 I'm Reuben Warren and I am Director of the National Center for Bioethics and Research and Health Care at Tuskegee University. And welcome to what I am sure will be a wonderful conversation. As you all well know, this is Black History Month and the Bioethics Center at Tuskegee and the Bioethics Center at Harvard. We've joined together to host this event, which I'm sure will be very exciting and very intriguing. So let me pause and have my co-partners introduce themselves. Dr. Drew. Welcome everyone I'm so glad you're here to join us this evening for this very special talk by Harriet Washington. I'm Dr. Drew, I'm the Director of the Center for Bioethics at Harvard Medical School and so delighted that we have this opportunity to to work together with the with Dr. Warren and Dr. Hodge and the Center for Bioethics at Tuskegee University to bring you this series of talks during Black History Month. So thanks for joining us and I'm sure we're going to have a great session. Thank you Dr. We have agreed that we could not have a full session without a what I'm calling a inter-cross-generational conversation. So I've asked, we've agreed that have two students, one from Harvard and one from Tuskegee to also introduce themselves and tell us a little bit about themselves. Janika. Hi everybody. My name is Sheikah Kallivore. I am a neonatal ICU nurse from Seattle, Washington. I'm currently doing my master's in bioethics at Harvard Medical School, set to graduate in May 2021. Miss Keaton. Hello, I'm Sinai Keaton. I'm a junior animal science major at Tuskegee University. I hope you all have gathered that we want to have a conversation and so we're encouraging you to to think and write and think and write and then share what you've thought and share what you've written. There's some ground rules that we need to go over before we actually start our session. Ashley. Hi everyone and thank you for joining us today. As a reminder, this event is being recorded and live streamed via Facebook and the event will be posted to the Harvard Medical School Center for Bioethics Facebook and YouTube pages. You can submit any questions you have using the Q&A feature that you can find at the meeting controls at the bottom of your screen. And then the selected questions will be discussed after this Washington presentation. You can continue the conversation if you'd like on Twitter. And you can use the chat feature during the event to share comments or any technical issues. As a reminder, the chat is public. And please share any comments you have using all panelists and attendees to ensure that everyone can see your comment. And if you're interested in continuing this event series, please visit us online and sign up for more information. Thank you. Last year. Dr. Trug and I had a conversation about some issues, some challenges that were interesting country if not the world. We talked and we thought what were those challenges and what were those issues. What came to mind obviously was a coronavirus pandemic. But what also came to mind was systemic racism, health inequities, ethical violations. But we agreed that we shouldn't start from a place where we didn't want to be, but start from a place where we wanted to be and to transform what was negative into what ought to be and what we believe to be a positive outcome. We also knew that we couldn't do it by ourselves so we asked our colleagues some at Harvard and some at Tuskegee to join in the conversations and we've been meeting every week, religiously to further the conversations. Every week, we meet to further the conversations. We meet like a window at Harvard. Like Linfarrow at Harvard. Christine Mitchell at Harvard, and David Hodge at Tuskegee so we've had some very healthy I believe conversations about how do we transform the negative into something positive what are the ethical issues that have to occur as we have these conversations. To do something together. We agree to not talk about what we're going to do only but to transform the conversation into action to use a bioethics term language we want to transform the Netherlands into beneficence and we've committed to do that. This is one of those events. This is Black History Month, and we will have we are having a series of events throughout this month to kind of talk about things that have occurred and should occur. But everybody's heard the word black history month, I guess, some of you have no clue what it is some of you know, don't know when it started or when it stopped or who started it. It started as Black History Week in February 1926 Carter G. Watson. Thought about he is thought to be the, the father of black history African American history and he thought about how to be transformed what we think we know and what we in fact know. He is also the founder of the Journal of Negro History, founded in 1916. In 1976 black history week was transformed into black history month. And we find ourselves celebrating again. Black History Month. Now to this evening's presentations this evening's event. Let me start in a maybe an unusual but I think an important way. A terrible thing to waste. Washington. Card Blanche. Harriet Washington. Insectuous madness. Harriet Washington. Deadly monopolies Harriet Washington, and the book that you all know, or at least should know. Medical apartheid. Harriet Washington, we are so honored to have a distinguished speaker share her thoughts about medical racism, medical medicine, excuse me racism medicine and bioethics, learning from the past to ensure a healthier future. The first event, Miss Washington medical apartheid goes viral. How infectious calluses by ethical erosions. Let me not present or introduce but let me please share with you this wonderful conversation, they were about to have. Harriet Washington, please join us. Thank you so much. Thank you so much, Dr. Warren, I've long known of you by reputation. And I just can't describe the thrill of actually having you introduce me with that generous introduction. And thank you all for coming to hear my musings on these two catastrophic events that I think a lot of us sense are linked the pandemic and unfortunate rise in racial violence. And certainly the fact that a lot of racist tropes that we would have liked to say goodbye to seem to be lingering with us. And if you'll give me a moment, I want to share some slides with you, which I discussed this in more detail. All right, I hope everyone can see these slides well. Medical apartheid go viral. What do I mean by that. I want to start at least briefly at the beginning, or what we like to think of at the beginning but first I'm going to just briefly summarize. Some of the points I hope to make and that I hope to have discussions with you about afterwards. And one is that when we look at the causes of the disproportionate infections and death from coronavirus 19. We fall into some very unfortunate habits of thought that have frankly haunted us since then, at least the 19th century. And we're focusing very often on biological dimorphism. What is different about the bodies of black people. We talk about race different were a real biological entity that is somehow driving these risks when actually it's disparate treatment and disparate exposure, including environmental racism as I detailed in an article for nature. We'll talk more about that in a minute. And also the fact that all too often in discussing the higher rates, blame the victim risk factors about a lot of focus on obesity in the context of race, a lot of focus on smoking, drinking, failing to practice social distancing, all things are within people's control with the implication that if they would only control these things they'd control the risk. And I'm going to talk to you about why these controllable factors are dwarfed by other social and medical factors that separate African Americans from good health. And also, if people take nothing else away from hearing me tonight, I want them to seriously question this national habit of thought we have that drives in message that African American fear, fear of participating medical research, fear of undergoing vaccination is engendered by the public health service study at Tuskegee, a little more accurate way of describing in the Tuskegee study. This study is not the cause. The cause is for centuries of abuse, frank torture and disparate treatment in the medical arena. And I hope to make a good case for that but the real case for that is made in the medical apartheid. So I also want to talk about the history of our vaccine ethical issues that rise level of exploitation. And we're not only talking about things that happened four centuries ago, the Horry deep history American history that so problematic and that we at least should know about at this point. I'm talking about some very recent history things that happened earlier this year, things that happened within the last decade. These are all historical events that drive people's logical fears. So the message is that the resistance that people of color have to pursuing research and accepting vaccines must be approached with respect. If you didn't dismiss it as simple paranoia. It's not paranoia based on historical fact. And then I want to talk a bit about in this country, the participation rates of African Americans in accepting vaccine, and how the dialogue around that it's heavily racialized, inaccurate, and frankly unethical, in that it stereotypes African American psyche. So fast in your seat belts, I'll try to make a case for all of this. Let's go back to the Nuremberg trials. That's very often where we date our more modern discussions of bioethics. We see it was American