 This is Democracy Now, democracynow.org, The Quarantine Report. All right, well, welcome to those of you in the room. Thank you for participating in person for those of you on Zoom. Lovely to have you on our Zoom and we will be monitoring questions over the Zoom chat as we have in the past. So really excited to welcome you to the McLean lecture series on gender equity and ethics. And today, as you know, we have Dr. Monica Peek, one of our internal speakers, talking with us and we're really excited to have her. And I will go ahead and introduce her now and get her started and then I'll summarize the future of our winter quarter series at the end of her talk. So Dr. Peek is the LNH Block Professor of Health Justice, the Associate Vice Chair for Research Faculty Development in the Department of Medicine and Executive Medical Director of Community Health Innovations, the Associate Director of the Chicago Center for Diabetes Translational Research, and the Director of Research slash the Associate Director of the McLean Center for Clinical Medical Ethics. Her renowned health services researcher, bioethicist and internist focused on health equity. Her research concentrates on promoting equitable doctor patient relationships among racial minorities, integrating medical and social needs of patients and addressing the impacts of structural racism on health outcomes. She has published extensively on social determinants of health, health disparities and healthcare education. Dr. Peek has served on the National Advisory Council of the Agency for Healthcare Research and Quality, the National Executive Council of the American Diabetes Association, the National Council of the Society of General Internal Medicine, and the International Board of Directors for Physician and Human Rights. She was a planning committee member of the National Academy's workshop series on evolving crisis standards of care and lessons from COVID-19. She helped develop the COVID-19 crisis standards of care for the state of Illinois and was a member of Mayor Lori Lightfoot's Racial Equity Rapid Response Team. She is a consultant to CME Outfitters where she leads nationwide innovative design to provide health equity education to clinicians. Dr. Peek received her MD from Johns Hopkins University, her MPH from Hopkins University, and earned her MSc from the University of Chicago. In 2022, Peek was elected to the National Academy of Medicine, which is considered to be one of the highest honors in the field of health and medicine. So welcome, Dr. Peek. We're excited to have you today. Thank you so much for the invitation. And I'm really excited to be here. So I am, for those of you who came to the McLean Conference, it's pretty much the same talk. Just a little slower, and I've added some slides. For those of you who didn't, then this will be all new and interesting, hopefully. And so I'll also try and keep it an eye on time. We have until 1.15 or so. Okay, so most of the series is about gender. And I think I may be one of the only ones who are doing taking an intersectional approach and thinking about gender and race. And so, so I'm going to be focusing on black women, but there are a lot of people who sit at lots of different intersections of gender and other marginalized identities. What I'm talking about could apply to lots of other people who carry around multiple marginalized identities and how that may relate to clinical ethics. So I first always want to start by just acknowledging and thanking the places that I sit on campus. Many of our all of which Julie name, thank you. It's a pleasure to be able to work in so many different capacities here at the university with so many colleagues. So I always also like to start with a definition of clinical medical ethics. And that is so just a level set and that's a medical field that helps patients, families and health professionals reach good clinical decisions by taking into account the medical details of the situation, the patients personal preferences values, socio economic considerations, and ethical concerns. It examines the practical ethical concerns that arise routinely and encounters amongst patients, families, health care professionals and health care institutions. So it is not only what happens between patients and clinicians at the bedside, but is also considering all of the things in their lived experience and the concerns that come out of the ethical concerns that sort of arise from those situations. So again I was I mentioned at the beginning that I'm taking sort of an intersectional approach and so what does that mean the term intersectionality was coined by Kimberly Crenshaw who is not like someone from way in the past she's alive and well and still writing she's a current scholar. And she talks to this this comes out of a body of black feminist thought. And but she talks about the combination of intersecting systems of oppression that perpetuate discrimination and disadvantage, based on factors such as race class sex and gender identity. But again, we have multiple social identities, and there can be multiple ways in which these identities intersect. And we know that that people who have who are multiple marginalized let's say, for example, black trans women that group has gotten a lot of public attention nationally recently are probably right now the most marginalized population in the country are at increased rates of homelessness so much hate crimes and violence against them. And it's not just because of one of their identities is because of all of their identity sort of combined at one time. And so people who have more than one marginalized social identity are at more than just the usual risk of health disparities both mental and physical. And so social identities are important for lots of reasons they're not just who we are and expressions of who we are and, and how we manifest in the world but they also reflect the amount of social power that we have and that's important, because it helps us navigate smoothly or less smoothly in the world, and that translates into health outcomes that's why I'm talking about it as a physician. And so these are again just a list of some of the kinds of identities that people carry in the ones that I'm talking about today, race, ethnicity, and gender, and also gender identity, although I'm going to focus on gender. And there's also obviously sexual orientation, a ability or disability age immigration status indigenous persons or nationality primary language income class, so many others. And again, it's important because of its, it's ties to social power. I know that the inequities in our society are not sort of randomly occurring, they occur specifically across fault lines, based on these marginalized social identities. So who is more likely to be on the wrong