My hospital is based in the southside of Chicago and has a predominantly black population. It follows, then, that we have a large number of Sickle Cell Patients. We do not, however, have a Sickle Cell Clinic, or an inpatient program. We don’t really learn about how to manage sickle cell patients– for the most part we slap them on a PCA, make sure they don’t get Acute Chest, and whine about how long it’s taking them to wean onto orals.
Here are my thoughts about it: SCD is a debilitating disease. They are at risk of horrendous complications; even the most notorious patients we see at our institution have had strokes, episodes of acute chest, seizures, MIs, you name it. Why do we put so much energy into declaring them drug seeking? Why are we not vehemently looking for a cure? Why is every academic center not rushing to be the one that fixes sickle cell anemia? Why aren’t we enrolling every SCD patient possible into bone marrow transplant programs? Why don’t we hire more SCD specialists in hospitals where we see SCD patients?
I am not trying to diminish the difficulty of living with Cystic Fibrosis in this comic. But there’s a reason the two diseases get compared: one predominantly affects white people, the other black, their prevalence is about the same (about 70-80k cases in the United States), and they both have a life expectancy that’s in the early 40s. Let’s just say the energy for CF patients is just different. To put it in perspective– NIH funding per person for CF between 2008-2017 was $2807 vs $812 for SCD. Philanthropic expenditures? $7690 vs $102. Annual CF publications? 1594 vs 926. You catch my drift.
We need to do better by our SCD patients. I want to be a Cardiologist, not a Hematologist, but for the next year I’m still going to be seeing these patients. I want to treat them with the dignity they deserve, and now that I am giving them their best shot.
1- Elander, et. al., Understanding the Causes of Problematic Pain Management in Sickle Cell
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