Healthcare Discrimination Against Transgender Individuals in the US

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Healthcare Discrimination Against Transgender Individuals in the US Editor-in-Chief Letter From Lauren Ho The Editor Senior Editors Mia Calzolaio Dear Reader, Charity Chu Destiney Green I am excited to release the third issue of Diagnosis, Horace Mann’s premier medical Johanna Scher journal! I am so proud to display the hard work of all of the writers and editors, and hope you enjoy reading this issue! Leah Sepiashvili In this special issue focused on marginalized groups in medicine, you will find ar- Juliette Shang ticles on the dangers of race-based medical testing, the Guatemala syphilis exper- iments, healthcare discrimination against transgender people in the US, a variety of doctor profiles (quick reads!), and much more! There also is the second part of a Junior Editors two-part interview with Dr. Chidi Akusobi ‘08 on how race is utilized in diagnosing patients, the school-to-doctor pipeline, and the importance of confronting systemic Malcolm Furman racism in the healthcare system. I would like to extend special thanks to all of the Sammi Strasser writers and editors for all of the time and effort they have dedicated to this issue. I would also like to thank our faculty advisor, Mr. Epstein, for his constant support, Emily Salzhauer guidance, and advice. Lamia Chowdhury Ari Borut Sincerely, Bodhi Lavine Fair Use Notice Diagnosis is a student publication. The opinions represented are those of the writers. The Horace Mann School is not responsible for the accuracy and contents of Diagnosis, and is not liable for any claims based on the contents or views expressed herein. All Layout Editor editorial decisions regarding grammar, content, and layout are made by the Editorial Board. All queries and complaints should Lauren Ho be directed to the Editor-In-Chief. Emma Chan This publication contains or may contain copyrighted material, Editor-in-Chief the use of which has not always been specifically authorized by the copyright owner. We are making such material available Volume I, Issue III in our efforts to advance understanding of issues of scientific significance. We believe this constitutes a “fair use” of any such copyrighted material as provided for in section 107 of the US Copyright Law. In accordance with Title 17 U.S.C. Section 107, this publication is distributed without profit for research and ed- Faculty Advisor ucational purposes. If you wish to use copyrighted material from this publication for purposes of your own that go beyond “fair use,” you must obtain permission from the copyright owner. George Epstein 2 3 The Dangers of Race-Based Medical Testing Interview with Chidi Akusobi ‘08 6 Lamia Chowdhury 34 Lauren Ho Racial Discrimination in the Scientific HIV/AIDS Activist Gao Yaojie: Still Fighting Injustices in her 90s Community: The Tuskegee Syphillis Zahra Motwani 8 Experiment 38 Mia Calzolaio The Elderly and COVID-19 Vaccines: Prioritized Yet Vulnerable Malcolm Furman The Horrific Baltimore Paint Lead Study 40 Charity Chu 12 Lack of Diversity in Genetic Testing: A Cause for Misdiagnosis Susan La Flesche Picotte: The First Native Sammi Strasser American Female Doctor 42 Mira Bansal 14 The Consequences of Historical Female Exclusion from Clinical Trials Dasha Dolgonos The Mother of Modern Medicine 44 Lamia Chowdhury 16 The Revolutionary Life of Mary Putnam Jacobi Volume I, Issue 3 I, Volume 46 Charity Chu Does Race Exist on a Genetic Level? Myra Malik 20 Rising Mortality Rates for African Americans, Asians, and Hispanics Diagnosed with Melanoma Healthcare Discrimination Against Transgender Sophie Rukin Individuals in the US 48 22 Ari Borut The Underdiagnosis of Mental Disorders in Women Charles Drew: Racial Advocate and Inventor of Miller Harris 24 the Large-scale Blood Bank 50 Elise Kang David Ho: Contributions to AIDS Research and Treatment Contents Health Disparities in the LGBTQ+ Community 52 Bodhi Lavine Zahra Motwani 26 Genetic Diseases that Disproportionately Affect Ashkenazi Jews Carlos Juan Finlay: The Man who Saved 54 Emily Salzhauer Millions 30 William Bramwell Inhumanity in the Guatemala Syphillis Experiments 32 Athena Rem https://www.freepik.com/free-vector/medical-healthcare-concept-banner-blue-color_6922716.htm https://nysba.org/events/lets-talk-about-race-the-origins-of-systemic-racism-in-the-united-states-and-tips-for-dismantling-those-systems-by-being-actively-anti-racist/ research project that’s goal is to iden- system for kidney-disease diagnosis patients have higher muscle mass tify and map all of the genes in the which does not consider race a deter- when it has been concluded that race human genome. Further, she points mining factor. does not exist on the genetic level) out that the production of creatinine By acknowledging existing prac- so that medicine is able to serve all is influenced by factors other than tices that disproportionately harm people equally, no matter their race. muscle mass as well, such as diet and one group of people and promote With more and more technological The Dangers of medications. Eneanya calls for more