side of the power, or to be on the fault line for these inequities are those who have less social power. So, if you are of a race that has more social power, then you're going to have fewer inequities that you face. And so, so again these things are more than additive. And so that's why they're important. My father was a black history professor. And so I grew up understanding not just the importance of history in general, but the importance of everything having a historical context, and to always be contextual and to always be historical no matter where you are. And so, as a health services researcher as a bioethicist as a clinician. I'm also a historian. I passed away in 2015, but I felt he would be really proud of me that my day to day life so much of what I do is what he did as a history professor is talk about history, because it really informs who we are today as a country, so much today as a country and it can tell us where we're going. And particularly if we don't have that sense that we are if we are operating in a vacuum, and if we're acting a historically like we somehow just landed here. Then we're bound to make the same mistakes. And one of the things that I think is most frightening is that our country is really trying to make sure that we're a historical. We are trying to make sure that children don't read an accurate sense of history that we're actively trying to erase our history. And that is something that other countries have not chosen to do when thinking about their own history and trying to learn from their mistakes as a country, and I think it's particularly dangerous for us as a country. Back to thinking about this intersection of race and gender for black women in our country in the south. There is this history, this bizarre history of sex crimes that really has put racial equity and gender equity at odds with each other. And what I mean by that is that black and white people have been having sex for hundreds of years. What was routinely happening is that the white masters were having sex with the women, raping the women and having offspring who would then be slaves. A lot of times those slaves would live in the house and, you know, have a better standard of living. And that has created sort of this sense of colorism that has perpetuated today. Because the lighter skinned slaves had more advantages, they had an easier life, they had more access to resources than the darker skinned slaves who had to work out in the field in a hot sun, backbreaking labor. And so the closer you were to whiteness, the more advantages you have. And that colorism persists across this country and across the world because the same kinds of racial oppression or colonization have exist across the world. But what but those kinds of sexual activity those weren't crimes that was just business as usual. It was considered a crime when black men had sex with white women that almost never happened, but it was talked about in such a way that you thought it was happening all the time. When it happened. It was usually because like men that because black people had no control over their own bodies, they weren't willing to risk getting killed for you know they were the enslaved. It would be because the master's wife would order a man to come have sex and if they were caught then she would say oh my God I've been raped and then the man would get killed. So these. So that became a sex crime. After slavery, when there was really no motivation to value black lives, because during slavery lives had a black people had a monetary value on their life because they were enslaved and to be brought, bought and sold. And then that is when you saw the rise of the clan of a lot of militia of a lot of pushback to try and keep black people back in their place who were trying to just be free. Right. And so the government the federal government was trying to help build a lot of schools and help, you know, educate freed slaves and get them into government and they were promised 40 acres in a mule I'm sure you probably heard about that. Nobody got that. And the white people were actively trying to keep any of that for happening, and they were terrorizing all other black people. And one of the ways they did this was by frequently saying that black men had been raping white women as an excuse for lynching them. I mean, and causing terror in the community. And so these these these fabricated sex crimes. That were a major source of tension. And so, white moms often use these dubious criminal accusations to justify the, the very frequent lynchings, and a common claim was used. The claim used to lynch black men was the perceived sexual transgressions against white women charges of rape were routinely fabricated these allegations were used to enforce segregation and advance the stereo type of black men as violent hyper sexual aggressors. These, this here is a picture of Emmett tell, and the woman who accused him who's still alive, as far as I know. And recently, in the past, I don't know, five to 10 years she admitted that she lied that she was not telling the truth when she said that he had whistled at her, just the whistling at her got him killed. Emmett Till was not from the south. He was from Chicago, lived right around here. And so his mother was not trained to live in the south to, you know, put her head down and to accept those circumstances she said oh no. I am going to let the world know what just happened to my son. And so there was she called all the national newspapers, everybody came she had an open casket. And that was like an international shock and sensation to see exactly what happened and what was happening in the south to black people for the crime of whistling at a white woman, which actually hadn't even happened. And so it was in that spurred, you know, a lot of activity and emotion and so these kinds of things that, you know, set the foreground for the civil rights movement. But this link or this this being at odds of the power that white women had over the lives and well being of black communities, black men in particular but the entire black communities. And so those two communities at odds for generations, and that power persists today. And so the example is that the two Cooper's unrelated Christian Cooper, the birder, who was in Central Park, and Amy Cooper, the non brooder, who was there with her dog unleashed, and Christian said can you put a leash on your dog because I'm trying to watch the police said, I'm going to tell them I'm going to call the police, because, you know, I know what police do to black men, if I call them and tell them that there's an African a man threatening my life, and she did call the police. Thankfully, unlike many times that we've all seen on TV. He was not beaten to death he was not arrested he was not