Saturday, June 10, 2023

Racism and Sexism Within the Behavioral Science Evidence Base - A Letter to Decision Makers

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Background Context 

This is a letter addressed to an opioid settlement funds distribution board in Oregon. The opioid settlement funds are the result of a collection of lawsuits filed against pharmaceutical drug manufacturing corporations for their role in worsening the ongoing American drug crisis. A crisis especially notable for the recent surge in preventable overdose deaths. Settlement awards of upwards of $50 billion dollars were awarded, in theory, to members of the population affected by the drug crisis. Fund allocation is managed by state and local governments, most commonly through formation of a governing board or council.

In the State of Oregon, state-level allocations are managed by the Opioid Settlement Prevention, Treatment and Recovery Board.

Many of these governing entities will desire to use evidence-based approaches to help guide decisions about funds use. The following letter, read out as part of public comment at the June 7th, 2023 Oregon board meeting, is a cautionary note about medical evidence given a backdrop of ongoing systemic racism, ableism, sexism, and other prejudicial biases. Biased backed into the root core of our medical knowledge base going back 120+ years, and in some instances 2,000+ years.

Statement Presented at the June 7th Oregon State Opioid Settlement Prevention, Treatment and Recovery Board

Dear members,

This Board has noted several times that it wishes for the use of settlement funds to be both evidence-based and culturally responsive. Given those goals, a colleague of mine posed a question last week I'd like the Board to take under consideration. If providing inclusive, culturally responsive, trauma-informed, and accessible care is considered innovative or a speciality, then what type of care are we providing now?

An obvious answer to that question is that such care is not the current standard. And we know this is true. We have studies showing that women are frequently and improperly diagnosed with borderline personality disorder simply for exhibiting basic human emotion. We know that black children are frequently and improperly diagnosed with oppositional defiant disorder, while their white counterparts with similar behavior patterns are diagnosed with ADHD. The black child is medically labeled as defiant while the white child is not. These examples are not rare one-offs. Hundreds of similar examples are out there.

I would ask this Board to keep these examples in mind every time they read through a medical research report or look over a medical data point. I would ask that you start learning everything you can about how the evidence base and practice of medicine is not immune to the racism, ableism, sexism, and other prejudice present in our society. Am happy to suggest resources and reports on this matter.

I need this legacy of prejudice to be understood. Because I very much desire that we have a conversation, ideally quite soon, about the fact that science is telling you that drug addicts are broken and diseased individuals. This is the same science that's guilty of being sexist towards women and racist toward black children. These aren't problems of some bygone era. These are problems with us right now in present times. This is science my peer community did not consent to or sign off on. It is science about us, without out. 

I want this Board to keep asking if it's drug users themselves who are broken, or if it's also, sometimes, the society around them that's broken? Could we not address both when considering treatment? These aren't questions with simple answers. These are questions deserving a nuanced conversation, and it's a conversation rarely supported by current medical practice.

These are questions you, right here, all have been empowered with resources to help investigate and answer. Please consider doing so. 

And, as a final note, will remind you again that the peer community has not been invited to those conversations, and is still not funded to write such reports. Which is a key reason why the mainstream science community keeps making so many mistakes when it comes to the topic of behavioral health. 

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This article brought to you by the currently unfunded Peer Voices Network. 

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Photo by James Eades on Unsplash

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