Racial Bias in Medicine Isn't Just an American Problem

The hospital gown offered no defense against the cold air or the searing pain radiating through her body. Each breath was a negotiation with a searing internal fire. Lying in that sterile bed, under harsh fluorescent lights, she was unquestionably at her most vulnerable, facing a landscape of agony she could not navigate alone. Her suffering was entirely dependent on the subjective assessment of the medical professionals who walked the polished floors.

When the doctor entered, she looked to him for answers, for relief, for the simple reassurance that he saw her ordeal and would help. She asked if the intensity of her pain was normal.

"Pain is never normal," he began, and for a moment, she felt a flicker of hope. But then he continued, his tone matter-of-fact, as if stating a simple, biological truth. "But you Black people can put up with it better."

The words landed a hammer on her chest. He didn't use her name. Throughout their interactions, he had referred to her only as "the African." Now, he was erasing her individual experience, replacing it with an ugly racist stereotype. He went on to say she should be grateful to be in a German hospital at all, because with her ailments, she would already be dead in Africa.

How do you advocate for yourself when the person you depend on for care denies the very legitimacy of your suffering? How do you trust the hand that is supposed to heal you when it is guided by a mind that sees you as a stereotype? The woman in that bed was not just a patient. She was Mirrianne Mahn, a city representative for Frankfurt, Germany. And in that moment, her title meant nothing. She was powerless.

Clinician biases affect may assessment of pain.

Source: wavebreakmedia / Shutterstock

The Fake Illness with Real Consequences

Mahn's horrific experience is not an anomaly. It is a symptom of a deep-seated bias within Western healthcare. These biases are not just an American problem, but occur in Canada and throughout Europe. In Germany, there is an informal, pseudoscientific name for this kind of racism: Morbus Mediterraneus.

In a new paper published in BMC Medical Ethics, my colleagues and I investigate this underexamined phenomenon. The term, meaning "Mediterranean disease," is a derogatory label used by many healthcare professionals to dismiss the pain of racialized patients—particularly women—as exaggerated or overly dramatic. This "diagnosis" has no scientific basis, yet it is used to justify the undertreatment of pain, leading to misdiagnoses, avoidable suffering, and an erosion of trust in medicine.

The Racist Roots of Modern Medicine

Our research shows that this phenomenon is a product of historical legacies, cultural misunderstandings, and unconscious biases.

The idea that people of color are biologically different and less sensitive to pain is a destructive myth with a long, dark history in medicine. During the colonial era, such false beliefs were used to justify the inhumane and unethical experimental treatment of racialized people. For instance, Nobel Laureate Robert Koch, a celebrated figure in German medicine, conducted forced and lethal experiments on thousands of Indigenous Africans, operating under the pervasive racial biases of his time. These foundational beliefs, though scientifically debunked, have cast a long shadow, and continue to exist in the unconscious minds of many practitioners today.

When Culture Is Mistaken for Pathology

Cultural norms profoundly shape how we describe pain. In many societies, including those in the Mediterranean and Middle East, openly expressing pain can be an adaptive social cue to elicit care and support from one's community.

However, in medical settings shaped by cultural norms that value stoicism and emotional restraint, these expressions can be misinterpreted as dramatization or a lack of credibility. This difference can lead directly to inadequate diagnostic efforts and delays in treatment.

The Unconscious Biases That Shape the Clinic

Even the most well-meaning provider can be influenced by implicit bias. In healthcare, these unconscious attitudes can lead to significant disparities in treatment for pain. Research has consistently shown that providers often harbor an "empathy gap," underestimating the pain of patients of color.

Bias Essential Reads

When the Brain Shapes Belief

Racism Is Not Innate

One study found that White German students exhibited stronger empathic brain responses to images of pain in light-skinned hands compared to dark-skinned hands, a difference correlated with their implicit bias scores. In the clinic, these biases can result in the withholding of appropriate pain relief and increased suffering for patients of color.

What Can Be Done?

Confronting a problem as entrenched as Morbus Mediterraneus requires systemic reforms across medical education, clinical practice, and policy. Based on our findings, we recommend several key actions:

• Implement mandatory anti-racism and structural competence training to equip healthcare professionals with the tools to recognize and challenge their own biases and the systemic factors that cause health disparities.
• Utilize standardized pain-assessment protocols to reduce subjective clinical judgments that can be influenced by racial or cultural bias.
• Increase racial diversity among healthcare workers to improve patient-provider communication, foster trust, and create a more culturally informed clinical environment.
• Empower professionals to address racist behavior when they witness it. Clinicians have an ethical duty to intervene when colleagues use derogatory, non-clinical terms, to protect patients from harm.

Mirrianne Mahn’s experience is a worrisome reminder that racial differences in pain treatment are not rooted in biology, but in bias. We must dismantle these prejudices and build a more just and inclusive system to ensure that every patient's pain is seen, heard, and treated with the dignity and urgency it deserves.