COVID-19 Chapter 16: Disparities, Take 2

months ago. And for comparison, the country has a population the size of California, and officially fewer than two thousand deaths have been linked to COVID here, But unofficially everyone knows our numbers are artificially low. We're pretty sure that due to social stigma, deaths in rural villages are being reported as heart attacks or something else. And testing rates are very low now as well, so it's also unclear

what the current spread of the disease is nationally. We know that we're better off than most of the world as far as disease spread goes, though, which is lucky. The bigger problem here has been with our food supply. Most people in Nepal are subsistence farmers, with very little

land who grow most of the cow they eat. About two thirds of the national population depends on this kind of small scale agriculture, and the national lockdowns we've faced, even more than the disease, have had a devastating impact on these rural communities. Our first case here was in January a student who returned from Muhan and after that we were all on high alert with restrictions on travel from China, then Europe, and on border crossings from India.

Then when we saw our second case in March, the entire country lockdown. This was a severe restriction on all movement nationally. Police in many areas took their jobs very seriously. Here in the city, I saw people being beaten with canes and arrested for going to the market or being outside at the wrong time. All transportation in the country

was stopped except with a medical permit. In some areas, police beat farmers for working in their own fields, and that kind of severe response was eventually reined in, but it was well covered in local press and many farmers around the country were understandably terrified because of it. Meanwhile, supply chains totally broke down in the first three months

of lockdown. We saw produce rotting in some parts of the country where buyers were unable to come pick it up and farmers were unable to deliver it to markets. Many farm supply shops were forced to close or were unable to restock their shelves, so farmers didn't have access to the seeds and basic supplies they needed for the

spring planting season. A lot of the corn or maize that went into the ground this spring was low quality seed left over on farms from a previous season, rather than more trustworthy, high yield varieties that farmers typically purchased to plant. For some crops that wouldn't matter much, but not corn, so we saw yields drop dramatically in those fields. Poor families depend on that crop for the summer months, all the way until October's rice harvest, and then the

rice harvest should carry them through to the following spring. Instead, we saw terrible hunger problems spreading across the country over a period of several months. Just to compound these food supply problems, this year, we were invaded by the fall army worm horn pest from the Americas that caused extensive damage at exactly the point when farmers weren't able to

buy supplies to manage it. At ide, we've been working with government and donors to coordinate the national response to the pest through integrated pest management approaches, which means low toxicity tools like pheromone traps and organic pesticides. Our surveys during the lockdown showed that our messages were getting out there about how to treat the pest appropriately, but because suppliers weren't open, farmers couldn't get the tools they needed

to respond. Then in June, we saw another insect plague, the desert locust, which came to Nepal for the first time since nineteen sixty. It's been a tough year for Nepal's farmers. Our summer rice harvest was good, though, but we're still seeing the after effects of that first strict lockdown. Prices for all foods here rose by about twenty five

percent during those months and they still haven't stabilized. We're all paying a lot more for food these days, and in rural communities that means people have less to eat and what they're eating is lower quality in cheap cereal grains. Meanwhile, households that depend on remittance is from family members working abroad lost their main source of income, and the one's hardest hit are landless renters and farm laborers who don't

have land of their own. Nepal's situation isn't really that unusual. Globally, there are half a billion small farmers around the world who have all been facing these same kinds of issues in the past year. They typically feed or support about half the world's population, so this isn't a small problem.

These kinds of small family farmers can sometimes be unusually resilient in a crisis because they've always had to depend on different coping strategies, But in an extended crisis like this, and in some areas like Nepal, a crisis after crisis after crisis. We've seen that supply chain breakdowns in the agriculture sector mean disruptions to the food supply months down the line. We've already seen what happens in the US

when there are interruptions in the toilet paper supply. Now just imagine what that situation is like for small farmers globally who haven't been able to harvest an food to feed their families or to bring to market, do both to COVID nineteen and to the world's response to it.

and unstable. Any pre existing problems like depression, housing instability, domestic violence, addiction, COVID makes these problems devastating and sometimes deadly. The hardest situations for me to watch involve family, maybe because I haven't been able to see my family and friends for so long. One of my patients in the ICU and his wife, who are forty somethings, able bodied,

working professionals in their child, all had COVID. While dad was in the ICU, Mom died of respiratory failure at home in front of her kid, who then had to spend two lonely weeks quarantining at a family member's house without seeing anyone. Another older gentleman was admitted with COVID only a day or two after two of his adult children had died of COVID. He spoke only a Mayan dialect, which we did not have access to in our language.