shot without questions being asked he managed to you know get away with with his life. He ended up, you know having her dog taken away temporarily she was fired from her job but that situation almost never happens like that. She entered that situation because she knew that all the cards were in her favor for her having a good outcome, and for him having a very bad outcome. So that power dynamic is one that persists today, and one that has made it a challenge for black women who are facing both sexism and racism to fully be a part of social movements that are fighting both of those things. We think about the sort of the context because we people and patients bring all of that with them to the clinical encounter, and we do as well as physicians. And so when we think about. So we'll start with sort of racism within the gender movement within anti sexism. And so the women's suffrage movement had a lot of black women that were in it. To be at the back of the marches and to be quiet in the marches. And I had, I'm a member of Delta Sigma Theta sorority we were very prominent. We're very proud that we were part of the suffrage movement type, not me personally, but my sorority was, and we have all these, you know, historical pictures black and white photos just like that of us, you know, being part of, but what we don't have pictures sort of being at the back of the line, you know we don't nobody wanted to see that we just have these photos of us being present, but we were asked, like everyone else was, like the headquarters of colored women voters were to be quietly involved in the movement and to not speak up. And that was in 1851 that sojourner truth spoke out at the Ohio women's rights convention and said, you know, we're women to aren't I, it was later transcribed into the ain't I a woman speech but her first language was French and so she probably wasn't a woman but anyway, she was making the claim that I'm also a woman who is fighting for women's rights to vote. Why is it that I'm not allowed to speak freely about this issue, because of the color of my skin. So the way back when, all the way up to, you know, issues of the me to movement. And are thinking about that primarily as a, you know, starting out as sort of a white women's actress movement and then everyone else saying hey that happened to me me to me to, but not fully addressing the women who have been most marginalized and probably most victimized who had the least amount of voice during those processes and those are women of color. We don't hear their voices as much as part of that movement. And then this is Angela Davis who most of us remember when she was young and vibrant and had the big afro and the big, you know, hoop earrings. She is still alive and kicking and still talking about, you know, solidarity and socialism. As she had said in Madrid, you know feminism is going to have to make a choice. We're either going to be anti racist or we're not who we cannot keep this kind of hedging our bets and you know whatever we know we understand that there is a lot of power associated with being white. There's a lot of power and privilege, but at some point, we're going to have to say in solidarity with all of the women color women of color around the world that we're going to, you know, have to be anti racist, or, like, or or not, you know, and so that that tension is something that has always been there. It has also been historically some sexism within the anti racism movement. And so this is a film that was made in Berlin, sort of highlighting some of the black women that were really critical to the civil rights movement it's called reflections on her black women in the civil black women and civil rights and it talks about some of the lesser known stories of black women's political organization between the sort of male dominant black power movement and the predominantly white and middle class feminist movement during the 1960s and 70s. And the resulting mobilization and sort of coming together of black women and other women of color. And that's how the term womanist came out, as opposed to feminist sort of this alternative theoretical way of being. All right, so now I'm going to tack a little bit. Now that we have sort of our historical and contextual framework for thinking about how these things have historically affected people in their lives have been at odds with these, how these things then come to impact patients and physicians. We always think that physicians, once we put on our white coat. This is pink but that we, you know, are doing the very best we can, and we are trying, but you know, there's just such a huge body of evidence that we all have biases, every one of us myself included. And if we just take that implicit association test we'll find out which ones we have. And not only that, but how we work and where we work puts us at increased risk for using those implicit biases, because it's the time pressures, the high the high cognitive demand, the uncertainty, we don't have all the answers. Okay, care everywhere has made that easier than when I was a resident and it was 3am and you couldn't get the records faxed over. We still have limited resources, but it's still that, you know, it's a race against time to get the right answer with people who, you know, may be sedated or the family's not there or they don't speak the language and you don't have the interpreter. So how do you get to the right answer with not all the right information, and you have to make a decision. And so we, a lot of times will rely more heavily on what we think might be happening, and what we think might be happening may bear no resemblance at all to what is happening. But it's those stereotypes and biases that are for baked into how we have learned to think about people and populations that come to the front. So there's this study that was done in the New England Journal of Medicine, like 20 years ago. Not using real people just pictures of people and that the right answer was to recommend to recommend people who the chest pain and these ekg and echo findings for cardiac catheterization. If you were black, you had 60% of the odds of being recommended for a cat. If you were a woman, you had 60% of the odds of being recommended for a cat. But if you were a black woman, compared to the white man, you had only 40% of the odds of being recommended for cardiac catheterization and so that's really important to be able to see that interactive effect of race and gender. But what we have an extreme shortage of now are studies that actually look at the interactive effects of race and gender, which you'll see when you look at the titles of studies will say age, and I'm sorry they'll say race and gender, of, you know, this kind of cancer, but what they'll do is do black versus white