March is National Colorectal Cancer Awareness Month — a health observance dedicated by President Clinton in 2000. Even though striving to achieve and maintain good health is a daily affair, March is specifically dedicated to raising awareness about colorectal cancer. During the third month of the calendar year, America’s healthcare sector emphasizes (as it does year-round) the importance of adhering to age-centric colorectal cancer screening recommendations. Also this month, public health professionals and their medical counterparts highlight current treatment options available to people who may receive screening results with abnormal findings. The United States Preventive Services Task Force recommends adults between the ages of 50 — 75 are routinely screened for colorectal cancer. According to the American College of Gastroenterology, African Americans should begin screening for colorectal cancer at age 45. A form of cancer originating from polyps turned cancerous, colorectal cancer is also known as colon cancer or rectum cancer. Polyps are projections of tissue from the inner lining of the colon. They are usually benign (non-cancerous) growths – yet at types may become cancerous.
According to the American Cancer Society, some 189,910 new cancer cases were expected to be diagnosed among African Americans in 2016. Prostate cancer tops the list, comprising 31% of all cancers black men develop. The second most prevalent type is lung cancer — representing 15%. At nine percent, colorectal cancer is the third most prevalent type striking black men. African American women in the United States develop breast cancer the most, representing 32% of all types. Lung cancer reflects 11% of all cancers experienced by black women, the second highest. Shared with black men, colorectal cancer ranks third among types afflicting black women — accounting for nine percent.
African Americans have the highest mortality rate and shortest survival time of any racial and ethnic group in the United States for most cancers, shares the American Cancer Society. I am neither a researcher, sociologist, social worker, nor an oncologist yet would like to share my thoughts around social and psychological determinants of health responsible — in part — for such disproportionate outcomes. One of many rules in blogging includes ending on a happy note – no such tone will be achieved in this blog.
The History of Malevolent Healthcare Actors
I am an African American native of southeast Alabama — Bullock County to be exact — an area of the state exhibiting many unflattering health statistics. Many of my relatives (my parents included) have always been deeply suspicious of our country’s healthcare system and the actors therein, especially Caucasian American male healthcare providers. From my understanding, this phenomenon stems from said healthcare providers having traditionally being the sole providers of health care fully recognized by mainstream institutions in the United States. Yes, there are records of successful African American doctors, the University of South Florida highlights a few of them. However, they did not enjoy the same autonomy, resources, and legitimacy as their white counterparts in the established health sector. While having made some of the most significant achievements in public health and medicine, alongside less celebrated people of color, white men also are responsible for the most horrific encounters black people have experienced within our healthcare sector.
White men were the orchestrators of research studies such as those elevating eugenics and the Tuskegee Syphilis Experiment. For a very long time, they were the sole interpreters of their very own research findings which shaped federal, state and local policies as well as mainstream healthcare practices and norms. White men sought no input from any other cultural perspectives — not even white women — for much of our country’s existence. Our ancestral compatriots generalized results of said studies without any resemblance to cultural competency. In 1994, tobacco industry executives – all of which were privileged white men – stood before the most powerful government the Earth has ever known and lied through their teeth about the addictive nature of their cigarettes. Millions of Americans at the time were hooked on their nicotine drenched cigarettes, scores of us were dying in droves from diseases caused by said cancer sticks. States’ budgets were hemorrhaging funds to keep afloat their Medicaid and Medicare programs. The tobacco executives lack of scruples is noteworthy given many white male healthcare providers touted cigarettes as a great product to consume, doing so publicly until 1964.
White male healthcare providers mostly performed questionable services resulting in wrongful deaths, disfigurement, psychological trauma, and other forms of atrocious health outcomes. After taking the Hippocratic Oath, in “providing” medical care to African Americans, white men have been documented countless times violating human rights, trampling Constitutional protections, ignoring the Golden Rule, unscrupulously breaching the Harm Principle and misusing oft quoted, poorly contextualized teachings of the Bible. For most of the United States’ existence, white men exclusively ran Congress, governorships and state legislatures. They enacted policies regulating the healthcare & pharmaceutical sectors – industries historically and currently run by white men.