Bank his family said goodbye over a video call. These stories, sadly, are common. COVID has disrupted our grieving process in horrifying ways. People die alone with strangers in full protective gear who don't speak their language. We are isolated, unable to hold each other or gather together. It's been a really hard year and in some ways a lost year. I am so angry and sad how our country has handled COVID.

I have moments of hope, like when I got my vaccine dosays, but I also fear things are going to get a lot worse before they get better.

back to Mexico. On many occasions, he would fly back to the US when he was unwell from not taking care of himself or treating his various ailments or illnesses, and my family would work diligently to get him healthy again, only to see him fly back to Mexico. Most recently, he had left an assisted care facility a few months into the pandemic to fly back to Mexico to be with his girlfriend, in spite of being asked not to because of the pandemic because it was dangerous for somebody

his age with his illnesses to be traveling. We'd not heard from him for many months, and then the day after Thanksgiving things changed. His girlfriend had reached out to us to see if we'd heard from him. She said that he was trying to make his way to the airport when he had gotten confused and started driving in circles. He was pulled over by the police and escorted back to the hotel. After explaining to the officers he didn't feel well and couldn't breathe, the police dropped him off

and said that they would call an ambulance. He had called his girlfriend and said he was confused, couldn't breathe, and felt like he was drowning. That was the last time anyone had spoken to him. The hotel staff found him deceased in his bed the next day. While the outcome might have been the same, we're disappointed that the police didn't do more to get our dad help. Instead of driving him back to the hotel. Why didn't they drive him to a hospital to make sure that he

was treated for whatever illness he was experiencing. We can't help but wonder if the police would have done more if he wasn't an older Hispanic man in the Southwest United States. Thank you for taking the time to hear our story. We hope that it shed some light on the discrimination that people of color experienced daily, both as part of this pandemic and the healthcare system in general.

aspects of conspiracy theories that kind of elude us. We talk about them in order to dismiss people's fears, but sometimes these are real conspiracies, not just conspiracy theories, and sometimes the fears are actually, you know, rational, So that makes a situation harder. But we need to confront that, and those are some things I'm working on. I'm also interested in the use of art in medicine to promulgate political stances and frankly perpetuate lies. So that's a fascinating topic. I keep busy.

You know, we'll be able to unable to drive, we be very tired. You also need to know what your options are. Are there other medications that are not experimental but are tested, tried and true that you might prefer to take. Are there the non medical things that you could do for your condition, or do you have the option of not taking any treatment at all? All these things have to be spelled out to you in great detail according to American law, and that's largely because of

abuses that we vowed would never happen again. Things likely here holocausts where people were murdered in the name of medicine pretending to do research, and the Nazi doctors actually focused on Jews, polls other people, but mostly Jews, and you know, they incurred harm force the mintarysearch sometimes killed them outright as part of studies. And then in this country we had prison research, the long history of abusing African Americans, and research arena that culminated in people's horror

over Tuskegee. All these things made Americans and American doctors swear that they would never have this done in medicine again. And it's worth noting was American doctors and lawyers who went to Nuremberg, Germany to confront the Nazi architects of the Holocaust. So all these things culminated in what we hear every day one way or another that in this country no one can be forced into medical research without their consent. But that's actually wrong. As I detail in

the book, many people have been escalating. We're talking about tens of thousands of people forced into medical research without their permission.

then that's a very important health disparity. In fact, in twenty sixteen University of Virginia study showed that half of all medical student surveyed thought that African Americans didn't feel pain the way whites did, and a good number of practicing doctors think that too. That's a very clear example

of health disparity that has wide ranging effects. Instead of having their pain addressed with appropriate medication or other treatment, African Americans are often dismissed as drug seeking and sent away without any medication, and stigmatizing notes in their medical charts. So that's a very dramatic example. But frankly, you'd be hard pressed to find any area of American medicine where you're not going to find disparities in the way that

black and white people are treated. And that emanates from the nineteenth century, where you had this wave of very prominent doctors and scientists telling the country and telling the world who African Americans were. And one of the things they said about African Americans was that African Americans had very different bodies from white people. They suffered very different diseases, they'd immunities to certain diseases, they didn't feel pain the

way whites did. These beliefs are not lodged in the past. These beliefs have surfaced today in these studies that consistently show that we don't creat African American pain. But I worry about the things that we're not studying. We're not following what other beliefs in the nineteenth century are still held by doctors, but we don't interrogate them. I see quite a few.

