Speaker 1: Hi. My name is Corey O'Hara and I'm Country director
Speaker 1: for ID Nepal. We are an international nonprofit that creates
Speaker 1: livelihoods for the rural poor. Currently, Nepal is looking pretty
Speaker 1: good on the COVID nineteen front. People don't mind wearing
Speaker 1: masks here in the climate's mild, so people can socialize outside.
Speaker 1: Tests are only showing a few hundred new cases per
Speaker 1: day now. That's down from about five thousand a few
Speaker 1: months ago. And for comparison, the country has a population
Speaker 1: the size of California, and officially fewer than two thousand
Speaker 1: deaths have been linked to COVID here, But unofficially everyone
Speaker 1: knows our numbers are artificially low. We're pretty sure that
Speaker 1: due to social stigma, deaths in rural villages are being
Speaker 1: reported as heart attacks or something else. And testing rates
Speaker 1: are very low now as well, so it's also unclear
Speaker 1: what the current spread of the disease is nationally. We
Speaker 1: know that we're better off than most of the world
Speaker 1: as far as disease spread goes, though, which is lucky.
Speaker 1: The bigger problem here has been with our food supply.
Speaker 1: Most people in Nepal are subsistence farmers, with very little
Speaker 1: land who grow most of the cow they eat. About
Speaker 1: two thirds of the national population depends on this kind
Speaker 1: of small scale agriculture, and the national lockdowns we've faced,
Speaker 1: even more than the disease, have had a devastating impact
Speaker 1: on these rural communities. Our first case here was in
Speaker 1: January a student who returned from Muhan and after that
Speaker 1: we were all on high alert with restrictions on travel
Speaker 1: from China, then Europe, and on border crossings from India.
Speaker 1: Then when we saw our second case in March, the
Speaker 1: entire country lockdown. This was a severe restriction on all
Speaker 1: movement nationally. Police in many areas took their jobs very seriously.
Speaker 1: Here in the city, I saw people being beaten with
Speaker 1: canes and arrested for going to the market or being
Speaker 1: outside at the wrong time. All transportation in the country
Speaker 1: was stopped except with a medical permit. In some areas,
Speaker 1: police beat farmers for working in their own fields, and
Speaker 1: that kind of severe response was eventually reined in, but
Speaker 1: it was well covered in local press and many farmers
Speaker 1: around the country were understandably terrified because of it. Meanwhile,
Speaker 1: supply chains totally broke down in the first three months
Speaker 1: of lockdown. We saw produce rotting in some parts of
Speaker 1: the country where buyers were unable to come pick it
Speaker 1: up and farmers were unable to deliver it to markets.
Speaker 1: Many farm supply shops were forced to close or were
Speaker 1: unable to restock their shelves, so farmers didn't have access
Speaker 1: to the seeds and basic supplies they needed for the
Speaker 1: spring planting season. A lot of the corn or maize
Speaker 1: that went into the ground this spring was low quality
Speaker 1: seed left over on farms from a previous season, rather
Speaker 1: than more trustworthy, high yield varieties that farmers typically purchased
Speaker 1: to plant. For some crops that wouldn't matter much, but
Speaker 1: not corn, so we saw yields drop dramatically in those fields.
Speaker 1: Poor families depend on that crop for the summer months,
Speaker 1: all the way until October's rice harvest, and then the
Speaker 1: rice harvest should carry them through to the following spring. Instead,
Speaker 1: we saw terrible hunger problems spreading across the country over
Speaker 1: a period of several months. Just to compound these food
Speaker 1: supply problems, this year, we were invaded by the fall
Speaker 1: army worm horn pest from the Americas that caused extensive
Speaker 1: damage at exactly the point when farmers weren't able to
Speaker 1: buy supplies to manage it. At ide, we've been working
Speaker 1: with government and donors to coordinate the national response to
Speaker 1: the pest through integrated pest management approaches, which means low
Speaker 1: toxicity tools like pheromone traps and organic pesticides. Our surveys
Speaker 1: during the lockdown showed that our messages were getting out
Speaker 1: there about how to treat the pest appropriately, but because
Speaker 1: suppliers weren't open, farmers couldn't get the tools they needed
Speaker 1: to respond. Then in June, we saw another insect plague,
Speaker 1: the desert locust, which came to Nepal for the first
Speaker 1: time since nineteen sixty. It's been a tough year for
Speaker 1: Nepal's farmers. Our summer rice harvest was good, though, but
Speaker 1: we're still seeing the after effects of that first strict lockdown.
Speaker 1: Prices for all foods here rose by about twenty five
Speaker 1: percent during those months and they still haven't stabilized. We're
Speaker 1: all paying a lot more for food these days, and
Speaker 1: in rural communities that means people have less to eat
Speaker 1: and what they're eating is lower quality in cheap cereal grains. Meanwhile,
Speaker 1: households that depend on remittance is from family members working
Speaker 1: abroad lost their main source of income, and the one's
Speaker 1: hardest hit are landless renters and farm laborers who don't
Speaker 1: have land of their own. Nepal's situation isn't really that unusual. Globally,
Speaker 1: there are half a billion small farmers around the world
Speaker 1: who have all been facing these same kinds of issues
Speaker 1: in the past year. They typically feed or support about
Speaker 1: half the world's population, so this isn't a small problem.
Speaker 1: These kinds of small family farmers can sometimes be unusually
Speaker 1: resilient in a crisis because they've always had to depend
Speaker 1: on different coping strategies, But in an extended crisis like this,
Speaker 1: and in some areas like Nepal, a crisis after crisis
Speaker 1: after crisis. We've seen that supply chain breakdowns in the
Speaker 1: agriculture sector mean disruptions to the food supply months down
Speaker 1: the line. We've already seen what happens in the US
Speaker 1: when there are interruptions in the toilet paper supply. Now
Speaker 1: just imagine what that situation is like for small farmers
Speaker 1: globally who haven't been able to harvest an food to
Speaker 1: feed their families or to bring to market, do both
Speaker 1: to COVID nineteen and to the world's response to it.
Speaker 2: I am a hospital social worker in Oregon, which has
Speaker 2: been relatively less hard hit than other areas of the
Speaker 2: country and world. It's still been an incredibly difficult and
Speaker 2: confusing year, even more so for our hardworking bedside staff,
Speaker 2: like the nurses, respiratory therapists CNAs. As a social worker,
Speaker 2: I can see every aspect of my patient's lives has
Speaker 2: been changed by the pandemic. Most commonly, people feel alone, disconnected,
Speaker 2: and unstable. Any pre existing problems like depression, housing instability,
Speaker 2: domestic violence, addiction, COVID makes these problems devastating and sometimes deadly.
Speaker 2: The hardest situations for me to watch involve family, maybe
Speaker 2: because I haven't been able to see my family and
Speaker 2: friends for so long. One of my patients in the
Speaker 2: ICU and his wife, who are forty somethings, able bodied,
Speaker 2: working professionals in their child, all had COVID. While dad
Speaker 2: was in the ICU, Mom died of respiratory failure at
Speaker 2: home in front of her kid, who then had to
Speaker 2: spend two lonely weeks quarantining at a family member's house
Speaker 2: without seeing anyone. Another older gentleman was admitted with COVID
Speaker 2: only a day or two after two of his adult
Speaker 2: children had died of COVID. He spoke only a Mayan dialect,
Speaker 2: which we did not have access to in our language.
Speaker 2: Bank his family said goodbye over a video call. These stories, sadly,
Speaker 2: are common. COVID has disrupted our grieving process in horrifying ways.
Speaker 2: People die alone with strangers in full protective gear who
Speaker 2: don't speak their language. We are isolated, unable to hold
Speaker 2: each other or gather together. It's been a really hard
Speaker 2: year and in some ways a lost year. I am
Speaker 2: so angry and sad how our country has handled COVID.