Welcome to America’s Mainstream Healthcare Sector — Leave Your Humanity at the Door
During the latter half of the 20th Century, African Americans were “allowed” to benefit from the advancements and latest technology mainstream consumers of healthcare services enjoyed for years – not exactly. African Americans who preceded me were treated as disposable human versions of lab rats. Think of Henrietta Lacks – the botched treatments she received for her cervical cancer at John Hopkins University. Doctors and researchers illegally extracted her cancerous cervical cells and used them for numerous studies. The findings of such experiments eventually formed aspects of the scientific basis our current multi-billion-dollar pharmaceutical industry now rests.
Let’s go back to the Tuskegee Syphilis Experiment, a 40-year state funded form of systematic torture. In studying black men with syphilis to prove to the Public Health Service they deserved treatment for the sexually transmitted infection, white researchers were granted nearly absolute autonomy in how they conducted the study. In the early 1930s, African Americans’ humanity did not cut the mustard in meeting requirements to receive treatment their white counterparts could readily access. Researchers did not seek informed consent. Eventually the researchers had access to penicillin (established in 1947 as the most effective treatment for syyphilis) yet withheld administering it to the black patients they examined in the study. They pretending to treat the black men with penicillin while only injecting them with placebos. Researchers purposefully allowed the virus to ravage the study participants’ brains, leading to unnecessary suffering and premature death.
Henrietta Lacks and Tuskegee are only two examples – many more exist. History has revealed patterns of systematic and state-sanctioned abuses experienced by African Americans. It is this well-established pattern on which deep mistrust of the healthcare system rests.
I Hear You Yet I Do Not Believe You
Financial distress, geography, and little flexibility in work schedules among other reasons are factors impeding many Americans – including black folks – from routinely seeing their healthcare providers. However, no other cohort within the American citizenry feels the level of distrust toward our healthcare sector as African Americans do. A lack of trust plays a role in deciding to forego routine check-ups, treating any new signs and symptoms such as those indicative of colorectal cancer, and explaining away the importance of heeding physicians, nurses, dietitians, or pharmacists’ medical advice. This wariness may invalidate test results regardless of their robust conclusions. Stern advice to control hypertension is minimized or outright disregarded. Calls to return for follow-up screening services to confirm causes of any given ailment are viewed as financial shakedowns.
“They don’t know what the hell they’re doing,” may reference a gastroenterologist who painfully administered a colonoscopy during the first visit, for example. “They won’t get me on that table and cut me open, poking and prodding. When its my time to go, God will do his work,” may be a response to a recommendation to undergo surgery to remove abnormal polyps. “That old mess they gave me, those pills ain’t worth a damn,” potentially goes another discussion that may arise if medication does not bring about desired results within the time frame a pharmacist stated.
Because of historical context, no medical advice or recommendation is immune to being placed in File 13 or otherwise raked over the coals and left there for dead. Giving doctors the benefit of the doubt is a long-gone privilege among some African Americans – even if they eventually decided to follow through on a clinical visit. This is not always the case — African Americans do not always respond with such vitriolic distrust to healthcare providers and medical treatment. I am one of them. My mother has become one of them as well. Yet, enough of us do — including my father – which plays a role in less than ideal health outcomes such as elevated colorectal cancer death rates and worse prognosis than our white or otherwise non-black counterparts.
It May be Colorectal Cancer — Or Not, Give Me A Ginger-Ale
Regarding colorectal cancer, many of the symptoms can be connected to other conditions. Recurring belly pain may be due to extreme flatulence resulting from routinely consuming raw vegetables or beans. Bloating and cramping may be attributed to irritable bowel syndrome (IBS) a condition of which black people may be aware and know how to self-medicate. Stomach pangs may be linked to lactose intolerance. For people working in professions requiring physical exertions, bloody stool and/or underwear may be construed as a sign of hemorrhoids. Over exertion at the gym or work may cause hemorrhoids, something people can treat with over the counter medications.
These hypotheticals may very well be symptoms indicative of colorectal cancer too. Expensive co-pays, having to figure out cumbersome healthcare insurance claims, and maneuvering around tight work schedules — barriers all Americans face not just African Americans — could cast the symptoms as less serious. Hoarding meager paid leave for vacations trips with family and friends is far more appealing than squandering it on sitting in doctor offices all day. Beyond $3 a gallon in some places, wasting gas on long commutes to the doctor’s office may be equally untenable. After seeing the doctor(s), having to stop by the pharmacy to purchase medication with expensive out-of-pocket costs that could cause drowsiness and thus lessen work productivity are additional headaches people of all races and ethnicities avoid with great fervor.
