June 23, 2023

This Week

• Top of Mind - The Terms Black vs African American - Does It Make a Difference in Health Care and Health Research?
• Telehealth is Here to Stay
• How the Color of Your Skin Affects an Important Pulmonary Measurement
• Do Regional Geography and Race Influence Management of Chronic Spontaneous Urticaria?
• What To Do If You Have a Skin Rash
• Health Tip of the Day

Top of Mind

The Terms Black vs African American -

Does It Make a Difference in Health Care and Health Research?

The terms ‘Black’ and ‘African American’ are used to refer to people of African descent in the United States. The distinction is often missed and used to mean the same thing. While both terms can be correct, they have different meanings. I never thought about it, but each term elicits a different impactful response. Describing how each is employed and perceived, broadly and in health contexts is valuable.

The term ‘Black’ is most often used as an umbrella term that includes all individuals with African ancestry, including those whose family members were enslaved in the United States. ‘African American’ is more commonly used to refer to those of African descent who are U.S. citizens and may have a connection to the United States through birth or immigration.

The distinction between these two terms can be important in health research recruitment, as the term that is used can shape perceptions, influence public opinion, and determine which populations are included. Studies have found that the use of ‘Black’ as an umbrella term is more likely to draw potential participants from various backgrounds, while ‘African American’ narrows the scope of recruitment to those with a U.S.-specific connection to African ancestry.

In terms of research and clinical trials, the use of ‘Black’ or ‘African American’ can also influence perceptions of the research, as well as the likelihood that potential participants will view it as relevant to their experience. Using the wrong term can lead to misunderstandings and mistrust, while using the right terms can help to build trust and demonstrate respect for potential participants.

Stay Healthy,

Dr. Mike

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Telehealth has become very popular since the COVID-19 pandemic started. I know a lot of doctors don't like it, but they don’t have my practice population. I practice in the urban inner city where just getting to the doctor’s office is just the first barrier. Too often appointments are missed because families not only cannot get to see me but cannot get home. If you get help on the phone, no more waiting in long lines at doctor's offices, or spending hours on public transportation just to get basic medical care.

I do think an in-person visit is valuable every once in a while, especially for acute symptoms. However, many visits with patients are simply just that, visits. Increasingly I depend more on what I hear instead of what I see. Especially with so many streaming services can give you at least a peak at the patient. More extensive evaluation often requires a blood test or imaging to complete the diagnostic workup anyway.

I know that I will get some pushback from my colleagues and I understand. But during the pandemic, I was able to navigate that period without missing significant disease. Almost always, what you hear determines more about what moves I make, than what you see. But to be sure it robs you of some essential information that makes medicine the specialty that it is.

I think that we need a hybrid model...some telehealth and some in office visits. But I know that the issue will not be negotiated by 3rd party payers on the basis of logic but on the basis of price.

When you have a serious respiratory or cardiac problem, it's important for doctors to know the level of your oxygen concentration. Several studies have revealed that skin color affects that measurement, especially when patients have often dangerously low oxygen concentrations. Darker skin colors overestimated the oxygen concentration. Overestimation of the pulse ox, in patients of color, is an issue of major concern since patients may seem healthier than they are. This is especially true for patients with respiratory diseases like those Chronic Obstructive Lung Disease, Asthma and those lung problems associated with COVID-19.

Chronic spontaneous Urticaria affects approximately 0.1% to 1.4% of persons worldwide. These researchers conducted a small, exploratory study of the role of race, ethnicity, and regional geographic distance to specialist care on chronic spontaneous urticaria prescribing practices. Most of the time treatment depends on the use of antihistamines, but there is on very effective drug used for more difficult cases, called Omalizumab. This study found higher rates of Omalizumab use were associated with White race in regional and patient-level analyses, though the reasons for this race-based finding are not clear.

Why is This Important? I am going to spend a little time on this response because this study illustrates what I have seen throughout my career as the only Black Allergist in the areas where I practice. Most physicians don't realize that chronic Urticaria is a most unpleasant clinical problem. It causes constant itching and often pain. As a consulting allergist we always start with antihistamines in various combinations. But in my experience, creativity in previous treatments for Black patients referred to me is usually non-existent and most of the time Benadryl only. There are two other levels of treatment that are more often than not ignored. Using type 2 antihistamines like Pepcid or Prilosec and, the gold standard omalizumab. It is an injection that is very effective in controlling the problem. It is almost never offered to Black patients until I see them. So, they suffer unnecessarily when this medicine is almost a wonder drug and very available. So, when we speak of the lack of health equity, this is but one example of how we need to be better informed about any condition before we accept, there is nothing that can be done.

According to a recent study, higher rates of Colorectal Cancer in individuals under 50, particularly among African Americans, could potentially be linked to diets that consist of high amounts of red meat and sugar. Research has shown that African Americans have a higher incidence and mortality rate of Colorectal Cancer compared to other racial and ethnic groups in the United States. This health disparity may be influenced by several factors, including socioeconomic status, access to healthcare, and cultural dietary patterns. Addressing these disparities and promoting healthier eating habits within the African American community is crucial to reducing the impact of Colorectal Cancer and improving overall health outcomes.

For more information, go to our website at www.aawellnessproject.org. or listen to our podcast at Blackdoctorsspeak.org on any podcast platform.

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