Speaker 2: I have moments of hope, like when I got my
Speaker 2: vaccine dosays, but I also fear things are going to
Speaker 2: get a lot worse before they get better.
Speaker 3: Hi Erin and Aaron, my name is Amanda, and I'm
Speaker 3: a microbiologist with a passion for epidemiology and infectious disease.
Speaker 3: My sister, Megan and I wanted to reach out and
Speaker 3: tell our dad's story because we feel it's a COVID
Speaker 3: story that needs to be told. Our father had immigrated
Speaker 3: from Mexico when he was a little boy and had
Speaker 3: made his life in the US. As he got older,
Speaker 3: he was spending more and more of his time traveling
Speaker 3: back to Mexico. On many occasions, he would fly back
Speaker 3: to the US when he was unwell from not taking
Speaker 3: care of himself or treating his various ailments or illnesses,
Speaker 3: and my family would work diligently to get him healthy again,
Speaker 3: only to see him fly back to Mexico. Most recently,
Speaker 3: he had left an assisted care facility a few months
Speaker 3: into the pandemic to fly back to Mexico to be
Speaker 3: with his girlfriend, in spite of being asked not to
Speaker 3: because of the pandemic because it was dangerous for somebody
Speaker 3: his age with his illnesses to be traveling. We'd not
Speaker 3: heard from him for many months, and then the day
Speaker 3: after Thanksgiving things changed. His girlfriend had reached out to
Speaker 3: us to see if we'd heard from him. She said
Speaker 3: that he was trying to make his way to the
Speaker 3: airport when he had gotten confused and started driving in circles.
Speaker 3: He was pulled over by the police and escorted back
Speaker 3: to the hotel. After explaining to the officers he didn't
Speaker 3: feel well and couldn't breathe, the police dropped him off
Speaker 3: and said that they would call an ambulance. He had
Speaker 3: called his girlfriend and said he was confused, couldn't breathe,
Speaker 3: and felt like he was drowning. That was the last
Speaker 3: time anyone had spoken to him. The hotel staff found
Speaker 3: him deceased in his bed the next day. While the
Speaker 3: outcome might have been the same, we're disappointed that the
Speaker 3: police didn't do more to get our dad help. Instead
Speaker 3: of driving him back to the hotel. Why didn't they
Speaker 3: drive him to a hospital to make sure that he
Speaker 3: was treated for whatever illness he was experiencing. We can't
Speaker 3: help but wonder if the police would have done more
Speaker 3: if he wasn't an older Hispanic man in the Southwest
Speaker 3: United States. Thank you for taking the time to hear
Speaker 3: our story. We hope that it shed some light on
Speaker 3: the discrimination that people of color experienced daily, both as
Speaker 3: part of this pandemic and the healthcare system in general.
Speaker 4: Thank you, and.
Speaker 3: Remember to wash your hands and wear your masks, you
Speaker 3: filthy animals.
Speaker 5: The Thank you so much for sharing your stories with us.
Speaker 5: To all of our first hand account providers, and thank
Speaker 5: you also to everyone who has written in to share
Speaker 5: your story with us. We really appreciate it and we
Speaker 5: are very grateful that you're willing to share your stories
Speaker 5: with us.
Speaker 6: Yeah, we really are.
Speaker 4: Hi.
Speaker 5: I'm erin Welsh and I'm erin alman Updek and.
Speaker 6: This is this podcast will kill you.
Speaker 5: Welcome to the sixteenth extallment mean sixteen episodes in our
Speaker 5: Anatomy of a Pandemic series covering COVID nineteen.
Speaker 6: That's a lot of episodes. We say this every episode,
Speaker 6: but well, we are very excited for this particular episode
Speaker 6: because we get to revisit a topic that we covered
Speaker 6: earlier in the Pandemic, but from a very different perspective. Yeah,
Speaker 6: so this week we are talking about disparities and what
Speaker 6: kind of disparities that we are seeing in COVID nineteen,
Speaker 6: particularly in the US, and we are super excited. But
Speaker 6: before we get ahead of ourselves, let's start with a quarantini.
Speaker 5: We should start with a quarantini. This week we're drinking
Speaker 5: Quarantini sixteen. Sixteen entire quarantines.
Speaker 6: That's a lot of quarantinies. It is a lot of recipes.
Speaker 5: It really is Aaron, You're a boss, are coming up
Speaker 5: with them all. So what is in the quarantine sixteen?
Speaker 6: The Quarantine sixteen is well it's rye whiskey, orange juice,
Speaker 6: lemon juice, and a bit of grianandine. Yeah, and we
Speaker 6: will post the full recipe for this Quarantini sixteen as
Speaker 6: well as our non alcoholic Placeberrita on our website this
Speaker 6: podcast will kill You dot com, as well as on
Speaker 6: all of our social media channels.
Speaker 5: Yes, other business items really quick.
Speaker 6: Erin the usual stuff. If you head to our website,
Speaker 6: you will find a link to our bookshop dot org
Speaker 6: affiliate account. You will find a link to our good
Speaker 6: riads list. You will find a link to merch to
Speaker 6: transcripts to alcohol free episodes, and a link where you
Speaker 6: can submit your first hand account for COVID nineteen for
Speaker 6: this Anatomy of a Pandemic series.
Speaker 5: Yeah, basically, we're just saying you should check out our website.
Speaker 5: There's a lot of stuff there, a lot of stuff there.
Speaker 4: Yeah.
Speaker 5: All right, So this episode, like Aaron said, we're very
Speaker 5: excited to be revisiting disparities. In our earlier episode on disparities,
Speaker 5: we had a really amazing conversation with doctor Jonathan Whittall
Speaker 5: from Doctors Without Borders about how vulnerable populations are disproportionately
Speaker 5: impacted by public health crises, and we discussed how these
Speaker 5: issues play out on a much more global scale.
Speaker 6: But in this episode, we're zooming in a bit to
Speaker 6: talk about racial disparities and healthcare in the US, and
Speaker 6: in particular, how the COVID nineteen pandemic has profoundly amplified
Speaker 6: these disparities. Where did these barities come from, what do
Speaker 6: they look like, especially in the context of COVID nineteen,
Speaker 6: how do we measure them? And importantly, what are we
Speaker 6: doing to reduce or eliminate these disparities to achieve actual
Speaker 6: health equity in this country.
Speaker 5: Yeah, that's a big one. To help us answer these
Speaker 5: questions and so many more, we are thrilled, like so
Speaker 5: fan girl excited.
Speaker 6: Oh my gosh. Yeah.
Speaker 4: Yeah.
Speaker 5: We got to chat with Harriet Washington, amazing writer, medical
Speaker 5: ethicist whose books Medical Apartheid, Deadly Monopolies, Infectious Madness, A
Speaker 5: Terrible Thing to Waste, and most recently Carte Blanche, The
Speaker 5: Erosion of Medical Consent have received wide critical acclaim.
Speaker 6: We recorded this interview on March tenth, and we were
Speaker 6: recording this on March twenty fifth, So just keep that
Speaker 6: in mind when we discuss any numbers and stuff like that,
Speaker 6: but you know what, let's just get to the interview.
Speaker 6: So we will let Harriet introduce herself right after this break.
Speaker 4: My name is Harriet Washington. I'm a writer and I
Speaker 4: focus on medical ethics research ethics. Typically, I've been doing
Speaker 4: a lot of work lately around informed consent and some
Speaker 4: of the hidden problems with it, such as it disappearing
Speaker 4: from the landscape without anyone really realizing it. But I
Speaker 4: also work on other things. I'm very concerned about conspiracy theories,
Speaker 4: and I've been to several international conferences presenting on some
Speaker 4: aspects of conspiracy theories that kind of elude us. We
Speaker 4: talk about them in order to dismiss people's fears, but
Speaker 4: sometimes these are real conspiracies, not just conspiracy theories, and
Speaker 4: sometimes the fears are actually, you know, rational, So that
Speaker 4: makes a situation harder. But we need to confront that,
Speaker 4: and those are some things I'm working on. I'm also
Speaker 4: interested in the use of art in medicine to promulgate
Speaker 4: political stances and frankly perpetuate lies. So that's a fascinating topic.
