> White medical trainees, reflecting the general population, can have false beliefs about biologic differences between Black and White patients (eg, “Black patients feel less pain”), and this racial bias leads to inaccurate pain diagnoses and treatment recommendations.8
IMO, it's a little unfair to ascribe deliberate, knowing application of racist stereotypes. That kind of rhetoric by researchers can have unintended consequences, however well-intentioned, such as with the overcorrection wrt opioids, and is often used by interest groups to change policy in directions not otherwise warranted by well-founded evidence. (It's sometimes like people using "think of the children" as a way to stream roll more nuanced, narrowly focused debate.) There is material evidence that, broadly speaking, different ethnicities have different skin characteristics, including thickness (which is admittedly often used in an imprecise manner, but can defensibly include characteristics like elasticity). It figures prominently into aging, and generally considered part of the reason why "whites" (for lack of more precise categorization) tend to wrinkle more with age, particularly relative to Asians with similar skin tone. (Contra stereotypes, some research shows Asians have "thicker" skin than whites and blacks, at least in the sense of being less prone to wrinkle for similar phenotypic pigmentation.) Papers that make the claim of prima facie racism like https://jamanetwork.com/journals/jamadermatology/article-abs... say in the abstract the beliefs are unfounded, but in the full article only go so far as to admit the evidence is equivocal or that doctors draw unnecessary or unsupported implications.[1]
Nonetheless, it's fair to say non-specialists shouldn't be making treatment decisions based on such poor and otherwise collateral evidence. And I would agree the evidence for racially disparate pain management treatment generally is very compelling, just that the racism is more implicit and unconscious. All race-based distinguishers are highly suspect, IMO, even when they accurately reflect a group in context. But unless and until medical systems comprehensively adopt personalized genetic profiling (given various limitations in cost, time, and well-researched data, something still pretty far off for general medicine), doctors are kind of stuck wrestling with old epidemiologic classifiers.
[1] The abstract says, "Although race is a social construct, the biomedical sciences—including dermatological science—have been used to promote the false idea that race has a biological basis. The study of race-based differences in skin thickness is an example." But the full-text says: "Race-based differences in skin thickness remain an active area of investigation. A review of the literature (1977-2014) reporting differences in aging skin across race and/or ethnicity noted that Asian and Black skin had 'thicker and more compact dermis' than White skin, 'with the thickness being proportional to the degree of pigmentation."4 A 2022 meta-analysis of 133 studies concluded that any difference in epidermal thickness in healthy human skin was minor, calling into question the usefulness of distinguishing skin thickness among racial groups.5" Note that this summation is putting a gloss onto research that is itself equivocal, but then is cited in policy debates to make claims about what "the science" unequivocally says.