differences, and male versus female differences, but they won't look at the interactive effects of race and gender, almost never. And I actually just looked again today to make sure that there wasn't like a whole bunch of literature that just came out. And so we really, really need to be able to look more carefully. Because there is an interactive effects. We do know that you know black women do worse, but we don't have as rich of a body as we should have. Because we're not looking we're not stratifying our analysis by both race and gender. And when we're doing regression models we're not doing interactive effects by race and gender, as frequently as we could and should. So this was a study a qualitative study by Tina sacks who was a PhD candidate here and ssa and she wrote a book. And so this is what Amazon says about her book. It challenges the idea that race and gender discrimination, particularly in healthcare settings is a thing of the past, and that questions. The persistent myth that discrimination only affects poor racial minorities. And so doing the book expands our understanding of how black middle class women are treated when they go to the doctor, why they continue to face inequities and securing proper medical care, and what strategies they use to fight for the best treatment. So this enter class into the equation. So we have race and gender but we also have class. So this is important for several reasons. One is to say that, despite where you are along the class spectrum. You are still going to be exposed to racism. And when you, when we do studies and look at people who report the most racism. It is frequently the people who are the highest SES, because we're like, Well, it can be that I'm poor because I'm not, you know, so it's not that I don't have insurance or income or that my clothes are shabby or that I smell bad or that I'm homeless or that, you know, like, like, okay, what, what else is left other than my brown skin or black skin, you know, and so it's usually the upper middle class to higher class persons are higher income persons that are more likely to report discrimination and racism than those of the lower income populations because there's so many things that could be working against them to be causing poor treatment. The other thing that I just want to put out there because a race and class are so frequently entangled and people are like, you know, if we could just disentangle them, you know, black people could just stop being poor. We could just get that, that, you know, that poverty out the way, then black people would be the same as whites. So like when you adjust for class, many of the differences go away. Many of them do go away. But what I would argue, and what is important, again, is for us not to be a historical. How is it that those two got so entangled in the first place is because we started out enslaved with no money and worked that way for 400 years, and then had no money to give for intergenerational wealth. And that there are laws and policies put in place to give money for GIs who are white, but not black, and that there are laws to keep black people in these poor little neighborhoods that had no resources that there, you know, there's just been a machine that had been built and has kept running to crush the lives hopes and dreams of, you know, black and brown people to this day, you know, and so that is why black people disproportionately are more poor, and you cannot disentangle the two. And so to only, you know, to adjust out for income is to adjust out for one of the major mechanisms by which racism works. And so yes, it would be great if black people could just stop being poor, but that takes more than just black people pulling themselves up by the bootstraps. It takes an addressment of systemic inequities. It takes an undoing of that machine that has been clobbering us for, you know, decades for hundreds of years, in order for that to happen. And so I, that's my little pet peeve. So I'm sorry. But I just have to say that. That, you know, that class is a huge thing, and that as scientists and health services researchers were frequently so quick to, you know, adjust for class and adjust for income and adjust for, you know, these things when for education when so frequently, they are the means by which marginalized people are kept oppressed. This is a study that was done and I apologize for not including the citation of obesity race and class in the United States. So this is all women. And what we see on the bottom line is that the higher income women have lower BMIs and the lowest income women have the highest BMIs and then middle in the middle so that makes sense. And when we, oops, wrong way. When we look at black and white women, there's a little bit of a difference. So the white one on the top. And you see that in general, their pattern is pretty much the same that the lower income women have the highest BMIs the richer women on the bottom. So when we look at the black women, what you'll see is that the low income women have sort of a flattening sort of a flat lining, and that the middle and high income women continue to increase so that over time they have bypassed the low income women and become much more obese than the lower income women. And so there are factors other than class that are contributing to the obesity epidemic amongst middle and high income women who are African American, and that they are significantly more obese than white women. Part of this may be that a lot of interventions have been targeted towards low income black women. Part of this may be the additional perceptions of stress, and we know how perceptions of racism and stress change the physiology. And those perceptions are more likely to occur in upper income women as I just mentioned. There are probably a lot of reasons to unpack this, but I just wanted to show it to you. I think it's very interesting. So this is a research study that was just done a year and a half, a year, yeah about a year and a half ago, and it looks specifically at black white disparities in women's physical health and the role of socio economic status and racism related stressors and again keep in mind as I just said about socio economic status. And so we know that there's significant disparities in black and white health outcomes for women, part of which is explained by SES or class. And what this study did was it added measures of racism discrimination over criminalization adverse neighborhood conditions, etc. And those two together accounted for 90% of the disparity and self rated physical health. So for those of you who are not health services researchers. We use self rated physical health, not just because it's like easy to survey because it is, but because it's also been validated against real morbidity and