Speaker 4: I keep busy.
Speaker 6: Well, thank you so much for joining us. We are
Speaker 6: so excited to chat with you today. So can you
Speaker 6: just start us off by telling us a bit about
Speaker 6: your new book that just came out and what inspired
Speaker 6: you to write it.
Speaker 4: Well, it's hard to think with inspiration is the right term.
Speaker 4: But the book is entitled carte Blanche and it focuses
Speaker 4: on how the erotional form consent informed consent is that
Speaker 4: very detailed and very informative mode of transmitting information to
Speaker 4: people who are thinking about engaging in metal research. Before
Speaker 4: you engage in the research, you ought to know what
Speaker 4: the risks are. You ought to know what the potential
Speaker 4: benefits might be. You ought to know that lifestyle effects.
Speaker 4: You know, we'll be able to unable to drive, we
Speaker 4: be very tired. You also need to know what your
Speaker 4: options are. Are there other medications that are not experimental
Speaker 4: but are tested, tried and true that you might prefer
Speaker 4: to take. Are there the non medical things that you
Speaker 4: could do for your condition, or do you have the
Speaker 4: option of not taking any treatment at all? All these
Speaker 4: things have to be spelled out to you in great
Speaker 4: detail according to American law, and that's largely because of
Speaker 4: abuses that we vowed would never happen again. Things likely
Speaker 4: here holocausts where people were murdered in the name of
Speaker 4: medicine pretending to do research, and the Nazi doctors actually
Speaker 4: focused on Jews, polls other people, but mostly Jews, and
Speaker 4: you know, they incurred harm force the mintarysearch sometimes killed
Speaker 4: them outright as part of studies. And then in this
Speaker 4: country we had prison research, the long history of abusing
Speaker 4: African Americans, and research arena that culminated in people's horror
Speaker 4: over Tuskegee. All these things made Americans and American doctors
Speaker 4: swear that they would never have this done in medicine again.
Speaker 4: And it's worth noting was American doctors and lawyers who
Speaker 4: went to Nuremberg, Germany to confront the Nazi architects of
Speaker 4: the Holocaust. So all these things culminated in what we
Speaker 4: hear every day one way or another that in this
Speaker 4: country no one can be forced into medical research without
Speaker 4: their consent. But that's actually wrong. As I detail in
Speaker 4: the book, many people have been escalating. We're talking about
Speaker 4: tens of thousands of people forced into medical research without
Speaker 4: their permission.
Speaker 5: Yeah, this kind of issue of eroding consent that you
Speaker 5: touch on in the book and how it disproportionately affects
Speaker 5: people of color, it's really just one dimension of health disparities,
Speaker 5: both here in the US and abroad. And we know
Speaker 5: that although health disparities have been around forever, it's only
Speaker 5: within the last few decades that that term itself was
Speaker 5: actually coined, and it's often only vaguely defined. Would you
Speaker 5: mind describing for us kind of what we mean when
Speaker 5: we talk about health disparities.
Speaker 4: Well, if you ask ten people to get ten different definitions.
Speaker 4: But I think the simplest and most useful definition is
Speaker 4: simply treating any group of people en mass differently than
Speaker 4: you treat other people. So if, for example, there are
Speaker 4: studies then showing that consistently and routinely African Americans are
Speaker 4: less likely to have their complaints of pain acknowledged and treated,
Speaker 4: then that's a very important health disparity. In fact, in
Speaker 4: twenty sixteen University of Virginia study showed that half of
Speaker 4: all medical student surveyed thought that African Americans didn't feel
Speaker 4: pain the way whites did, and a good number of
Speaker 4: practicing doctors think that too. That's a very clear example
Speaker 4: of health disparity that has wide ranging effects. Instead of
Speaker 4: having their pain addressed with appropriate medication or other treatment,
Speaker 4: African Americans are often dismissed as drug seeking and sent
Speaker 4: away without any medication, and stigmatizing notes in their medical charts.
Speaker 4: So that's a very dramatic example. But frankly, you'd be
Speaker 4: hard pressed to find any area of American medicine where
Speaker 4: you're not going to find disparities in the way that
Speaker 4: black and white people are treated. And that emanates from
Speaker 4: the nineteenth century, where you had this wave of very
Speaker 4: prominent doctors and scientists telling the country and telling the
Speaker 4: world who African Americans were. And one of the things
Speaker 4: they said about African Americans was that African Americans had
Speaker 4: very different bodies from white people. They suffered very different diseases,
Speaker 4: they'd immunities to certain diseases, they didn't feel pain the
Speaker 4: way whites did. These beliefs are not lodged in the past.
Speaker 4: These beliefs have surfaced today in these studies that consistently
Speaker 4: show that we don't creat African American pain. But I
Speaker 4: worry about the things that we're not studying. We're not
Speaker 4: following what other beliefs in the nineteenth century are still
Speaker 4: held by doctors, but we don't interrogate them. I see
Speaker 4: quite a few.
Speaker 6: Yeah, absolutely so. In these discussions of health disparities, Sometimes
Speaker 6: the conversation focuses solely on barriers to quality healthcare in
Speaker 6: the US, but in reality, those inequalities are only one
Speaker 6: part of the story. So can you talk a bit
Speaker 6: about how it's not just being able to go to
Speaker 6: a doctor or afford a doctor, but how things like
Speaker 6: access to education, chronic stress, and environmental racism interact with
Speaker 6: and compound each other when it comes to these health disparities.
Speaker 4: I frankly don't see any difference between environmental exposure and
Speaker 4: the more traditional barriers you mentioned. It's simply an barrier.
Speaker 4: The fact is that, you know, the African Americans, Native
Speaker 4: Americans and Hispanic Americans are much more likely to be
Speaker 4: forced to live in areas that a butt toxic s
Speaker 4: viewing industrial parks, bust depots, are old housing that is
Speaker 4: rife with interior lead pain. These exposures are strictly racial.
Speaker 4: In fact, they had been characterized for a very long
Speaker 4: time as socioeconomic, and people often spoke about vulnerable people
Speaker 4: being low income people. And although poverty is a risk factor,
Speaker 4: it's a risk factor that is dwarfed by racism. Studies
Speaker 4: have shown consistently that your race is what dictates whether
Speaker 4: you're exposed to environmental autoxins or not. In fact, one
Speaker 4: study showed that African Americans with an average income of
Speaker 4: like sixty thousand dollars a year are more exposed to
Speaker 4: environmental toxicity than very poor whites who only have an
Speaker 4: income of say ten thousand dollars a year very poor.
Speaker 4: So it's not poverty, it's race. And these barriers are
Speaker 4: of many varieties, but they're racial barriers, and that's what's
Speaker 4: really important to me. They can be categorized in many ways,
Speaker 4: but if you're focusing on the victims and focusing on
Speaker 4: improving their health, then the most important character relation to
Speaker 4: me is how prevalent they are and what effect they
Speaker 4: have on people's health. Environmental racism has an extremely profound
Speaker 4: effect on people's health, and yet it's not often enough
Speaker 4: included in initiatives to resolve health issues and address health disparities.
Speaker 4: I wrote an article for Nature last year showing that
Speaker 4: environmental racism is a key indicator of stability to coronavirus nineteen.
