on publishing the race of Black doctors. Beside each entry appeared the label “col.” for “colored.”

Based on this information, I created a digitized dataset of the 1906 directory and detailed geographic and demographic patterns associated with where Black doctors trained and practiced. Of the 41,828 physicians listed in the 1906 directory, only 746 were Black – or 1.8%.

Most Black doctors in the South were trained by a handful of Southern medical schools established to educate African Americans. Over half – 57% – of Southern Black physicians attended Meharry Medical College in Nashville, Tennessee, or Howard University Medical School in Washington, D.C. – schools that are still in existence.

But nearly a third – 29% – of Southern Black physicians attended schools that would be closed a few years after the 1906 directory’s release. In 1910, at the behest of the AMA, educator Abraham Flexner released a report after studying the standards of medical schools in the U.S. and Canada.

The results of the Flexner report was devastating to the number of Black doctors. Citing low admissions standards and poor quality of education, Flexner recommended closing five of the seven historically Black medical schools that trained the vast majority of Black doctors.

By 1912, three Black medical schools were shut down. By 1924, only two remained in operation – Meharry and Howard.

The consequences of this extremely limited educational landscape for aspiring Black physicians are reflected in the data. In most Southern states, the distance between medical school and practice locations was significantly greater, even before the closings, for Black doctors compared with their white counterparts.

The deep roots of inequalities

To help interpret where Black doctors established practices in the South, I also linked directory data to other historical sources, including the U.S. Census.

What I found was that places with larger Black populations were more likely to have a Black doctor, as were places that were closer to a Black medical school.

Many contemporary scholars and activists are looking to the past in order to increase the public’s understanding of how race has played a historical role in the health outcomes of Black Americans.

For example, Dr. Uché Blackstock, a Black physician, illustrates many instances of medical racism throughout American history in her most recent book, “Legacy: A Black Physician Reckons with Racism in Medicine,” and shows their lasting impacts on how Black patients are treated and the quality of health care they receive.

She was one of the first, for example, to warn health officials about the disproportionate impact of COVID-19 on communities of color. As she wrote in 2020: Black Americans were more vulnerable during the pandemic “because of several manifestations of structural racism, including lack of access to testing, a higher chronic disease burden and racial bias within health care institutions.”

Without an accounting of how racial disparities in medicine were formed, it’s much more difficult to determine which kinds of progressive measures are needed to provide redress.

Future analyses will help unpack these racial disparities in greater detail. But for now, both academic researchers and the public can use our data to explore the importance of historically Black medical schools and the lives of Black physicians during the Jim Crow era.

It’s my belief that their legacies deserve to be a better-known part of the history of American medicine.

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Escalating Workplace Violence Rocks Hospitals

Image: EHS Today

BY MARLENE HARRIS-TAYLOR

KAISER HEALTH NEWS

Across the country, many doctors, nurses and other health care workers have remained silent about what is being called an epidemic of violence against them.

The violent outbursts come from patients and patients’ families. And for years, it has been considered part of the job.

When you visit the Cleveland Clinic emergency department — whether as a patient, family member or friend — a large sign directs you toward a metal detector.

An officer inspects all bags and then instructs you to walk through the metal detector. In some cases, a metal wand is used — even on patients who come in on stretchers. Cleveland Clinic officials say they confiscate thousands of weapons like knives, pepper spray and guns each year. The metal detectors were installed in response to what CEO Tom Mihaljevic calls an epidemic.

“There is a very fundamental problem in U.S. health care that very few people speak about,” he said, “and that’s the violence against health care workers. Daily — literally, daily — we are exposed to violent outbursts, in particular in emergency rooms.”

Many health care workers say the physical and verbal abuse come primarily from patients, some of whom are disoriented because of illness or from medication. Sometimes nurses and doctors are abused by family members who are on edge because their loved one is so ill.

Cleveland Clinic has introduced other safety measures — such as wireless panic buttons incorporated into ID badges and more safety cameras and plainclothes officers in ERs.