prosecutors and American doctors who were confronting the Nazi architects of the Holocaust. Remember, of course, the Holocaust was predicated on abuse, murder, torture genocide, all of it thinly veiled in medical research. American doctors on denuded this exposed it confronted not the doctors and demanded justice, but the same doctors who were demanding justice at Nuremberg were ignoring our domestic events, which in many cases closely paralleled the horrific occurrences in Europe. There are things happening this country that were just as bad, sometimes worse, and a few of them are being conducted by some of the very doctors at Nuremberg. I think it's important to remember that because it's so much easier to point the finger at another country or another culture in terms of ethical failings, where more reluctant to face our domestic wrongs. And that is actually what a lot of my work has been based upon the understanding that the canon of history of medicine has successfully elided the experience of African Americans. We're not there very often. This was brought home to me really, really dramatically when I attended a history of medicine conference in Lübeck, Germany in 2001. And it was billed as a global enterprise. And there was nobody there from the third world global South Africa, but there were people there from Asia, Russia, and Europe. And all these experts in history of medicine, I thought perfect opportunity to talk to them about my interest in African Americans and their mistreatment in the healthcare system, often also guides his research. And they all told me to a person. Nothing happened except a Tuskegee study. And I really knew differently. I had spent enough time in the bowels of the county library, pouring over old medical journals to know a great deal had happened. But these experts in the history of medicine were telling me it wasn't there. If they didn't see it, that meant no one was seeing it. And that's why I knew I had to write a compendium to document what I knew to happen. And it was written because it's true. And history should encompass the truth. The experience of African Americans is also important and should be part of history. But it was also written because of the prevalent attitude that belief in these abuses was always dismissed as paranoia. Not true. The equivalent of urban legends or mythologies. I heard that consistently. And I wanted to make sure no one could ever dismiss that history as simply someone's imagination again. So I documented the facts. And what I want to point out is that the book has got 15 chapters. It could have had many more. But I had to stop writing at some point. And there is not a sphere of American medicine in which African Americans have not been disproportionately abused. Research conducted that violated any number of ethical strictures and later laws and simply treated with a basic disregard for their humanity. This is a matter of history. And this forest centuries of abuse is what has has informed African American reticence reluctance to engage with the medical system. It's not a matter of overreacting to a single study and it's problematic when people characterize it as overreacting to a single study because then you're saying something about the African American psyche being particularly fearful. Or having illogical reaction to one study. No, unfortunately, it's a frankly logical reaction to four centuries of abuse. And it's important to understand it that way because today, a lot of our discourse around coronavirus and who will and who will accept vaccines who will and who won't sign up for research relies upon this old inaccurate belief that the Tuskegee study is driving African American fears. It's not. It's driving the reluctance. In fact, more to the point what is driving the ethical flaws in our healthcare system when it comes to race race of course is a construct that we use because it's convenient it's a way of discourse but you know saying the word race and incorporating into medicine doesn't mean that it's a biological reality. It's not. It is, however, social reality and a social reality that is so powerful that has actually affected the way African Americans are treated. And so ironically, we have biological problems, medical problems that emerge from the way black people are treated, which are very easy to see as quote unquote racial problems endemic to the reality of once race when in reality they're imposed on people. It's not. It's sometimes a fairly subtle concept, and very often in popular discourse, it's hopelessly confused and conflated. So we're often talking about race what we should be talking about is racism. As Dorothy Roberts very cogently pointed out, it is racism that created race, not the other way around the people who first put forward their case that African Americans are profoundly different from whites. Did so, because they're an intermediate by belief systems that had nothing to do with science. They simply overlaid science to make it more palatable. And that's exactly what happens today. But we have to always remember that it is not simply African Americans and their behavior, but also the untrustworthy of the healthcare system that has brought us to this past. So in the 19th century, we have nucleus of scientists, the best scientists in the country, some of the best in the world, and they were united in several beliefs about African Americans. They told the world to African Americans were and they and none of the beliefs were flattering. They said that African Americans were so profoundly different from whites, physiologically, mentally and psychologically that they belong to a different species. Most of these scientists were polygenists. So they said whites belong to one species, black belong to another. They had different diseases, they had different immunities they had different behaviors, their bodies were profoundly flawed but at the same time, very strong and resistant to disease. They resisted pain, resisted dying from yellow fever, for example. So, and they resisted sun illness, you know, heat illness so unlike a white man, a black man could work hard all all day long in the subtropical sun and not have heat stroke. So all these things supported the slave system by creating the African American or the black body as one that is perfect for enslavement, not really human you didn't have to feel badly about the way you treated them. Very hardy was to disease, you don't have to worry about exposing them to disease and malaria climates. You don't have heat strokes you could work them all day. All these beliefs supported the enslavement system. And that's partly because at that point doctors had less prestige and lower income they have today, and they were dependent on that system for their income. The best way of running a medical practice, according to Dr. Samuel not one of the screw. He said the best practice that among slaves. And often they contract themselves to a slave owner to care for their slaves for a certain amount of time for a certain amount of money. And that's what they did. They told themselves as the experts in the African American or in the black body. And so other doctors in the north, and in Europe, listen to them. When they said black people didn't feel pain like whites did that became, you know, a tenant, a medical tenant that was accepted everywhere. And few of these doctors are listed here biological dimorphism was the reigning construct so they believe that these black bodies are very different from white bodies. And I argue that not only that they often blame the African Americans for their own illnesses, saying things like black people could not be trusted to care for themselves, or to follow doctors orders. But at that time, and well into, you know, actually early 20th century, African Americans had no real medical agency, while enslaved, all that was needed was a slave owners permission you didn't need a slave's permission. If you wanted to amputate to an abortion treat the slave not treat the slave all that was up to the slave owner. When he was outside and consulted his opinion meant nothing. So when a slave named Sam refused to undergo on operation that involved removing his entire jaw lower jaw without anesthesia. Everyone ignored him. It was done anyway, you know, so when African Americans complained of ailments, the doctors assured us that they didn't have, they were dismissed as malingering. You're pretending to feel pain, you're pretending to have malaria, we well know that you don't get malaria, but they did have certain illnesses that whites didn't have some of them were physical, but the interesting ones to me were psychiatric and one of those was well, you know, attitude disease, it's your big and all these illnesses had symptoms like talking back to a master, destroying a master's property refusing to work. And the name plus ultra striking a white man or talking back to a white man, all these things carried severe penalties up to death. But the more interesting one to me is the Drapedomania. It's also the most infamous one Drapedomania was that illness events by a slave, a black slave who ran away. So if you're a slave in ancient Greece and Rome and ran away as considered normal but if you're a slave in the Americas and run away. Now you've got an illness and the treatment for that illness according to Dr. Samuel Cartwright was to work the person, the offending out away from everyone else in privacy, work them vigorously and then frankly beat them nine drops of essence of raw hide I think was the terminology is. So, the accusations of malingering and restricting their access to health care. The