As the nation honors Martin Luther King each year, it is helpful to remember that this civil rights leader was not only a thinker but a man of action.
As today’s social justice navel-gazers are pondering white privilege, Marxist critical race theory, and “the intersectionality of health equity,” COVID-19 is busy killing black and brown Americans. Black Americans are dying from COVID-19 at rates more than 1.5 times their share of the population. Hispanic and Native Americans face similar disparities. Black Americans are twice as likely to be hospitalized as whites. Moreover, when admitted to the hospital, people from racial and ethnic minority groups were in worse shape than their white counterparts. Consequently, they were more likely to die.
Where Biden Should Focus
President-elect Joe Biden has promised a racial disparities task force in response to COVID-19. However, it’s unclear if such a task force is necessary. The Health and Human Services’ published the seminal Heckler Report documenting health disparities for minorities 35 years ago, including lower life expectancy and a higher death rate from heart disease and diabetes. We have had information about health disparities for people of color for decades, so why do we need another task force to ruminate about disparities?
It is well known that Black Americans have persistently higher rates of hypertension compared to whites. Indeed, 75 percent of black people in the United States develop high blood pressure by the age of 55 compared to 55 percent of white men and 40 percent of white women. To make matters worse, fewer black than white Americans have their blood pressure under control. Additionally, Black American adults are 60 percent more likely than non-Hispanic white adults to have diabetes, as well as more complications, such as amputations and kidney failure.
Early in the COVID journey, clinicians found that hypertension and obesity were key predictors of COVID mortality. Unsurprisingly, Black patients hospitalized with COVID-19 were more likely to have high blood pressure and diabetes compared with all other racial and ethnic groups combined. Additionally, obese hospitalized patients were more likely to die. Further, people with darker skin—63 percent of Hispanic people and 82 percent of black people have low vitamin D levels. And vitamin D may lessen the severity of COVID disease.
In one study, compared with other racial groups, black people were less likely to have been tested for COVID prior to being seen at the hospital. The researchers noted that the key advantage to earlier diagnosis is the decrease in community spread. The study fails to acknowledge that early diagnosis would lead to early treatment. Why? The party line is that there is no early treatment. This is not true; early treatment works.
Early COVID-19 Treatment
Given the severity of COVID in Black Americans, one gets the feeling that withholding treatment is a familiar tune. In the disgraceful 40-year Tuskegee experiment, treatment was withheld from black men with syphilis so scientists could learn the natural history of the disease. The control group continued to receive placebos, despite the fact that penicillin became the recommended treatment for syphilis several years into the experiment. It is extremely fortunate that randomized controlled studies have become the norm.
Anthony Fauci of the National Institutes of Allergy and Infectious Diseases exhorts about the need for controlled studies and dismisses vast clinical experience. But as Tom Frieden, former director of the Centers for Disease Control and Prevention, noted, “waiting for more data is often an implicit decision not to act, or to act on the basis of past practice rather than on the best available evidence.” Fauci was criticized for blocking treatment during the AIDS epidemic.
Lessons from Poorer Countries
Cuba, India, Algeria, and Costa Rica are achieving lower overall death rates with early treatment with hydroxychloroquine, an antimalarial drug with more than 50 years of safety on the record. These countries also have a large population of people of color. Other countries are using ivermectin, an antiparasitic used to treat scabies. Perhaps because these drugs are inexpensive compared to the new potential wonder drugs and ICU care, poorer countries were eager to try something that worked, rather than wait for a piece of the pie in the sky.
Repurposing FDA-approved drugs that have been used safely on millions of patients is not a new procedure. Amazingly, a combination of an antibiotic (doxycycline), a diabetes drug (metformin), a treatment for intestinal worms (mebendazole), and the cholesterol-lowering statin Lipitor was found to extend the survival of people with glioblastoma, a type of brain cancer! The authors of the innovative study noted that “it is well recognized that high-cost randomized controlled trials may not be an economically viable option for studying patent-expired off-label drugs. In some cases, randomized trials could also be considered as ethically controversial.” Money talks, helping patients walks.
While hand-wringing over the tragic COVID patient deaths, the “chosen ones” end up silencing discussion about preventive and early treatment. Senate hearings on the subject were ignored, even mocked. In their eyes, there’s no need for early treatment with safe medications because the (experimental) vaccine has arrived. Meanwhile, people continue to die, needlessly.
Let’s not repeat Tuskegee. When there is a low risk and reasonable likelihood of helping, let the patient and doctor choose between doing nothing or actively treating. Positive clinical results and the morality of life and death matter more than crowing about scientific purity.
Marilyn Singleton, M.D., J.D.(marilynsingletonmd1@gmail.com), is a board-certified anesthesiologist and immediate past president of the Association of American Physicians and Surgeons.