misconceptions based on race and advances, it is likely that the scientif- and more institutions to take these attempting to change them, these so- ic community will be able to create facts into consideration and question cieties are challenging the status quo more just and accurate practices that the reliability of race-based testing to create a more equitable medical take into account all people, includ- Race-Based when it comes to kidney disease. world. It is essential to question older ing those with complicated identities, The example of Noah perfectly practices in the face of new research like our friend Noah. displays the issues with taking race (one example being that Black into consideration when calculating Medical Testing eGFR. The first problem is that there are no guidelines for determining the eGFR of mixed-race individuals, Lamia Chowdhury who, according to the 2010 census, make up about seven percent of the US population. Secondly, since Noah self-identified as Black, he will have to wait longer to get a kidney et me introduce you to primary test used to diagnose kidney cluded that race also plays a factor transplant. This is because a patient Noah. He has just moved disease is a measurement of one’s in creatinine production because of is not usually put onto the waitlist to the city and is filling estimated glomerular filtration rate a few studies determining that Black until their eGFR reaches about 20, out paperwork at his new (eGFR). To understand what this Americans tend to have a higher and Noah’s eGFR will always be a Ldoctor’s office. He has no trou- figure means, it is essential to un- muscle mass than their White coun- bit higher than a White patient’s as ble answering questions about his derstand the function of the kidneys. terparts. As a result, the equation also long as race is part of the equation. A personal information until the form These two bean-shaped organs serve has been adjusted so that the eGFR recent study suggests that if race was asks for his race. He is of Bosnian as the body’s filtering system; they of a Black patient is automatically not taken into consideration when and Sudanese descent, but there is no cleanse the blood of toxins which raised by more than 20% to account calculating eGFR, the condition of multiracial option. Since his African can be anything from a simple Advil for the extra muscle mass, which approximately one-third of Black features are far more prominent, to lots of alcohol. Creatinine, one continues to be in the equation today. patients would be reclassified as a he simply checks the box that says of these toxins, is easy to quantify But, muscle mass of a living human more severe stage of kidney disease, Black. Noah doesn’t think much through a blood or urine test. This can not directly be measured, only and they would thus be prioritized more of this because it is a routine number can be plugged into an equa- that of a cadaver, or dead person, for treatment options like transplant question on most questionnaires. tion in order to determine someone’s can. Instead, the conclusion that referrals and dialysis sessions. Evi- However, it turns out that Noah’s eGFR, a measure of how well their eGFR should be adjusted based on dently, Black patients are not receiv- selection will play a significant role kidneys are functioning. racial lines was drawn from differ- ing the potentially needed treatment later on in his life when his doc- There are a number of different ences observed in other factors such as quickly as they should, which can tor suspects that he needs a kidney elements that affect the relationship as body fat, potassium, calcium, and lead to a lower quality of life and transplant. In comparison to White between creatinine numbers and creatinine levels from three small higher risk of death. people, a disproportionate number of eGFR, though. Creatinine is pro- studies of only a few hundred Black Both the American Society of Black people are victims of kidney duced as a result of repeated wear and White patients. Nephrology (the study of kidneys) disease. In fact, a Black person is and tear on one’s muscles, so those Dr. Nwamaka Eneanya MPH, of and National Kidney Foundation about three times as likely to expe- with a higher muscle mass will the Hospital of the University of have worked to address this problem. rience kidney failure, yet far less naturally have more creatinine in Pennsylvania argues that race-based They have created a joint initiative likely to receive a transplant. their bloodstream. Because of this, kidney disease diagnoses should called the Task Force on Reassessing One important factor that causes adjustments are made in accordance not be contingent on these studies the Inclusion of Race in Diagnosing this disparity is the method through to gender and age, since women and because of their small scale, and Kidney Diseases, which, through which doctors determine who quali- older adults tend to have less muscle also because race does not exist on extensive research, analysis, and dis- cussion, has published a report that fies as a candidate for the transplant mass.
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