1 00:00:05,760 --> 00:00:10,120 I'M ALAN SCHECHTER, AND I 2 00:00:10,120 --> 00:00:14,640 WELCOME YOU TO THIS LECTURE IN 3 00:00:14,640 --> 00:00:17,400 THE BIOMEDICAL LECTURE SERIES 4 00:00:17,400 --> 00:00:22,720 SPONSORED BY THE OFFICE OF NIH 5 00:00:22,720 --> 00:00:23,320 HISTORY. 6 00:00:23,320 --> 00:00:24,960 WE ARE VERY PLEASED TO HAVE AS 7 00:00:24,960 --> 00:00:26,840 OUR SPEAKER TODAY DR. OTIS 8 00:00:26,840 --> 00:00:29,920 BRAWLEY, WHO IS THE BLOOMBERG 9 00:00:29,920 --> 00:00:30,560 DISTINGUISHED PROFESSOR OF 10 00:00:30,560 --> 00:00:32,160 ONCOLOGY AND EPIDEMIOLOGY AT 11 00:00:32,160 --> 00:00:33,520 JOHNS HOPKINS, WHO WILL TALK TO 12 00:00:33,520 --> 00:00:35,240 US TODAY ON THE EVOLUTION OF 13 00:00:35,240 --> 00:00:36,760 MINORITY HEALTH RESEARCH. 14 00:00:36,760 --> 00:00:38,760 BEFORE I GO FURTHER ABOUT 15 00:00:38,760 --> 00:00:41,840 TODAY'S TALK, AND DR. BRAWLEY, 16 00:00:41,840 --> 00:00:43,880 I'D JUST LIKE TO MENTION THAT WE 17 00:00:43,880 --> 00:00:48,720 ARE VERY PLEASED THAT AN 18 00:00:48,720 --> 00:00:49,920 INDIVIDUAL WAS RECENTLY 19 00:00:49,920 --> 00:00:52,760 DESIGNATED AS THE OFFICIAL NIH 20 00:00:52,760 --> 00:00:54,720 HISTORIAN, STARTING I THINK NEXT 21 00:00:54,720 --> 00:00:59,160 WEEK, DR. KIM PELLIS, WHO HAS 22 00:00:59,160 --> 00:01:00,680 BEEN A SENIOR STAFF MEMBER IN 23 00:01:00,680 --> 00:01:02,880 THE OFFICE OF THE NIH DIRECTOR 24 00:01:02,880 --> 00:01:04,440 FOR MANY YEARS, WHO WILL BECOME 25 00:01:04,440 --> 00:01:06,280 THE DIRECTOR OF THE OFFICE OF 26 00:01:06,280 --> 00:01:08,800 NIH HISTORY AND THE STETTEN 27 00:01:08,800 --> 00:01:09,680 MUSEUM VERY SHORTLY. 28 00:01:09,680 --> 00:01:12,520 BUT NOW LET ME RETURN TO TODAY'S 29 00:01:12,520 --> 00:01:16,240 TALK AND OUR SPEAKER. 30 00:01:16,240 --> 00:01:17,560 DR. BRAWLEY WAS TRAINED IN 31 00:01:17,560 --> 00:01:20,280 MEDICINE AT THE UNIVERSITY OF 32 00:01:20,280 --> 00:01:21,720 CHICAGO, AND THEN DID FURTHER 33 00:01:21,720 --> 00:01:22,920 INTERNAL MEDICINE TRAINING AT 34 00:01:22,920 --> 00:01:24,640 THE UNIVERSITY OF MICHIGAN 35 00:01:24,640 --> 00:01:28,760 BEFORE COMING TO THE NIH, THE 36 00:01:28,760 --> 00:01:32,840 NATIONAL CANCER INSTITUTE, IN 37 00:01:32,840 --> 00:01:36,560 1988, TO DO AN ONCOLOGY 38 00:01:36,560 --> 00:01:37,440 FELLOWSHIP, WHERE HE REMAINED 39 00:01:37,440 --> 00:01:39,320 FOR 13 YEARS, JOINING THE STAFF 40 00:01:39,320 --> 00:01:42,360 OF THE NCI. 41 00:01:42,360 --> 00:01:46,960 BUT IN 2001, HE WAS RECRUITED TO 42 00:01:46,960 --> 00:01:50,280 ATLANTA, TO EMORY UNIVERSITY 43 00:01:50,280 --> 00:01:51,560 SCHOOL OF MEDICINE, AS MEDICAL 44 00:01:51,560 --> 00:01:55,080 DIRECTOR OF THE GEORGIA CANCER 45 00:01:55,080 --> 00:01:58,440 CENTER, AND ALSO AS A SENIOR 46 00:01:58,440 --> 00:02:00,640 PROFESSOR IN THE ONCOLOGY 47 00:02:00,640 --> 00:02:04,160 PROGRAM AT EMORY. 48 00:02:04,160 --> 00:02:09,240 FROM 2007 TO 2018, HE WAS ALSO 49 00:02:09,240 --> 00:02:10,680 THE MEDICAL AND SCIENTIFIC 50 00:02:10,680 --> 00:02:13,280 DIRECTOR OF THE AMERICAN CANCER 51 00:02:13,280 --> 00:02:16,880 SOCIETY IN ATLANTA, AND HAD A 52 00:02:16,880 --> 00:02:18,960 VERY DISTINGUISHED TRACK THERE, 53 00:02:18,960 --> 00:02:21,640 BEING INVOLVED IN MANY DIFFERENT 54 00:02:21,640 --> 00:02:23,480 STUDIES, INCLUDING HEALTH 55 00:02:23,480 --> 00:02:28,120 DISPARITIES AND THE ROLE OF 56 00:02:28,120 --> 00:02:32,840 SCREENING IN DIAGNOSING AND EVEN 57 00:02:32,840 --> 00:02:33,440 OVERDIAGNOSING CANCER IN THE 58 00:02:33,440 --> 00:02:34,760 COUNTRY AND IN THE WORLD, IN 59 00:02:34,760 --> 00:02:36,360 FACT. 60 00:02:36,360 --> 00:02:39,440 IN 2018, DR. BRAWLEY LEFT 61 00:02:39,440 --> 00:02:41,880 ATLANTA AND CAME TO HOPKINS, 62 00:02:41,880 --> 00:02:43,960 WHERE HE IS A PROFESSOR OF 63 00:02:43,960 --> 00:02:47,640 ONCOLOGY AND EPIDEMIOLOGY AS I 64 00:02:47,640 --> 00:02:47,920 MENTIONED. 65 00:02:47,920 --> 00:02:49,720 HE ALSO HAS ROLES IN THE KIMMEL 66 00:02:49,720 --> 00:02:51,320 CANCER CENTER THERE, AND THE 67 00:02:51,320 --> 00:02:58,560 SCHOOL OF PUBLIC HEALTH. 68 00:02:58,560 --> 00:02:59,760 EARLIER THIS WEEK HE PRESENTED A 69 00:02:59,760 --> 00:03:02,720 TALK TO THE NIMH INNOVATIVE 70 00:03:02,720 --> 00:03:04,680 SEMINAR SERIES ON BEHAVIORAL 71 00:03:04,680 --> 00:03:08,720 EFFECTS ON CANCER INCIDENCE AND 72 00:03:08,720 --> 00:03:15,240 OUTCOMES, BUT TODAY'S TALK IS 73 00:03:15,240 --> 00:03:16,560 COMPLEMENTARY TO THAT TALK IN 74 00:03:16,560 --> 00:03:23,240 WHICH HE WILL TALK ABOUT HIS OWN 75 00:03:23,240 --> 00:03:24,560 THOUGHTS AND PERSPECTIVE ON THE 76 00:03:24,560 --> 00:03:26,080 EVOLUTION OF MINORITY HEALTH 77 00:03:26,080 --> 00:03:26,600 RESEARCH. 78 00:03:26,600 --> 00:03:28,720 IT'S GOING FROM VARIOUS TITLES, 79 00:03:28,720 --> 00:03:30,440 INCLUDING SPECIAL POPULATIONS 80 00:03:30,440 --> 00:03:35,920 AND HEALTH DISPARITIES TO ITS 81 00:03:35,920 --> 00:03:36,280 CURRENT FORM, WHICH HE WILL 82 00:03:36,280 --> 00:03:37,400 PRESCRIBE HISTORICALLY AND HIS 83 00:03:37,400 --> 00:03:39,240 PERSPECTIVES FOR THE FUTURE. 84 00:03:39,240 --> 00:03:40,720 IN THE MEANWHILE, I'D LIKE TO 85 00:03:40,720 --> 00:03:42,040 TURN THE SCREEN OVER TO 86 00:03:42,040 --> 00:03:44,040 PROFESSOR BRAWLEY FOR HIS TALK 87 00:03:44,040 --> 00:03:46,000 ON MINORITY HEALTH RESEARCH. 