Academic Review 2024

33 ACADEMIC REVIEW 2024

Inadequate pain treatment for POCs Pain which persists for longer than three months is known as chronic pain (The Lancet, 2021). First- and second-year medical students were asked whether Black people’s skin is thicker than white people’s in a survey and 40% agreed with this statement (Sabin, 2020). Incorrect beliefs like this worsen the pain treatment disparity. Another unscientific belief is that: ‘Black people’s nerve endings are less sensitive than white people’s nerve endings.’ The statement is false but many participants which included over 400 medical students agreed with the statement (Swetlitz, 2016). J Marion Sims who was the ‘father of modern gynaecology’ tested surgical techniques on enslaved Black women without anaesthesia (Bachynski, 2018). In the 19th century it was believed that Black people felt less pain than white people. This shows us that this misconception of pain has been a part of medicine for a very long time and is still shaping how it is practised today. Healthcare providers form stereotypes based on the media’s portrayal of Hispanic Americans and African Americans when reporting on substance abuse. African Americans and Hispanic Americans are actually less likely to misuse opioid prescriptions; white people are more likely to misuse drugs Cardiovascular diseases affect more than one in three female adults in America (Mozaffarian, et al., 2016). A conclusion was reached by the Physicians’ Health Study that aspirin may reduce the risk of heart diseases. However, this conclusion does not apply to women as it was conducted on 22,071 men and no women (LaMorte, 2021). 2,000 years ago, during an influenza outbreak Hippocrates stated that men and women respond differently to disease and the same is true with the medication which is given to treat diseases (Brazil, 2020). The thalidomide disaster occurred in the 1950s and 60s (Kim & Scialli, 2011). Thalidomide was prescribed to pregnant women to help mitigate morning sickness. Foetal development was affected by the drug and 10,00 children were born with thalidomide-related disabilities. This disaster was a catalyst for the exclusion of women of childbearing potential from drug trials in 1977 by the FDA (Perez, 2020). Many researchers were cautious when it came to clinical trials involving women due to this horrific disaster. How women are overlooked due to the knowledge gap and the lack of testing of drugs

endangering themselves (Wyatt, 2013). Black veterans who are under the age of 65 are less likely to be prescribed opioids than white veterans even if they report high levels of pain (Burgess, et al., 2015). The language barrier between healthcare providers and some Hispanic Americans affects the pain treatment which they receive (Hollingshead, Ashburn-Nardo, Stewart, & Hirsh, 2016). Race/ ethnicity can affect hepatic metabolism, renal secretion and bioavailability and these are some possible factors that influence the pharmacokinetics of analgesics. When healthcare providers are prescribing analgesics they should consider genetic factors. Pain assessment and treatment is difficult as pain is not always caused by an injury. This means that a healthcare provider must use their own judgment which can be influenced by unconscious biases. White participants in a study could more easily recognize pain in white faces than Black faces (Sabin, 2020). Healthcare providers might not be able to see the pain in a darker person of colour which increases the chance that they will be given a lower pain treatment. Implicit bias is sometimes to blame for inadequate pain treatment. This meant that biomedical research involved men exclusively for about a decade. This ban was a protectionist policy which led to women being underrepresented in biomedical research. Two contradicting defences are given by the research community about the exclusion of women. The first is that there is no significant difference between the genders apart from the reproductive systems. If this was true, then it would mean that there was no need for exclusion of women. The other defence is that because of the fluctuation of female hormones results will not be consistent (Cleghorn, 2021). Women’s hormone levels depend on factors including the stage of the menstrual cycle, hormone replacement therapy, pregnancy and if they are postmenopausal. As drugs are mostly tested on males it means that we have dismissed the drugs which could work for women but not men (Hillman, 2020). Women are more likely to have an adverse drug reaction than men (Whitley & Lindsey, 2009) This emphasizes that pharmacodynamics