key: cord-0878724-0ootebfh
authors: Chisholm-Burns, Marie
title: The disease of racism
date: 2020-07-17
journal: Am J Health Syst Pharm
DOI: 10.1093/ajhp/zxaa254
sha: 7fbfc08898dfd90e04f7a63e42063c424d3a2e50
doc_id: 878724
cord_uid: 0ootebfh

In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time.

The last few months have simultaneously been a period of chaos, confusion, turmoil, and, hopefully, reflection. Our world has been infected with a novel coronavirus causing the wrath of a pandemic while, at the same time, the United States has wrestled with its history, morality, and public protest against the systemic racism that has existed since the very birth of this country. The adverse effects of coronavirus disease 2019 (COVID-19) have disproportionally affected African Americans, acting as a mirror to the inequitable systems and their various mutations that this population faces every day in the United States.

While COVID-19 has claimed the lives of many individuals and has taken the lives of African Americans at a disproportionate rate, I think a far greater fear for many are the deaths associated with systemic or structural racism (defined as social and institutional structures, including policies and cultures, that were or are usually developed and upheld by supremacist ideologies), 1 such as those of individuals who have now become household names: George Floyd, Ahmaud Arbery, Breonna Taylor, and countless others. As difficult as it may be to read and hear about (and is certainly more difficult for many to accept), racism is not a new disease.

Rather, what we are witnessing now is an awakening to the reality of a long-prevalent and virulent disease that has never been eradicated. Racism masks itself behind innocuous fronts and hides deep within established systems, not unlike viruses that can integrate into cellular machinery until the window of opportunity rises. The perseverance of racism in our day-to-day lives, propped up by our culture and facilitated by our systems, penetrates every segment of society, from our police to our judicial system and even our healthcare system. 2, 3 Several years ago, a colleague and I published a seminal article in the pharmacy literature entitled "Pharmacotherapeutic Disparities: Racial, Ethnic and Sex Variations in Medication Treatment." 4 Significant disparities in drug treatment across races were revealed, with the majority of disparities, found in over 70% of the 240 studies reviewed, associated with differences in the receipt of prescription drugs. Approximately 30% of the disparities were associated with differences in the drug prescribed, drug dosing or administration, or wait time to receiving medication. Adverse outcomes attributed to these differences resulted in increased hospitalizations, decreased rates of therapeutic goal attainment, and increased deaths among minority populations. Yet another picture of despair.

My son, who is currently 16 years old and African American, pointed out to me the similarities and differences of the novel coronavirus and racism. One of the differences he pointed out, as we had the "uncomfortable" conversation about why protests erupted after George Floyd's death and news broadcasts shifted from COVID-19 to racial unrest in the United States, is that while racism has been around a long time, COVID-19 has not. As I tried to understand my son's chronological comment, we explored the interconnected nature of society and discussed why and how the coronavirus spreads (and the importance of social distancing and mask wearing). He asked yet another question: If people are all connected, and racism over years in the United States has claimed the lives of many, just like COVID-19 has, why are we not racing to find a cure for racism with the same vigor that we are racing to find a cure for COVID-19? We spoke about the statements that various organizations have issued denouncing racism, and while that is comforting and appreciated, he persisted with his questioning. He demanded a national call to action for the cure for racism-just like the action plan drawn up for the battle against COVID-19, which includes preventative action steps of social distancing and handwashing as well as research into safe and efficacious treatment options and vaccinationand a description of what those action steps would look like.

As the specter of police brutality against African Americans once more dominated the news with the shooting death of Rayshard Brooks in Atlanta, all I could think about was that as healthcare professionals, our job is to save lives. I continued to ponder the challenging question my son asked: Where is the call to action for a cure for this deadly, age-old disease of racism?

As the cases of both diseases-COVID-19 and racism-escalated, I was reminded of a 1966 quote from Dr. Martin Luther King, Jr., in which he stated, "Of all the forms of inequality, injustice in health care is the most shocking . . . ." 5 Maybe Dr. King did not tag racism as a disease, as my 16-year-old does today, but nonetheless the quote still holds true over 50 years later, demonstrating that much progress is still painfully lacking. Neither prevention nor cure has been delivered to a nation desperately in need of healing.

Then it occurred to me that my son is not asking for equality among races and ethnicities, nor is he really asking for equity. Instead, he is asking for liberation from racism altogether. Only through the acknowledgment of the need for liberation can we plot the course for discovery of the cure for racism. Of course, this is much easier said than done. My son and I conversed on that topic, too, as I considered where we-especially we healthcare professionals-should start. I thought about this as I visited my dentist the next day and he said, "I am providing you with the same advice that I would for my wife or mother." That caring disposition was comforting, as sitting in the dental chair makes me anxious. I not only listened but also took my dentist's recommendations to address my dental care. "This is it," I proclaimed to myself: the start of perhaps the answer to my son's questions about finding the cure to racism. What if everyone treated each other the way they want their spouse, parent(s), son or daughter to be treated? What if I treat people the way I want to be treated? By implementing the perfection of radical empathy (defined as striving to understand and share the feelings of others with the intent to authentically connect with another) into our daily practice, we may be able to eradicate racism. Treat others as if they were your loved one, as if they were you. Offer them your best and use your privilege to help others and to break down barriers, to liberate. COVID-19 and racism have made our lives pause, and we are truly "all connected and therefore all affected." Let us use these intercepting events as opportunities to heal and eradicate these diseases.

I challenge myself and my healthcare colleagues to take action to treat the disease of racism. I will close by wishing all great health, fortune, peace, and prosperity, and with this quote by Dr. King 

The author has declared no potential conflicts of interest.

Structural racism. Racial Equity Tools. Accessed

Racism and health inequity among Americans

Police brutality: more than just racism

Pharmacotherapeutic disparities: racial, ethnic, and sex variations in medication treatment

Presentation at the Second National Convention of the Medical Committee for Human Rights

Letter from Birmingham Jail