88 00:03:46,000 --> 00:03:46,640 DR. BRAWLEY. 89 00:03:46,640 --> 00:03:47,640 >> THANK YOU. 90 00:03:47,640 --> 00:03:49,440 I WANT TO THANK DR. SCHECHTER, 91 00:03:49,440 --> 00:03:53,720 MY OLD FRIEND DR. GOTTESMAN, DR. WANJEK FOR ARRANGING THIS. 92 00:03:53,720 --> 00:03:55,680 IT IS REALLY A PRIVILEGE TO BE 93 00:03:55,680 --> 00:03:57,040 HERE AND A PRIVILEGE TO TALK A 94 00:03:57,040 --> 00:04:00,840 LITTLE BIT ABOUT HISTORY AND THE 95 00:04:00,840 --> 00:04:01,000 NIH. 96 00:04:01,000 --> 00:04:06,200 I REALLY GREW UP AT THE NIH, AND 97 00:04:06,200 --> 00:04:07,440 REALLY BECAME A DOCTOR THERE SO 98 00:04:07,440 --> 00:04:08,440 I'M VERY FOND OF IT. 99 00:04:08,440 --> 00:04:10,800 I AM A PROFESSOR AT THE SCHOOL 100 00:04:10,800 --> 00:04:12,040 OF PUBLIC HEALTH AT JOHNS 101 00:04:12,040 --> 00:04:13,800 HOPKINS AND THE SCHOOL OF 102 00:04:13,800 --> 00:04:15,000 MEDICINE AT HOPKINS. 103 00:04:15,000 --> 00:04:16,720 IN ADDITION, I DO SOME 104 00:04:16,720 --> 00:04:20,000 CONSULTING BOTH FOR THE NIH, 105 00:04:20,000 --> 00:04:20,880 CDC, THE DEPARTMENT OF DEFENSE 106 00:04:20,880 --> 00:04:22,280 AND SEVERAL COMPANIES. 107 00:04:22,280 --> 00:04:24,480 NONE OF THIS TALK HAS TO DO 108 00:04:24,480 --> 00:04:26,320 ABOUT ANY OF THOSE EXCEPT A LOT 109 00:04:26,320 --> 00:04:29,840 HAS TO DO ABOUT THE NIH. 110 00:04:29,840 --> 00:04:34,440 I'M GOING TO TELL YOU RIGHT NOW, 111 00:04:34,440 --> 00:04:35,760 I WAS TAUGHT FROM AN EARLY AGE 112 00:04:35,760 --> 00:04:36,920 THAT YOU SHOULD LABEL THINGS 113 00:04:36,920 --> 00:04:37,960 WHAT YOU KNOW, WHAT YOU DON'T 114 00:04:37,960 --> 00:04:39,840 KNOW AND WHAT YOU BELIEVE, BUT 115 00:04:39,840 --> 00:04:41,040 QUESTION WHAT YOU KNOW MORE SO 116 00:04:41,040 --> 00:04:43,440 THAN ANYTHING ELSE, BUT QUESTION 117 00:04:43,440 --> 00:04:44,040 ALL THINGS. 118 00:04:44,040 --> 00:04:46,200 AND THESE ARE GOOD RULES FOR 119 00:04:46,200 --> 00:04:46,760 HEALTHCARE. 120 00:04:46,760 --> 00:04:48,520 AND I'M GOING TO APPLY THAT TO A 121 00:04:48,520 --> 00:04:50,040 FEW THINGS AS I MAKE A FEW 122 00:04:50,040 --> 00:04:53,360 COMMENTS DURING THIS TALK. 123 00:04:53,360 --> 00:04:54,560 WE'RE GOING TO TALK ABOUT THE 124 00:04:54,560 --> 00:04:56,280 EVOLUTION OF AN ACADEMIC 125 00:04:56,280 --> 00:04:56,640 DISCIPLINE. 126 00:04:56,640 --> 00:04:57,920 IT WAS FIRST CALLED MINORITY 127 00:04:57,920 --> 00:04:59,880 HEALTH BACK IN THE 1970s AND 128 00:04:59,880 --> 00:05:03,200 80s, AND THEN SPECIAL 129 00:05:03,200 --> 00:05:04,280 POPULATIONS HEALTH, IT EVOLVED 130 00:05:04,280 --> 00:05:07,120 INTO HEALTH DISPARITIES OR THE 131 00:05:07,120 --> 00:05:08,440 STUDY OF DISPARITIES IN HEALTH 132 00:05:08,440 --> 00:05:12,800 UNDER THE LEADERSHIP OF DAVID 133 00:05:12,800 --> 00:05:13,120 SANCHER. 134 00:05:13,120 --> 00:05:14,560 OTHERS HAVE STARTED CALLING IT 135 00:05:14,560 --> 00:05:15,840 HEALTH EQUITY AND IT'S NOW 136 00:05:15,840 --> 00:05:17,600 STARTING TO BLOOM INTO THE 137 00:05:17,600 --> 00:05:19,440 PHRASE "HEALTH JUSTICE." 138 00:05:19,440 --> 00:05:20,440 MORE ON THAT IN A BIT. 139 00:05:20,440 --> 00:05:21,760 WHEN WE TALK ABOUT HEALTH 140 00:05:21,760 --> 00:05:24,040 EQUITY, I WANT YOU TO THINK 141 00:05:24,040 --> 00:05:26,800 ABOUT THE FOLLOWING. 142 00:05:26,800 --> 00:05:29,200 EQUALITY IS EVERYBODY GETS THE 143 00:05:29,200 --> 00:05:30,520 SAME THING. 144 00:05:30,520 --> 00:05:32,920 EQUITY REALIZES THAT SOME 145 00:05:32,920 --> 00:05:35,640 PEOPLE, SOME GROUPS, SOME 146 00:05:35,640 --> 00:05:37,600 POPULATIONS WHEN WE'RE DOING 147 00:05:37,600 --> 00:05:39,080 HEALTH, MAY NEED A LITTLE BIT 148 00:05:39,080 --> 00:05:40,440 MORE THAN OTHER POPULATIONS TO 149 00:05:40,440 --> 00:05:44,040 GET TO WHERE WE ALL WANT TO BE. 150 00:05:44,040 --> 00:05:45,440 SOME PEOPLE MAY NEED A LITTLE 151 00:05:45,440 --> 00:05:48,080 BIT MORE. 152 00:05:48,080 --> 00:05:49,960 NOW, HOW CAN WE PROVIDE ADEQUATE 153 00:05:49,960 --> 00:05:52,280 HIGH QUALITY CARE TO INCLUDE 154 00:05:52,280 --> 00:05:54,240 PREVENTIVE SERVICES AND 155 00:05:54,240 --> 00:05:56,040 PREVENTIVE SERVICES ARE 156 00:05:56,040 --> 00:05:57,280 FREQUENTLY FORGOTTEN, IS ONE OF 157 00:05:57,280 --> 00:05:58,160 THE MOST IMPORTANT QUESTIONS 158 00:05:58,160 --> 00:05:59,440 THAT WE CAN ASK. 159 00:05:59,440 --> 00:06:01,640 HOW CAN WE PROVIDE ADEQUATE HIGH 160 00:06:01,640 --> 00:06:03,640 QUALITY CARE TO POPULATIONS THAT 161 00:06:03,640 --> 00:06:05,160 SO OFTEN DON'T RECEIVE IT? 162 00:06:05,160 --> 00:06:07,360 I WANT TO START OUT WITH A 163 00:06:07,360 --> 00:06:08,440 LITTLE HISTORY. 164 00:06:08,440 --> 00:06:14,120 REVEREND RICHARD ALEB ALLEN AND 165 00:06:14,120 --> 00:06:16,800 REVEREND ABSALOM JONES WERE TWO 166 00:06:16,800 --> 00:06:17,720 BLACK MINISTERS TOWARDS THE END 167 00:06:17,720 --> 00:06:19,480 OF THE 17 HUNDREDS LIVING IN 168 00:06:19,480 --> 00:06:20,040 PHILADELPHIA. 169 00:06:20,040 --> 00:06:21,280 THIS WERE ONLY ABOUT 50,000 170 00:06:21,280 --> 00:06:22,800 PEOPLE IN PHILADELPHIA AT THE 171 00:06:22,800 --> 00:06:23,640 TIME, ALTHOUGH IT WAS THE 172 00:06:23,640 --> 00:06:25,400 LARGEST CITY IN THE THEN EARLY 173 00:06:25,400 --> 00:06:27,400 UNITED STATES. 