fact that slaves are meant to live. For the most part, near animals far away from the whites for fear of infectious disease meant they were exposed to diseases that whites were protected from. And that's exactly what happens in this country with environmental racism. The harms that African Americans, Native Americans and Hispanic Americans are threatened with by environmental exposure are harms that whites are largely protected from. In the past it was things like segregation that offered legal protection lacks for physically barred from going to areas where whites live. But then as the law laws were taken down, they were replaced very quickly by social contracts. In the past, leases typically had and you can still find a few surviving leases typically had clauses barring someone from selling his home in a white area to a black person, or even renting to a black person. So, we still have you know remnants of this, we still have this mentality. Also, I remember early on I encountered resistance people said to me it doesn't make any sense Harriet because a slave owner would want his slaves to be healthy. He wouldn't want to stick slaves on his hands. But the truth is that caring for the enslaved person was not a matter of maintaining his or her health. It was for whites, the Western healing diet of a patient and physician. Beautiful relationship had nothing to do with the care of black people, especially during enslavement because what was valued was not their health but their fitness for work. Charlotte Fett lays that out brilliantly and very clearly with co piece examples, and the one that's really stuck with me is this discourse around treating malaria. This infectious disease was endemic in America during that time. They're at least four strains, although two or some similar they tend to be confused but at least four strains, and they were very poorly understood that immunity was very poorly understood. But doctors were united in their belief that black people were much less likely to die of malaria. So, you know, a black person who had malaria would be treated by the slave owner or his wife, or another slave, and only when he's at death door would they call in doctors. We know this because doctors always complained about it in their journals. So the doctor would come in and be paid maybe a dollar for saving the slaves life, if he could do that. Doctors were used primarily for testifying the fitness. So if you had a slave that you wanted to purchase you want to make sure that he was fit for work, you call in the doctor examine the slave, certify that they were fit for work. Fine. But after you own that slave if you discovered he had conditions or illnesses that prevented you from getting the work you expected. Maybe the slave was older than he had been billed as maybe the slave had a chronic infirmity that prevented him from working his heart or for long, then you went to court. And the doctors would be called in to certify that the slave had been sold an unfit situation or that slave wasn't. And each time the doctor would be paid $50. That was a lot of money back then, much more than you got for treating slaves. So that's an indication that fitness for work rather than health was really important. That's very important because although no one accuses doctors of doing that today, we still have a healthcare system that bears some of the stigmata of these old proofs. I think you can look no further than Medicare, look at Medicaid and some of the very illogical seeming things that they will and will not pay for. They don't really make sense, but sometimes I make sense of do look at it through a fitness lens. But biological dimorphism was the theory of the day with fitness for work, not health as a goal. So blaming the victim is something that has been very resilient. We still see this the great deal. As we do with the, with the immunities I've listed a few of them here. The really important one I think is pain for many reasons. The fact that doctors thought black people didn't feel pain. Also meant they didn't think they felt anxiety or heart disease which back then they thought was predicated on the same nervous system constructs. They thought they didn't suffer mental illnesses. And with this belief fairly entrenched. It's almost laughable today actually look back at you think why would, you know, any scientific person think that black people don't feel pain. Their theory was that the nervous systems of black people were so primitive, they didn't feel pain, or the more nuanced emotions like anxiety, but the claim for kind of ludicrous, you know, that you can take off the empty leg of someone while they're holding it because they don't feel pain. That claim is duplicitous but people believed it. And we can laugh at it now but how do we behave today. We had a series of studies, the most recent one in 2016 by University of Virginia, documenting the fact that in the study half of all medical students queried believe that black people didn't feel pain as much as whites did. A good many practicing physicians also said that they believe the black people were more resistant to the radiation. A lot of the beliefs that would be very much at home in the 19th century. Now, the curious thing is, I doubt you can find a textbook that's going to say this. I would be really surprised if you could find any lecturer who will stand up and say to medical students that black people don't feel pain in the way that whites do, but they're learning this. And I think that they're learning this on the clinical floors. When they first gone to clinical floors, they observe how their chief residents and their attendings and their instructors are treating black patients when they see black patients repeatedly turned away after complaining about pain and asking for medication. When they see them routinely turned away and dismissed as drug seeking, they integrate that because it has a part of their medical training. And then it's perpetuated. They treat their patients that way. And the people that they treat an instruction will also do so. This is very, very disturbing to me that a belief from the 19th century is still alive and kicking today. But I also am haunted by the things that we're not testing for. We're doing periodic examinations of pain beliefs. Are we looking at other things? Are we looking at dimorphism? Are we looking at the belief that blacks and whites have different illnesses? That also is current. Don't forget that a lot of most people in the country and a lot of physicians seem to think that sickle cell disease isn't only strikes African Americans when we know that's not true. Dr. James Bowman at Chicago told me that he had a difficult time instructing students who saw repeatedly black people diagnosed with sickle cell when they really had Bellosemia, for example, no one could really conceive of the black person not having sickle cell. So we still have this hangover in medical education that's translating into poorer patient care. And here's a colossus to Dr. James Marion Sims that stood across from the Academy of Medicine where I'm a fellow. Every time I went for a meeting, but more to the point, the area is in East Harlem where it's heavily populated by black and Hispanic women who had to walk past the statue every day. He was called the father of American gynecology, but his work was predicated on the savage abuse of black women with vesicle vaginal fistula. They were enslaved and so he acquired them and locked them in a shack on his property and repeatedly did intimate genital surgeries on them for years trying to find a way to close vesicle vaginal fistula. And he finally found out how to do it and immediately went to Paris and then came to New York where he later became president of the American Medical Association. And now we call him the father of American gynecology, but his success again was predicated on the savage abuse of black women. And this makes him a very representative doctor, because it's very common for doctors to achieve important things, be lauded as medical heroes, with no regard for how they achieved what they achieve. There aren't ethical questions about the treatment of African American women. Even today, I am happy to say that in 2018, I was there when the statue was pulled down and banished from Central Park. But there are a lot of people there, including doctors who made that happen. It was mostly the women who lived there black Hispanic women, but they couldn't have done it without the doctors who helped them. And after over 10 years, they got New York City to finally agree to banishing the statue. But the day was taken down. There are also doctors there who are defending Dr. Sims, who are saying that he was misunderstood. They said he didn't use anesthesia because there wasn't anesthesia to be used. They said that he was a benefactor to these women. These women were a terrible pain without him, they would have lived out their lives with this horrible condition. And the defense of Dr. Sims struck me in their blindness, their ethical blindness, because they're casting as beneficence something that entailed total withdrawal of consent informed or otherwise informed consent was not actually a practice back then but simple consent was, was necessary in fact. No consent, the infliction of pain, the refusal to mitigate that pain. And doc, you know, very often I hear doctors say to me, there was no anesthesia but they're wrong. There was anesthesia it wasn't recorded in the medical journals until 1846. It was in common use before then more to the point Dr. Sims himself and his own biographies memoirs rights of considering whether