EMILY KWONG, BYLINE: Ready.
MADDIE SOFIA, HOST:
Hey, everybody. It's Maddie Sofia.
KWONG: And Emily Kwong.
SOFIA: All this week, we'll be celebrating and recognizing the scientific contributions of Black researchers.
KWONG: That's right. Today is a new episode. But for the rest of the week, we'll be re-airing some SHORT WAVE favorites, featuring scientists in entomology, aka insect studies...
SOFIA: Engineering...
KWONG: Virology...
SOFIA: And materials science - talking to Black scientists who are not only advancing their fields but challenging who gets to be a part of science and who science is really meant to serve.
KWONG: It's going to be a great week. Here's the show.
SOFIA: You're listening to SHORT WAVE from NPR.
KWONG: So Maddie, let me ask you - as a kid, what did you want to be when you grew up?
SOFIA: Ooh, definitely a veterinarian.
KWONG: Nice. I wanted to be a Broadway actress, I think.
SOFIA: Oh, same thing as you're doing right now pretty much.
KWONG: (Laughter) None of this came true. When Owen Garrick got asked that question, however, there was no doubt in his mind what he wanted to be.
OWEN GARRICK: I always wanted to be a doctor since I was a kid - taking care of people, helping folks go from being unhealthy to healthy, making my grandparents proud - that sort of thing.
KWONG: Like a lot of kids, Owen squirmed as he got his flu shot. But he also saw the logic in it.
GARRICK: It's not like shots are fun. Well, they weren't fun for me. But I somehow just thought - hey, this must be a good thing. It's keeping me healthy; it's keeping other people healthy.
SOFIA: Yep - that sounds like a future doctor to me.
KWONG: Indeed. Owen attended Yale medical school, loved his time there. He was one of 10 Black students in the class of 1998. So 10% of his graduating class was Black.
SOFIA: Which is higher than today's national average of Black students in medical schools, right?
KWONG: Oh, yeah. And that's what we're going to talk about in today's episode - diversity in medicine.
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KWONG: Though Black people make up 13% of the U.S. population, they represent only 5% of physicians and less than 6% of medical students. And now as the CEO of Bridge Clinical Research, Owen wanted to investigate the link between this lack of diversity among doctors to health disparities experienced by Black communities in the U.S. - higher rates of death and disease.
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KWONG: Owen wanted to know what could be done about that in the very place where a person gets their medical advice - a doctor's office.
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GARRICK: You have this generally accepted principle of the importance of diversity in the health care profession but not a lot of empirical evidence.
KWONG: So today on the show, we go to the doctor's office...
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KWONG: ...And look at the role Black doctors play in reaching patients in their communities, which can have long-term impacts on their health.
SOFIA: This is SHORT WAVE, the daily science podcast from NPR.
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SOFIA: All right, Emily Kwong, today we're going to California to spend time with Dr. Owen Garrick. His study named Does Diversity Matter? Experimental Evidence from Oakland (ph) was published last year. Where do you want to start?
KWONG: OK. Let's pick up where we left off with health disparity. There are many reasons for it, like lack of medical access, lack of insurance. But for some folks, they also mistrust doctors. Throughout history, medical institutions have exploited or neglected communities of color. In a video about their research, Owen and his colleague Dr. Marcella Alsan talk about one of the most egregious examples the Tuskegee Study in which syphilis treatment was withheld from Black men so they could be studied by scientists working for the U.S. government.
SOFIA: Right. And we don't have to reach back to Tuskegee to identify reasons for mistrust.
KWONG: No.
SOFIA: There are many well-documented cases of racist practice by doctors. We can look back to last week, last month, last year.
KWONG: Yeah. Legal hospital segregation went unchallenged until the 1960s, and there's still de facto segregation in some hospitals today. There's obviously been gains towards equal access, but the point is that history is woven with examples for why this lack of trust is earned. Medical mistrust is a real term, and it's more prevalent among folks from racial and ethnic minorities, including Black men.
