Vision Circle

It would expand and improve the discussion if we had numbers -- the sort of hard numbers you are calling for, Lester. It would certainly make sense for Black folks to join with other folks to address the policy issues of adequate funding for public health issues in general and AIDS/HIV in particular.

And it is easy to fall into a self-hate trap that blames the victims.

That said, we do have a behavior issue that we can resolve individually and the result can be felt collectively. Don't do IV drugs or un-safe sex and you are almost 100% assured of not getting HIV today. There was once a risk of getting it from blood products, but those supplies are well-screened today.

The books and articles, even if we disagree with the politics and motives of the writers, do help to bring focus on the problem. We don't need more funding to better address the issues within our communities: it does not take much funding to expand the discussion of the issues. It costs nothing for parents to discuss the issues with their kids.

The one article I think is cited as the template interviewed 5000 black men in nightclubs in six cities. Significant problems with the sampling...but from this number only 169 have engaged in behavior which potentially qualifies as "dl behavior."

I am sure that some individuals can change their behavior--specifically as far as sex practices are concerned. IV drug use is addictive behavior and much harder to control. But the bottom line is still some sort of PUBLIC policy. And there's no way around funding. Funding for pamphlets and brochures. Funding for training. Funding for research. Funding for clinics.

Now normally I'm about "in the meantime" politics. To that extent, as we don't have funding NOW, and what little funding we have is being CUT, we have to do SOMETHING. But that something will do nothing more than stemming a flood with a finger without focused political mobilization.

No way around it.

You are probably right about the sampling problems, but I think that they extend beyond sampling. How about "only 169 ..." I would suspect that since we are talking about self-reporting, that number is way low -- maybe in the order of an order of magnitude.

If you factor in the tendancy for multiple partners this cohort is likely to have, the public health risks are fairly high. But, we agree: better stats and better methods will help our dialog.

BTW, I'm not arguing that part of the issue isn't a funding issue and that funding issues ultimately are policy issues and we, as an informed electorate need to do more about policy issues. I'm just saying that "in the meantime...." it is not like we are helpless: we don't need lots of funding to bring this issue to a higher degree of attention.

Think about it: mailing lists and other Internet distribution are essentially free -- at least there is a low initial cost and almost "0" incremental cost to get the messages out.

Have you ever seen one of those email chain letters? And the reality of the small number of degrees of separation that we have? If each of your frat buddies sent an email with info on the public policy issues of AIDS, how long would it take to blanket this country?

Bottom line: while we can never really know the full extent of the DL issue, we don't have to be precise to know that the impact for those unknowingly envolved is a death sentence. Who needs Government funding to address those issues in our immediate circles? 'Course, we don't really talk about these things in our immediate circles!

Added....

Unfortunately, I don't think your Black Slate editorial furthers or directs the discussion that should be happening. I think you do a good job of pointing out that at the core are some public policy issues, but it seems to me that you have a larger responsibility (particularly, with your new research focus).

AIDS/HIV is not limited, in our communities, to homosexual and IV drug use: we need to talk about that. We should be able to easily get beyond self-serving books and other things that might exploit the situation -- just like exposes' from third-generation welfare recipients should not inform the discussion about real welfare reform.

But we haven't been able to. And the reason why--just like with welfare--is because journalistic anecdotes have replaced evidence, reason, and political mobilization. The first step to deal with this is CRITIQUE. One thousand words is adequate to begin that conversation.

It isn't enough to be able to give solutions.

Writing wise, for this you need a combination of hard hitting pieces (much longer in length) like the book that brought AIDS to general awareness in the first place (the title escapes me at the moment). In public health research you need someone to popularize the results in magazine length pieces (maybe 10,000 words). And short pieces like mine to point you to the real stuff.

So, where is the focus of your critique?

Is it that you think the DL is over-reported; over sensationalized?

Is it that you want to drive home the point of what you call the mythology of the pathology? (I think IV drugs and unprotected sex are pathological -- and it don't matter much if we are talking about black folks or white!)

Is it that neither party (nor any of the fringe ones) have a solid plank on public health issues of particular interest to black communities?

Bottom line: I think that there are places for the anecedotal: they start the dialog. Now it is up to you public intellectuals to maintain the dialog and draw in some of the subtle nuances and some of the scholarly techniques and critiques.

And you public intellectuals who are also political scientists, I'm looking for you to tie in the political issues -- and not just a focus on the inadequacy of some pop poll.

'Nuff said.

An added thought: I guess I'm waiting, Lester, for the time that you write about black folks forming coalitions with others who might share our policy perspectives and needs: that's how we ultimately will impact public policy -- from health to wealth. Focussing on more narrow, black-specific issues doesn't have legs, as I see it.

Now I'm really through for the night.

I understand what you are saying. I've got two responses.

The first is that you should stop waiting, and write what you expect to see yourself. I write largely for two reasons--first is that I need to write to live (not simply materially but spiritually as well). But the second is that I've got a large enough ego that I believe not only that my voice is unique, but that I have something important to say that no one else is saying.

I've known you long enough to know you've got the ego.

And by pointing out flaws in my work it appears as if you've got something different in mind.

