Earlier today, The Atlantic published a Q&A with me regarding my recent publication on history, pain, and stigma.

The Q&A is the subject of a fascinating, wide-ranging conversation I had with the journalist, Sarah Zhang.  At one point, we have the following exchange:

Those attitudes, practices, and beliefs are handed down, and of course, they’re also racialized. One of the things we know is that persons of color, especially black people in the U.S., are much less likely to receive opioids than white people. As it turns out, it might actually be good for them.

Zhang: Right—and that’s one of the reasons why the opioid epidemic has been centered around white communities.

Goldberg: Yes, people of color might be missing some of the opioid epidemic than comparably situated white people, that’s a public health gain, but they’re also experiencing pain stigma, and that’s a public health loss.

On Twitter, several readers of this exchange were concerned that this might seem to indicate a belief that racial discrimination in access to health care resources is acceptable if it results in salutary health consequences.

This is not what I meant, but when it comes to racism, what the speaker means is far less relevant than what the speaker says.  Language matters.

Here is what I should have said:

Racial discrimination in access to health care resources is immoral.  Period.

There is an active debate, of which I am part, regarding whether stigma can ever be justified if it produces good public health ends.  I do not think it can be so justified, but others disagree.

Regardless, that debate is inapplicable here because, when opioids were being liberally prescribed, they were widely believed to produce more benefit than harm.  They were perceived as a health good.  Therefore, access to such an intervention was widely deemed to be just and right, and racial inequalities in such access were not justifiable when they were occurring.  Denying people what was widely believed to be a salubrious intervention along racial lines cannot be justified retrospectively because it resulted in some unintended health good.

Thoughts?

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