Ask Dr. Rob: Poverty and Medicine

Obviously, many of the letters sent to me since my inaugural "Ask Dr. Rob" post have been a bit on the silly side.  I will go that route fairly soon.  But one of the questions was actually quite serious.

Mario, who works over at the Huffington Post writes:

How does a scientific report about skin cancer get spun to focus on the rich while ignoring the poor?  

He then referred me to an article by Deborah Blum which describes the media spin in regard to a scientific report on skin cancer.

I\’d like to tell you a story of skin cancer, wealth, poverty and, I\’m afraid, journalism done badly.

My morality tale starts this Monday with the announcement of a study in this month\’s British Journal of Dermatology: a report by scientists in Belfast, who had tracked and analyzed skin cancer rates in Northern Ireland over 12 years.

Their primary finding, based on data from 1993 to 2004, echoed what many researchers have been saying: melanoma and other skin cancers are increasing alarmingly fast worldwide. Even in Ireland — hardly a sun-blistered climate — doctors report a 62 percent increase in skin cancer samples sent to laboratories and a 20 percent increase in patients.

There has been much speculation about the global rise in skin cancer, ranging from heavy use of tanning salons, to overexposure on beaches, to thinning of the planet\’s ozone layer, which famously blocks the worst of the ultraviolet radiation that bombards our atmosphere.

But news coverage of this study didn\’t look for answers to such questions. Rather, they focused on a fact highlighted in the press release — that the sharpest increase, at least among the largely fair-skinned people of Northern Ireland, is among those who live in affluence. Melanoma is two-and-a-half times more common in people who live in moneyed neighborhoods, according to the analysis, and the less lethal skin cancers, such as basal cell carcinoma, were 41 percent more likely to occur.

What separates the excellent journalists from the rest is that they notice things that nobody else notices.  Was this simply a story about wealthy people basking in the sun and getting the just deserts for affluent lifestyle?  That is how the press reported it.  But Ms. Blum read beyond this report:

But as opposed to the news coverage, the report is not particularly obsessed with the wealthy. In fact, if you read the study, rather than the press release, there\’s a sense of genuine concern about the poorer patients. The researchers real focus is on underestimating skin cancer among the poor. Or to quote directly, "It is possible that patients from lower socioeconomic groups do not present for medical care," leading to under-reporting of skin cancers, emphasizing an underlying worry that the numbers are missing some very sick people.

This is far from just politically correct angst. Study after study, in country after country, shows exactly that disparity. In the United States, it happens to be a worsening problem. A 2003 report by the National Cancer Institute analyzed "socioeconomic variations in U.S. cancer incidence" between 1975 and 1999. It found that people in poor neighborhoods are far more likely to have their cancers diagnosed late rather than early. Which means, not surprisingly, that they\’re far more likely to be killed by those cancers.

How could the media have missed that?  How could we all have missed that?  The problem is not simply that rich people get cancer, it is that poor people don\’t get diagnosed.  Somehow, however, we get lazy, not reading the original article but focusing on the headlines in the news.  The news organizations are doing what they are designed to do: write stories that will attract attention.  The image of ladies basking on the beach is far easier to sell than the image of poor people with undiagnosed cancers.

At the end of the month, one of the physicians in my practice will leave us and start a practice among the indigent people in our city.  He worked in a similar practice in Memphis, where he trained, and has always had a heart to serve those who are normally neglected.  While he will be missed, he leaves us with a strong message: don\’t neglect the poor.

I have re-written the end of this article a number of times, as it always seems to come off sounding preachy.  The bottom line is that there are many uncomfortable truths in this world: people are sick, in pain, dying, and neglected.  As healthcare workers these truths are harder to ignore than for most.  Yet as a society we can\’t  afford to forget about these people, or worse yet, ignore them. 

Thanks for the question!

I promise the next one will be more along the lines of the first.