Paying the Black Tax — A Non-Deductible Expense
Now, consider having to endure these processes and inconveniences with the knowledge your ancestors — even more proximal relatives such as your father of grandfather — were intentionally and systemically treated as disposable guinea pigs by medical providers. Think about your mother or grandfather, role models you idolized. These loved ones were important figures who taught you the fundamentals of life. Imagine their being told they were receiving effective medication yet after their death an autopsy reveals scores of doctors intentionally withheld life-saving medication and allowed a treatable condition to ravage their bodies — eventually prematurely killing them. Being deeply suspicious of the healthcare sector with that sort of generational experience seems less like paranoia, implacable complaining, and baseless drama, does it not? This is what we call the black tax.
From a healthcare perspective, the black tax has primed us to interpret physicians, nurses or pharmacists’ every off-putting non-verbal cue, questionable intonation, and unnecessarily pompous word choice as signals of danger and/or undeserved disdain — irrespective of healthcare providers intentionality. Experiencing these scenarios may reinforce thoughts of evil mad scientists, unscrupulous practitioners, and healthcare providers making decision through the lens of racial animus. Potentially, accepting early signs of colorectal cancer as some other less serious condition becomes far more appealing than the psychological trauma of dealing with allegedly murderous doctors.
Whoa, Where Are You Sticking That Tube?
Being screened and treated for colorectal cancer may be in a league of its own. Why is that? The anus. A colonoscopy is the gold standard of screening tests for colorectal cancer. It is the best procedure in determining if any symptoms are due to something other than cancer. If colorectal cancer has developed, colonoscopies can guide oncologists toward the most appropriate treatment right away. This screening test can identify abnormal and potentially cancerous polyps, including expediting their removal. African American heterosexual men are probably the most homophobic people I have ever personally encountered. Yes, I said it. So? Stop being homophobic if you dislike my calling attention to it.
Anyway, a colonoscopy entails a gastroenterologist lubricating a tube with a camera, light, and tools on the end and inserting said tube into one’s anus, through their rectum and into their large intestine. There is a strong aversion to anyone doing anything to heterosexual men’s anuses — black men included. It is their right to be weird about it — yet this weirdness plays a role in delaying initial screenings or postponing any necessary follow-up procedures involving sticking instruments up their asses. If colorectal cancer is currently underway, the potentially deadly condition advances closer to being inoperable because life-saving medical procedures are mistaken for unwanted ass-play.
The Ex-Lover Who Will Not Go Away — Big Tobacco
Smoking is a risk factor for colorectal cancer. African Americans smoke less that their white counterparts, yet the tobacco industry (Big Tobacco) far more heavily markets their products to black communities. Enter any convenience store in economically depressed neighbors, especially those with majority-minority populations. The retail spaces are inundated with ads for cigarettes and now e-cigarettes. Consider discounted pricing strategies in those same areas – offsetting depressed purchasing power of smokers overall and underserved black smokers in particular. Big Tobacco provides retailers with kickbacks for methodically placing their products on stores’ shelves. With millions of dollars spent of research, Big Tobacco knows exactly where to place products to increase the likelihood smokers repeatedly purchase and use them.
The tobacco industry sponsors sports events popular among African Americans. This illustrates a false sense of support to the desires of black folks. X tobacco company donated $30,000 to pay for y. “Hell, we can count on X tobacco company when our own city doesn’t give a damn;” goes a hypothetical interpretation of the tobacco industry’s sponsorship.
I recently learned Big Tobacco was also the first of industries to offer professional advancement within its executive ranks to African Americans, while other sectors were far less welcoming for much longer. This was by design of course, to solidify industry loyalty among Africans Americans who were finally grateful to have access to gainful employment. “Don’t bite the hand that feeds you” is an unshakable ethos in the black community, and I would imagine others. These tobacco industry mind games keep smoke rates elevated and the fallout from the colorectal cancer it causes that much deadlier.