174 00:06:27,400 --> 00:06:29,040 IN 1793, THERE WAS A YELLOW 175 00:06:29,040 --> 00:06:31,440 FEVER EPIDEMIC. 176 00:06:31,440 --> 00:06:37,680 IT WAS BELIEVED WIDELY THAT 177 00:06:37,680 --> 00:06:40,240 BLACK PEOPLE, NEGRO PEOPLE, DID 178 00:06:40,240 --> 00:06:41,680 NOT GET YELLOW FEVER, THIS WAS 179 00:06:41,680 --> 00:06:43,120 ONLY SOMETHING THAT WHITE PEOPLE 180 00:06:43,120 --> 00:06:43,400 GOT. 181 00:06:43,400 --> 00:06:44,960 AS A RESULT, THERE WERE ALL 182 00:06:44,960 --> 00:06:49,360 KINDS OF REQUESTS THAT NEGROES 183 00:06:49,360 --> 00:06:51,200 COME AND NURSE THE SICK, BURY 184 00:06:51,200 --> 00:06:55,880 THE DEAD, AND SO FORTH. 185 00:06:55,880 --> 00:06:59,720 THIS WAS WRITTEN BY ALLEN ABOUT 186 00:06:59,720 --> 00:07:02,040 THE FACT THAT BLACKS ACTUALLY 187 00:07:02,040 --> 00:07:03,560 DID GET YELLOW FEVER. 188 00:07:03,560 --> 00:07:06,440 THIS WAS THE BEGINNING, AT LEAST 189 00:07:06,440 --> 00:07:08,880 THE FIRST THAT I CAN FIND 190 00:07:08,880 --> 00:07:10,480 DOCUMENTED WHERE THERE WAS THIS 191 00:07:10,480 --> 00:07:12,000 DIFFERENCE BETWEEN BLACK AND 192 00:07:12,000 --> 00:07:14,440 WHITE OR NEGRO AND CAUCASIAN 193 00:07:14,440 --> 00:07:15,640 BIOLOGY. 194 00:07:15,640 --> 00:07:17,840 AND THAT'S GOING TO BE A THEME 195 00:07:17,840 --> 00:07:23,280 FOR THE REST OF THIS TALK THAT 196 00:07:23,280 --> 00:07:24,400 WE HAVE BEEN STUCK ON THIS THING 197 00:07:24,400 --> 00:07:25,920 ABOUT RACE FOR SO LONG. 198 00:07:25,920 --> 00:07:27,040 NOW THIS HAS BEEN WRITTEN ABOUT 199 00:07:27,040 --> 00:07:28,360 A FEW TIMES. 200 00:07:28,360 --> 00:07:29,440 HARRIET WASHINGTON WROTE THE 201 00:07:29,440 --> 00:07:30,640 MOST AUTHORITATIVE BOOK THAT I 202 00:07:30,640 --> 00:07:33,160 KNOW OF CALLED "MEDICAL 203 00:07:33,160 --> 00:07:34,240 APARTHEID," AND IT TALKS ABOUT 204 00:07:34,240 --> 00:07:36,560 MEDICAL RESEARCH AND DIFFERENCES 205 00:07:36,560 --> 00:07:38,280 IN RACIAL TREATMENT OVER A 206 00:07:38,280 --> 00:07:42,400 PERIOD OF ABOUT 200 YEARS. 207 00:07:42,400 --> 00:07:44,360 ANOTHER WONDERFUL BOOK, "BAD 208 00:07:44,360 --> 00:07:45,360 BLOOD" BY JAMES JONES. 209 00:07:45,360 --> 00:07:48,320 THIS IS BAD BLOOD ABOUT THE 210 00:07:48,320 --> 00:07:49,520 TUSKEGEE SYPHILIS EXPERIMENT, 211 00:07:49,520 --> 00:07:53,360 NOT BAD BLOOD ABOUT THE COMPANY 212 00:07:53,360 --> 00:07:53,840 THERANOS. 213 00:07:53,840 --> 00:07:55,240 AND I WANT TO TELL YOU A LITTLE 214 00:07:55,240 --> 00:07:57,320 ABOUT THE TUSKEGEE SYPHILIS 215 00:07:57,320 --> 00:07:59,520 EXPERIMENT WHICH IS NOT REALLY 216 00:07:59,520 --> 00:08:02,040 APPRECIATED BY A LOT OF PEOPLE. 217 00:08:02,040 --> 00:08:03,440 FIRST, THE OFFICIAL NAME OF THE 218 00:08:03,440 --> 00:08:06,080 STUDY WAS THE STUDY OF UNTREATED 219 00:08:06,080 --> 00:08:08,280 SYPHILIS IN THE NEGRO MALE. 220 00:08:08,280 --> 00:08:11,880 AND BACK IN THE LATE 1920s, 221 00:08:11,880 --> 00:08:13,200 THERE WAS SIGNIFICANT SYPHILIS, 222 00:08:13,200 --> 00:08:14,400 ESPECIALLY IN THE SOUTHERN 223 00:08:14,400 --> 00:08:16,040 UNITED STATES. 224 00:08:16,040 --> 00:08:17,600 SYPHILIS CONTROL EFFORTS, WHICH 225 00:08:17,600 --> 00:08:20,080 WERE LARGELY SEX EDUCATION, 226 00:08:20,080 --> 00:08:21,560 IDENTIFICATION AND ISOLATION OF 227 00:08:21,560 --> 00:08:28,040 THE INFECTED, AND TREATMENT WITH 228 00:08:28,040 --> 00:08:29,640 MERCURIALS, OF ALL THINGS, WERE 229 00:08:29,640 --> 00:08:31,440 STYMIED BY THE DEPRESSION. 230 00:08:31,440 --> 00:08:33,440 MANY FELT THAT MONEY FOR 231 00:08:33,440 --> 00:08:34,080 SYPHILIS CONTROL, WHICH WAS 232 00:08:34,080 --> 00:08:36,040 SHORT, SHOULD BE SPENT ON THE 233 00:08:36,040 --> 00:08:38,000 WHITE POPULATION BECAUSE BLACKS 234 00:08:38,000 --> 00:08:40,240 DON'T DIE OF SYPHILIS. 235 00:08:40,240 --> 00:08:43,120 AGAIN, THIS THEORY THAT BLACKS 236 00:08:43,120 --> 00:08:44,840 ARE BIOLOGICALLY DIFFERENT FROM 237 00:08:44,840 --> 00:08:48,480 WHITES SUCH THAT AN INFECTIOUS 238 00:08:48,480 --> 00:08:50,040 DISEASE DOESN'T AFFECT BLACKS 239 00:08:50,040 --> 00:08:51,320 VERSUS WHITES. 240 00:08:51,320 --> 00:08:54,200 NOW, SOME OF WHAT I WILL CALL 241 00:08:54,200 --> 00:08:56,320 THE GOOD WHITE PEOPLE BACK IN 242 00:08:56,320 --> 00:08:58,440 THE LATE 1920s, ACTUALLY GOT 243 00:08:58,440 --> 00:08:59,640 INTO A LITTLE BIT OF TROUBLE 244 00:08:59,640 --> 00:09:00,960 WITH THEIR EXAGGERATION. 245 00:09:00,960 --> 00:09:04,440 THEY WOULD GO TO A 2 BY 2 BLOCK 246 00:09:04,440 --> 00:09:06,440 TENEMENT HOUSING PROJECT IN 247 00:09:06,440 --> 00:09:07,960 BIRMINGHAM, ALABAMA, TEST ALL 248 00:09:07,960 --> 00:09:11,400 THE MEN LIVING THERE FOR 249 00:09:11,400 --> 00:09:13,440 SYPHILIS, FIND THAT 25% OF THOSE 250 00:09:13,440 --> 00:09:15,080 MEN HAD SYPHILIS, AND THEN THEY 251 00:09:15,080 --> 00:09:17,680 WOULD SAY, SEE, WE DESPERATELY 252 00:09:17,680 --> 00:09:19,920 NEED TO SPEND MONEY ON SYPHILIS 253 00:09:19,920 --> 00:09:23,360 CONTROL IN THE BLACK POPULATION. 