In fact, they had been characterized for a very long time as socioeconomic, and people often spoke about vulnerable people being low income people. And although poverty is a risk factor, it's a risk factor that is dwarfed by racism. Studies have shown consistently that your race is what dictates whether

you're exposed to environmental autoxins or not. In fact, one study showed that African Americans with an average income of like sixty thousand dollars a year are more exposed to environmental toxicity than very poor whites who only have an income of say ten thousand dollars a year very poor. So it's not poverty, it's race. And these barriers are of many varieties, but they're racial barriers, and that's what's

really important to me. They can be categorized in many ways, but if you're focusing on the victims and focusing on improving their health, then the most important character relation to me is how prevalent they are and what effect they have on people's health. Environmental racism has an extremely profound effect on people's health, and yet it's not often enough included in initiatives to resolve health issues and address health disparities.

I wrote an article for Nature last year showing that environmental racism is a key indicator of stability to coronavirus nineteen. In fact, the risk factors caused by in regular racism are the same risk factors that make one susceptible to coronavirus nineteen. So these are all all barriers to better health for people of color. But of course we have to realize that we will indict some of the barriers

as if they arose of their own. These barriers arose for a reason, and that means that in some sense, these barriers were all created by people. It's racist policies that sometimes date from the nineteen fifties and sixties that dictate how African Americans are trapped in areas where there's a lot of environmental toxicity. So we have to remember that these are human decisions, human actions, and existing policies

and laws that need to be changed. It's not just a matter of HM this seems to be standing between African American and good health. We have to take a more holistic view.

color and otherwise comparable white people. And that's because of our healthcare system. We have a healthcare system that is rife with policies and behaviors that may not be encoded in policy, but certainly exists. These behaviors are part of the healthcare system. So one thing that frustrates me is how frequently when we look at health care disparities, and we see a very pronounced health care disparity, the initial

response is to look at African American behavior. How can we change it, How can we educate African Americans, How can we get them to come to the doctor more often? How can we remove the sphere of medical research. That's the wrong focus. In fact, to focus on African Americans is to imply that there's something pathological about African American behavior. When it's not African American behavior. It's the untrustworthy of

the US healthcare system. If you don't look at both things, not only are you not going to be successful in changing it, you are unfairly stigmatizing people of color. Some of these measures are not very good measures. I mean, one of the things that is illogical is how often people will invoke education. They'll say, well, well educated people seem to have better health according to this measure, and better education will improve African American health status. Better education

is always a good thing for variety of reasons. But this is an error. What you have to understand that for African Americans, race actually countermands many of the advantage of education. For example, African American men who are college graduates earn less money on average than white high school graduates.

Doctor David Williams the Harvard School of Public Health, a brilliant public health scientist, was relating to me how when he went to the reunion of his class at Yale, most of the African American men in the class had already died. The fact is having a Yale degree did not save them from the effects of healthcare disparities. So education is not a good measure, and we have to stop using measures that have not been proven because too often,

in my view, they are direct mythologies. That's a mythology. It also has the subtle form of blaming the victim. You know, if you had done better in school. If you're a smarter and more diligent student, then you wouldn't be suffering. So that's not true and that's not fair.

we have been slow to do. Quite frankly. One of the ways in which I think my vision has been informed by the research I did looking at the history of medicine is that I have a different idea of why we have some of these disparate treatment that leads to early death and greater disability. People use a term bias. I'm not saying that it's not accurate. It's often appropriate. But what I see is not so much bias as mythology.

The nineteenth century scientists that I mentioned earlier on, they had this belief of this nucleus of beliefs about African Americans, and they basically veiled their beliefs, you know, their mythology about who blacks were. They veiled it thinly and scientific data to make it look scientific. Science was beginning to trump other ways of knowledge in the nineteenth century, and that made it more palatable, It made it more impressive,

didn't make it scientific though. So these beliefs about who African Americans are, why they die, and why they survive are largely mythological, you know, sort of perpetuated from the nineteenth century without enough scrutiny. We need to in this era of evidence based medicine, we need to go back to the drawing board and start applying scientific analysis to

some of our beliefs and policies. We have policies that, for example, assume the education is going to elevate health status in life expectancy, maybe I don't think so we need to look at this. We need to have research that looks more objectively about certain measures. If African Americans are dying early, very often the focus is on biological dimorphism differences or purported differences between black and white bodies.

