When Is Racial Profiling OK? In the Doctor's Office
—Christine. M. Kukka, Project Manager, HBV Advocate
What two topics are among the
most difficult to discuss in this country? Race and sex.
What factors can help define if you are at risk for
hepatitis B or C? Two big ones are race and sexual history.
While race and sexual history
have a huge bearing on our health, these topics often get
short shrift in the doctor's office. Because of the
discomfort of this conversation (along with economic and cultural
barriers to health care), about two-thirds of the estimated 5
million Americans infected with hepatitis B or C don't
know they're infected. Their doctors never thought to
It's challenging to get a true
snapshot of a patient's sexual history due to fear of
judgment, lack of confidentiality, and the lurking homophobia
and sexism that afflicts both providers and patients. It is the
rare provider who can tease out information about numbers of past
sexual partners and practices and other information that
can signal a heightened risk of infection. Throw in
cultural, language, class and economic barriers, and the chance
of having that discussion disappears.
So if our history of risky
behaviors isn't on the table, what is available to spur
doctors to order hepatitis tests? The things that a doctor
can't miss—such as our age, gender, and race/ethnicity. When it
comes to finding the millions of Americans with undiagnosed and
untreated hepatitis B and C, race matters and there's
plenty of science to back this up.
A far higher percentage of Asian-Americans
and Pacific Islanders (one in 12) and African-Americans are
infected with the hepatitis B virus than are whites or Hispanic
Americans. Vietnamese-American men are over 10
times more likely to have liver cancer due to untreated
hepatitis B than their white counterparts.
African Americans are twice as
likely to be infected with hepatitis C compared to the
general U.S. population. While African Americans represent
only 12 percent of the U.S. population, they make up roughly 22
percent of the estimated 3.2 million persons with chronic
hepatitis C infection. Moreover, liver disease, often hepatitis
B- and C-related, is a leading cause of death among
African Americans ages 45-64.
So why don't doctors
automatically screen Asian- and African-American patients
for hepatitis? Is it a waylaid attempt at political
correctness? Or does ordering a test for hepatitis B or C carry
with it an unspoken judgment or suspicion of drug use or suspect
sexual practices that are often linked to ethnic or racial
It is a fine line doctors straddle here. It is
racist to test a patient for a sexually transmitted disease
simply because of sexual stereotypes attached to that
patient's race or ethnicity. It is not racist to test
because the patient belongs to an ethnic group or race with a
high rate of a treatable, preventable illness.
One doctor, writing in The New York Times
several years ago, admitted, "I always take note of my patient's
race. So do many of my colleagues. We do it because
certain diseases and treatment responses cluster by
ethnicity. Recognizing these patterns can help us diagnose
disease more efficiently and prescribe medications more
effectively. When it comes to practicing medicine,
stereotyping often works."(1)
Race doesn't matter if you're
treating a broken leg, but it does matter when you're
performing a physical on a patient whose parents
immigrated from Africa or Asia.
In the case of hepatitis B and C,
doctors should allow race and ethnicity to guide their
screening decisions because millions of patients are
slipping through the health care system's cracks. Failure to
identify a hepatitis B or C infection leads to new infections and
new liver cancers.
Hepatitis B and C are complex
diseases. Diagnosing a patient with viral hepatitis often
leads to complicated treatment decisions, painful
disclosures, and immunization of family members. Sometimes,
patients just don't want to know, but they need to.
Labels: Asian Americans and Pacific Islanders (AAPIs), Disease Management, disparities, HBV and African-Americans, race