mortality, with the exception perhaps of my own mother who's a hypochondriac. So for most people, if you asked them about if you asked them to rate their own health as, you know, fair, good, you know, very good or excellent that actually matches with what will happen. Currently and in the future, as far as their own morbidity and mortality. Same thing with mental health. So it is easy to do easier than like looking in everyone's electronic medical record, but also is a valid assessment tool, someone's health. So if you looked at the measures by a survey of do you have these kinds of chronic diseases they didn't ask an exhaustive list. It accounted for 50% of the disparity and the prevalence of the diseases that they did ask. So this is a table that no one can read, but does show in the top the box the chronic health conditions and the fair slash poor reported physical health status, and that they were statistically significant. And then this is a study that looked at perceived discrimination and health related quality of life, gender differences between older African Americans. So we're looking at gender differences between people of the same race. And this was some of our friends in town Lisa Barnes right at Rush, Elizabeth Dickens used to be here here at USC and then at rush and then now she's, I don't know where she is now since she's in Maine. More women reported in a poor overall health related quality of life than men, and that higher perceived discrimination was related to worse overall health rate health related quality of life with stronger effects for women. Overall, and in mental health related quality of life, although there were no gender differences found in physical health related quality of life. So we see that there, there's evidence of gender related differences within a race. There's evidence of race related differences within a gender for black women. And then we know sort of the historical context of why some of that might be one of the things I want to talk about. Because many of our guests have, I'm sure talked a lot, or we'll be talking about gender and methods and how that works is, why does how wide is racism cause poor health that's usually like a whole lecture in itself. I got one slide. Lots of lots of mechanisms but limitations to access to healthcare and health promoting goods and services, like healthy food, excellent schools, opportunities for education, etc. Those things that are, you know, we call structural racism, limited access to healthy environments, neighborhoods, safe and stable housing. Think about all the houses without the lead paint, and the kids eat in the paint, and then what that does for their cognitive development. Think, and so like Baltimore, Chicago, all of these old houses filled with lead paint. And when I moved into my condo with my kids, they weren't of paint eating age but you know there's lead dust around and I asked and I asked the people, could I test the water and the, you know, whatever for lead paint, and they're like, you can test if you want, but we're not making any changes. The offer is like, are you trying to kill my children, like, I couldn't even believe it. No, anyway, they want to come back and visit. Anyway, congratulations on getting into Nam. Anyway, so we think about what happened in Flint, Michigan, right, all that horrible water that people have been drinking all that time. You know, people need parks and recreation. There's always some breaking news story about toxins, there was one recently, you know, causing all this cancer and of course the company is always saying that there are no health risks, so we don't know anything about that. And then there's a health study that just showed like 10,000 people just died and you know, those are always in marginalized communities, very poor communities, usually communities with lots of immigrants or poor people black people who don't have social capital to say no, don't do this, you know, that would never happen in the middle of Lincoln Park, you know, but it will happen in Pilsen, as it did, right. It will happen in Gary, Indiana, as it did. And so these limited access to healthy environments is one of the ways that structural inequities and structural racism causes poor health. And then just the exposure to the acts of chronic discrimination, and not just like the egregious things of like seeing George Floyd being murdered, you know, or your grandfather being lynched. Those are, those are, those are the major occurrences, right. But it's actually the, the little things that happen every day, getting followed around in the store because they think you're trying to steal. Can I help you? Can I really, really can I help you? You know, someone cutting in front of you in line, you know, so I have had to have my hand act like a crowbar, but I was here first. I'm like this is like something I routinely, why is that something I have had to make a part of my routine life, you know, where people act like I'm so invisible. I'm a whole person standing right here that they cannot see me. They cannot value. They look right through me and will walk right past me. This is 2022. You know, and I have to say excuse me, I'm next still to this day. You know, and so those kinds of things. Two people have the same seat on the plane. I'm the one who has to get ejected. I, you know, all of these things. And one time I will never forget this day I was here in Chicago I had four of those things happen to me in one day. The last being me almost getting ejected from my plane seat as I was leaving from Chicago and I was like I think I'm gonna have a stroke. I don't have blood pressure, but like, I know discrimination causes these horrible things and you know. So it changes your biology. It changes your pathophysiology. All that chronic stress changes your hippo always start and then your HPA axis. It changes your inflammatory state your, your autonomic system just all of your, your, your things that increases your cortisol, your C reactive protein, and there have been so many studies. And so it leads to things like all of the things that I see in practice that Julie sees in practice that Deb sees in practice that Vinnie sees in practice, obesity, hypertension, diabetes, cancer, all these chronic diseases what I've just come to call the diseases of oppression. Because of how they change our body. It also changes our DNA. And there was a study that came out last year or the year before that showed that some of the methylation methylation changes in our DNA that happen can occur those same changes can show up not only in our babies, but in our babies babies can be three generations out. And so when we wonder what happens when people leave their poor environments, but their children are still having problems. And then their