You'll see a lot of intense and expensive research going on and find what looked to me as rather modest differences. If their differences all very modest differences, a lot of investment is made in finding them, and the argument that because there seems to be preponderance of some kind of subtle genetic difference, all this effort and resources poured into that. But sometimes there are screamingly important differences that are not

being investigated, for like environmental exposure. If we spend the same amount of money on finding ways of separating people of color from a constant environmental assault, I think that would be money better spend. So we need to do

the research to find out what's going on. One of the things that I found really frustrating, almost comical, if it weren't so sad, is the focus on the Tuskegee experiment as a rationale for the supposed reluctance of African Americans to join clinical trials for COVID vaccine and now

to accept the vaccine. You know, I get so frustrated when I hear this because having studied this history in great depth and understanding that the history of medicine has allied in the experience of African Americans, I realized that researchers invoke Tuskegee because that's all they know. They don't know about the history. They don't know about the many, extensive, rich and frankly and flagrantly the violations that have taken

place that African Americans know about. It happened to their family, it might have happened to them, and so they will invoke Tuskegee. But where's the research to show it. I've looked. The research is very poor. It begins with the assumption that Tuskegee is at fault, which is not the way science operates. They should be asking open ended questions. That's research that needs to be done. In fact, it has been done. Thomas Lavisa Johns Hopkins did a series of

studies and found that it's not Tuskegee. In fact, he found in one of his studies that people who had never heard of Tuskee, where African Americans who had never heard of that study were more fearful of medical research than people who had. So despite all the evidence, you know, we are still clinging to this mythology that black people are afraid of Tuskegee and therefore they're not interacting with

the healthcare system appropriately, which is not true. First of all, they are interacting appropriately, and second of all, if they were not, you could not blame Tuskegee for it. But again, like this is like some very stubborn ignorance that needs to be resolved, and public health science should be focused on resolving it.

higher rate in African Americans in whites. This is not at all a novel event. It's quite something we frankly should have expected. Infectious disease simply reflects what's already transpiring, the vulnerabilities that already exist due to things like environmental racism, due to things like disparate access to healthcare and poorer treatment when you finally do access healthcare. All these things, you know, are vulnerabilities that are magnified whenever you have

a health crisis. An infectious disease is like the perfect agent to magnify these things, and it's happened repeatedly and frankly, coronavirus nineteen. I would love it if it were the last wave of emerging infectious disease that we faced, but that's very unlikely. Look what we've gone through just in the past decade or so. You know, HIV, hepatitis, c zica, chigos disease. A lot of these have not been well recognized in the media because they're affecting enclaves of people

of color, toxoplasmosis. You know, these diseases are coming in waves, and they're coming regularly. We're going to be dealing with others after coronavirus nineteen. So I think it's time to act on what we already know that when you have people who are already marginalized and separated from healthcare access and treated poorly by the healthcare system, once they interact with that, of course these people are going to become victims of the infectious disease. And yet where's all the scrutiny.

A lot of the scrutiny. The scrutiny is on African American behavior. Oh what are they doing? Are they feeling to practice social distancing? Even the Surgeon General. Remember in April last year, Surgeon General got on TV. He did deliver a good message for the most part, but then he began talking about avoiding drug use and alcohol use as if these were special concerns for African Americans. And

he's African American, and he's a surgeon general. He certainly knew or should have known, the African Americans and Hispanic Americans were less likely to be able to practice social distancing, as he urged them to do, It's time to take our heads out of the sand and apply what we already know about the vulnerability of populations who are treated badly by the healthcare system to these infectious diseases, including but not limited to coronavirus nineteen.

You know, where you are crowded aroung people, where you can not social distance, where you are forced to share elevators with people, and you're almost certainly to be exposed in this very dense environment to someone who's infected. But then there are other things as well. In France, there was a study. I forget exactly what data came out,

but I found it staggering. There was a study coming out of France basically saying one of the reasons why we're seeing high rates in black people in the US and in the UK, and we can expect to see it in France, is that black people react differently to infection. Black people are semtically more susceptible to infection. I'm reading the study and I'm thinking, I'm not epidemiologists, but this is just not making any sence. They didn't talk about

any particular infectious agent. They wrote infection very broadly, so I'll just say I had my strong doubts, and yet the paper was published. I didn't see any retractions. I didn't see criticism of it. It's something that was simply accepted. The belief in bodily differences, of course, often evolves around genetics, and so I've also read about very small genetic differences purportedly found between African American and white, and the thing

is that it's a bit meaningless. If there was indeed some genetic difference, how do you know it's a difference in African Americans. A lot of the research that uses racial labels never defines how they came by that racial label.