254 00:09:23,360 --> 00:09:25,400 25% OF ALL BLACK MEN IN THE 255 00:09:25,400 --> 00:09:26,160 SOUTHERN UNITED STATES HAVE 256 00:09:26,160 --> 00:09:27,520 SYPHILIS. 257 00:09:27,520 --> 00:09:29,440 AND THEN, OF COURSE, THE MORE 258 00:09:29,440 --> 00:09:31,520 RACIST WHITES WOULD SAY, YOU'RE 259 00:09:31,520 --> 00:09:34,200 MAKING OUR POINT. 260 00:09:34,200 --> 00:09:34,800 THEY'RE NOT DYING. 261 00:09:34,800 --> 00:09:39,640 SHOW US THE BODIES IF 25% HAVE 262 00:09:39,640 --> 00:09:40,040 SYPHILIS. 263 00:09:40,040 --> 00:09:42,520 SO WHAT ENDED UP HAPPENING WAS 264 00:09:42,520 --> 00:09:45,680 THE U.S. PUBLIC HEALTH SERVICE, 265 00:09:45,680 --> 00:09:48,840 CDC DIDN'T EXIST AT THE TIME. 266 00:09:48,840 --> 00:09:50,640 THE U.S. PUBLIC HEALTH SERVICE 267 00:09:50,640 --> 00:09:53,680 ORGANIZED THE STUDY OF UNTREATED 268 00:09:53,680 --> 00:09:54,640 SYPHILIS IN THE MEE GROW MALE. 269 00:09:54,640 --> 00:09:58,840 WE IN THE NEGRO MALE. 270 00:09:58,840 --> 00:09:59,840 WE WOULD CALL THIS A CASE 271 00:09:59,840 --> 00:10:01,720 CONTROL STUDY TODAY. 272 00:10:01,720 --> 00:10:04,240 IT COMPARED 399 MEN WITH 273 00:10:04,240 --> 00:10:06,320 SYPHILIS WITH AN AGE MATCHED 201 274 00:10:06,320 --> 00:10:07,280 MEN WHO DID NOT HAVE THE 275 00:10:07,280 --> 00:10:07,520 DISEASE. 276 00:10:07,520 --> 00:10:08,520 THEY WERE FOLLOWED OVER A PERIOD 277 00:10:08,520 --> 00:10:11,080 OF TIME TO SEE WHAT THE RESULTS 278 00:10:11,080 --> 00:10:12,080 OF SYPHILIS WAS. 279 00:10:12,080 --> 00:10:16,760 YOU SEE, IRONICALLY, THE 280 00:10:16,760 --> 00:10:18,400 TUSKEGEE SYPHILIS STUDY WAS 281 00:10:18,400 --> 00:10:19,280 DESIGNED TO SHOW THAT BLACK 282 00:10:19,280 --> 00:10:22,400 PEOPLE ARE LIKE WHITE PEOPLE. 283 00:10:22,400 --> 00:10:24,240 PARTICIPANTS UNFORTUNATELY WERE 284 00:10:24,240 --> 00:10:25,000 LIED TO. 285 00:10:25,000 --> 00:10:26,960 MOST WERE TOLD THEY HAD BAD 286 00:10:26,960 --> 00:10:28,480 BLOOD AND THEY THOUGHT THEY WERE 287 00:10:28,480 --> 00:10:30,440 ALL GETTING SOME KIND OF 288 00:10:30,440 --> 00:10:33,480 TREATMENT FROM THIS STUDY. 289 00:10:33,480 --> 00:10:35,400 IT WAS USUALLY VITAMINS. 290 00:10:35,400 --> 00:10:37,600 PARTICIPANTS GOT FREE MEDICAL 291 00:10:37,600 --> 00:10:39,520 EXAMS, FREE MEALS, BURIAL 292 00:10:39,520 --> 00:10:39,800 INSURANCE. 293 00:10:39,800 --> 00:10:42,400 THEY ALSO GOT TO DRIVE IN THE 294 00:10:42,400 --> 00:10:44,040 SHINY CARVE A BLACK NURSE WHO 295 00:10:44,040 --> 00:10:45,240 ORGANIZED THE ROUNDUPS. 296 00:10:45,240 --> 00:10:47,160 HERE'S A ROUNDUP WHERE MEMBERS 297 00:10:47,160 --> 00:10:50,120 OF THE STUDY WERE LOOKED AT ONCE 298 00:10:50,120 --> 00:10:50,600 A YEAR. 299 00:10:50,600 --> 00:10:52,640 THEY ACTUALLY HAD ROUNDUPS ONCE 300 00:10:52,640 --> 00:10:56,000 A YEAR FROM 1930 TO 1971. 301 00:10:56,000 --> 00:10:58,760 THEY GOT MEDICAL EXAMS, WHICH 302 00:10:58,760 --> 00:11:02,040 INCLUDED PAINFUL SPINAL TAPS, 303 00:11:02,040 --> 00:11:03,160 UNNECESSARY X-RAYs. 304 00:11:03,160 --> 00:11:05,040 I SHOULD NOTE THAT PENICILLIN 305 00:11:05,040 --> 00:11:06,400 BECAME THE TREATMENT OF CHOICE 306 00:11:06,400 --> 00:11:07,760 FOR SYPHILIS IN THE MID 40s, 307 00:11:07,760 --> 00:11:09,480 BUT THESE MEN WERE NOT TREATED. 308 00:11:09,480 --> 00:11:12,120 THE STUDY WAS ENDED IN 1972, 309 00:11:12,120 --> 00:11:13,840 AFTER THE ASSOCIATED PRESS 310 00:11:13,840 --> 00:11:15,280 PUBLISHED ARTICLES ABOUT IT. 311 00:11:15,280 --> 00:11:17,680 NOW THE STUDY WAS NEVER A 312 00:11:17,680 --> 00:11:18,120 SECRET. 313 00:11:18,120 --> 00:11:21,080 LOCAL DOCTORS WERE TOLD NOT TO 314 00:11:21,080 --> 00:11:24,040 TREAT THESE MEN IN 1936 AND 315 00:11:24,040 --> 00:11:25,080 BEYOND. 316 00:11:25,080 --> 00:11:26,320 RESEARCHERS KEPT THE MEN OUT OF 317 00:11:26,320 --> 00:11:27,520 THE DRAFT BECAUSE IF THEY WERE 318 00:11:27,520 --> 00:11:30,160 DRAFTED INTO THE MILITARY, THEY 319 00:11:30,160 --> 00:11:33,800 MIGHT BE DIAGNOSED AND TREATED. 320 00:11:33,800 --> 00:11:36,720 THE MAYCON COUNTY, ALABAMA 321 00:11:36,720 --> 00:11:38,160 MEDICAL SOCIETY, WHICH WAS A 322 00:11:38,160 --> 00:11:39,280 CHAPTER OF THE BLACK NATIONAL 323 00:11:39,280 --> 00:11:40,520 MEDICAL ASSOCIATION, ENDORSED 324 00:11:40,520 --> 00:11:42,840 THE STUDY IN 1969. 325 00:11:42,840 --> 00:11:44,360 THOSE OF YOU WHO REMEMBER 326 00:11:44,360 --> 00:11:47,280 HISTORY MAY RECALL THAT WE HAD A 327 00:11:47,280 --> 00:11:49,120 BLACK SURGEON GENERAL NOMINEE 328 00:11:49,120 --> 00:11:50,800 WHO LOST HIS NOMINATION BECAUSE 329 00:11:50,800 --> 00:11:53,520 HE WAS INVOLVED IN THIS, OR 330 00:11:53,520 --> 00:11:54,600 THERE WERE RUMORS HE WAS 331 00:11:54,600 --> 00:11:56,040 INVOLVED IN THIS. 332 00:11:56,040 --> 00:11:57,600 SEVERAL ARTICLES WERE PUBLISHED 333 00:11:57,600 --> 00:12:00,440 OVER THE YEARS IN MAJOR JOURNALS 334 00:12:00,440 --> 00:12:02,600 ABOUT THE TUS KEY GOA SYPHILIS 335 00:12:02,600 --> 00:12:04,040 STUDY. 336 00:12:04,040 --> 00:12:04,880 INTERESTINGLY, SEVERAL OF THESE 337 00:12:04,880 --> 00:12:06,560 ARTICLES WERE PUBLISHED IN 338 00:12:06,560 --> 00:12:07,920 PLACES LIKE THE JOURNAL OF THE 339 00:12:07,920 --> 00:12:08,840 AMERICAN MEDICAL ASSOCIATION. 