children are still having problems like what is happening. It can be that the, the, the imprint of all of this racism and poverty and trauma on people tracks with their family over generations. So it's a lot. Then, what we're supposed to be talking about today is the differential treatment the implicit or explicit bias within healthcare. And that is something that again, regardless of your class, black women are faced with. So we have these high profile cases of people like Serena Williams who postpartum was pro-thrombotic and had a DVT and a PE. But her nurse said that her nurse said that she was crazy. You have a famous patient. You can call them anything, but you're not supposed to call them crazy. Right. We all know how you're supposed to treat like high, important people. Anyway, she almost didn't get worked up for her pulmonary embolism. We're thankful she's still alive, because she had to advocate for herself. But we will, for those of us who've seen King Richard, she knows and was taught by her father how to be a good advocate for herself. Right. And she had to be a tennis player because that is that is a crazy field. And so she advocated for herself and got herself treated. This Dr. Moore, probably nobody know about her except for her patients, but became high profile because she put herself on Facebook right before she died. And so if you haven't heard about her, we are all going to listen about her story, because she was talked about on Democracy Now. And so this is a five minute clip that I'm going to This is Democracy Now, democracynow.org, The Quarantine Report. I'm Amy Goodman. As the United States reports, world record deaths and hospitalizations from COVID-19 in the final days of 2020. We look at how the pandemic that's ravaged the country this year has shown stark new light on racism and medical care. Let's begin with a now viral video recorded by black physician Dr. Susan Moore and posted to her Facebook earlier this month, in which she describes racist treatment by medical staff at a hospital in Indianapolis who did not respond to her pleas for care, despite being in intense pain and being a doctor herself. Dr. Moore says she had to beg to receive the antiviral drug remdesivir and pain medication and accuses a doctor at Indiana University Health North Hospital of ignoring her pleas because she was black. This is Dr. Susan Moore. As she summoned the energy to speak from her hospital bed days before she would die, she had an oxygen tube in her nose. At that time, I don't even see two treatments of the remdesivir. He said, ah, you don't need it. You're not even short of breath. I said, yes, I am. Then he went on to say, you don't qualify. I'm lost because I've gotten two treatments. Then he further stated, you should just go home right now. I'm not giving you any more narcotics. I wasn't so much pain from my neck. My neck hurts so bad. I got a drug addict and he knew I was with me wanting, which I can do. So I started asking, send me to another hospital where they can treat me. If they're not going to treat me here properly, send me to another hospital in a stat, a T, of my neck with and without contrast. The CT went down a little bit into my lungs and you could see new pulmonary infiltrates, new lymphadenopathy all throughout my neck. And all of a sudden, yes, it will treat your pain. You have to show proof that you have something wrong with you in order for you to get the medicine. I put forward and I maintained. If I was white, I wouldn't have to go through that. The other thing that that white Dr. Bannick said was that if I stayed, that he would send me home Saturday at 10 p.m. in the dark. Who does that on a week? Who does that? This is how black people get killed when you send them home and they don't know how to fight for themselves. I had to talk to somebody, maybe the media, somebody to let people know how I'm being treated up in this place. And he gladly told me, I know you're a doctor. And he didn't want the black doctor to have no medicine, nothing. And then I had the nerve to say it's because I am the nurse that I got the medicine. Really? Because of you? No. How about it because I had that stat CT in my neck where it showed all of that lymph adenopathy in infiltrates? That's what I said. This is what happens. Dr. Susan Moore died due to complications from COVID-19 on December 20. Just over two weeks after she recorded this video and posted it to her Facebook page, she was 52 years old. Her 19-year-old son Henry Muhammad is now left to care for her parents who are both suffering from dementia. The president and CEO of Indiana University Health issued a statement in response to her death, saying the technical aspects of the treatment she received, quote, may not have shown the level of compassion and respect we strive for in understanding what matters most to patients, unquote. Dr. Moore's chilling message has been compared to the video of George Floyd begging for his life as he was killed by Minneapolis Police. When we come back, we'll speak to two leading black women doctors fighting racial disparities in health care. They co-wrote a piece in The Washington Post titled, Say Her Name, Dr. Susan Moore. Stay with us. This is Democracy Now!, democracynow.org. I need some technical assistance. This one? No. My son is my IT support. He's only 14. So thank you, Julie. So in the past, in so these last two cases, both Serena Williams and with Dr. Moore, what they complained most about initially was their communications with their health care team, right? And so that finally gets us into the realm of shared decision making, clinicians, ethics. But all of this we have to know is coming with us into that room with us. So we think about shared decision making as having sort of three components, information sharing, deliberation about the pros and cons, and then making a decision about treatment and having an implementation plan. And for medical students, I always just say it's really your soap note, where you're thinking about the subjective, the O is really not as relevant, the assessment, and then the plan for each of these parts of the soap note. It's not just you writing things down. It's you having a bi-directional conversation with a patient and you sharing your thoughts about what is happening. So it's not patients like the doctor came in, but I still don't know what's going on. They're running some tests. Can you tell me what's going on? Which is unfortunately, infrequently, how patients feel about their care. Well, this is a model that tries to sum up what I've been talking about for the past hour, which is that there are patients and I'm pointing at my screen like you can actually see it. Is there a pointer? The mouse is a pointer. Oops. All right. This is beyond my skill level. Oh, so if