So I ask you for the second time, to WRITE YOURSELF AND GET OUT THERE. Either here on Vision Circle, or elsewhere. There's a need for it, and even a little bit of loot.

The second response is related. I could really use partners in this endeavor because not only can I not possibly cover everything--even when the column goes weekly--it has been a challenge for me to turn the corner to more proactive columns because of the general mess we find ourselves in. I believe my critique is necessary because of what I am getting back from people I know. But more IS needed.

Step up.

Thanks, I'll give it some consideration.

It used to be ego, but now I think it is more about the wisdom that comes from experience: being a part of that generation that preceeded you, I probably have a different perspective on the issues.

To that end, providing a counter-balance and/or critique to what you have written hopefully adds to the dialogue. Of course, these blogs don't really lend themselves all that well to deep dialogue -- in a day or two, this thread will be buried and gone.

What I really need is time or a job where writing is part of the gig. Mostly, it is the time thing right now: I don't have enough time to go much beyond these "drive by" encounters.

Interestingly enough on the last part we are in similar straits. I'm stretching to write here and on Africana.com for the reasons I noted above. But that stretching means that I don't have the time to delve into examples of political organizing and success like I'd like to. And I DO have a health disparities postdoc, but I'm not in Baltimore yet so I haven't begun to dig into THAT literature like I'd like. I should be able to make the turn to more proactive pieces after the election, because hopefully by then I'll have more information about the field of public health, and more experience doing work on the ground in Baltimore. We'll see.

BTW,

I sent you a reference to a Health Disparities issue that was published in the Wall Street Journal -- did you get it? I didn't get a response from you and I sent it from one of those new gmail accounts.

Check out the Friday, August 6th copy of WSJ -- Weekend section, I believe: "A Case of Colorblind Care." The reference is apparently to an article in the New England Journal of Medicine (August 5 edition? Author says "yesterday's edition). I've not had the chance to look up the NJM article, but I think you will find the WSJ article interesting (from a conservative think tank).

When you get rolling in B'more, you will probably find me a more collaborative "partner:" health care issues are something I really care about and am willing to find some time to do something in that area.

I did get it, and I apologize for not contacting you notifying you that I did. I remember when the person involved came out with her book on the political correctness of health. I browsed through it, and thought it was absolutely horrible. I am biased and acknowledge that, but I have not found pieces from any conservative think tank worth reading more than a summary. Pushing market based initiatives and black pathology are trademarks. I've got a bibliography that I'll try to duplicate and send to you...or maybe I'll just put it here.

".... but I have not found pieces from any conservative think tank worth reading more than a summary ....."

I agree and understand, but .....

Somebody has to counter these claims and attempt to see that a more balanced and nuanced view is put before the same readers who are exposed to authors like her.

Your position and your new fellowship offer a vantage point to speak out against this nonsense.

I plan to get the original article: maybe I'll bike over to the University Medical Library tomorrow and see if I can get a copy. The biking will be part of my exercise program and I love wondering around the stacks of the medical library. Too much good stuff to read!

Got it! You are absolutely right. I've got a long drive to Baltimore ahead of me. I should be able to use that for reading and writing.

I found the abstract online:

Volume 351:575-584 August 5, 2004

Primary Care Physicians Who Treat Blacks and Whites

Peter B. Bach, M.D., M.A.P.P., Hoangmai H. Pham, M.D., M.P.H., Deborah Schrag, M.D., M.P.H., Ramsey C. Tate, B.S., and J. Lee Hargraves, Ph.D.

ABSTRACT

Background In the United States, black patients generally receive lower-quality health care than white patients. Black patients may receive their care from a subgroup of physicians whose qualifications or resources are inferior to those of the physicians who treat white patients.

Methods We performed a cross-sectional analysis of 150,391 visits by black Medicare beneficiaries and white Medicare beneficiaries 65 years of age or older for medical "evaluation and management" who were seen by 4355 primary care physicians who participated in a biannual telephone survey, the 2000–2001 Community Tracking Study Physician Survey.

Results Most visits by black patients were with a small group of physicians (80 percent of visits were accounted for by 22 percent of physicians) who provided only a small percentage of care to white patients. In a comparison of visits by white patients and black patients, we found that the physicians whom the black patients visited were less likely to be board certified (77.4 percent) than were the physicians visited by the white patients (86.1 percent, P=0.02) and also more likely to report that they were unable to provide high-quality care to all their patients (27.8 percent vs. 19.3 percent, P=0.005). The physicians treating black patients also reported facing greater difficulties in obtaining access for their patients to high-quality subspecialists, high-quality diagnostic imaging, and nonemergency admission to the hospital.

Conclusions Black patients and white patients are to a large extent treated by different physicians. The physicians treating black patients may be less well trained clinically and may have less access to important clinical resources than physicians treating white patients. Further research should be conducted to address the extent to which these differences may be responsible for disparities in health care.

What interests me is that the Resident Scholar from the American Enterprise Institute concludes that this study supports the the claim that racism does not play a "meaningful role in the health status of African-Americans."

Like racism does not does not have a meaningful role in where many African-Americans live and receive their healthcare. Funny, the physicians in those areas are not as well trained. Duh.