SOFIA: Right. So let's talk about how this lack of trust plays out.
KWONG: Right. So doctors, we see them for more than just broken wrists and chickenpox. Right?
SOFIA: Yeah.
KWONG: They diagnose preventable and chronic conditions as we get older, like cardiovascular disease or cancer or stroke. And if you don't trust your doctor, you won't see that person as often, and you'll miss out on these routine things.
GARRICK: So going to the doctor annually, getting your screenings, getting flu shots.
KWONG: When those services aren't pursued or accessible, health disparity is inevitable. In the U.S., Black men don't live as long as non-Hispanic white men - by one estimate, 4 1/2 years less.
SOFIA: Wow.
KWONG: Yeah. And most of this gap in life expectancy is attributed to chronic diseases like high blood pressure, diabetes or a delayed cancer diagnosis.
SOFIA: Right. So just the kinds of conditions where early screening or checkups could really save your life.
KWONG: Exactly. And so with this connection in mind between health disparities and prevention medicine, Owen and his collaborator Dr. Marcella Alsan began to wonder how they might make it easier for Black men to go to the doctor and get preventative care.
GARRICK: The big question is, does the race of the doctor matter in terms of his ability to encourage and actually get Black men, in our case, to increase their uptake - so to do more of the services which are all recommended?
SOFIA: So basically, does having a Black doctor improve health outcomes for Black men?
KWONG: Yes, that was the research question driving Owen, Marcella and economist Grant Graziani. They took this on through a clinical study called the Oakland Health Disparities Project.
SOFIA: OK. Tell me about it.
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KWONG: Well, first, they had to recruit hundreds of Black men to participate in this study. Setting out in Oakland, they found some success at flea markets but the most success recruiting at Black barbershops.
GARRICK: If you go to my barbershop, you have people like me and my kids sitting next to whoever's next. And that could be someone well-educated, wealthy; it could be someone who's not.
KWONG: They offered study participants coupons to receive care at a clinic they set up on Saturdays just for the study and staffed by doctors. Some of the doctors at the clinic were Black, and some were white, others Asian American.
SOFIA: Gotcha - so some Black doctors and some non-Black doctors.
KWONG: Yes. And over 600 Black men voluntarily came to the clinic for care.
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KWONG: So they got there. They were given a tablet which showed a picture of the doctor they'd be seeing. And that doctor was randomly assigned by the researchers. The next screen would let them choose from a menu of five different preventative care services - BMI measurement, blood pressure screening, diabetes screening, cholesterol screening and a flu shot.
SOFIA: I mean, that's a pretty wide variety of services.
KWONG: Yeah. They - the researchers wanted to include some that were more invasive than others. So to calculate BMI, doctors just measure your height and weight. But with a cholesterol screening, it requires a prick of blood. And the flu shot is, of course, the flu shot.
SOFIA: Yeah, a little more invasive but over very quickly.
KWONG: Yes. Here's what's interesting. When these patients were shown a picture of their doctor, it didn't seem to impact what services they chose, whether they opted for the flu shot or not. But once the doctor walked in the room and started to treat the patient, that totally changed. And Owen was stunned by the data he got back.
GARRICK: I remember thinking - all right, we need to double-check this 'cause this is pretty serious. This is really surprising.
SOFIA: Ooh, I know that feeling. What did they find out? (Laughter).
KWONG: Well, Black doctors were 20% to 26% more successful at getting their patients to take those more invasive preventative services...
SOFIA: Wow.
KWONG: ...The ones that can really save your life. Black doctors were 71% more likely to get their patients to receive a cholesterol screening, whereas non-Black doctors were 45% as likely.
SOFIA: Wow. I mean, those are pretty big differences, Kwong. Like, I can see why Owen wanted to check his data.
KWONG: Yeah.
SOFIA: So what factors in the research made Black doctors so much more successful at connecting with their patients?