or not to use it and deciding it wasn't worth it. Why wasn't it worth it despite the fact that he wrote of the women suffering horrible pain. It wasn't worth it because they were black, and they couldn't really have been in that much pain. So this these paintings testified to the difference in how black and white women retreated. They also testified to something else, the use of art and literature to prevent fictions about physicians and medical care. The middle drawing shows a slave woman kneeling with her hand to her breast a very Victorian attitude of submission. The sheet is hung of course for modesty. And the two women peeking behind the curtain expression to their faces which you can't see I'm afraid in this reproduction. Don't look afraid like childlike curiosity what's going to happen here. But this was a lie. As Sims himself described the sessions, the two other doctors were there in part to hold the women down as stem slicing to their genitalia, their shrieks of pain and horror. There was no sheet to shield them from the world, but Sims would invite in colleagues and even businessmen that he knew to watch the spectacle. So it was a blatant not only no respect for the woman herself. No concern for the pain that she was in the inflection of pain. No need to acquire her consent or educated about what was happening. And the image on the right contrast that with the treatment of a white woman problematic in its own way, but respectful. The doctor is kneeling to examine her but he's not looking at her because even being a doctor did not permit you to look at a woman's unclothed body back then. Not a few are white women for black women there's no problem but for white women would avert your eyes and a gentlemanly fashion. And so even though women of course were being restricted dramatically in the social sphere. There is still a sense that women had a care white women had a certain character black women had of one that was mirror image white women were sexually chased and fiercely defensive mothers, but black women were sexually who didn't care about their kids murderously indifferent mothers. There was a diagnosis called overlaying that only applied to black women, who a black woman would roll over her baby in her sleep and smother it. And it was a racialized diagnosis. It only applied to black women they were well known to not care about their children's fate. Here's some scenes from Dr. Sims statue being taken down. And one of the ethical the reasons that really struck me is I go back to Germany at least once a year. And there are now these all these stupelsteiner the little brass plaques, often in sidewalks in front of homes, where people who are victims of the Holocaust people who were taken away. And I think it's not or to Auschwitz, never seen again. It's commemorated, you know, this woman died Auschwitz, you know, 1943 in Germany, despite their horrific history, inexcusable practices, they've learned to venerate the victims of the Holocaust. In this country we still seem to be focused on honoring the perpetrators of abuse. And I was really happy to see some statue come down for that reason. I don't think he's a medical hero. I think our definition of medical heroism is a bit flawed in that we focus on what the person purportedly has achieved without focusing on how he achieved it. Who was abused, who was neglected on even what data were corrupted. And I think we need to focus more on how people conduct medicine practice medicine conduct research. If we want to have a higher level of ethics, then we need to reward that as long as rewarding people who are abusing others in the practice in the research and medicine that we're going to perpetuate that behavior. There's a few present day black disease and immunities illustration that we have not completely gotten over this construct. I think it's really important to look at history, as we trace some of the ethics pertaining to Coronavirus, and it's racial divide. It's important to realize that early on in 2020 seems like a long time ago right more than a year ago. And then on the prevalent myth was that people of color were immune to Coronavirus. We often think about the African Americans in this country, who early on said I've heard that African Americans don't get Coronavirus, but there was more to it than that. There were medical publications detailing low rates in Africa, wondering why the rates were so low and speculating or something different about African American bodies, or their vulnerability to infection that was protecting them. So we were skipping right to biological dimorphism, not looking at all the many, many other variations in sufficient detail, I think. And unfortunately, our sloppy look at the data worked against us when it took us so long to realize that there were higher rates in African Americans and higher death rates. We were looking at socioeconomic data, TDC looked at socioeconomic data with the assumption that you could capture racial data from that you can't because a wealthy African American is still subject to many of the vulnerabilities that will escalate his disease risk. And a lot of discussion of Coronavirus in the global south focused on old biases old mythologies about low intelligence and their fearfulness of Western medicine and interpreted their low infection rates as avoidance when in reality it was much more likely due to some poor data collection or insufficient death collection resulted from their lack of working healthcare infrastructures. A really common sense question you assume that people would focus on earlier on but the focus seemed very heavily on biological dimorphism instead. And here in this country we did the same thing. There are millions of discussions in April when the news was reported in the news media, people need to talk about behavioral causes. I mentioned a few of them briefly earlier. I heard people say, Well, are okay African Americans have higher risk but it's really race aren't isn't it really because these people are using drugs and alcohol. They're not practicing social distancing are they. You know, it could be a factor of where people choose to live a New York State legislators said that to me. And of course I want to tell him that nobody chooses to live in a tenement building in New York City, people live there because they don't have another choice. And then the discussions about obesity seem to be frequently racialized. And that made me think of what happened in SARS to outbreak, and I found an article and wire that examine this in detail. And I pointed out that during, during that outbreak, the same dialogue was very common people were saying obesity is a risk factor definitely a risk factor. But when they analyze the data, they found that the people with a higher BMI were more likely to survive, despite the fact that some policies on militated against giving high BMI patients ventilators. So you can examine that on its own that sounds very interesting. I like the rationale behind that. So the, the really hard factor for a lot of people to absorb is that it's not common, of course, on the whole it's much better not to be obese. It's very dangerous to be obese, but there are some conditions against which obesity can either be protective or not escalate one's risk. And instead of simply assuming that this wasn't a risk factor. A lot of people just made that jump. In fact, a lot of scientists made that jump, and it may be the fact when we analyze the data. Holy, we may find that that's exactly the fact, but we don't know that we can't. We shouldn't start out from the beginning in April, making that assumption. And definitely not basing policy on it. Even our surgeon general brilliant African American physician who certainly should have known better invoked social distancing. You know, he should have known that 25 are the people who are essential workers and cannot practice social distancing who have to confront others on the subway trains and restaurants and hospital floors that they're cleaning have no choice. The most evoked avoiding drugs alcohol smoking is if these were important risk factors. And of course he also offended a lot of people with inappropriate ethnic patrol. People thought was unnecessary but I suspect the ethical, the ethical problem with it was, again, respect, you know, unfortunately, despite his I'm sure his intention was not that I find it hard to believe he would intend to do that. But the effect was, many people were offended, many people, it was found disrespectful. And if you have a medical leader who issues a statement found to be disrespectful to a group. I don't think that's going to increase the chances of getting that group to trust that this person has their best interests at heart. That was unfortunate step. The risk factors are really things that enhance vulnerability of African Americans that have not had not at that point gotten the kind of ink and attention they should have. I wrote about this in April was published in May, took quite a while to be vetted and published. In the end, nature agreed with me, and they published that environmental racism, all the risk factors environmental racism are also risk factors for coronavirus, everything from vitamin D deficiency to heavy metal exposure. All these things and to the lung, kidney and heart disease escalation caused by air pollution. All these things increase risk for coronavirus. It's not the only cause of course, but it's emblematic in that the treatment of African Americans again, not anything about their bodies that's inherently different is what's driving up their risks. And I think it's really important to look