{"doi":"10.1002/ajh.26032","title":"End the pain: Start with antiracism","abstract":"A young, black man with sickle cell disease (SCD) presents to a New York City emergency department with severe leg pain, having fallen days previously. He waits to be seen by a physician… Implicit bias defines the attitudes that impact our actions and decisions about people or things in an unconscious manner.1 In recent years, implicit bias training in higher education has provided a space for many clinicians to evaluate their own personal attitudes towards both patients and coworkers. Implicit biases are the often defined “hidden biases of good people”.2 As this understanding of implicit bias has taken root in our collective consciousness from the late 20th century to the present, the goal to confront bias in medicine has become an institutional value. Nonetheless, tangible improvement in minority health has been slow moving. The current Covid-19 pandemic exposes these deficiencies acutely.3 Although more and more clinicians are developing an intellectual understanding of implicit bias, this awareness has failed to eradicate racism in healthcare.4 A key deficiency of the current understanding of implicit bias, is that it allows us to view our behaviors as impersonal entities—good people involuntarily producing biased actions. Racism is a personal moral failing that is not solely a belief of personal superiority over another person due to race, but also describes the support of impersonal structures wired to adversely impact groups of people on the basis of race. Ibram X. Kendi defines a racist as “one who is supporting a racist policy through their actions or inaction or expressing a racist idea.”5 On the other hand, an antiracist is a person who supports “antiracist policy through their actions or expression of an antiracist idea.”5 Antiracism implies action always and dismantles passivity. In Kendiʼs view, this means that being a racist or antiracist is not a fixed identity. It is dependent on oneʼs actions at a point in time, from moment-to-moment. In addition, the tenets of antiracism hold that as long as we continue to concentrate on the fact that we are “good” we will never truly be convinced to fundamentally change our behaviors. “Youʼre not too jaundiced.” “If you want, we can do labs to see if you are in crisis.” “Weʼre only going to give two scripts. No more after that.” “I understand, Miss, but itʼs like, this is what happens all the time, too. The first thing out of your mouth was ‘Iʼm sending you homeʼ … I feel, honestly, Miss, Iʼm trying to hold tears back now.” So, SCD is a congenital disorder that primarily impacts black patients, people who already face racism in every facet of American society. Although often debilitating, SCD has not evoked the same empathy from health providers as other diseases impacting other racial groups.7, 8 Many believe this lack of empathy and understanding is influenced by the race of the population who are predominately affected by the disease. A documentary is a careful construction of reality portrayed as truth, and while this doctor-patient interaction was authentic, it illuminates common misunderstandings of the disease. For we who care for patients with SCD, this was a troubling encounter. The impacts of portraying SCD in this manner could be damaging to patients, physicians, and viewers unfamiliar with this disease. The first misconception created by this encounter is that drug-dependence and addiction are one and the same. Yet 90% of patients with SCD do not suffer from opioid addiction. Equating SCD with drug-seeking behavior feeds into misguided, non-evidence-based thinking.9 It also crafts a perception of patients with SCD as delinquents, criminals, and immoral people who should not be trusted. Rather, SCD is a genetic disorder that results in dysmorphic red cells occluding vasculature. So, SCD does not cause dependence on pain medication. It causes pain, organ failure, and early death. In the absence of adequate disease-modifying treatment for over a century and lack of","journal":"American Journal of Hematology","year":2020,"id":114136,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":2,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9584,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":104356,"name":"Leslie S. Kean","orcid":"0000-0003-0475-3926","position":1,"is_corresponding":false},{"id":522350,"name":"Natasha M. Archer","orcid":"0000-0002-6460-5872","position":2,"is_corresponding":false},{"id":537517,"name":"Tolulope O. Rosanwo","orcid":"0000-0003-3773-3518","position":0,"is_corresponding":true}],"reference_count":6,"raw_metadata":null,"created_at":"2026-07-18T23:13:29.674622Z","pmid":"33085798","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}