Speaker 4: In fact, the risk factors caused by in regular racism
Speaker 4: are the same risk factors that make one susceptible to
Speaker 4: coronavirus nineteen. So these are all all barriers to better
Speaker 4: health for people of color. But of course we have
Speaker 4: to realize that we will indict some of the barriers
Speaker 4: as if they arose of their own. These barriers arose
Speaker 4: for a reason, and that means that in some sense,
Speaker 4: these barriers were all created by people. It's racist policies
Speaker 4: that sometimes date from the nineteen fifties and sixties that
Speaker 4: dictate how African Americans are trapped in areas where there's
Speaker 4: a lot of environmental toxicity. So we have to remember
Speaker 4: that these are human decisions, human actions, and existing policies
Speaker 4: and laws that need to be changed. It's not just
Speaker 4: a matter of HM this seems to be standing between
Speaker 4: African American and good health. We have to take a
Speaker 4: more holistic view.
Speaker 5: Absolutely. What are some of the ways that we actually
Speaker 5: kind of measure these health disparities.
Speaker 4: They're measured in so many ways. Sometimes people look at
Speaker 4: the years of life lost, the years of health loss,
Speaker 4: and depending on what question you're trying to answer, there
Speaker 4: are variety of ways who can do it, and some
Speaker 4: measurements are better for certain estimations. But what's really important
Speaker 4: is the fact that no matter what measure you use,
Speaker 4: if it is an accurate measure, you're going to find
Speaker 4: a dramatic difference in the health status of people of
Speaker 4: color and otherwise comparable white people. And that's because of
Speaker 4: our healthcare system. We have a healthcare system that is
Speaker 4: rife with policies and behaviors that may not be encoded
Speaker 4: in policy, but certainly exists. These behaviors are part of
Speaker 4: the healthcare system. So one thing that frustrates me is
Speaker 4: how frequently when we look at health care disparities, and
Speaker 4: we see a very pronounced health care disparity, the initial
Speaker 4: response is to look at African American behavior. How can
Speaker 4: we change it, How can we educate African Americans, How
Speaker 4: can we get them to come to the doctor more often?
Speaker 4: How can we remove the sphere of medical research. That's
Speaker 4: the wrong focus. In fact, to focus on African Americans
Speaker 4: is to imply that there's something pathological about African American behavior.
Speaker 4: When it's not African American behavior. It's the untrustworthy of
Speaker 4: the US healthcare system. If you don't look at both things,
Speaker 4: not only are you not going to be successful in
Speaker 4: changing it, you are unfairly stigmatizing people of color. Some
Speaker 4: of these measures are not very good measures. I mean,
Speaker 4: one of the things that is illogical is how often
Speaker 4: people will invoke education. They'll say, well, well educated people
Speaker 4: seem to have better health according to this measure, and
Speaker 4: better education will improve African American health status. Better education
Speaker 4: is always a good thing for variety of reasons. But
Speaker 4: this is an error. What you have to understand that
Speaker 4: for African Americans, race actually countermands many of the advantage
Speaker 4: of education. For example, African American men who are college
Speaker 4: graduates earn less money on average than white high school graduates.
Speaker 4: Doctor David Williams the Harvard School of Public Health, a
Speaker 4: brilliant public health scientist, was relating to me how when
Speaker 4: he went to the reunion of his class at Yale,
Speaker 4: most of the African American men in the class had
Speaker 4: already died. The fact is having a Yale degree did
Speaker 4: not save them from the effects of healthcare disparities. So
Speaker 4: education is not a good measure, and we have to
Speaker 4: stop using measures that have not been proven because too often,
Speaker 4: in my view, they are direct mythologies. That's a mythology.
Speaker 4: It also has the subtle form of blaming the victim.
Speaker 4: You know, if you had done better in school. If
Speaker 4: you're a smarter and more diligent student, then you wouldn't
Speaker 4: be suffering. So that's not true and that's not fair.
Speaker 6: Right, Yeah, So these these health disparities are also often
Speaker 6: measured as outcomes, like the differences in mortality rate or
Speaker 6: years of life lost instance of particular diseases. But these
Speaker 6: outcomes represent the end result of a lifetime or multiple
Speaker 6: generations worth of inequalities, and the narrative too rarely focuses
Speaker 6: on addressing the root causes of these inequalities. So can
Speaker 6: you talk about why it's important to understand the context
Speaker 6: of these disparate outcomes?
Speaker 4: That is such a brilliant question, because if you think
Speaker 4: about it, frankly, what good is it to examine this
Speaker 4: at the end of life? You know, what we'd like
Speaker 4: to do is intervene so that lifespan can look more
Speaker 4: like the normal American lifespan, and intervening is something that
Speaker 4: we have been slow to do. Quite frankly. One of
Speaker 4: the ways in which I think my vision has been
Speaker 4: informed by the research I did looking at the history
Speaker 4: of medicine is that I have a different idea of
Speaker 4: why we have some of these disparate treatment that leads
Speaker 4: to early death and greater disability. People use a term bias.
Speaker 4: I'm not saying that it's not accurate. It's often appropriate.
Speaker 4: But what I see is not so much bias as mythology.
Speaker 4: The nineteenth century scientists that I mentioned earlier on, they
Speaker 4: had this belief of this nucleus of beliefs about African Americans,
Speaker 4: and they basically veiled their beliefs, you know, their mythology
Speaker 4: about who blacks were. They veiled it thinly and scientific
Speaker 4: data to make it look scientific. Science was beginning to
Speaker 4: trump other ways of knowledge in the nineteenth century, and
Speaker 4: that made it more palatable, It made it more impressive,
Speaker 4: didn't make it scientific though. So these beliefs about who
Speaker 4: African Americans are, why they die, and why they survive
Speaker 4: are largely mythological, you know, sort of perpetuated from the
Speaker 4: nineteenth century without enough scrutiny. We need to in this
Speaker 4: era of evidence based medicine, we need to go back
Speaker 4: to the drawing board and start applying scientific analysis to
Speaker 4: some of our beliefs and policies. We have policies that,
Speaker 4: for example, assume the education is going to elevate health
Speaker 4: status in life expectancy, maybe I don't think so we
Speaker 4: need to look at this. We need to have research
Speaker 4: that looks more objectively about certain measures. If African Americans
Speaker 4: are dying early, very often the focus is on biological
Speaker 4: dimorphism differences or purported differences between black and white bodies.
Speaker 4: You'll see a lot of intense and expensive research going
Speaker 4: on and find what looked to me as rather modest differences.
Speaker 4: If their differences all very modest differences, a lot of
Speaker 4: investment is made in finding them, and the argument that
Speaker 4: because there seems to be preponderance of some kind of
Speaker 4: subtle genetic difference, all this effort and resources poured into that.
Speaker 4: But sometimes there are screamingly important differences that are not
Speaker 4: being investigated, for like environmental exposure. If we spend the
Speaker 4: same amount of money on finding ways of separating people
Speaker 4: of color from a constant environmental assault, I think that
Speaker 4: would be money better spend. So we need to do
Speaker 4: the research to find out what's going on. One of
Speaker 4: the things that I found really frustrating, almost comical, if
Speaker 4: it weren't so sad, is the focus on the Tuskegee
Speaker 4: experiment as a rationale for the supposed reluctance of African
Speaker 4: Americans to join clinical trials for COVID vaccine and now
Speaker 4: to accept the vaccine. You know, I get so frustrated
Speaker 4: when I hear this because having studied this history in
Speaker 4: great depth and understanding that the history of medicine has
Speaker 4: allied in the experience of African Americans, I realized that
Speaker 4: researchers invoke Tuskegee because that's all they know. They don't
Speaker 4: know about the history. They don't know about the many, extensive,
Speaker 4: rich and frankly and flagrantly the violations that have taken
Speaker 4: place that African Americans know about. It happened to their family,
Speaker 4: it might have happened to them, and so they will
Speaker 4: invoke Tuskegee. But where's the research to show it. I've looked.