KWONG: This is the part of the study that most interests me. It boiled down to better communication between the doctor and the patient but in these really nuanced ways. Sessions with the doctors weren't recorded, and neither the patient nor the doctor knew the study was about racial matching. It was a double-blind study.
SOFIA: OK. Got it.
KWONG: But in the hallways, as patients were getting their height and weight measured, the researchers noticed the conversation between Black doctors and Black patients flowed more openly.
GARRICK: You know, they were talking a lot about nonhealth matters - birthday parties that were coming up, weddings, et cetera. In fact, I think some of the Black physicians even got invited to a few weddings.
SOFIA: Aw, Kwong, that's really nice.
KWONG: Yes. In fact, some of the doctors and patients have apparently stayed in touch.
Anyway, this open communication about nonmedical things, it was even reflected in the notes - the notes that the Black doctors were taking. They were jotting down, this patient's kid has a birthday coming up or they have this transition in their life, their job, et cetera.
GARRICK: One of the, if not the main reason for this difference was that there was more communication, more trust, a closer bond, as it were, you know, being developed in that short interaction compared to the non-Black physicians.
KWONG: And that makes sense, right?
SOFIA: I mean, totally. With a doctor you trust, you open up more, which gives the doctor more of a full picture of your health. And you know, like, maybe you're more likely to follow their recommendation.
KWONG: Absolutely. And Maddie, all of that was borne out in the study. It's not that non-Black physicians did a bad job. They just weren't as successful getting through to their patients. And to be clear, Owen isn't advocating for segregation in medicine. What he's advocating for is having more Black doctors in the workforce period.
GARRICK: The medical community changes its behavior based on strong evidence. It's not just the right thing to do emotionally or spiritually or morally, but it's the right thing to do for your patients. Because we can show it leads to better health outcomes.
SOFIA: Yeah. I mean, they made a data-driven case for just how important it is to make sure there are more Black doctors.
KWONG: Exactly. Now, while the paper has been well-received by the medical community, it will take a lot more than that at the med school level for anything to change.
GARRICK: It takes time to, like, create a Black doctor. Right? So you have to go through four years of medical school, you know, three, four years residency training. So you're talking, you know, eight years before you can actually begin to move that needle.
KWONG: And of course, we don't have that kind of time. These mortality gaps persist. COVID-19 is disproportionately affecting Black and Latinx communities. So I wondered, with the workforce we have, can non-Black doctors be trained to improve trust with their Black patients? And Owen said this.
GARRICK: I think they're going to have to be. Right?
KWONG: Owen believes that more data and training of non-Black physicians to spot their own biases as they treat diverse patient populations can make a difference. But it won't push the needle nearly as much as hiring a workforce that actually matches the population. The last sentence of the study reads, quote, "Given the current supply of Black doctors, a more diverse physician workforce might be necessary to realize these gains." So there is a lot of work to do.
What keeps you going doing the work, knowing that - as you uncover more and more of these gaps?
GARRICK: You know, what keeps me - there are a few things that keep me going. One, you know, you have these inflection points where you have, you know, some success. So I think our publication and our findings in this study I would define as success.
KWONG: Yeah.
GARRICK: The other part is, you know, I'm still part of this community.
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GARRICK: If anything, my family keep me going - right? - and my friends because I want to make sure that it's not just, you know, the very theoretical underserved or Black or Hispanic patient. Right? These are friends and family members. And I look at it as more as, are you around to enjoy a grandchild's wedding or graduation from high school and college? Right? So living a healthier, longer life affords, you know, more of those personal interactions. So those are the things that, you know, for me, keep me going.
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SOFIA: Today's episode was produced by Rebecca Ramirez, edited by Viet Le and fact-checked by Brit Hanson.
KWONG: Tune in tomorrow, where we'll be continuing this series celebrating the contributions of Black scientists and engineers.
SOFIA: I'm Maddie Sofia.
KWONG: And I'm Emily Kwong.
SOFIA: Thanks for listening to SHORT WAVE from NPR.
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