But these incidents aren’t limited to emergency rooms.

Allysha Shin works as a registered nurse in neuroscience intensive care at the University of Southern California’s Keck Hospital in Los Angeles. One of the most violent incidents she has experienced happened when she was caring for a patient who was bleeding inside her brain.

The woman had already lashed out at other staff, so she had been tied to the bed, Shin said. She broke free of the restraints and then kicked and punched Shin in the chest — before throwing a punch at her face.

“There was this one point where she swung, and she had just glanced off the side of my chin. If I hadn’t dodged that punch, she could have knocked me out,” Shin said. “And she very well could have killed me.”

The encounter left Shin shaken and anxious when she returned to work days later. She still has flashbacks.

She used to be afraid to speak about these types of attacks, she said, because of what she calls a culture of accepting violence in most hospitals. “It is expected that you are going to get beat up from time to time,” Shin said.

According to the Occupational Safety and Health Administration, incidents of serious workplace violence are four times more common in health care than in private industry. And a poll conducted by the American College of Emergency Physicians in August found nearly half of emergency physician respondents reported having been physically assaulted. More than 60% of them said the assault occurred within the previous year.

Groups representing doctors and nurses say that, while the voluntary safety improvements that some hospitals have enacted are a good first step, more needs to be done.

There is still a code of silence in health care, said Michelle Mahon, a representative of the labor group National Nurses United. “What happens if they do report it?” she said. “In some cases, unfortunately, they are treated as if they are the ones who don’t know how to do their job. Or that it’s their fault that this happened.”

“There’s a lot of focus on de-escalation techniques,” Mahon added. “Those are helpful tools, but oftentimes they are used to blame workers.”

In California, the nurses’ labor union pushed for a law giving OSHA more authority to monitor hospital safety. The group is now backing a national effort to do the same thing. “The standard that we are recommending federally holds the employer responsible,” Mahon said. “It mandates reporting of incidents and transparency.”

The Workplace Violence Prevention for Health Care and Social Service Workers Act, introduced last fall in Congress, would require hospitals to implement plans to prevent violence. And any hospital could face fines for not reporting incidents to OSHA, Mahon said.

The goal of the legislation — and of the union — is to hold administrators more accountable for acts of violence in their hospitals.

This story is part of a partnership that includes Ideastream, NPR and Kaiser Health News.

Antibiotics Or Not? Improved Method Of Diagnosing Infection May Soon Help Doctors Decide

Image via Athlone Laboratories

(MEDICAL XPRESS)--Researchers have found a novel way to diagnose and manage patients with fever. How? Through new biomarkers that can tell the difference between bacterial and viral infection.

The most common reason that parents seek medical care for their children is fever. But only in a small proportion (5 to 10 percent) of these cases is the fever caused by a life-threatening bacterial infection. Most of the time, febrile illness – illness caused by high fever – is brought on by a viral infection that runs its course without any need for antibiotic treatment. However, since there are no reliable tests, many children are unnecessarily administered antibiotics, which are used for treating bacterial rather than viral infections.

The inadequacy of the current methods used to identify a bacterial infection constitutes a major problem for healthcare providers around the world. At present, clinicians detect the presence of bacteria through blood, urine or spinal fluid cultures. However, many of these tests are neither very sensitive nor very specific. Furthermore, since the results of bacterial cultures take at least 48 hours to become available, the decision whether to administer antibiotics has already been made by that time.

It is with the aim of improving diagnosis and the management of febrile patients that the EU-funded PERFORM project was launched. It's applying novel methods to identify biomarkers in the blood of febrile children. Their purpose is to accurately distinguish bacterial from viral infection.

Identifying infection through genes and proteins

To achieve this goal, the project team is developing an extensive biobank with samples from earlier EU-funded studies added to thousands of new cases from European and West African countries. Rather than being used to identify bacteria that cause fever, the biobank samples are being utilised to identify the pattern of genes and proteins activated by the infection. Using this pattern, the team will identify a 'signature' that distinguishes bacterial from viral infection. The most accurate of the biomarkers will then be evaluated in febrile patients in different healthcare settings across Europe.