at it objectively and find the real risks, rather than, you know, invoking phantom ones I think do more harm than good. So, I want to pivot for a moment and talk about African American reticence which is invoked during the studies when we frequently read about African Americans not volunteering at high enough numbers, even that African American failure to volunteer at it sufficiently might block the development of a vaccine. So in other words, should the pandemic not abate would have been our fault, you know, that's a very difficult pill to swallow, especially when, in my opinion, it's based on mythology rather than fact, because both the medical media and the news media were very fast to invoke Tuskegee, they invoked it as the as the cause. The reason why African Americans won't volunteer for studies high enough and will not accept the vaccine is their fear, their fear generated by the Tuskegee study. As I mentioned before, the problem with invoking that study to the exclusion of four centuries of medical abuse and mistreatment is that you are assuming that people are overreacting. You're assuming that people are overreacting to a single study, and therefore their fear is not based on any real danger, but that's actually not true. People are not reacting just to the Tuskegee study and the body, large body research, substantiating that when you look at it as I have shares of very simple and dramatic flaw. Researchers go in with the assumption that the Tuskegee study is the cause, instead of asking an open in question, as should be done in this case. They ask about the study. Thomas Leviste, I think did a really powerful important work when he's at Johns Hopkins. He did a slew of studies, asking people trying to examine whether Tuskegee was indeed a factor. He found among other things that African Americans would never heard of Tuskegee study were more likely than other African Americans to fear medical research. His research has, and others, of course, has dramatically shown that this assumption is not based on fact that is not Tuskegee, but rather a long history of distrust based on mistreatment that is causing this. There's something else here too that is going unaddressed. Quick reminder, here's some of the things that might have undergirded African American reluctance to be involved with medical research. But, you know, of course, we're also only focusing on African Americans behavior. Why do African Americans reject the vaccine? Why do so many African Americans who engage in studies? You know, there are two questions here that need to be asked in concert. You have to ask about African American behavior, yes, but also ask about interrogate the trustworthiness of the health care system. Those two things go hand in hand. You can't talk about African American behavior without talking about what's engendering that behavior. And that is indeed the case as I submit that the US health care system is an untrustworthy one that has shown itself to be unreliable to countenance far too much racialized abuse racialized bias in conduct and in treatment, then that's part of the problem. We can't isolate African American behavior as if it's the only problem. It's not. There's a context here and the larger context is they don't trust the system because it's not trustworthy. So I also was curious about the vaccine testing dialogue because I kept looking for numbers that I could not find. Okay, African Americans are not participating in enough numbers. Well, how frequently are they signing up? All these studies belaboring this and all these newspaper reports definitely don't go into detail about the numbers. But thanks to a very generous researcher at Johns Hopkins, who supplied me with data, I found that for the Pfizer and Biontech study, African Americans did participate at 10% of the research population, 10% of the subjects were African American. In modernized trial, 10% again, roughly 10%, 9.8 or something like that. Okay. African Americans constitute 12.7 US population 12.7%. If 10% are volunteering, that's a very respectable showing. And my question is too is, how about other racial groups anybody look at those. I mean, the behavior of white Americans is much more key, because there's so many more white Americans and black Americans. We should at least be reading something about how many white Americans were volunteering. Were they volunteering at their rate in the population, which I don't know what it is, but let's assume conservatively it's 80%. We're 80% subjects white Americans. It's a rhetorical question. It's also an ethical one. You can't single out a group like this and examine their behavior, criticize their behavior. In this case, it turns out criticize their behavior without any logical or factual basis and escape an accusation that your intense scrutiny of this group, you know, amounts to demonization. You're blaming people for something they haven't done essentially. And again, that's important for more than just, you know, because it's not right, but it's not just an ethical abstraction. We're talking about the system being trustworthy. And this is not going to be. This will not encourage people to trust the system. This knowledge or a sense that they're being singled out in their behavior scrutinized and criticized. So if you're going to criticize behavior, make sure at least that it's accurate. This case it wasn't. So the dialogue now is focusing on accepting the vaccine are African Americans accepting the vaccine actually the dialogue that we're reading is that they're not accepting the vaccine. They are reluctant once again why because of Tuskegee that's a predominant dialogue. But I want to offer other facts. And that is that, first of all, again, vaccines skepticism is rife in this country. A very sad fact, we have to do something about it we have to address this in a way that's going to work. But we have to also understand that it's cuts across all socioeconomic groups and all ethnic groups and most vaccine skeptics again are white. So we can't simply focus on African Americans. It's not ethical, and it's not going to work. Also, we're focusing on behaviors of African Americans and criticizing them. But is the real issue perhaps that policies are hampering African American access to the vaccine. I know I had a great deal of difficulty getting on an appointment for the vaccine. And I'm old enough that I should not have had, I feel so much difficulty but I did. I have a lot of friends who also are having problem getting access to vaccine. Their supplies are not what we want them to be. But as many African Americans fight and you know relentlessly scrutinize the list and try to sign up and get access to the vaccine. There's no spotlight on us. The focus is all on these beautiful people who are refusing to accept the vaccine. I'm sure they exist, but they're far from the whole story. And they're certainly far from a representative, accurate story, which would focus on people of all ethnicities. Also, the decision to prioritize according to a sounds very logical. And at first glance is a good ethical case to be made for it. These are the people older people are more likely, as we know, to be infected and to die. Suffer horrible complications of it. I have a 97 year old on who survived coronavirus, and she's doing very well except she's got some memory problems that disturb her. And so, certainly the elderly, you can make a good case for that. But there's a problem with this, because African Americans are also at very high risk, also more likely to be infected and die. And African Americans are less likely to be elderly African Americans Hispanic Americans are young populations. That's true of every ethnic group that has low life expectancy, compared to whites, which is just about every ethnic group. So, you know, when you look at people nonagenarians, there are twice the percentage of nonagenarians in the white population is a black population. So an age based exclusionary process is going to discriminate against African Americans, who are also at high risk. It's something I think that needs fine tuning. And it may be a bit late to rethink it now, but certainly, since I think this will not be our last encounter with a potent, you know, infectious disease emerging infectious disease, we need to rethink this for the next time. So do we really want it only to be aged or do we need to modify this with other ethical, you know, considerations. Also, health care professionals are prioritized. Again, that makes a lot of sense, unless you think about it, not in terms of being a health care provider professional like a doctor or a nurse, but in terms of exposure. People who wash the floors and hospitals, the patient care systems who feed patients are also sharing risk. Their risks are not always at the level of someone doing invasive surgery, or actually, you know, including ventilators, but the risk is much higher than anyone else. So they need to be included in this formula to somehow you need to be nuances that allow for exposure, because this one quite frankly looks a little bit like status base, there's an element of classism here that we need to get rid of. And so, yes, protect healthcare professionals, but also protect that person working in the hospital every day, doing his part by keeping it clean, keeping people fed, doing what needs to be done, the thankless work entails exposure. And I want to talk a bit about vaccine fear, the things that justify them, you know, we dismiss people's fears of vaccines, I think, out of an understanding that a lot of the predominant dialogue about from vaccine rejectors, it's simply not true. We