Speaker 4: The research is very poor. It begins with the assumption
Speaker 4: that Tuskegee is at fault, which is not the way
Speaker 4: science operates. They should be asking open ended questions. That's
Speaker 4: research that needs to be done. In fact, it has
Speaker 4: been done. Thomas Lavisa Johns Hopkins did a series of
Speaker 4: studies and found that it's not Tuskegee. In fact, he
Speaker 4: found in one of his studies that people who had
Speaker 4: never heard of Tuskee, where African Americans who had never
Speaker 4: heard of that study were more fearful of medical research
Speaker 4: than people who had. So despite all the evidence, you know,
Speaker 4: we are still clinging to this mythology that black people
Speaker 4: are afraid of Tuskegee and therefore they're not interacting with
Speaker 4: the healthcare system appropriately, which is not true. First of all,
Speaker 4: they are interacting appropriately, and second of all, if they
Speaker 4: were not, you could not blame Tuskegee for it. But again,
Speaker 4: like this is like some very stubborn ignorance that needs
Speaker 4: to be resolved, and public health science should be focused
Speaker 4: on resolving it.
Speaker 5: So of course, the health disparities have existed long before
Speaker 5: the COVID nineteen pandemic, but in this last year I
Speaker 5: think they've really become both magnified and deepened in many ways.
Speaker 5: So can you talk a bit about the disproportioned impact
Speaker 5: that COVID nineteen has had on communities that were already
Speaker 5: facing significant barriers to healthcare.
Speaker 4: Well, it's devastating. We already know that life expectancy has fallen.
Speaker 4: The volume of deaths alone is completely devastating, and it's
Speaker 4: not novel. You know, this is not unique at all.
Speaker 4: Think of what happened with HIV early on in the
Speaker 4: eighties and nineties, when we didn't really know what we
Speaker 4: were dealing with. In the eighties, one thing that emerged
Speaker 4: very quickly was that it was infecting and killing many
Speaker 4: more African Americans and whites. This hepatitis C twenty percent
Speaker 4: higher rate in African Americans in whites. This is not
Speaker 4: at all a novel event. It's quite something we frankly
Speaker 4: should have expected. Infectious disease simply reflects what's already transpiring,
Speaker 4: the vulnerabilities that already exist due to things like environmental racism,
Speaker 4: due to things like disparate access to healthcare and poorer
Speaker 4: treatment when you finally do access healthcare. All these things,
Speaker 4: you know, are vulnerabilities that are magnified whenever you have
Speaker 4: a health crisis. An infectious disease is like the perfect
Speaker 4: agent to magnify these things, and it's happened repeatedly and frankly,
Speaker 4: coronavirus nineteen. I would love it if it were the
Speaker 4: last wave of emerging infectious disease that we faced, but
Speaker 4: that's very unlikely. Look what we've gone through just in
Speaker 4: the past decade or so. You know, HIV, hepatitis, c zica,
Speaker 4: chigos disease. A lot of these have not been well
Speaker 4: recognized in the media because they're affecting enclaves of people
Speaker 4: of color, toxoplasmosis. You know, these diseases are coming in waves,
Speaker 4: and they're coming regularly. We're going to be dealing with
Speaker 4: others after coronavirus nineteen. So I think it's time to
Speaker 4: act on what we already know that when you have
Speaker 4: people who are already marginalized and separated from healthcare access
Speaker 4: and treated poorly by the healthcare system, once they interact
Speaker 4: with that, of course these people are going to become
Speaker 4: victims of the infectious disease. And yet where's all the scrutiny.
Speaker 4: A lot of the scrutiny. The scrutiny is on African
Speaker 4: American behavior. Oh what are they doing? Are they feeling
Speaker 4: to practice social distancing? Even the Surgeon General. Remember in
Speaker 4: April last year, Surgeon General got on TV. He did
Speaker 4: deliver a good message for the most part, but then
Speaker 4: he began talking about avoiding drug use and alcohol use
Speaker 4: as if these were special concerns for African Americans. And
Speaker 4: he's African American, and he's a surgeon general. He certainly
Speaker 4: knew or should have known, the African Americans and Hispanic
Speaker 4: Americans were less likely to be able to practice social distancing,
Speaker 4: as he urged them to do, It's time to take
Speaker 4: our heads out of the sand and apply what we
Speaker 4: already know about the vulnerability of populations who are treated
Speaker 4: badly by the healthcare system to these infectious diseases, including
Speaker 4: but not limited to coronavirus nineteen.
Speaker 6: Yeah, this this mythology that there is a biologic basis
Speaker 6: for health disparities. This narrative has shown up repeatedly throughout
Speaker 6: discussions of COVID nineteen. Can you talk a little bit
Speaker 6: more about that and how What are some of the
Speaker 6: examples that you have seen in which this like race
Speaker 6: based medicine has shown up during this specific COVID nineteen pandemic.
Speaker 4: Oh, there's so many. The focus on social distancing, Okay,
Speaker 4: so that's behavioral, but also plays on an old trophy
Speaker 4: that African Americans cannot be trusted to act in their
Speaker 4: own best interests medically, they're unable to comprehen the right
Speaker 4: way to behave So people began talking about where people
Speaker 4: choose to live, which is completely absurd. No one chooses
Speaker 4: to live in a walk up tenement in New York City.
Speaker 4: You know, where you are crowded aroung people, where you
Speaker 4: can not social distance, where you are forced to share
Speaker 4: elevators with people, and you're almost certainly to be exposed
Speaker 4: in this very dense environment to someone who's infected. But
Speaker 4: then there are other things as well. In France, there
Speaker 4: was a study. I forget exactly what data came out,
Speaker 4: but I found it staggering. There was a study coming
Speaker 4: out of France basically saying one of the reasons why
Speaker 4: we're seeing high rates in black people in the US
Speaker 4: and in the UK, and we can expect to see
Speaker 4: it in France, is that black people react differently to infection.
Speaker 4: Black people are semtically more susceptible to infection. I'm reading
Speaker 4: the study and I'm thinking, I'm not epidemiologists, but this
Speaker 4: is just not making any sence. They didn't talk about
Speaker 4: any particular infectious agent. They wrote infection very broadly, so
Speaker 4: I'll just say I had my strong doubts, and yet
Speaker 4: the paper was published. I didn't see any retractions. I
Speaker 4: didn't see criticism of it. It's something that was simply accepted.
Speaker 4: The belief in bodily differences, of course, often evolves around genetics,
Speaker 4: and so I've also read about very small genetic differences
Speaker 4: purportedly found between African American and white, and the thing
Speaker 4: is that it's a bit meaningless. If there was indeed
Speaker 4: some genetic difference, how do you know it's a difference
Speaker 4: in African Americans. A lot of the research that uses
Speaker 4: racial labels never defines how they came by that racial label.
Speaker 4: I'm constantly amused to see research in which African Americans
Speaker 4: and Hispanic Americans and whites are compared and contrasted without
Speaker 4: ever defining the terms, because Hispanic Americans can be people
Speaker 4: of any race, so some of the Hispanics that are
Speaker 4: referring to are undoubtedly people who identify as white, or
Speaker 4: as black, or as both Hispanic and black, and so
Speaker 4: it really it makes no sense. I think that a
Speaker 4: lot of the data is not only less than rigorous,
Speaker 4: that even if there is a small difference, you know,
Speaker 4: there's no proof that that difference actually has a significant
Speaker 4: effect on coronavirus infection or effects. Race simply maps very
Speaker 4: poorly ontogenetics, and yet people are clinging to the straw
Speaker 4: in order to support their belief of biological dimorphism. Meanwhile, again,
Speaker 4: things that we know are impacting once risk of developing
Speaker 4: and sickening and dying from coronavirus go unaddressed, not only
Speaker 4: environmental exposure, although that's very important, but also things like
Speaker 4: your access to a doctor. More African Americans don't than
Speaker 4: whites lack a primary care physician. Without a primary care physician,
Speaker 4: you not only have greatly reduced immediate access to necessary
Speaker 4: health information, you have no advocate within the healthcare system.