I'm constantly amused to see research in which African Americans and Hispanic Americans and whites are compared and contrasted without ever defining the terms, because Hispanic Americans can be people of any race, so some of the Hispanics that are referring to are undoubtedly people who identify as white, or as black, or as both Hispanic and black, and so

it really it makes no sense. I think that a lot of the data is not only less than rigorous, that even if there is a small difference, you know, there's no proof that that difference actually has a significant effect on coronavirus infection or effects. Race simply maps very poorly ontogenetics, and yet people are clinging to the straw

in order to support their belief of biological dimorphism. Meanwhile, again, things that we know are impacting once risk of developing and sickening and dying from coronavirus go unaddressed, not only environmental exposure, although that's very important, but also things like your access to a doctor. More African Americans don't than

whites lack a primary care physician. Without a primary care physician, you not only have greatly reduced immediate access to necessary health information, you have no advocate within the healthcare system. And if you're African American, you need an advocate because when you get to the healthcare system, you're likely to be treated differently. You know, your symptoms are likely to be dismissed, your pain is dismissed, you're sent home very

often without appropriate treatment or any treatment. And then when you sicken, worsen and die and go to the hospital, if you're fortunate enough to have access to the hospital, then you're not going to get the same type of treatment as whites. So all these things we know exist

and we should be focused on quantifying and eliminating these things. Instead, we're hunting for some mythical genetic difference that is going to explain to us why people of color are more vulnerable, when frankly, we already know why they're more vulnerable and it has nothing to do with genes.

not be our last emerging infectious disease. There's going to be another one. Every time we have new health challenge, we will have to go back to the drawing board and undertake the get you know, the really quick policies, the things that you know are aim at changing people's behavior very quickly are likely to be temporary as well. I think it makes more sense for us to face the facts and look at long term changes that will

yield long term solutions. And that means something more intense, something a little bit more comprehensive, that's going to take longer time. So if we do that, if we look for meaningful, persistent changes, we have to look at where the problems are. First of all, we've done a lot of studies showing that they exist, but fewer studies looking at why they exist and how to address them. For example, lots of studies on pain. We know African American pain

is going to is treated very badly. It's not acknowledged, it's not treated appropriately. People are are stigmatized as drug seeking when they're in pain. We know this, so we need to focus now on how to fix it. What's causing this? And you know, frankly, sometimes it's good to know what causes a problem, but sometimes I think it's wasted time and effort that we really can't afford rather than worry about what exactly is causing the problem, because that can be grounds for a lot of them. Let's

just say unhelpful nasal gazing. People talk about implicit bias in part because it's more comfortable than talking about explicit bias. What's important is that there is bias and it needs to be ended. So we often talk about education and training, but look at pain. I'm not sure education and training is the route. I'm sure it's not enough because if you look at pain, the studies showing that half of medical students, a good proportion of practicing doctors think African

Americans don't feel pain and treat them accordingly. So we've established that if you talk about education and training, where are you going to do it? How are you going to direct it? You don't find this information in textbooks. That's not why medical students think this. They think that because this is what they're learning on the clinical floors.

They begin on the clinical floors and the latter part of their education, and they see consistently African American people who are complaining of pain being turned away as drug seeking. That's a tacit part of their training. They internalize that, they replicated and then they will teach that to their own students and residents. So we need to break that cycle. Instead of education and training. I think we need to treat this like we treat other behavioral problems. It's really

a quality of services problem. A medical student would not be allowed to graduate without acquiring certain knowledge and certain skills. A resident would not be allowed to finish the residency if you weren't able to do certain things required of it.