340 00:12:08,840 --> 00:12:11,200 SO THAT GIVES YOU A LITTLE 341 00:12:11,200 --> 00:12:15,000 PICTURE AGAIN OF THIS BELIEF 342 00:12:15,000 --> 00:12:16,520 THAT BLACK BIOLOGY IS DIFFERENT 343 00:12:16,520 --> 00:12:19,320 FROM WHITE BIOLOGY. 344 00:12:19,320 --> 00:12:21,360 THEN OF COURSE WE GO INTO THE 345 00:12:21,360 --> 00:12:24,200 1960s, AND WE HAVE THE CIVIL 346 00:12:24,200 --> 00:12:26,600 RIGHTS MOVEMENT. 347 00:12:26,600 --> 00:12:27,680 THE CIVIL RIGHTS MOVEMENT 348 00:12:27,680 --> 00:12:29,320 BECOMES EVEN MORE OF AN 349 00:12:29,320 --> 00:12:30,640 APPRECIATION OF HEALTHCARE 350 00:12:30,640 --> 00:12:31,280 ISSUES. 351 00:12:31,280 --> 00:12:33,120 MANY PEOPLE DON'T REALIZE THAT 352 00:12:33,120 --> 00:12:37,200 IN THE 1960s, HOSPITALS WERE 353 00:12:37,200 --> 00:12:39,160 SEGREGATED BLACK VERSUS WHITE, 354 00:12:39,160 --> 00:12:42,280 SCHOOLS WERE SEGREGATED BLACK 355 00:12:42,280 --> 00:12:43,160 VERSUS WHITE, SCHOOLS INCLUDING 356 00:12:43,160 --> 00:12:45,800 MEDICAL SCHOOLS. 357 00:12:45,800 --> 00:12:48,080 IN THE 1970s, THE EARLY 358 00:12:48,080 --> 00:12:50,240 1970s, RICHARD NIXON SIGNED 359 00:12:50,240 --> 00:12:51,040 THE NATIONAL CANCER ACT. 360 00:12:51,040 --> 00:12:52,840 NOW THIS PUT A LOT OF MONEY IN 361 00:12:52,840 --> 00:12:55,200 THE CANCER RESEARCH AND 362 00:12:55,200 --> 00:12:57,400 REVITALIZED THE NATIONAL NATIONAL CANCER 363 00:12:57,400 --> 00:12:59,560 INSTITUTE, BUT IT ALSO CREATED 364 00:12:59,560 --> 00:13:01,400 SOME PROGRAMS THAT GAVE US MORE 365 00:13:01,400 --> 00:13:03,240 AND MORE INFORMATION ABOUT 366 00:13:03,240 --> 00:13:06,440 OUTCOMES, AND IT HELPED TO 367 00:13:06,440 --> 00:13:07,440 STIMULATE THE BEGINNING OF 368 00:13:07,440 --> 00:13:08,760 OUTCOMES RESEARCH, NOT JUST IN 369 00:13:08,760 --> 00:13:10,040 CANCER BUT IN OTHER THINGS. 370 00:13:10,040 --> 00:13:12,000 ONE ASPECT OF THE NATIONAL 371 00:13:12,000 --> 00:13:16,080 CANCER ACT WAS THE CREATION OF 372 00:13:16,080 --> 00:13:17,720 THE NATIONAL CANCER INSTITUTE'S 373 00:13:17,720 --> 00:13:19,160 SURVEILLANCE EPIDEMIOLOGY END 374 00:13:19,160 --> 00:13:21,520 RESULTS PROGRAM. 375 00:13:21,520 --> 00:13:23,520 IT, ALONG WITH SOME OTHER STATE 376 00:13:23,520 --> 00:13:27,240 REGISTRIES, THEN ALLOWED US TO 377 00:13:27,240 --> 00:13:29,320 ACTUALLY GET INCIDENCE AND 378 00:13:29,320 --> 00:13:30,080 MORTALITY DATA AND FIGURE OUT 379 00:13:30,080 --> 00:13:31,960 WHAT SURVIVAL RATE WERE, FIGURE 380 00:13:31,960 --> 00:13:35,080 OUT WHO WAS GETTING CANCER. 381 00:13:35,080 --> 00:13:36,520 ALSO EVEN DO SOME WORK ON WHY 382 00:13:36,520 --> 00:13:39,040 THEY WERE GETTING CANCER. 383 00:13:39,040 --> 00:13:40,640 THE SEER PROGRAM EXISTS TO THIS 384 00:13:40,640 --> 00:13:43,240 DAY AND HAS DONE SOME MARVELOUS 385 00:13:43,240 --> 00:13:44,040 WORK. 386 00:13:44,040 --> 00:13:46,760 ONE EXAMPLE OF WHAT THEY DID WAS 387 00:13:46,760 --> 00:13:48,080 PLOT MORTALITY BY RACE. 388 00:13:48,080 --> 00:13:52,240 AND HERE, YOU CAN SEE INTO THE 389 00:13:52,240 --> 00:13:56,000 1980s, THEY ONLY DID BLACK, 390 00:13:56,000 --> 00:13:57,040 WHITE, FROM 1975 ONWARD, AND YOU 391 00:13:57,040 --> 00:13:59,440 CAN SEE IN THE 1970s, 392 00:13:59,440 --> 00:14:00,840 INTERESTINGLY, THERE WAS NO 393 00:14:00,840 --> 00:14:04,240 DIFFERENCE IN BLACK OR WHITE 394 00:14:04,240 --> 00:14:05,680 MORTALITY FOR BREAST CANCER. 395 00:14:05,680 --> 00:14:07,560 FOR EVERY 100,000 BLACK WOMEN, 396 00:14:07,560 --> 00:14:10,840 IT WAS ABOUT 32 DEATHS A YEAR, 397 00:14:10,840 --> 00:14:13,120 FOR EVERY 100,000 WHITE WOMEN, 398 00:14:13,120 --> 00:14:15,680 IT WAS ABOUT 32 DEATH PER YEAR. 399 00:14:15,680 --> 00:14:16,760 THE SEER PROGRAM WHICH ACTUALLY 400 00:14:16,760 --> 00:14:19,040 GIVES US DATA USUALLY ABOUT 401 00:14:19,040 --> 00:14:20,640 THREE YEARS BEHIND. 402 00:14:20,640 --> 00:14:22,000 THE 2019 DATA IS COMING OUT 403 00:14:22,000 --> 00:14:23,640 RIGHT NOW. 404 00:14:23,640 --> 00:14:26,360 THE SEER PROGRAM DOCUMENTED 405 00:14:26,360 --> 00:14:29,520 INCREASING BREAST CANCER 406 00:14:29,520 --> 00:14:30,640 DISPARITY, BLACK VERSUS WHITE, 407 00:14:30,640 --> 00:14:32,000 FROM A TIME WHEN THERE WASN'T 408 00:14:32,000 --> 00:14:32,240 ONE. 409 00:14:32,240 --> 00:14:34,320 BY THE WAY, BY EXECUTIVE ORDER 410 00:14:34,320 --> 00:14:36,280 IN THE 1980s, RONALD REAGAN 411 00:14:36,280 --> 00:14:39,360 ORDERED THAT WE START COLLECTING 412 00:14:39,360 --> 00:14:41,640 AND PUBLISHING DATA FOR 413 00:14:41,640 --> 00:14:42,840 HISPANICS, NATIVE AMERICANS AND 414 00:14:42,840 --> 00:14:44,440 ALASKA NATIVES AND ASIANS, AND 415 00:14:44,440 --> 00:14:46,440 THAT'S WHY THE LINES FOR THOSE 416 00:14:46,440 --> 00:14:48,040 GROUPS START IN 1990. 417 00:14:48,040 --> 00:14:51,120 HERE YOU CAN SEE ALL THE WAY TO 418 00:14:51,120 --> 00:14:53,440 2015. 419 00:14:53,440 --> 00:14:56,240 BUT IN THE LATE 1970s, EARLY 420 00:14:56,240 --> 00:14:57,760 1980s, STARTING TO GET A SENSE 421 00:14:57,760 --> 00:15:00,680 OF SOME OF THESE DISPARITIES. 422 00:15:00,680 --> 00:15:03,400 NOW PATRICIA ROBERTS HARRIS WAS 423 00:15:03,400 --> 00:15:04,640 SECRETARY OF HEALTH EDUCATION 424 00:15:04,640 --> 00:15:07,080 AND WELFARE IN THE LATE CARTER 425 00:15:07,080 --> 00:15:07,640 ADMINISTRATION. 