know, for example, that Mercury and autism, that link was debunked long ago. We know that Mercury doesn't exist in hardly any vaccines now and not in levels that are going to cause any problems. We know that a lot of the fears about adulterants, etc, are just not reasonable when you consider the, when you balance them against the risk of having a child who dies or is, you know, forever, you know, injured has life altering injuries for a disease that we can prevent two vaccines. We know all that but there are other problems with vaccines that don't get as much discussion that don't get as much visibility in this country. I spent a lot of time looking at them. Earlier, 2002, again in April, that was very eventful month, two French doctors, one of which, who held the French National Institute of Health agreed that the research pertaining to coronavirus that were being criticized as being ethically troubled involving placebo studies, for example, do the research in Africa. That's where we need to go. Remember the AIDS studies with prostitutes. We need to do more of that. So they had this discourse. And there's a lot of outreach, a lot of pearl clutching for very upset that they talked about taking ethically troubled research to Africa, but I've been reading in medical journals, several pieces of people posing exactly that. Is the developing world the place to go with some of these ethically troubled research studies? And of course, it's a horrible question to even be posed. You know, the implication that people in developing world are less deserving of the protections that we enjoy. Very troubling. And yet it happened that a lot of publicity, certainly in Africa, a lot more in France and in the US, I wrote a piece for an African journal and I realized at that point that people in Africa were of course very well aware of that and very unhappy about it. But also, there were publications in this country for a lot of African Americans who have Afrocentric interests, for example, placed like the final call, the black Muslims in paper covered it. So African Americans are aware of this, even though perhaps you might not be aware of their, you know, the details and the degree of outrage. So that certainly would establish some fears that I find justified. Also, we've had a lot of research studies in the developing world conducted by US researchers that have been problematic, ethically troubled, sometimes criminal, sometimes legal challenges like 1996 Pfizer's testing of antibiotic against a meningitis epidemic. Lots of issues. I won't go into a lot of detail here, but they resulted in some deaths, disabilities, a falsified letter of approval being produced, and a $75 million settlement that Pfizer agreed to. So, again, very high profile people know of that. And the CIA polio vaccine experiments, terrible. The CIA conducted a sham vaccination campaign, pretending to vaccinate people giving them one dose of a three dose, you know, design, and did that in order to draw blood and find relatives of Osama bin Laden when they were looking for him. When they found him they abandoned the sham research. All these people thought they had been immunized would not been immunized. Then the word got out about their true import of this quote unquote vaccination campaign. And it was horrible. People doing real vaccination campaign sometimes paid with their lives, they were killed by people who fear that you're just another CIA operative here to do heaven knows what to us. Polio rates went up, unsurprisingly, so you can't knowing this history, you cannot dismiss the fears as paranoia. The fears are justified, the behaviors have on fed these fears, fed the resistance, and one can only sympathize with people who fear getting a vaccine, because they know of history like that, and are afraid that it might pertain to them. I had a piece in New York Times, ages ago 2007, where I detailed some of the recent history of the many cases in which Western doctors have gone to Africa and perform and abusive studies. Frank murders. There's a doctor who murdered three people here in New York, I think in another state. He went to jail for it, but it was also found that he was a suspect in the murder of 60 people when he was in Zimbabwe practicing there. So even if you're not living in a country where these doctors have been, you know, conducting their abuse. You know about these things, you know about these things, the word gets out, it spreads the fear of healthcare providers, spreads a fear of medicine, and these fears are not things to be dismissed as paranoid, or on, you know, without basis because they do have a basis. You know, our responsibility should be to convince people that our healthcare system won't countenance behavior like this, and that we are actually their protectors, rather than, you know, their potential abusers. And we can only do that if we take their fears, and they're concerned seriously. One of the questions I wanted to address is that. Yeah, I asked how I'm doing on time. We're running a little behind, but we'll get a little more time. This is so powerful. I'll be brief. I'll be as quick as I can. Thank you. Okay, another argument, an ethical argument that's put forward very frequently is that because African Americans have a higher risk and they do have a higher risk, higher risk of infection, higher risk of death. And because of that, they will stand to benefit more from any approved safe therapeutic, and that's an argument for volunteering for studies. But it's a good argument. I don't think so. I don't think it's an ethical argument either because casting research participation as a benefit is problematic. It's not definitely a benefit. We can hope, of course, that it will result in a medication that's going to be safe and effective, but we can't know that. And we certainly cannot ethically promise that or even imply that if we knew the thing we were studying was going to be beneficial and effective and safe. It wouldn't be research right we just be applying it so we can't promise that and yet we're implicitly promising people that we say that. And even beyond that, what we found is that if you go to the third world, Global South Africa, what we find is that people living there are often given the same promise. The reason and they're also, it's also a rationale. We're conducting research on with a lot of mind in Brazil, because it's effective against leprosy. There's a lot of leprosy in Brazil, resilience will be the most will benefit the most and that's why we're focusing our research study here. The problem is that once the drug is found to be effective and safe, the resilience will have no access to it. People in the Global South rarely have access to drugs that have been improved using their bodies, because their price out of range, and often not even offered for sale in their country. The company knows that nobody in that country. Nobody in, for example, Suriname can afford a million dollars a year for this cancer drug. Once it's perfected, it's brought back to the US to Western Europe where people can afford this drug. So it's not only not an ethical promise to make it's a promise that you can't fulfill. And we won't even, of course, not to even mention the fact that sometimes drugs are not found to be safe and not found to be effective, in which case the people you've been conducting research with have been suffering all the ills, not only all the risk, but all the ills. You know, this imbalance between risk and benefits is really important because one can certainly say it violates the distributive justice, which it does. But it also violates the implicit promise made to these people because if you are conducting research with these drugs, people in the developing world are taking all the risk. But then when the drug is available and they can't afford it, the dialogue in this country is often, well, people are saying we should give them the drug, we should donate it. We can't afford to cure all of Africa. We can't afford to treat everybody in the world. There's no recognition that we are in the debt of these people because they are the ones who assume the risk when we were not willing to do it. And so instead of looking on it as some kind of, you know, a large guess that we're giving them something, I see as satisfying a debt. If their ability to, if their willings take risk meant that the drug is now available to us, I think we have a moral obligation when arguing ethical one, but I like moral obligation to give it to them because they have earned it in a way that we have not. I think that's another way of looking at this question. And a really good example of that was what happened in 2014. I remember being really, really unhappy that there were a lot of arguments against giving Z map to West Africans when it was found or when it seemed to be effective against Ebola. It was given to healthcare workers working in Africa, but it wasn't given to Africans. It was not even given to the chief virologist of what country was he in Sierra Leone. Um, Jake, who had been treating Ebola patients long before Westerners got there, he, he didn't, he wasn't even told the drug was available. No one gave him the drug and he died. But the white doctors practicing there Keith Brantley, etc. were given the drug when Brantley got back to the US he said, I understand why I should get the drug as a healthcare provider. I can understand informed consent. I can understand the risk and balances, but Africans cannot. And I thought it was a really damning statement, but you know, I'm not trying to single him out. A lot of people felt that way. A lot of people had various reasons