access to and affordability of treatment; access to and ability to live in healthy environments; access to and ability to practice a healthy diet; the culture of the individual and the family

Page 2 of 6 Multicultural America: A Multimedia Encyclopedia

racism; access to and affordability of treatment; access to and ability to live in healthy environments; access to and ability to practice a healthy diet; the culture of the individual and the family; family roles in decision making; views of leaders and authority figures; religious practices; and culturally specific behavioral factors such as dietary restrictions, use of home remedies, cultural communication styles, and mistrust or misconcep- tions about the health care system. In addition, the approach to medications might vary by culture, ethnicity, and race. An individual’s or group’s decision on when to seek care, levels of pain tolerance, and genetic differ- ences in medication metabolism and response might also be factors to consider in terms of medical treatment and culturally related medicines. Therefore, application of diversity to the practice of medicine while following ethical protocols in treatment is key.

Historically, ethical protocols were not consistently followed when ethnically diverse patients underwent med- ical treatment, including the lack of prior consent for medical research. One of the most well-known instances was the Tuskegee Study of Untreated Syphilis in the Negro Male. From 1932 to 1972, the U.S. Public Health Service conducted a longitudinal study on syphilis in poor, rural African American sharecroppers, who were given the impression that they were being provided with free health care when in fact they had not given in- formed consent and were denied treatment, even though penicillin had become the standard treatment for syphilis as early as the late 1940s. As a result of the undisclosed information concerning diagnosis and pos- sible treatment for the disease, many participants died of syphilis or spread it. When the story about the un- ethical study broke, public outcry led to the establishment of the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research and federal laws and regulations that further protect participants in medical research. Additional efforts related to the development, revision, and enforcement of ethical standards in biomedical research continue today.

Another well-known example of the mistreatment of minorities in medical research is the case of Henrietta Lacks, who had cervix cells removed, without her explicit permission or knowledge, while undergoing treat- ment for cervical cancer. Her cells were then multiplied in the lab, sold, and used extensively in research, with no financial recompense to Henrietta Lacks (who passed away from the disease) or her family. As a result of Henrietta Lacks’s case, the ethical issue of informed consent became standard protocol within the medical system. These two infamous cases, as well as countless other instances of discriminatory medical practices based on stereotypes, prejudice, and ignorance, widened the power gap between the medical community of mostly Caucasian male doctors and the ethnically and racially diverse patient populations that they served.

Ethnic and racial minorities were also barred from entering medical school, with the first African American doctor graduating from an American medical school in 1847. However, it was not until much later that medical schools were desegregated. Continued discrimination, lower access to quality education and mentoring, and socioeconomic factors still create barriers that prevent ethnic and racial minorities from applying to and enter- ing medical school.

Contemporary Medicine

As U.S. demographics have diversified and the struggle for equal rights has reshaped American society, the practice and teaching of medicine have changed. Since the 1960s and 1970s, medical schools across the na- tion have focused efforts on programs designed to increase and diversify the physician workforce so that doc- tors will better reflect and serve the diverse demographic populations that make up American society. Efforts include continued work on pipeline and baccalaureate programs that help prepare underserved, underprivi- leged, and ethnic and racial minority students to become competitive applicants for medical school through academic counseling, standardized test and interview preparation, and rigorous biomedical courses.

However, certain ethnic populations are still underrepresented in medicine, and more work needs to be done earlier to encourage young students to dream about and prepare for a career in medicine and to help them graduate from college. The Supreme Court will rule on whether or not race can be considered as one of many

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