How the Pearson Publishing Company Can Help to End Medical

Discrimination
By Sairis Perez-Gomez
Perhaps no field is more universally respected than medicine. The ability to heal and provide
treatment has been a valued part of every culture since the dawn of recorded history. The healers
in a community ensured its overall health and tirelessly taught the next generation the different
ways to heal. Still in 2018, nurses in hospitals serve the same role and uphold the time-honored
tradition to heal and serve. In today’s world, nurses, in addition to hundreds of mentors, also use
textbooks to learn as much as they can best of their abilities.
It has been brought to my attention that a recent publication from the Pearson Publishing
Company is a recipient of public outcry due to a chart in one of its nursing textbooks. The
textbook entitled Nursing: A Concept-Based Approach to Learning featured a chart that
rightfully upset some nurses who were studying the textbook. The chart provided a list of
religions, races, and ethnic groups and assumed, without providing actual evidence, the people in
these groups would react to pain in certain ways. The most alarming part of this passage were
that the stereotypes were presented as being scientific fact. The text also seemed to encourage the
idea that a nurse should treat a patient in a certain way simply due to their ethnicity and race.
In this report I will address the long existing problems between race. Next, I will analyze why
people reacted the way they did and lastly, I will present ways to address the problems, solve it,
and hopefully avoid it in the future.

A Brief History of the Discrimination in Medicine, and its lingering

side-effects
One of the darkest moments of America’s past was the existence of slavery, and this horrid
institution also fostered a painful part of the history of medicine in America. The “father of
gynecology” J. Marion Sims experimented on female slaves without the use of pain killers,
despite them being invented already. He claimed in an 1857 lecture the his operations on the
women, who could not protest or stand up for themselves, were not “ painful enough to justify
the trouble.” (Gordon) This belief that African Americans perceive pain differently still affects
medicine today. A study done be the University of Virginia in 2016 elucidated the beliefs about
race held by practicing medical professionals and medical students. Beliefs included that “their
(blacks) nerve endings are less sensitive than white.” (Gordon) Despite laws and other
movements being created these problems affects still linger within our society and institutions.
This is just a brief examination of the medical history of one racial group in America. It does not
even begin to scratch the surface. The effects of racism are still prevalent and present in modern
America and to ignore them, especially in medicine, would be a shame.
Other false statements about race that were tested by the University of Virginia

This chart provides a series of stereotypes in the items column and the next five columns show how many
participants in each year of their medical training agreed with the statements. (Courtesy of PNAS/Hoffman et al)

Although the chart in the nursing textbook does not encourage experimentation on non-
consenting patients, it still contributes to the belief that people of color perceive pain differently.
The textbook was the first volume in a series. This textbook was also possibly the first textbook a
nursing student would use. The next generation should not be taught such beliefs, and as a
company the Pearson Publishing Company has taken responsibility, but how can we avoid this
problem in the future.

What this Controversy Displayed About Medicine in America

The biggest problem facing this text is that it states numerous stereotypes as scientific fact. The
public outcry, from professionals and citizens, is similar. These stereotypes, especially the
stereotypes in medicine, are harmful because they are hurtful reminders of what minorities have
suffered and they inhibit honest medical practice. Below is a cropped version of the photo I
found from the textbook. In this analysis I will first discuss the most alarming points, then I will
discuss what the rest of the page says. Lastly, I will analyze the Pearson Publishing Companies
response to this problem.
Problems within the Six Sections of this Document

All the problems in this document can be summed up in the three points below:
1. it assumes all patient with a certain ethnicity or race will react in the same way to pain
2. it assumes followers of a certain religion will view pain the same way
3. it groups people together based on appearances/beliefs
These three sentiments are shared between all the sections. In the Arab/Muslim, Asians, Blacks,
Jews, and Hispanics section all mention in various ways that people in these groups believe the
must enter pain to go on to the next life. There are two things wrong with this section. The first
being that all people in these groups are religious and secondly that the pain their earthly bodies
endures should not be treated as carefully as pain endured by other groups. In the Asians section,
the book goes as far to discuss Chinese patients specifically. It says they may not ask for
medicine because they do not want to distract the nurse from “a more important task.” What
happens if a person of Chinese ancestry does not ask for medicine simply because they are not
sure what to take and they expect the medical professionals to help? Besides assuming all people
from a certain group will act in a certain way it forgets one ethnic and racial group, those of
Caucasian descent or who identify as white. What this chart contributes to is stigma against
people considered to be minorities in American society.

Problems with the way this page is constructed

Imagine an exhausted nursing student finishing up their readings for class. Now imagine them
arriving to the page with the chart. Because the nursing student is tired of reading text their eyes
will naturally be drawn to information being presented in a chart.

Charts and infographics help to condense information. So, instead of reading through the text
that is presumably beneath the chart, the student would read the chart and assume all they need to
know on this page was condensed onto the chart. But, the danger in this is that the text beneath
the chart provided a “brief disclaimer” to take the above information with a grain of salt. If you
are wondering if this situation plausible, please recall to the way people reacted on Twitter. Like
our theoretical nursing student, they only read the chart even the rest of the information was
available in the image circulating around online. I will insert the rest of the text that was
circulating around online below.

The two “disclaimers” are boxed

I put the disclaimers in quotations because I believe they do not fully explain that the above
information cannot be applied to every situation a nurse may encounter. A nurse is often the first
person to treat a patient. For this reason, nurses should not be taught to make so many
assumptions about their patients without taking time to know them and hear what their symptoms
are. I understand that in medical settings, like ERs, the fast pace does not allow for real
connections, but a nurse should treat each patient as a unique case. The Pearson Publishing
Company has the power to stop in the cycle of nurses and other medical professional from
creating more harmful work places.
Looking Forward
After receiving backlash on Twitter the company responded appropriately. Tweets from the
official Pearson Publishing Company were promptly sent out and as an added bonus even an
apology video was filmed. The video was excellent since is followed genre conventions but
chose to not have the speaker of the video cry fake tears. Owning up to the mistake was a great
idea. Since the book is no longer printed, the problem of more nursing students finding this book
in their curriculums has slightly decreased. However, because the once 243 dollar textbook is
still being used, nursing students still write bad reviews about it. It is apparently filled with
grammatical errors and as of November 2018 the average price is 118 dollars.

Screenshot of Tweets sent out by the Pearson Publishing Company as a response

Solutions

The two responses I could find from the company were appropiate however some other solutions
would be:
- asking nursing programs to stop using this text
- using a diverse panel to review textbooks before publication

With the power of the internet it should be easy to ask schools to stop using the textbook.
However the second solution is slightly more difficult to achieve. A diverse panel could help to
approve new ideas for passages in the textbook, especially those concerning their own cultures,
races, and ethnicities. Since there is not much diversity training in medicine today, wouldn’t
creating this panel help to create more diversity in the classroom? Also, from a PR standpoint,
this effort to prevent mistakes like these from happening would be greatly appreciated by the
public. In today’s world there always seems to be a new controversy and a new formal apology
from a company, but rarely do we action following those words. This is why I believe the
company should use both options.

Conclusion
Although this text cannot single handedly improve the American healthcare system it can serve it
can aid to stop the existence of bias in medicine by starting in the classroom. Essentially, this
text cannot stop racism however with a little more conscious thought it can help contribute to the
end of racism. By instilling good values in nurses before their careers have even begun while
they are still in the class room can help to make the future of medicine much greater.