why it shouldn't be given to Africans. Sanjay Gupta said, we can't give it to Africans because it's been tested in monkeys. And if we now give it to Africans people will criticize us for giving them a drug that's been tested in monkeys. That made absolutely no sense to me. I said, I'll tell you, I'll show you what I said. I hope you can hear this. I can't hear it. Oh, sorry, hold on. Yeah, and some platforms isn't there's an additional thing you have to do to hear audio. So I'll summarize what I said, it's quicker anyway. Say again. I said, she was saying I said first of all, well okay first of all giving the drug to someone else after monks have gotten it's never been a problem in the past. There's a requirement actually most drugs have to be given to tested and animals tested in people. So that's a non issue, but more to the point, the real issue is not whether it's been tested and the real issue is that very often developing world, we give people drugs and we do research studies that do not conform to us standards. The Declaration of Helsinki has actually been changed in the way that lowers the standard of protection in my opinion, but even had it not been, we are testing drugs on people and very often, there are missing consent forms. Accusations that people have not been told what's done to them, accusations that the documents that need to be formed have been falsified. Accusations that people have been, you know, sort of induced or coerced into the study through various means. I said so they're not being conducted according to the Code of Federal Regulation that lays out very clearly what you can and cannot do in conducting medical research because they're so far away from governmental scrutiny. It's easier to cut corners. That's exactly what has happened in some studies. And that's the real issue. And in this country, we've also had our ethical issues and there are more than I can go into in detail right now but they include things like DNRs, which are predicated on discussion and consent between the physician and a patient about why restriction of care might be in the patient's best interest. Instead, some institutions have announced we're instituting mandatory DNRs on everyone coronavirus. In some cases, they were immediately given letters from the federal government saying what you're proposing is not actually permitted by federal regulations. Sometimes they actually stipulate that they're not going to withhold care from people who have certain physical conditions or limitations. People in wheelchairs, people who are already dependent on ventilators, people with some kind of chronic condition that weakens their constitution. They will say we're not going to give you the care we would give to anybody else. Ambulance groups in Newark, New Jersey announced they're no longer going to give CPR to people that they think have coronavirus to prevent their staff from being infected. And even we have studies where ketamine is being forced on people, biomes attendants who say that sometimes police makes them do it, they're given ketamine without their permission. So all these things either violate the law, the code of federal regulations and ethical strictures, but in a few cases, unfortunately, they don't violate the law. That's because laws passed in 1996 have permitted certain types of research without informed consent. They permit research on unconscious trauma victims and they permit research with what's deemed under the law as things that only create minimal risk. Very vague language that actually encompasses giving people ketamine, a potent, a very potent drug, usually used only in surgical theater. It's forced on people without their consent and some people who have undergo this die. A lot of them end up, I think 40% end up in the hospital on a ventilator. And when they wake up, they're given a form to sign saying you've been enrolled in the ketamine study, but if you don't want to be in it, sign this form will withdraw you. How do you withdraw somebody after you've given them ketamine? Well, they're saying that they're withdrawing you from the study. That means they're not going to use your data. People are not concerned about using their data. They're concerned about waking up in the hospital on a ventilator after having a forcible injection. They haven't even been told about. These things are happening in this country today. And they're mandated under the law. I've got the title right here. If someone wants to look it up, CFR 5021, 23.24. Basically, these are exceptions to informed consent. The informed consent that we have been led to think is our basically our birthright, something that every American's entitled to is no longer the case. They're now increasing exceptions. And when I talk to other ethicists, very often they tell me, well, they're rarely used, but they're not. You know, I quickly found that 720 people in this country were enrolled in the study of artificial blood. Many were enrolled in the resuscitation outcomes consortium. Many were enrolled in studies of various patented valves, chemicals, ketamine. So it's burgeoning increasingly in this country, you're at risk of being enrolled in a study without your knowledge or consent. And they're also neo eugenic actions that are very concerning this coronavirus patient, Michael Hixon. He was confined to a wheelchair. He developed coronavirus went to the end up in ICU, but began to recover. His wife was told that he recovered you taking on the ICU, but they then put him in hospice and she asked why and they the doctor explained to her. He's in a wheelchair. He doesn't have much of a quality of life. We're going to withdraw food, water and medication from him. She said why, because he's in a wheelchair he has no quality of life. She said the doctor says that's correct. And indeed, Mr. Hixon died six days later. And unlike other people who have said to me and who have reported this was done to their young loved one, his wife recorded the call between her and the doctor. So she indicated her intent to sue. I don't know if she's actually mounted the lawsuit yet, but the question is how many people just happening to him. How many of these neo eugenic decisions are being made about who is and who is isn't worthy of treatment. It's a very disturbing development and it's a factor of infection, because the suspension of informed consent tends to escalate during wartime and during periods of infection when urgency seems to drive people's willingness to dispense with ethical niceties like consent. And here's like the best known I think victim of the ketamine study Elijah McClain, who the police was followed him home, determined that he was agitated, called the ambulance attendance. They injected him with ketamine and he died he was died by the next day, but he's not the only one. These studies are being conducted in Minneapolis and several other US cities I think he was. He lived in Colorado, Colorado, I forget which city, but again, these studies are across the nation, and they're very quietly, you know, robbing people of their right to inform consent legally. So thank you very much for listening to me. And I'm looking forward to our discussion. My, my, my, thank you so much. Let's, let's thank her for me. We have time and I took it as a prerogative of the start of the meeting to go over because I couldn't I couldn't stop so let's have a few questions. We have time to the three questions. So I want to, first of all, convey a deep sense of gratitude to you miss Washington for that incredibly important and salient conversation. And given the enthusiasm in the chat box, I see that many people feel the same way. So that also thank you to our faculty organizers for advocating for this to be an intergenerational conversation and so as we go into the Q&A I'll start off by handing it off to our co-moderator, Miss Sinaya Keen, who's an undergraduate student at Tuskegee University with her question. Thank you. First of all, I'd like to say thank you miss Washington for that wonderful session. Thank you. So how would you recommend to bring about racial change in unity with the country. Excellent question. I think we have to view this for what it is. It's not a matter of changing African American behavior toward the healthcare system. It's a matter of changing the behavior of the healthcare system toward African Americans and other marginalized peoples. I think that it's something we have to do together. I hear from a lot of people and I understand the mentality. They're saying things like, oh, we should only trust black doctors, you know, and I understand that but the reality is there aren't enough black doctors to go around, right. And the other, most people, most black people are treated by white doctors. And the bigger reality is that it's a problem for the whole nation. There's a lot of detail, but there's a lot of research, some of them right at Harvard that shows that the poor health and low income in people of color. They harm not only people of color and poor people. They also harm the middle class countries that treat people of color or marginalized people differently. And they also have to read disparities that harm middle class people too. So if you go to countries in Europe, where things are more equitable, you find the middle class does better. So it's everybody's problem. You know, it's a problem that has focused on African Americans, we're the ones who've been the victims and mistreated, but everybody is suffering in my opinion. And you know, I see glimmerings of hope. The Committee on Health Care Disparities, a joint venture of the National Medical Association, the black