This is the largest ribonucleic acid expression study of its kind to date, whose additional goal is to distinguish infections from inflammatory causes of fever. The project will also conduct an observational study on the management of children suffering from febrile illness. Through the unique insight it will gain on how febrile children are managed across Europe and West Africa, the study will serve as a guide for future researchers on how to improve management.

By improving methods of diagnosing bacterial infection and managing febrile patients, PERFORM ultimately aims to reduce the unnecessary administration of antibiotics in those children suffering from viral infection. This will contribute to current global endeavours to counter antimicrobial resistance, which has become an increasingly serious threat to global health.

Throughout its 5-year duration, PERFORM (Personalised Risk assessment in febrile illness to Optimise Real-life Management across the European Union) will create a comprehensive management plan for children suffering from fever. The plan is set to be implemented in Europe's different healthcare systems and will link sophisticated new genomic and proteomic approaches to clinical phenotyping.

Scientists at Children's Hospital Los Angeles Identify Mechanism Critical to Lung Formation and Regeneration

PRESS RELEASE

Eya1 phosphatase acts to maintain barrier integrity in the lung

(LOS ANGELES, Jul 02, 2012 BUSINESS WIRE) -- Scientists have provided the first evidence that an enzyme called Eya1 protein phosphatase is a critical regulator of lung function and that this may have broad implications for sufferers of a variety of pulmonary diseases. "Identification of the role of Eya1 in establishing pulmonary tight junction and barrier integrity could have a significant impact on asthma, chronic obstructive pulmonary disease, and acute respiratory distress syndrome, all diseases characterized with disruptions in permeability," said Ahmed El-Hashash, PhD, investigator at The Saban Research Institute of Children's Hospital Los Angeles and assistant professor at the Keck School of Medicine.

Proper formation of lung epithelium is essential to life. The normal growth and functioning of the lung depends on the formation of tight junctions between adjacent cells making up the alveolar epithelial sheet, a thin layer of tissue separating neighboring alveoli. Alveoli are the site of gas exchange between the lung and blood vessels. Loss of these tight junctions alters the exchange of oxygen and carbon dioxide. Permeability dysfunction has been implicated in both acute lung injury and acute respiratory distress syndrome, a life-threatening lung condition that prevents adequate oxygen from getting from the lungs and into the blood.

Until now, very little has been known about the basic regulatory mechanisms underlying permeability barrier formation and integrity of the lung epithelium. David Warburton, MD, director of Developmental Biology and Regenerative Medicine at The Saban Research Institute, and El-Hashash provided the first evidence that the enzyme Eya1 protein phosphatase controls tight junction and permeability barrier formation in the lung epithelium. They have also provided the first evidence that Eya1 enzyme coordinates a complex network of other cellular proteins and molecules that are essential for epithelial barrier integrity, and are therefore critical to optimal lung function. Both in vivo and in vitro experiments showed that interfering with Eya1 phosphatase function resulted in defective formation of tight junctions and the permeability barrier.

"These findings identify a novel therapeutic option for lung diseases like COPD and ARDS," said Warburton. "Our discovery of Eya1 enzyme control of pulmonary barrier integrity suggests that influencing alveolar epithelial junction formation by manipulating the activity of enzymes has the potential to identify future targets for the treatment of lung injury and may provide solutions to the problems concerning regeneration of lung tissue for restoration of functional alveoli."

Results of the study will be published in the Journal of Cell Science.

About Children's Hospital Los Angeles

Children's Hospital Los Angeles has been named the best children's hospital in California and among the top five in the nation for clinical excellence with its selection to the prestigious US News & World Report Honor Roll. Children's Hospital is home to The Saban Research Institute, one of the largest and most productive pediatric research facilities in the United States, is one of America's premier teaching hospitals and has been affiliated with the Keck School of Medicine of the University of Southern California since 1932.

SOURCE: Children's Hospital of Los Angeles.