These students and these practicing doctors should not be allowed to advance in their profession until they've demonstrated that they are treating all patients equally, and we need to devise structures for assessing that the way we assess whether they can run a central line or do any other tasks required for their profession. We need to assess that not on paper and pencil tests. Medical students are all smart enough to know to give the right answer doesn't mean

they're doing the right thing. But we need to build that into medical education and make behaving appropriately per requisite for graduating, for advancing in your field, for getting a promotion, for becoming chief resident. It's time to monitor the behavior

of not only the individuals, but also the systems. Hospitals that should be checked overseen, their data should be scrutinized, and hospitals that show a record of not treating a group of patients appropriate, like African Americans or anyone else, should be made to undergo penalties. You know, we shy away from penalties for healthcare providers because we have such

respect for them, they have such high social status. But I think we need to use these rewards and penalties, meaningful penalties that will not only encourage compliance, but also send them message to health care providers that this is important. It's an important hallmark of your ability to practice medicine. Well, so I think we need a change of perspective here. I also think we need to have laws that change the policies and laws reinforce health care disparities. One of

them in the research arena is a structure of IRBs. Ironbs, by law, only have to have one person who is unrelated to the institution on the IRB board. So what can that person do? You're sitting there and you're facing what five, ten, fifteen scientists, all of whom want to do a particular study. You are the appointed layperson and you're not comfortable with it. But what kind of effect can you have? First of all, you know you're intimidated.

These are scientists. You don't speak their jargon. You can't understand everything that they're saying, and they certainly don't have any incentive to listen to you. You have to be there, you're allowed to speak. But what influence do you have? You have no influence, You can't And so I wrote in Medical Apartheid, that was back in two thousand and seven, that IRB should be constituted of half lay persons and

half scientists. And that way the lay persons on the IRB could have a real voice and some real leverage. If the people from whom you're going to draw the subject pool hear about the study you want to conduct and they have questions or concerns, this is a way to make their concerns addressed in a meaningful way. And then I heard from peers who said to me, that's not going to work because lay people can't understand the scientific you know, nuances and procedures, and they're not gonna

know what's going on. I said, but scientists can explain it to them. Otherwise, how can the scientists explain it to the subjects they enroll in the study, as they're required to do by law. Scientists are very good explaining even complicated centered issues. It takes some time. You can't do it off the top of your head very often. But I know I've read a lot of studies, I've talked to a lot of researchers, and I know how good they are at doing this. So it's something that

needs to be done. We need to involve lay people in numbers that will make their participation meaningful. This will also, I think, lower resistance in the larger community. When they know that people like them are involved in advising the studies, I think they'll have greater confidence it's not something that's just being you know, enforced on them from above, so to speak. So I think those are really important policy changes. I have others as well in that. One of my

big recommendations is to get rid of healthcare lobbyists. Lobbyists have no place in healthcare. Essentially, what's happening is, I understand it, we're electing lawmakers to enact our will, and instead the lawmakers are essentially receiving money via lobbyists to enact the will of corporations that might be very different from what we have in mind. In fact, frankly, I think they often are. The corporations are focused on the bottom line, not on improved healthcare as their number one policy.

So those are two big changes we need to revoke. I think the laws around that encourage patenting by corporations of universities. The law was passed in Laws of Past in nineteen eighty and the shorthand is of Badal Act, and there were other lesser laws. But this is what actually changed American medical research and changed the agenda setting from the institution that was a public health centered institution to corporations who again are centered on the bottom line.

These corporations are why their focus on maximizing profits is almost not completely, but almost total. And that's why we have twenty drugs for rectile dysfunction and only one new drug for malaria in the last couple decades. So I could go on, but those are my basics.

but I mean more than that. I mean right now, we have a healthcare system in which there is an interaction between patients and their physicians and perhaps a patient advocate. But the healthcare system has got to give more points of entry for lay persons into the system. There are already some unused avenues for monitoring and oversight within the healthcare system. We need to start using them. For example, in research, there are provisions built into the law for

government oversight of medical research. Provisions are very important because you have IRBs that are supposed to conform to laws, and I don't know how many, but I'm sure many of them do, but many of them do not. Many of them have permitted too much research that is clearly in violation of laws and of ethical strictures. But the oversight is not well funded. There's no money for the oversight.