doctors group and the AMA. I've been to some of their meetings and it's very heartening. There you have physicians who are united by their concern about this. And frankly, it doesn't have a color. You know, the real dividing line is, are you a person who thinks that this state of fear is acceptable, or are you not. And I think that's what should drive us. Along the same lines of an action oriented question and attendee and anonymous attendee asked how do we get these discussions at the forefront of media and lobby groups. Well, when it comes to the media, I'm trying, but I really think it's a matter of, you know, public health in particular, determining that it's one of their, you know, one of their points of action. And I think, you know, there are schools of public health like Harvard, again, where they've long recognized the importance of communication of, you know, have of, of partnering with communication and being able to integrate their social marketing messages, you know, in the, in the media. I think we need to do that, but do it on steroids. You know, a lot of the information being repeatedly, you know, promulgated as we spoke, I got several emails from the telegraph in London, asking me about the Tuskegee experiment, right. So, I think that it's much more meaningful if you have public health leaders and physicians, promulgating messages than other people, you know, like, I'm confident in what I have to say but it'd be so much more powerful. If we had physicians and doctors getting together, issuing statements, talking to media, writing op-eds, you know, investing this message with their authority, that's really important. I think it's something that some schools of public health do really well, but we need to do it much more, much more prevalent. I teach a course at Columbia on journalism and bioethics. And it's because I think it's so important for the people training in bioethics to become media savvy. Two more questions. There is a question from Izzy Hernandez. She says, thank you. Thank you for such a great talk. I was wondering how you think bioethics education should be reconstructed and taught in order to ensure that future bioethicists do not discriminate misconceptions, such as one you brought up about black Americans are distressed of the medical research in the medical system, generally because of the Tuskegee. Bioethics, I don't want to use this language frankly, but bioethics owes much to the history of medicine. I think the more you know about the history of medicine, the more powerful a case you can make a bioethics, the more sophisticated, you know, your observations can be, the more details you can add. And a lot of people in this country, including a lot of people in history of medicine aren't knowledgeable about the role of African Americans in the history of medicine. I think that has to be brought to the forefront. It needs to be inculcated in the history of medicine. I'd hate to see what happened with black history happened to history of medicine because now in school, I think it's a travesty. We teach black history think American history. That's wrong. There's one American history. It ought to encompass black history. There's one history of medicine in this country. It needs to encompass the experience of African Americans. If that happens, I think we can't help but evolve better ways of addressing problems, because we will then have closer to the whole story. We'll really, we'll better understand why things are as they are the historical roots of the things we're facing and looking at them in historical context and including everybody in discussion will help us formulate better bioethical structures that will include all the information, not just from one group's perspective. Last and firing question. There's a question. Chloe Adams white. You mentioned that race is a social construct rather than a biological construct. However, I know in some cases there are differences that should considered when formulating medication or vaccines. That is the need for diversity in clinical trials. Okay, I didn't catch all of that something about formulating medicine. Pretty much she wants to know, should clinical trials be formulated different based off of biological construct. No. And I think that the assumption that they need to be is based on some really broad illogic you don't really have to be a scientist to understand it. A lot of the discussion and argument around quote unquote personalized medicine that is actually racialized medicine. If you look at it logically. Basically, it's not personalized medicine. All it's the exact opposite of personalized medicine, you know, it's stereotype medicine. And the fact that people will say that there's support for it. You can find support for it very often testifies to the fact that they're either looking at to narrow a spear. Or they're making certain assumptions. For example, I've seen repeatedly the assumption made that a biological difference is found between two groups is due to race. You don't know that it might be due. You know, you're saying it might be due to race when in reality. So groups that have very different exposures to an environmental contaminant or groups that have very different diets are very, you know, if you're not looking at these other criteria, then you're not going to see anything but the criterion that you're focused on that happens all too often. And also an assumption that a biological difference is genetic happens a lot too. So you look at biological data and try to translate it to genetics without realizing that a lot of the problem is looking at groups of people like African Americans and assuming that being African American is the most important thing about them might not be. It might not be the most important factor that unites them. And in fact, it might not be uniting them at all except in your front through your lens. So you should be really careful about basic logic in first collecting these data and then processing them instead of like making time warm time honored assumptions that may not actually be accurate. But let's bring this to not a in but a pause and, and this was powerful powerful powerful. Michael panelists, please close and thoughts closing comments. I'd like to thank you to Harriet. You know, you're you're a voice for so much of the truth that has not been adequately explored or expressed and it's a real privilege to be able to learn from you. Thank you. Thank you that means a lot. Thank you so much. Got two other panelists. Anyone else want to hear your voice. I just wanted to just send another note of gratitude to you miss Washington I remember reading your book and that was the catalyst to me joining this field of study, because I saw another black woman was talking about it and and I definitely felt motivated after I read your book to apply to this program and here I am speaking to you sharing that with me. Made my day. Thank you. Of course. Hello, Professor Washington. My name is David Hodge I work with Dr Warren at the National Center for bioethics at Tuskegee and some of you some of the students and I keep that you see here in the moderator moderators box, host box, and a host of other students from the community right now so this has been a very, very important conversation we really appreciate your name has become a tremendous metaphor for this conversation with medical ethics. So we appreciate that there's no way for us to talk about Dr Warren Sims and all Tuskegee all have yet to lax without crossing path with the work that you've done so we have tremendous appreciation for what you have done, and what you continue to do you, you have overwhelmed us today. Thank God this is on, this is on Facebook is also on YouTube but we'll be on YouTube. So I'm certain that many of us will be able to not look at it again, but can use as a teaching tool for our students so thank you thank you thank you for representing so well today. I appreciate that. I remember my time at Tuskegee very fondly. So, it's really good to hear. We are very proud that you you shared some time with us as well. Miss Keaton, I know you have something that's closed this session out. Thank you again, and also I would say that this is encouraging message to continue to make an impact in the community, and to learn more about. Thank you. I would like to close by thanking you again and just sharing how proud we are of the work that you're doing. It travels all over the world, and we couldn't have started this this month off with a better speaker with a better topic and with with the kind of intriguing conversation we're having. So this is I hear the sound of another book coming so. Again, thank you so very very much. Thank you. And I'd like to again thank all the people who participated we had almost 300 people. Oh, yeah, we so we started off being and we're going even higher and my colleagues at the Harvard Bow Ethics Center and at Tuskegee, we've only just begun so again, I'm closing this session out and with with a wonderful thank you and we appreciate you very very very much. It's been a deep honor Dr Warren thank you will be in touch no doubt. Alright. Okay, and for all of you who have been listening, listen on we'll be here this time. Next Wednesday, same time. Another powerful conversation. And we're focusing on the US Public Health Service surface study at Tuskegee. What are the, the dissident family members. It's going to have a conversation with us as well as a. So it's going to be a good conversation. Yes, yes indeed. Alright, so all all hearts and minds are clear. And we thank everybody and we'll talk to you this time. All right, right.