426 00:15:07,640 --> 00:15:09,040 SHE WAS ACTUALLY THE HUD 427 00:15:09,040 --> 00:15:10,440 SECRETARY BEFORE SHE WENT TO 428 00:15:10,440 --> 00:15:10,640 HEW. 429 00:15:10,640 --> 00:15:13,640 IT WAS CALLED HEW AT THAT TIME, 430 00:15:13,640 --> 00:15:15,240 FOR THOSE OF YOU WHO DON'T HAVE 431 00:15:15,240 --> 00:15:16,240 GREY HAIR. 432 00:15:16,240 --> 00:15:21,600 AND SHE STIMULATED SOME GREATER 433 00:15:21,600 --> 00:15:23,040 INTEREST IN STUDYING SOME OF 434 00:15:23,040 --> 00:15:24,440 THESE DIFFERENCES AMONG 435 00:15:24,440 --> 00:15:24,840 POPULATIONS. 436 00:15:24,840 --> 00:15:26,640 AT THAT TIME, IT WAS STILL 437 00:15:26,640 --> 00:15:28,240 CALLED MINORITY HEALTH. 438 00:15:28,240 --> 00:15:30,320 MARGARET MARY HECKLER WAS A 439 00:15:30,320 --> 00:15:33,480 REPUBLICAN CONGRESSWOMAN WHO 440 00:15:33,480 --> 00:15:36,280 PRESIDENT REAGAN APPOINTED TO BE 441 00:15:36,280 --> 00:15:37,440 SECRETARY OF HEALTH AND HUMAN 442 00:15:37,440 --> 00:15:38,320 SERVICES, EDUCATION HAD DROPPED 443 00:15:38,320 --> 00:15:39,920 OUT TO BE ITS OWN DEPARTMENT BY 444 00:15:39,920 --> 00:15:42,240 THIS TIME. 445 00:15:42,240 --> 00:15:45,040 AND MARGARET MARY HECKLER, OUR 446 00:15:45,040 --> 00:15:46,040 SECRETARY HECKLER WAS VERY 447 00:15:46,040 --> 00:15:47,880 INTERESTED IN THIS ISSUE, AND 448 00:15:47,880 --> 00:15:50,960 WITH THE ENCOURAGEMENT OF 449 00:15:50,960 --> 00:15:52,160 SEVERAL VERY PROMINENT BLACK 450 00:15:52,160 --> 00:15:53,120 PHYSICIAN, ONE OF WHOM YOU'LL 451 00:15:53,120 --> 00:15:56,520 SEE A PICTURE OF LATER, A MAN 452 00:15:56,520 --> 00:15:58,600 NAMED SULLIVAN, SHE COMMISSIONED 453 00:15:58,600 --> 00:15:59,240 THE HECKLER REPORT. 454 00:15:59,240 --> 00:16:01,120 AND HERE'S THE REPORT OF THE 455 00:16:01,120 --> 00:16:05,840 SECRETARY'S TASKS FORCE ON MY 456 00:16:05,840 --> 00:16:06,360 MORTGAGE HEALTH. 457 00:16:06,360 --> 00:16:08,320 THIS IS A GROUP OF PEOPLE WHO 458 00:16:08,320 --> 00:16:09,440 MET VERY MUCH LIKE THE SURGEON 459 00:16:09,440 --> 00:16:13,040 GENERAL'S TASK FORCE ON TOBACCO. 460 00:16:13,040 --> 00:16:16,200 THEY MET REGULARLY AND THEY 461 00:16:16,200 --> 00:16:17,960 PUBLISHED THIS VERY LARGE REPORT 462 00:16:17,960 --> 00:16:21,240 ABOUT BLACK AND MINORITY HEALTH, 463 00:16:21,240 --> 00:16:22,440 AND THIS REPORT ULTIMATELY 464 00:16:22,440 --> 00:16:26,160 CAUSED A NUMBER OF THINGS TO 465 00:16:26,160 --> 00:16:27,040 OCCUR. 466 00:16:27,040 --> 00:16:29,840 IT LED TO PIVOTAL LEGISLATION, 467 00:16:29,840 --> 00:16:31,440 FUNDING, POLICY, RESEARCH, AND 468 00:16:31,440 --> 00:16:33,160 INITIATIVES FOCUSED ON MINORITY 469 00:16:33,160 --> 00:16:35,800 HEALTH AND LATER HEALTH EQUITY. 470 00:16:35,800 --> 00:16:38,640 IT LED TO THE ESTABLISHMENT OF 471 00:16:38,640 --> 00:16:39,440 THE OFFICE OF MINORITY HEALTH, 472 00:16:39,440 --> 00:16:42,600 FIRST WITHIN THE DEPARTMENT OF 473 00:16:42,600 --> 00:16:54,240 HEALTH AND HUMAN -- THE NIH 474 00:16:54,240 --> 00:16:55,000 OFFICE OF MINORITY HEALTH UNDER 475 00:16:55,000 --> 00:16:59,440 THE LEADERSHIP OF JOHN ROFFEN 476 00:16:59,440 --> 00:17:01,760 ULTIMATELY BECAME AN INSTITUTE. 477 00:17:01,760 --> 00:17:03,880 NOW HERE'S LOU SULLIVAN, 478 00:17:03,880 --> 00:17:05,440 SECRETARY OF HEALTH AND HUMAN 479 00:17:05,440 --> 00:17:07,760 SERVICES IN THE GEORGE H.W. BUSH 480 00:17:07,760 --> 00:17:09,040 ADMINISTRATION, AND BEFORE THAT, 481 00:17:09,040 --> 00:17:11,160 WAS A MEMBER OF THE CANCER 482 00:17:11,160 --> 00:17:12,440 ADVISORY BOARD. 483 00:17:12,440 --> 00:17:17,920 HE WAS A REAL MOVER AND SHAKER 484 00:17:17,920 --> 00:17:19,360 IN THIS AREA OF MINORITY HEALTH. 485 00:17:19,360 --> 00:17:22,680 THIS TIME THE EMPHASIS WAS ON 486 00:17:22,680 --> 00:17:25,120 RACE, AND MINORITY HEALTH 487 00:17:25,120 --> 00:17:30,280 CULMINATED WITH THE 1993 NIH 488 00:17:30,280 --> 00:17:31,480 REVITALIZATION ACT, WHICH WE 489 00:17:31,480 --> 00:17:33,040 STILL LIVE WITH, WHICH SAYS THAT 490 00:17:33,040 --> 00:17:34,880 ALL NIH FUNDED PHASE 3 STUDIES 491 00:17:34,880 --> 00:17:36,960 SHALL BE DESIGNED SUCH THAT 492 00:17:36,960 --> 00:17:39,360 VALID SUBSET ANALYSIS CAN BE 493 00:17:39,360 --> 00:17:41,240 DONE BETWEEN THE RACES. 494 00:17:41,240 --> 00:17:45,000 HERE WE HAVE THAT SAME THEME OF 495 00:17:45,000 --> 00:17:47,840 RACE, RACIAL DIFFERENCES, AND 496 00:17:47,840 --> 00:17:48,920 BLACK-WHITE BIOLOGY BEING 497 00:17:48,920 --> 00:17:49,800 DIFFERENT. 498 00:17:49,800 --> 00:17:51,240 INDEED THERE WERE CONGRESSMEN 499 00:17:51,240 --> 00:17:54,040 WHO SAID THE BLACK-WHITE 500 00:17:54,040 --> 00:17:56,000 DISPARITIES ARE DUE TO 501 00:17:56,000 --> 00:17:57,040 MINORITIES NOT BEING INCLUDED IN 502 00:17:57,040 --> 00:17:57,760 CLINICAL TRIALS. 503 00:17:57,760 --> 00:17:58,760 I ACTUALLY THINK THAT'S WRONG. 504 00:17:58,760 --> 00:18:00,040 AND WE'VE DEVELOPED TREATMENTS 505 00:18:00,040 --> 00:18:01,840 FOR WHITE AND NOT BLACKS. 506 00:18:01,840 --> 00:18:04,760 THAT'S A DIRECT QUOTE FROM JESSE 507 00:18:04,760 --> 00:18:08,040 JACKSON, JR., WHO WAS THEN A 508 00:18:08,040 --> 00:18:08,480 CONGRESSMAN. 