It's there in the law, but it's not happening. So that means that you know, the research generated by institution is as good as its IRB. You have a conscientious, meticulous patient at IRONB, you have good research. You have another type of IRONB or IRB that is reliant on fast track approval, essentially rubber stamping research, then that's exactly what you're going to get. That's why we need the federal oversight that's already in the law needs to be

funded and put into operation. We also have provisions in the law to remedy some of the problems caused by the jealous corporate protection of patents. You know, they're protecting their patents above all else and will they often will produce medications that costs better part of a million dollars

a year so that people can't afford it. There's a provision for this in the law that allows the government to step in, take the patent from that company, give it to a company that commits to producing a drug at an affordable price, pay off the first company something for the use of the patent, and that way the first company gets some money, not the million dollars a year they were looking for, of course, but people who

need the medication will get the medication. That's a great solution. Well, not a great solution, but considering the system, which I think is not a bad system, that is a solution. But our government refuses to undertake it. They won't use it to give our people affordable drugs. They used to allow direct TV, but they don't use it to allow

us to have good drugs. So, you know, we have to look at things that are already in the law that could afford us some relief and could afford African Americans and other people easier affordable access into the healthcare system that we're just not using. We're ignoring that. I don't know why we're ignoring it, but I will say it's yet another reason why we need to get lobbyists

out of healthcare. I'm not saying the lobbyists have anything to do with this, but I am saying that it certainly benefits the lobbyists if we don't exploit these laws. So I think we need to make lawmakers free to do the will of the people, unencumbered by financial interests from these companies.

and white people deliberately. And these policies haven't disappeared. They exist today in the Dakota Access Pipeline, in the Flint water crisis, and they persist in unequal access to clean water, fresh food, clear air, safe housing, and many other things that a lot of people take for granted. These barriers created and enforced by racist laws and policies, especially within healthcare, and behaviors not encoded in policies. These have a direct

impact on the health of people today. Despite these systemic inequalities and barriers, much of the focus of health disparities, especially racial disparities, focuses on individual human behavior, essentially blaming the victims of health disparities for their conditions.

of excess stress. And of course it's important that we measure these outcomes and that we're having these discussions, but it does us no good if we don't also address the root causes of these disparities and how they interact and compound each other to lead to such stark differences. So step one is finding out, okay, what are these disparities. But step two, which really should be taken alongside step one, is how do we increase health equity by addressing the

roots of these disparities. These are not something that we can fix by making one simple chain. We need to put some of our resources to understanding what it is about the healthcare system, the legal system, the educational system, housing policies, our entire society in general that perpetuates these

outcomes that we can measure. Racial disparities are often multigenerational and are always multifaceted, and making any improvements requires us to take a step back to see the bigger picture and put policies in place that address the roots of these inequalities rather than at the branches.

biological differences between races, leading to race based medicine. However, these supposed biological differences are rooted in pure racist mythology, perpetuated in the nineteenth century when self styled scientists then levailed their racist views in scientific language, despite the fact that in the decades since there have been ample studies illustrating that these biological differences in race truly are mythology and have no basis In fact, these racist notions permeate

the way medicine is taught and practiced today. Many physicians make decisions based on this mythology, the myth of differences in pain, tolerance, lung capacity, predisposition to certain diseases, and there is a tremendous amount of research conducted to find

a biological basis for racial disparities and health outcomes. Instead, we need to use those resources to go back to the drawing board and actually apply evidence based medicine to addressing health disparities, rather than relying on this mythology created

and perpetuated by eugenesis and racists. We have to shift the focus from these supposed biological differences, which truly do not exist, and instead focus on the things that are actually different due to systemic racism, like access to healthcare, like environmental conditions like access to education, clean food, water. I mean, the list goes on and on.

They are hospitalized at at least three times greater rates and account for significantly higher proportions of deaths due to COVID, and the same is true for other minority groups. Native Americans are almost four times as likely to be hospitalized due to COVID, Hispanica Latino people three times as likely. And the thing is, these are national estimates that I'm citing from the CDC. Some individual studies in various states have found much higher disparities among racial and ethnic groups.

And the thing is it hasn't been limited to COVID disease hospitalization or death. Job losses have also been higher among black and Hispanic Latino people. COVID has caused increases in food, insecurity, housing instability, access to other medical care, including routine vaccinations for kids, and we have done a terrible job in ensuring equitable access to vaccinations so far,

and not just in the US. According to one study in England, elderly black people were half as likely to be vaccinated compared to white people for COVID nineteen and in the US, a patchwork of vaccine distribution has led to severe in equies by race and ethnicity that vary state by state, but overall the stats are pretty grim.

Some reports and news outlets seem to tie this inequity all back to vaccine hesitancy, but that's really its own form of victim blaming and it's not the root cause of the disparities that we're seeing.

do the work to become more inclusive. This might mean having more points of entry into the medical system. It might mean more monitoring and oversight with actual repercussions for non compliance, and it might mean changes to laws such that there is an incentive to prioritize actual human health and well being instead of corporate interests.