Speaker 4: And if you're African American, you need an advocate because
Speaker 4: when you get to the healthcare system, you're likely to
Speaker 4: be treated differently. You know, your symptoms are likely to
Speaker 4: be dismissed, your pain is dismissed, you're sent home very
Speaker 4: often without appropriate treatment or any treatment. And then when
Speaker 4: you sicken, worsen and die and go to the hospital,
Speaker 4: if you're fortunate enough to have access to the hospital,
Speaker 4: then you're not going to get the same type of
Speaker 4: treatment as whites. So all these things we know exist
Speaker 4: and we should be focused on quantifying and eliminating these things. Instead,
Speaker 4: we're hunting for some mythical genetic difference that is going
Speaker 4: to explain to us why people of color are more vulnerable,
Speaker 4: when frankly, we already know why they're more vulnerable and
Speaker 4: it has nothing to do with genes.
Speaker 5: I feel like that sums it up. So how can
Speaker 5: we actually work to increase health equity in this country?
Speaker 5: What are some things that we could do at an
Speaker 5: individual level to help, and what are in your mind
Speaker 5: some policies at the state or national level that could
Speaker 5: help narrow this gap.
Speaker 4: How much time do you have I do have some ideas.
Speaker 4: In the context of coronavirus, discussions about policy are focused
Speaker 4: on basically I call it the get rich quick syndrome.
Speaker 4: They're focused on things that can be affected very quickly
Speaker 4: in hopes that you'll have a rapid change. That's highly unlikely,
Speaker 4: and even if we're going to work, I'm not sure
Speaker 4: that's direction we'd want to go. Remember I said that,
Speaker 4: and I'm sure you are very well aware. This will
Speaker 4: not be our last emerging infectious disease. There's going to
Speaker 4: be another one. Every time we have new health challenge,
Speaker 4: we will have to go back to the drawing board
Speaker 4: and undertake the get you know, the really quick policies,
Speaker 4: the things that you know are aim at changing people's
Speaker 4: behavior very quickly are likely to be temporary as well.
Speaker 4: I think it makes more sense for us to face
Speaker 4: the facts and look at long term changes that will
Speaker 4: yield long term solutions. And that means something more intense,
Speaker 4: something a little bit more comprehensive, that's going to take
Speaker 4: longer time. So if we do that, if we look
Speaker 4: for meaningful, persistent changes, we have to look at where
Speaker 4: the problems are. First of all, we've done a lot
Speaker 4: of studies showing that they exist, but fewer studies looking
Speaker 4: at why they exist and how to address them. For example,
Speaker 4: lots of studies on pain. We know African American pain
Speaker 4: is going to is treated very badly. It's not acknowledged,
Speaker 4: it's not treated appropriately. People are are stigmatized as drug
Speaker 4: seeking when they're in pain. We know this, so we
Speaker 4: need to focus now on how to fix it. What's
Speaker 4: causing this? And you know, frankly, sometimes it's good to
Speaker 4: know what causes a problem, but sometimes I think it's
Speaker 4: wasted time and effort that we really can't afford rather
Speaker 4: than worry about what exactly is causing the problem, because
Speaker 4: that can be grounds for a lot of them. Let's
Speaker 4: just say unhelpful nasal gazing. People talk about implicit bias
Speaker 4: in part because it's more comfortable than talking about explicit bias.
Speaker 4: What's important is that there is bias and it needs
Speaker 4: to be ended. So we often talk about education and training,
Speaker 4: but look at pain. I'm not sure education and training
Speaker 4: is the route. I'm sure it's not enough because if
Speaker 4: you look at pain, the studies showing that half of
Speaker 4: medical students, a good proportion of practicing doctors think African
Speaker 4: Americans don't feel pain and treat them accordingly. So we've
Speaker 4: established that if you talk about education and training, where
Speaker 4: are you going to do it? How are you going
Speaker 4: to direct it? You don't find this information in textbooks.
Speaker 4: That's not why medical students think this. They think that
Speaker 4: because this is what they're learning on the clinical floors.
Speaker 4: They begin on the clinical floors and the latter part
Speaker 4: of their education, and they see consistently African American people
Speaker 4: who are complaining of pain being turned away as drug seeking.
Speaker 4: That's a tacit part of their training. They internalize that,
Speaker 4: they replicated and then they will teach that to their
Speaker 4: own students and residents. So we need to break that cycle.
Speaker 4: Instead of education and training. I think we need to
Speaker 4: treat this like we treat other behavioral problems. It's really
Speaker 4: a quality of services problem. A medical student would not
Speaker 4: be allowed to graduate without acquiring certain knowledge and certain skills.
Speaker 4: A resident would not be allowed to finish the residency
Speaker 4: if you weren't able to do certain things required of it.
Speaker 4: These students and these practicing doctors should not be allowed
Speaker 4: to advance in their profession until they've demonstrated that they
Speaker 4: are treating all patients equally, and we need to devise
Speaker 4: structures for assessing that the way we assess whether they
Speaker 4: can run a central line or do any other tasks
Speaker 4: required for their profession. We need to assess that not
Speaker 4: on paper and pencil tests. Medical students are all smart
Speaker 4: enough to know to give the right answer doesn't mean
Speaker 4: they're doing the right thing. But we need to build
Speaker 4: that into medical education and make behaving appropriately per requisite
Speaker 4: for graduating, for advancing in your field, for getting a promotion,
Speaker 4: for becoming chief resident. It's time to monitor the behavior
Speaker 4: of not only the individuals, but also the systems. Hospitals
Speaker 4: that should be checked overseen, their data should be scrutinized,
Speaker 4: and hospitals that show a record of not treating a
Speaker 4: group of patients appropriate, like African Americans or anyone else,
Speaker 4: should be made to undergo penalties. You know, we shy
Speaker 4: away from penalties for healthcare providers because we have such
Speaker 4: respect for them, they have such high social status. But
Speaker 4: I think we need to use these rewards and penalties,
Speaker 4: meaningful penalties that will not only encourage compliance, but also
Speaker 4: send them message to health care providers that this is important.
Speaker 4: It's an important hallmark of your ability to practice medicine. Well,
Speaker 4: so I think we need a change of perspective here.
Speaker 4: I also think we need to have laws that change
Speaker 4: the policies and laws reinforce health care disparities. One of
Speaker 4: them in the research arena is a structure of IRBs. Ironbs,
Speaker 4: by law, only have to have one person who is
Speaker 4: unrelated to the institution on the IRB board. So what
Speaker 4: can that person do? You're sitting there and you're facing
Speaker 4: what five, ten, fifteen scientists, all of whom want to
Speaker 4: do a particular study. You are the appointed layperson and
Speaker 4: you're not comfortable with it. But what kind of effect
Speaker 4: can you have? First of all, you know you're intimidated.
Speaker 4: These are scientists. You don't speak their jargon. You can't
Speaker 4: understand everything that they're saying, and they certainly don't have
Speaker 4: any incentive to listen to you. You have to be there,
Speaker 4: you're allowed to speak. But what influence do you have?
Speaker 4: You have no influence, You can't And so I wrote
Speaker 4: in Medical Apartheid, that was back in two thousand and seven,
Speaker 4: that IRB should be constituted of half lay persons and
Speaker 4: half scientists. And that way the lay persons on the
Speaker 4: IRB could have a real voice and some real leverage.