509 00:18:08,480 --> 00:18:11,320 THESE MANDATES FOR SUBSET 510 00:18:11,320 --> 00:18:12,440 ANALYSIS WERE MADE BECAUSE DRUGS 511 00:18:12,440 --> 00:18:14,680 MAY NOT WORK IN MINORITIES AS 512 00:18:14,680 --> 00:18:16,800 THEY WORK IN MAJORITIES, IT WAS 513 00:18:16,800 --> 00:18:17,560 SAID. 514 00:18:17,560 --> 00:18:19,000 TRUTH IS, AND WE'LL SHOW SOME 515 00:18:19,000 --> 00:18:21,920 DATA ON THIS, FOR MOST PART, THE 516 00:18:21,920 --> 00:18:23,240 DRUGS DO NOT WORK BECAUSE 517 00:18:23,240 --> 00:18:26,960 UNDERSERVED PEOPLE DON'T GET THE 518 00:18:26,960 --> 00:18:27,840 DRUGS. 519 00:18:27,840 --> 00:18:29,440 ONE OF THE THINGS THAT MOTIVATED 520 00:18:29,440 --> 00:18:31,000 THIS LEGISLATION, THERE WERE 521 00:18:31,000 --> 00:18:32,520 SEVERAL, BUT ONE THAT MOTIVATED 522 00:18:32,520 --> 00:18:36,240 THIS LEGISLATION, AN EXAMPLE OF 523 00:18:36,240 --> 00:18:37,440 HOW THIS CAN REALLY CAUSE THINGS 524 00:18:37,440 --> 00:18:40,640 TO BE MUCKED UP, IS THIS STUDY 525 00:18:40,640 --> 00:18:45,040 WAS PUBLISHED IN JAMA IN 1991. 526 00:18:45,040 --> 00:18:46,680 IT WAS ONE OF THE FIRST 527 00:18:46,680 --> 00:18:50,480 RANDOMIZED STUDIES TO SHOW THAT 528 00:18:50,480 --> 00:18:52,240 THE DRUG WAS EFFECTIVE IN 529 00:18:52,240 --> 00:18:54,640 DELAYING THE PROGRESSION OF 530 00:18:54,640 --> 00:18:56,240 HIV/AIDS. 531 00:18:56,240 --> 00:19:00,120 THERE WERE SEVERAL STUDIES THAT 532 00:19:00,120 --> 00:19:02,040 WERE PUBLISHED BY JAMA IN THAT 533 00:19:02,040 --> 00:19:04,200 YEAR, ACTUALLY IN THE SAME 534 00:19:04,200 --> 00:19:08,040 ISSUES, THAT SHOWED THAT WHITE 535 00:19:08,040 --> 00:19:12,240 PEOPLE BENEFITED MORE SO THAN 536 00:19:12,240 --> 00:19:19,040 BLACK PEOPLE FROM AS TEE., AND 537 00:19:19,040 --> 00:19:19,920 ZIDOVUDINE THERAPY. 538 00:19:19,920 --> 00:19:21,560 NOW, THE FOLKS WHO WROTE THIS 539 00:19:21,560 --> 00:19:26,040 PAPER WERE ACTUALLY SUCH THAT 540 00:19:26,040 --> 00:19:27,360 THEY DID EVEN FURTHER STUDY TO 541 00:19:27,360 --> 00:19:29,880 TRY TO FIGURE OUT WHY AZT WAS A 542 00:19:29,880 --> 00:19:32,040 BETTER TREATMENT FOR WHITES 543 00:19:32,040 --> 00:19:33,840 VERSUS BLACKS. 544 00:19:33,840 --> 00:19:35,120 THEY WERE ACTUALLY ABLE TO NAIL 545 00:19:35,120 --> 00:19:36,760 DOWN THAT THE BLACKS IN THE 546 00:19:36,760 --> 00:19:38,720 STUDY WERE SOCIOECONOMICALLY 547 00:19:38,720 --> 00:19:40,640 LESS SUPPORTED THAN THE WHITES 548 00:19:40,640 --> 00:19:42,800 IN THE STUDY, AND THE BLACKS IN 549 00:19:42,800 --> 00:19:45,360 THE STUDY DIDN'T TAKE THE DRUG 550 00:19:45,360 --> 00:19:47,640 AS OFTEN AS THE WHITES IN THE 551 00:19:47,640 --> 00:19:48,960 STUDY. 552 00:19:48,960 --> 00:19:50,360 INDEED ADHERENCE TO TAKING THE 553 00:19:50,360 --> 00:19:52,680 DWRUG WAS SOMEWHERE 554 00:19:52,680 --> 00:19:55,080 DRUG WAS SOMEWHERE AROUND 50% OF 555 00:19:55,080 --> 00:19:56,400 WHITE ADHERENCE TO TAKING THE 556 00:19:56,400 --> 00:19:57,240 DRUG. 557 00:19:57,240 --> 00:20:02,080 AGAIN, IF YOU DON'T TAKE THE 558 00:20:02,080 --> 00:20:03,720 DRUG, NOW THEY PUBLISHED THIS 559 00:20:03,720 --> 00:20:05,880 AND WENT ON TO PUBLISH OTHER 560 00:20:05,880 --> 00:20:11,040 STUDIES TO SHOW THAT AZT OR 561 00:20:11,040 --> 00:20:12,120 ZIDOVUDINE IS EFFECTIVE IN 562 00:20:12,120 --> 00:20:13,600 TREATING BLACKS OR NEGROES, BUT 563 00:20:13,600 --> 00:20:17,120 IT IS A FACT TO THIS DAY IN MANY 564 00:20:17,120 --> 00:20:18,600 OTHER URBAN CITY, I HEARD IT IN 565 00:20:18,600 --> 00:20:20,040 BALTIMORE LAST WEEK, THERE'S 566 00:20:20,040 --> 00:20:21,440 FOLKLORE THAT NIH DRUGS HAVE 567 00:20:21,440 --> 00:20:22,760 BEEN PROVEN NOT TO WORK IN 568 00:20:22,760 --> 00:20:23,280 BLACKS. 569 00:20:23,280 --> 00:20:30,400 NOW, IT INTERESTING, AZT ISN'T 570 00:20:30,400 --> 00:20:32,040 EVEN USED TO TREAT HIV ANYMORE, 571 00:20:32,040 --> 00:20:35,640 BUT THIS FOLKLORE THAT ANTI-AIDS 572 00:20:35,640 --> 00:20:37,040 DRUGS DON'T WORK IN BLACK PEOPLE 573 00:20:37,040 --> 00:20:39,760 IS STILL PERSISTENT, AND STILL A 574 00:20:39,760 --> 00:20:42,160 REASON MANY BLACKS AND 575 00:20:42,160 --> 00:20:43,440 ESPECIALLY IN AMERICA'S INNER 576 00:20:43,440 --> 00:20:50,200 CITIES, DON'T TAKE THE DRUGS. 577 00:20:50,200 --> 00:20:52,240 NOW, LEGISLATION LED TO MANY 578 00:20:52,240 --> 00:20:53,240 EFFORTS TO INCREASE MINORITY 579 00:20:53,240 --> 00:20:53,680 ACCRUAL. 580 00:20:53,680 --> 00:20:55,760 THERE HAVE BEEN NUMEROUS 581 00:20:55,760 --> 00:20:58,280 NIH-SPONSORED MEETINGS ON 582 00:20:58,280 --> 00:20:58,960 RECRUITMENT, ACADEMIC 583 00:20:58,960 --> 00:21:02,000 INSTITUTIONS ACTUALLY HAD TO 584 00:21:02,000 --> 00:21:04,080 DEVELOP RELATIONSHIPS, THAT'S 585 00:21:04,080 --> 00:21:05,280 THE ONE GOOD THING OUT OF THIS, 586 00:21:05,280 --> 00:21:06,720 AND THEN THERE'S SOME CLINICAL 587 00:21:06,720 --> 00:21:07,640 RESEARCH ORGANIZATIONS THAT MADE 588 00:21:07,640 --> 00:21:08,360 IT INTO A BUSINESS. 589 00:21:08,360 --> 00:21:12,240 THAT MAY NOT BE SUCH A GOOD 590 00:21:12,240 --> 00:21:14,800 THING. 