I do it like, okay, I'm just going to let you guys follow along with what I'm saying. So you have a patient and a provider. They have these little things inside them, which represent all of their social identities. And they have to look at each other through these lenses, these normative lenses that color their perceptions of what they're seeing and hearing about the person that's sitting in front of them. We ultimately want the patient and provider to trust each other and their decision making preferences impact whether or not they'll share in that decision. But part of the goal is to have them listen and hear accurately what the person is trying to actually communicate. And part of that is through building trusting relationships that sort of in safe spaces. Here in the middle, there's shared decision making going on. And if that actually happens, it can enhance things that you see trust is all over this. It can enhance trust people's self confidence that they can do the plan, their satisfaction with care of their understanding about their disease and can lead to patients actually being more inherent to the plan of care and managing their disease can lead to more patient centered who has delivered more job satisfaction and culturally human culturally cultural humility and culturally competent care, which both can increase and improve health outcomes for marginalized patients. And so patients are sitting within this first little darker blue bubble of the Kent the clinic, but that clinic is sitting someplace in the in a community, and that community is sitting someplace within the society of what is happening in the world today. And that clinic has a black man just been shot and it's on the news and everyone's talking about it, you know, is a Supreme Court about to come down and weigh in on Roe v Wade, as they did, you know, what is happening in the world around race and gender that are impacting how our patients are going to hear what you're trying to tell them. What baggage are they carrying with them from from their lived experience that impacts what they think you're saying, or trying to say. And how can we as providers do a better job of listening to them and their stories, hearing what they're trying to tell us and form better alliances with them to improve their care. So, this is Dr. Siegler's famous four box method to approach ethical decision making that people go over in case conferences. And I mentioned this because it still hasn't come out yet. But there is a paper coming out in the Journal of Clinical Ethics. Peter maybe you know sadness. I don't know. It's in. Oh, soon. Okay. Because this journal is now housed here at the University of Chicago. And so it is. So this is not it this is still the standard four box method, but it's an expansion of this that tries to incorporate the sense of thinking about how structural racism, and other elements like that can impact not just sort of the contextual features, but how they may interact with the medical indications patient preferences and quality of life all of the processes in ways that are important for us thinking about the ethical case at hand, and make us more sensitive to the true ethical issues that are going on. This is a figure that is from a paper a review paper that Monica Vela led that we just found out like last week was one of the top 100 review papers in that journal so it's been sort of around on Twitter again we're super excited Monica Vela is wonderful. She was here for years and is now doing wonderful work at UIC. And really, it's talking about implicit bias and how that works in healthcare systems. I think we need individual physicians, and that we can do our best, but really what we need to do to be able to continue to do our best for patients is to have a life, you know, outside the health care system that is addressing the social and structural determinants of health within the community and the workplace, so that people can have the financial means equal access to health care, education, healthy green spaces, plentiful healthy foods low rates of violence, equally spaced and healthy, you know, protections in the workplace low rates of incarceration, lots of exercise language that's concordant when they come into health care they can have all of the things that it needs to be mentally and emotionally healthy. You know, everyone should have that. Right now, only some of us have that. And so when only some of us have that they come into the health care system already with so many more advantages. I was just somehow every time I give a talk, I end up crying. I was texting with one of my closest friends, who is like this famous journalist, we grew up in the same small town. And turns out he texted me and he's like, Oh, I've got to, you know, leave on Thursday and I have these symptoms. I think I need tamo flu and some antibiotics and I was like, you know, older horses like what's going on. I said, I think you need these tests, go to the urgent care turns out he's got COVID. But, you know, so I helped manage him through all the things because many of the doctors didn't want to order some of the tests he needed. And he needed the treatment and he's like the doctor was trying to send me away without it and I said go find the doctor. You have you know risk factors that make you, you know, and so he's like, you know, it is so scary when you're sick, and you go to the doctor. You know, think about how many people look like us, but they're not famous like you, or they don't have a doctor like me on speed diet. And this is just one of the fraction of the ways that our people are getting killed in the health care system that's supposed to be taken care of them. You know, and so we need all the good things outside of the health care system, which we don't have. And so we need all of the best treatment. Once we get inside the health care system. And then we may have a chance at health equity. We may have a fighting chance. So I'm going to end there. Just reminding us about what clinical medical ethics is. And encouraging us all to remember to be historical and contextual when we see our patients to think about not only the experiences that they have lived through, but what their parents and their parents have lived through. History is a strange thing. You know, when you're very young, 10 years ago, seems like a lifetime away. You know, I was born in 1969, like right around the time that, you know, King and, you know, all these people were getting shot. And but it seemed like the civil rights movement was like something in the 1900 1800 you know just like so far away. You know, but the older I get I realized what just a wrinkle in tying. This has been, you know, how much progress what we have made, but how fragile that progress has been, and how quickly