Speaker 4: If the people from whom you're going to draw the
Speaker 4: subject pool hear about the study you want to conduct
Speaker 4: and they have questions or concerns, this is a way
Speaker 4: to make their concerns addressed in a meaningful way. And
Speaker 4: then I heard from peers who said to me, that's
Speaker 4: not going to work because lay people can't understand the
Speaker 4: scientific you know, nuances and procedures, and they're not gonna
Speaker 4: know what's going on. I said, but scientists can explain
Speaker 4: it to them. Otherwise, how can the scientists explain it
Speaker 4: to the subjects they enroll in the study, as they're
Speaker 4: required to do by law. Scientists are very good explaining
Speaker 4: even complicated centered issues. It takes some time. You can't
Speaker 4: do it off the top of your head very often.
Speaker 4: But I know I've read a lot of studies, I've
Speaker 4: talked to a lot of researchers, and I know how
Speaker 4: good they are at doing this. So it's something that
Speaker 4: needs to be done. We need to involve lay people
Speaker 4: in numbers that will make their participation meaningful. This will also,
Speaker 4: I think, lower resistance in the larger community. When they
Speaker 4: know that people like them are involved in advising the studies,
Speaker 4: I think they'll have greater confidence it's not something that's
Speaker 4: just being you know, enforced on them from above, so
Speaker 4: to speak. So I think those are really important policy changes.
Speaker 4: I have others as well in that. One of my
Speaker 4: big recommendations is to get rid of healthcare lobbyists. Lobbyists
Speaker 4: have no place in healthcare. Essentially, what's happening is, I
Speaker 4: understand it, we're electing lawmakers to enact our will, and
Speaker 4: instead the lawmakers are essentially receiving money via lobbyists to
Speaker 4: enact the will of corporations that might be very different
Speaker 4: from what we have in mind. In fact, frankly, I
Speaker 4: think they often are. The corporations are focused on the
Speaker 4: bottom line, not on improved healthcare as their number one policy.
Speaker 4: So those are two big changes we need to revoke.
Speaker 4: I think the laws around that encourage patenting by corporations
Speaker 4: of universities. The law was passed in Laws of Past
Speaker 4: in nineteen eighty and the shorthand is of Badal Act,
Speaker 4: and there were other lesser laws. But this is what
Speaker 4: actually changed American medical research and changed the agenda setting
Speaker 4: from the institution that was a public health centered institution
Speaker 4: to corporations who again are centered on the bottom line.
Speaker 4: These corporations are why their focus on maximizing profits is
Speaker 4: almost not completely, but almost total. And that's why we
Speaker 4: have twenty drugs for rectile dysfunction and only one new
Speaker 4: drug for malaria in the last couple decades. So I
Speaker 4: could go on, but those are my basics.
Speaker 6: Yeah, so we have one final question for you. So
Speaker 6: you just went through many different things that we can
Speaker 6: do to kind of help to increase health equity in
Speaker 6: this country at a hospital level, at a national level,
Speaker 6: and so on. But in general, how can the medical
Speaker 6: establishment work to earn the trust of these communities that
Speaker 6: we have historically disenfranchised and in many ways as we've
Speaker 6: talked about during this interview continue to disenfranchise when it
Speaker 6: comes to.
Speaker 4: Health US healthcare system is untrustworthy. If it wants to
Speaker 4: gain the trust of people, it must become trustworthy. And
Speaker 4: I know it's tetological, but it's also reflecting the fact
Speaker 4: that this will not be a fast solution. It's been
Speaker 4: four centuries of abuse in the healthcare arena, so it's
Speaker 4: unrealistic to expect to fix the problem in a few
Speaker 4: months or even in a year. But the healthcare system
Speaker 4: has things it needs to do desperately. One of them
Speaker 4: is to become more inclusive. And I mean racially inclusive,
Speaker 4: but I mean more than that. I mean right now,
Speaker 4: we have a healthcare system in which there is an
Speaker 4: interaction between patients and their physicians and perhaps a patient advocate.
Speaker 4: But the healthcare system has got to give more points
Speaker 4: of entry for lay persons into the system. There are
Speaker 4: already some unused avenues for monitoring and oversight within the
Speaker 4: healthcare system. We need to start using them. For example,
Speaker 4: in research, there are provisions built into the law for
Speaker 4: government oversight of medical research. Provisions are very important because
Speaker 4: you have IRBs that are supposed to conform to laws,
Speaker 4: and I don't know how many, but I'm sure many
Speaker 4: of them do, but many of them do not. Many
Speaker 4: of them have permitted too much research that is clearly
Speaker 4: in violation of laws and of ethical strictures. But the
Speaker 4: oversight is not well funded. There's no money for the oversight.
Speaker 4: It's there in the law, but it's not happening. So
Speaker 4: that means that you know, the research generated by institution
Speaker 4: is as good as its IRB. You have a conscientious,
Speaker 4: meticulous patient at IRONB, you have good research. You have
Speaker 4: another type of IRONB or IRB that is reliant on
Speaker 4: fast track approval, essentially rubber stamping research, then that's exactly
Speaker 4: what you're going to get. That's why we need the
Speaker 4: federal oversight that's already in the law needs to be
Speaker 4: funded and put into operation. We also have provisions in
Speaker 4: the law to remedy some of the problems caused by
Speaker 4: the jealous corporate protection of patents. You know, they're protecting
Speaker 4: their patents above all else and will they often will
Speaker 4: produce medications that costs better part of a million dollars
Speaker 4: a year so that people can't afford it. There's a
Speaker 4: provision for this in the law that allows the government
Speaker 4: to step in, take the patent from that company, give
Speaker 4: it to a company that commits to producing a drug
Speaker 4: at an affordable price, pay off the first company something
Speaker 4: for the use of the patent, and that way the
Speaker 4: first company gets some money, not the million dollars a
Speaker 4: year they were looking for, of course, but people who
Speaker 4: need the medication will get the medication. That's a great solution. Well,
Speaker 4: not a great solution, but considering the system, which I
Speaker 4: think is not a bad system, that is a solution.
Speaker 4: But our government refuses to undertake it. They won't use
Speaker 4: it to give our people affordable drugs. They used to
Speaker 4: allow direct TV, but they don't use it to allow
Speaker 4: us to have good drugs. So, you know, we have
Speaker 4: to look at things that are already in the law
Speaker 4: that could afford us some relief and could afford African
Speaker 4: Americans and other people easier affordable access into the healthcare
Speaker 4: system that we're just not using. We're ignoring that. I
Speaker 4: don't know why we're ignoring it, but I will say
Speaker 4: it's yet another reason why we need to get lobbyists
Speaker 4: out of healthcare. I'm not saying the lobbyists have anything
Speaker 4: to do with this, but I am saying that it
Speaker 4: certainly benefits the lobbyists if we don't exploit these laws.
Speaker 4: So I think we need to make lawmakers free to
Speaker 4: do the will of the people, unencumbered by financial interests
Speaker 4: from these companies.
Speaker 6: Thank you so so much, Harriet. It was such a
Speaker 6: joy to chat with you. It was unbelievable. What a
Speaker 6: great conversation.
Speaker 5: Oh my gosh. Yeah, we covered so much information.
Speaker 6: Yeah, we really did so as per usual. Shall we
Speaker 6: go over some five learning points?
Speaker 5: Let us do that all right.
