The Mount Sinai journal of medicine, New York
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There is a serious, continuous and increasing shortfall of organs, especially kidneys, for the purpose of transplantation. This shortfall is especially remarkable in African American populations. Because the incidence of hypertension (HTN) and associated end-stage renal diseases (ESRD) is 17 times greater in African Americans, this minority group, which comprises only 12% of the U. ⋯ Also, because they get more poorly matched organs, their kidney transplant graft survival is 10-20% lower than that for other racial groups. The African American community is unaware of the special needs in members of their own race. Steps must be taken to increase minority awareness of the need for well-matched transplant organs and their involvement in the donation process.
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Physicians licensed to practice medicine have enjoyed socially endorsed, legally underwritten status-trust to a remarkable degree. However, such trust is not endorsed equally by all segments of American society, most notably, by African Americans. ⋯ On the other hand, overinterpretation of this fact needlessly risks despair. A theory of trust provides guidance in resolving clinical conflicts.
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What steps, if any, should be taken to eliminate the distrust that many racial minorities feel toward the health care system in the United States? Is this distrust an issue of social justice or should it be viewed as an instance where people unreasonably fail to take advantage of existing opportunities? I argue that this distrust is an issue of social justice and that the state does have an obligation to eliminate or mitigate it, especially in the area of public health.
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This article reviews the current legal arguments for and against affirmative action in medical education. It concludes that many of the traditional legal defenses for race-based admissions are imperiled or defunct. The author suggests that the best and probably most viable justification for affirmative action policies is the one that recognizes that racial diversity in the medical profession is important because it provides the physicians with whom minority patients can feel safe and comfortable. ⋯ Unfortunately, minorities' historical and current experience with the medical profession and health delivery system frequently breeds suspicion rather than faith. As a result, society and the medical profession have a compelling interest and duty to produce physicians who can inspire trust in patients. In the short-to-medium term, race-conscious admissions policies may be necessary to fulfill this duty.
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Sickle cell disease is an autosomal recessive disease that primarily affects persons of African ancestry. The hallmark of the disease is hemolytic anemia and vaso-occlusive crisis. Patients often have recurrent and severely painful episodes that necessitate the use of opioids. ⋯ The socio-cultural disparity between patients and providers may play a role. However, the lack of knowledge and understanding of the underlying pathophysiology of the disease and pain are the key issues. Education, research and hands-on experience, resulting in changes in attitudes and behaviors, will ultimately lead to a more empathic approach to the sickle cell patient.