it can be eroded. We've already learned that lesson with Roe v way. And there are other lessons that many people are ready to teach us around racial equality, given the opportunity. And so I'll stop there because I always like to leave time for questions and I'm supposed to stop officially at 115 so we have 10 minutes for questions. If you always cry I'm always inspired by your talks every time I learned something from you and it really helps me grow as a clinician so I really appreciate that. And the one thing I was thinking from this talk is I had really not heard the term colorism before and I was just thinking to my reflecting on my practice and wondering like how does that affect health care does it, you know, how should I be more aware, you know as a physician so I don't know if you have perspective on that that that concept of colorism and how it, you know, gets into health care. You know, there was a study that was done I don't know who did it. I was listening to it on NPR. And they were saying that darker skin person. If they are like wearing all the symbols of like, you know, a Gucci bag step out of a Mercedes like, you know, like an affluence, and they have, you know, a beautiful face and they, you know, whatever, but if their skin is dark. They will still associate them with poverty with being dirty with crying with all of these other things, more so than with someone who was lighter skinned and may have none of those associations. There's a study that Kamara Jones did many years ago. That looked at the difference again in self reported health between minorities who looked like minorities and minorities who looked like they were white, because you know, there were many who especially right after slavery who could pass for white and he did. He had to make that and there's a movie about that Netflix, who made very difficult choices to leave their families behind for their own opportunities. And those people had much better health than the minorities who looked like they were black, significantly better health, not as good as those who are white. But significantly better than those who are darker skinned and looked like they were black. And it's a reflection of what happens when other people see you and react to the color of your skin and how you look. So we can take questions in the room. We can take questions on zoom I can facilitate anybody in the Q amp a any other questions in the room that we can. Yeah, Dr. I'll repeat for the people on zoom so Dr. Congratulations for her Martin Luther King University Chicago honor I'm not sure the exact title and then we're just saying as we recognize the history of Martin Luther King day. How can we like keep the that history alive when it's you know kind of being attacked in all sizes. I'm sorry that was a very short summary of a very eloquent question. Yeah, you know I think the it's the hands on deck and everybody's work, all this is, and what I think have found is fascinating is that like Netflix has gotten in the game. Right. You know, they're making all these movies and documentaries and things about history and like an entertaining way. You know is is another way of teaching outside of the classroom. And so I was like and so when my kids were learning you know the 13th and 14th amendment and I went back and was telling my son study. I had all this information I was learning all these details you know the so and so in Missouri compromise and I was with somebody in clinic and I just felt like I had a share you know like this. Did you know you have this information you want to share they're like no I just, you know, but um, but I say that to say I don't even know what, but I think that that. So, everyone has a role to play, so that for me, what black people have always done is teach our own kids our own history at night, I still when my kids are 14. Lay with them at bed at night before they go to sleep and talk about black history and we read, you know black history every night, because they're not going to get what they need in school. And I think that we, you all have done a great job with like changing the way that the sixth floor looks, you know intentionally. And, you know, institutionalizing our current history. I think the more we can institutionalize things and make them not one offs but a true part of the curriculum as the curriculum is changing. It's a, it's a great opportunity. So, you know, and then the data supports so many things, you know, around patient centered care around, you know environments that don't have implicit bias for all learners. You know, there's so much compelling data around racism harming us all dragging us all down, right, not just the marginalized. Including the poor white people, right. But anyway, so I think that's continuing. What what fortifies me is like having my, my, my various tribes might my, in my band of warriors. And continue to just to do the work in spite of and continue to fight until until we can't. And even when we're not supposed to. You know, Martin Luther King always talked about, you know, doing what is morally right, even if it's legally wrong. You know, because so many things have been legal that were wrong that we needed to change. And when Trump was in office he was trying to make a number of things legal that were morally wrong. And right now we have some things that are legal that are morally wrong. And as positions we are going to eventually have to start making some very difficult personal choices that are political. And so we have some tough roads ahead of us. Any other questions. All right, well I just want to thank Dr peek again for a wonderful talk and I'll just remind you all that we are in our middle of the winter series and we have the next few weeks will be virtual next week is a panel on allyship with chicken Jane and two of her male colleagues. And then still is also is coming virtually about thriving in medicine, navigating adversity and healthcare the week after that. Starting on February 8 we'll be back in person so two weeks virtual and then back in person for the rest of the winter quarter so Dr Humphrey, and then Lady Ross is coming back. Monica can be switched with her but looking forward to having everyone there but one last thanks to Dr Pete for a wonderful time. I'm going to stop the recording and we'll have the ethics fellows come down to the front. Let me do this recording thing first. Actually maybe I'll let me I'm actually maybe I'll let be different on a stop the recording so that doesn't record here but if the ethics fellows when I come down to the front will just have that same informal discussion with Dr peak that we have with the rest of the speakers. I think that's not what didn't happen but I mean the recording thing is there so I don't know. That's not the recording.