Speaker 6: Number one, The many barriers to healthcare that exist were
Speaker 6: put into place by people. Environmental racism is one example
Speaker 6: where explicitly racist policies like redlining, segregation policies, the Indian
Speaker 6: Removal Act and so anymore created inequalities in environmental conditions
Speaker 6: between black, Native American, Hispanic or Latino and other minorities
Speaker 6: and white people deliberately. And these policies haven't disappeared. They
Speaker 6: exist today in the Dakota Access Pipeline, in the Flint
Speaker 6: water crisis, and they persist in unequal access to clean water,
Speaker 6: fresh food, clear air, safe housing, and many other things
Speaker 6: that a lot of people take for granted. These barriers
Speaker 6: created and enforced by racist laws and policies, especially within healthcare,
Speaker 6: and behaviors not encoded in policies. These have a direct
Speaker 6: impact on the health of people today. Despite these systemic
Speaker 6: inequalities and barriers, much of the focus of health disparities,
Speaker 6: especially racial disparities, focuses on individual human behavior, essentially blaming
Speaker 6: the victims of health disparities for their conditions.
Speaker 5: Yeah, number two, Racial disparities in health are generally reported
Speaker 5: as outcomes disproportionate death rates or infection rates, disease prevalence,
Speaker 5: shorter life expectancies. These disparities don't magically appear in a vacuum.
Speaker 5: They are the result of a lifetime or generation's worth
Speaker 5: of unequal access to healthcare, of racist medical or environmental policies,
Speaker 5: of excess stress. And of course it's important that we
Speaker 5: measure these outcomes and that we're having these discussions, but
Speaker 5: it does us no good if we don't also address
Speaker 5: the root causes of these disparities and how they interact
Speaker 5: and compound each other to lead to such stark differences.
Speaker 5: So step one is finding out, okay, what are these disparities.
Speaker 5: But step two, which really should be taken alongside step one,
Speaker 5: is how do we increase health equity by addressing the
Speaker 5: roots of these disparities. These are not something that we
Speaker 5: can fix by making one simple chain. We need to
Speaker 5: put some of our resources to understanding what it is
Speaker 5: about the healthcare system, the legal system, the educational system,
Speaker 5: housing policies, our entire society in general that perpetuates these
Speaker 5: outcomes that we can measure. Racial disparities are often multigenerational
Speaker 5: and are always multifaceted, and making any improvements requires us
Speaker 5: to take a step back to see the bigger picture
Speaker 5: and put policies in place that address the roots of
Speaker 5: these inequalities rather than at the branches.
Speaker 6: Number three. Speaking of root causes, a lot of attention
Speaker 6: in medical research has been paid to trying to prove
Speaker 6: biological differences between races, leading to race based medicine. However,
Speaker 6: these supposed biological differences are rooted in pure racist mythology,
Speaker 6: perpetuated in the nineteenth century when self styled scientists then
Speaker 6: levailed their racist views in scientific language, despite the fact
Speaker 6: that in the decades since there have been ample studies
Speaker 6: illustrating that these biological differences in race truly are mythology
Speaker 6: and have no basis In fact, these racist notions permeate
Speaker 6: the way medicine is taught and practiced today. Many physicians
Speaker 6: make decisions based on this mythology, the myth of differences
Speaker 6: in pain, tolerance, lung capacity, predisposition to certain diseases, and
Speaker 6: there is a tremendous amount of research conducted to find
Speaker 6: a biological basis for racial disparities and health outcomes. Instead,
Speaker 6: we need to use those resources to go back to
Speaker 6: the drawing board and actually apply evidence based medicine to
Speaker 6: addressing health disparities, rather than relying on this mythology created
Speaker 6: and perpetuated by eugenesis and racists. We have to shift
Speaker 6: the focus from these supposed biological differences, which truly do
Speaker 6: not exist, and instead focus on the things that are
Speaker 6: actually different due to systemic racism, like access to healthcare,
Speaker 6: like environmental conditions like access to education, clean food, water.
Speaker 6: I mean, the list goes on and on.
Speaker 5: Yeah, it really does. Number four. While the disparities that
Speaker 5: we are seeing with COVID are not unique, and infectious
Speaker 5: diseases often reflect the vulnerabilities that exist in societies, the
Speaker 5: disparities that we are seeing today due to COVID are
Speaker 5: bleak in the US studies throughout this pandemic have consistently
Speaker 5: found that Black people are at least twice as likely,
Speaker 5: and some studies have found up to six to eight
Speaker 5: times as likely to test positive for COVID than white people.
Speaker 5: They are hospitalized at at least three times greater rates
Speaker 5: and account for significantly higher proportions of deaths due to COVID,
Speaker 5: and the same is true for other minority groups. Native
Speaker 5: Americans are almost four times as likely to be hospitalized
Speaker 5: due to COVID, Hispanica Latino people three times as likely.
Speaker 5: And the thing is, these are national estimates that I'm
Speaker 5: citing from the CDC. Some individual studies in various states
Speaker 5: have found much higher disparities among racial and ethnic groups.
Speaker 5: And the thing is it hasn't been limited to COVID
Speaker 5: disease hospitalization or death. Job losses have also been higher
Speaker 5: among black and Hispanic Latino people. COVID has caused increases
Speaker 5: in food, insecurity, housing instability, access to other medical care,
Speaker 5: including routine vaccinations for kids, and we have done a
Speaker 5: terrible job in ensuring equitable access to vaccinations so far,
Speaker 5: and not just in the US. According to one study
Speaker 5: in England, elderly black people were half as likely to
Speaker 5: be vaccinated compared to white people for COVID nineteen and
Speaker 5: in the US, a patchwork of vaccine distribution has led
Speaker 5: to severe in equies by race and ethnicity that vary
Speaker 5: state by state, but overall the stats are pretty grim.
Speaker 5: Some reports and news outlets seem to tie this inequity
Speaker 5: all back to vaccine hesitancy, but that's really its own
Speaker 5: form of victim blaming and it's not the root cause
Speaker 5: of the disparities that we're seeing.
Speaker 6: Yeah, so number five, how do we fix it? It
Speaker 6: is not going to be easy and it's not going
Speaker 6: to be quick. It has been four centuries of abuses
Speaker 6: and healthcare in this country, so we can't expect to
Speaker 6: fix the problem overnight, and we can't expect that education
Speaker 6: itself is going to fix the problem. We have to
Speaker 6: apply meaningful changes in the way clinical medicine is taught
Speaker 6: and practice. Individuals and institutions need to be held accountable
Speaker 6: for disparities that persist, and the healthcare system has to
Speaker 6: do the work to become more inclusive. This might mean
Speaker 6: having more points of entry into the medical system. It
Speaker 6: might mean more monitoring and oversight with actual repercussions for
Speaker 6: non compliance, and it might mean changes to laws such
Speaker 6: that there is an incentive to prioritize actual human health
Speaker 6: and well being instead of corporate interests.
Speaker 5: It's going to be along road, that's for sure.
Speaker 1: Oh.
Speaker 6: Yeah, absolutely.
Speaker 5: If you'd like to look in more detail and know
Speaker 5: exactly where we got some of the data in this
Speaker 5: episode from, we have links to all of our sources
Speaker 5: on our website, this podcast will kill You dot com.
Speaker 5: Most of the stats came directly from the CDC's website,
Speaker 5: as well as a couple of peer reviewed journal articles
Speaker 5: that we found.
Speaker 6: Again, thank you so much, Harriet for taking the time
Speaker 6: to chat with us. I feel like this was a
Speaker 6: very informative Yeah.
Speaker 5: Episode, absolutely definitely, and I think a really important one
Speaker 5: as well. M h.
Speaker 6: Yeah, and thanks again also to everyone who provided a
Speaker 6: first hand account. We really appreciate it.
Speaker 5: Yeah, thank you. Thank you to Bloodmobile for providing the
Speaker 5: music for this episode and all of our episodes.
Speaker 6: And thank you to the Exactly Right Network, of whom
Speaker 6: we are a very proud member.
Speaker 5: And thank you to you listeners for listening through this episode.
Speaker 5: We hope that you learned something yeah and enjoyed it.
Speaker 6: Yeah. Well, until next time wash your hands.
Speaker 5: You filled the animals