591 00:21:14,800 --> 00:21:15,880 I'M ALSO PERSONALLY CONCERNED, 592 00:21:15,880 --> 00:21:17,240 I'VE BEEN OUTSPOKEN ABOUT THIS, 593 00:21:17,240 --> 00:21:19,200 THAT THE FEDERAL MANDATE PUTS 594 00:21:19,200 --> 00:21:21,680 UNDUE PRESSURE ON NIH-FUNDED 595 00:21:21,680 --> 00:21:22,600 RESEARCHERS, ESPECIALLY DATA 596 00:21:22,600 --> 00:21:23,960 MANAGERS, TO GIVE WHITE PATIENTS 597 00:21:23,960 --> 00:21:25,560 THE OPTION OF ENTERING A 598 00:21:25,560 --> 00:21:27,160 CLINICAL TRIAL AND GIVE BLACKS 599 00:21:27,160 --> 00:21:29,840 AND OTHER MINORITIES THE HARD 600 00:21:29,840 --> 00:21:32,080 SELL BECAUSE THEY REALLY NEED 601 00:21:32,080 --> 00:21:34,280 THE MINORITIES ON CLINICAL 602 00:21:34,280 --> 00:21:34,600 TRIALS. 603 00:21:34,600 --> 00:21:35,960 NOW, THE OTHER PROBLEM, OF 604 00:21:35,960 --> 00:21:38,000 COURSE, IS THERE'S NO SUCH THING 605 00:21:38,000 --> 00:21:41,600 AS A VALID SUBSET ANALYSIS, IT 606 00:21:41,600 --> 00:21:42,120 SCIENTIFICALLY IMPOSSIBLE. 607 00:21:42,120 --> 00:21:43,360 LET'S LOOK AT A CLINICAL TRIAL 608 00:21:43,360 --> 00:21:45,440 THAT I WAS INVOLVED WITH IN THE 609 00:21:45,440 --> 00:21:47,280 EARLY 1990s, WHEN I WAS AT THE 610 00:21:47,280 --> 00:21:50,040 NCI. 611 00:21:50,040 --> 00:21:55,280 THAT IS PACLITAXEL AND CISPLATIN 612 00:21:55,280 --> 00:21:57,040 VERSUS CYCLOPHOSPHAMIDE AND 613 00:21:57,040 --> 00:21:57,320 CISPLATIN. 614 00:21:57,320 --> 00:22:01,080 THE OLD STANDARD WAS 615 00:22:01,080 --> 00:22:04,240 CYCLOPHOSPHAMIDE AND CISPLATIN 616 00:22:04,240 --> 00:22:07,840 AND WE THOUGHT MIGHT BE 617 00:22:07,840 --> 00:22:10,480 PACLITAXEL AND CISPLATIN. 618 00:22:10,480 --> 00:22:14,440 WOMEN WITH OVARIAN CANCER WERE 619 00:22:14,440 --> 00:22:15,760 ENROLLED, 386 WERE FOUND TO BE 620 00:22:15,760 --> 00:22:20,000 ELIGIBLE AND RANDOMIZED TO 621 00:22:20,000 --> 00:22:24,040 EITHER GETTING PACLITAXEL AND 622 00:22:24,040 --> 00:22:28,760 CISPLATIN OR CISPLATIN AND 623 00:22:28,760 --> 00:22:29,160 CYCLOPHOSPHAMIDE. 624 00:22:29,160 --> 00:22:32,840 YOU CAN SEE OF 216 WITH 625 00:22:32,840 --> 00:22:37,760 MEASURABLE DISEASE, YOU CAN SEE 626 00:22:37,760 --> 00:22:45,040 73% VERSUS 60%. 627 00:22:45,040 --> 00:22:46,880 MEDIAN PROGRESSION-FREE SURVIVAL 628 00:22:46,880 --> 00:22:51,720 WAS ALSO BETTER. 629 00:22:51,720 --> 00:22:52,600 PROPORTIONAL REPRESENTATION OF 630 00:22:52,600 --> 00:22:53,640 BLACK WOMEN WAS THERE, BY THE 631 00:22:53,640 --> 00:22:54,240 WAY. 632 00:22:54,240 --> 00:22:57,400 THERE WERE 26 BLACK PATIENTS. 633 00:22:57,400 --> 00:23:00,560 IF ONE BELIEVES THE ANSWER IS 634 00:23:00,560 --> 00:23:01,760 DIFFERENT IN BLACK WOMEN VERSUS 635 00:23:01,760 --> 00:23:04,360 WHITE WOMAN, YOU ACTUALLY NEED 636 00:23:04,360 --> 00:23:06,360 216 BLACK WOMEN COMPARED TO 216 637 00:23:06,360 --> 00:23:06,560 WHITE. 638 00:23:06,560 --> 00:23:11,600 YOU CAN'T DO IT WITH 26 OF THE 639 00:23:11,600 --> 00:23:13,040 216 BEING BLACK. 640 00:23:13,040 --> 00:23:16,520 NOW, WE NEED TO WORRY ABOUT 641 00:23:16,520 --> 00:23:18,040 TREATMENT EFFECTIVENESS, 642 00:23:18,040 --> 00:23:19,440 ESPECIALLY IN A POPULATION, WE 643 00:23:19,440 --> 00:23:21,760 ALSO NEED TO WORRY ABOUT 644 00:23:21,760 --> 00:23:22,040 EFFICACY. 645 00:23:22,040 --> 00:23:24,640 WHEN I TALK ABOUT EFFECTIVENESS, 646 00:23:24,640 --> 00:23:28,440 WE'RE TALKING ABOUT IN AN IDEAL 647 00:23:28,440 --> 00:23:30,000 SITUATION LIKE IN CLINICAL 648 00:23:30,000 --> 00:23:32,040 TRIALS, WHERE THE DATA IS MORE 649 00:23:32,040 --> 00:23:33,760 PERFECT, THE PATIENT ARE 650 00:23:33,760 --> 00:23:35,280 HEALTHIER, EVEN THOUGH THEY HAVE 651 00:23:35,280 --> 00:23:36,720 CANCER, THEY'RE HEALTHIER, THEY 652 00:23:36,720 --> 00:23:38,360 VOLUNTEER TO GO INTO THESE 653 00:23:38,360 --> 00:23:39,120 TRIALS. 654 00:23:39,120 --> 00:23:40,480 THE PHYSICIANS ARE OFTEN MORE 655 00:23:40,480 --> 00:23:42,400 EXPERT AS WELL. 656 00:23:42,400 --> 00:23:45,800 EFFICACY IS HOW IS IT WORK -- 657 00:23:45,800 --> 00:23:47,720 DOES IT WORK IN THE REAL WORLD. 658 00:23:47,720 --> 00:23:51,360 SO OUR SEER AND POPULATION BASED 659 00:23:51,360 --> 00:23:52,760 REGISTRIES TELL US ABOUT 660 00:23:52,760 --> 00:23:53,400 EFFICACY, CLINICAL TRIALS TELL 661 00:23:53,400 --> 00:23:54,400 US ABOUT EFFECTIVENESS. 662 00:23:54,400 --> 00:23:57,560 NOW, FOR GENERALIZABILITY, WE 663 00:23:57,560 --> 00:23:59,520 WANT A POPULATION THAT MIRRORS 664 00:23:59,520 --> 00:24:01,400 THE POPULATION IN GENERAL, BOTH 665 00:24:01,400 --> 00:24:04,840 IN CLINICAL SETTING AND SOME OF 666 00:24:04,840 --> 00:24:06,520 THE EPIDEMIOLOGY I GET INVOLVED 667 00:24:06,520 --> 00:24:08,400 WITH, WE WORRY ABOUT PEOPLE 668 00:24:08,400 --> 00:24:11,120 TREATED AT UNIVERSITY HOSPITALS 669 00:24:11,120 --> 00:24:12,240 VERSUS PEOPLE TREATED IN 670 00:24:12,240 --> 00:24:15,920 COMMUNITY HOSPITALS. 671 00:24:15,920 --> 00:24:19,000 RICH VERSUS POOR, AS WELL AS 672 00:24:19,000 --> 00:24:20,000 WITH GENETICS, WE SHOULD PAY 673 00:24:20,000 --> 00:24:21,640 ATTENTION TO THINGS LIKE RACE. 674 00:24:21,640 --> 00:24:23,160 THE CLINICAL TRIALS PARTICIPANTS 675 00:24:23,160 --> 00:24:25,680 NEED TO BE A REPRESENTATIVE 676 00:24:25,680 --> 00:24:28,160 BIOPSY OF THE GENERAL POPULATION 677 00:24:28,160 --> 00:24:29,440 IF THIS MEDICAL AUDIENCE WILL 678 00:24:29,440 --> 00:24:31,080 LET ME GET AWAY WITH USING THE 679 00:24:31,080 --> 00:24:34,640 PHRASE "REPRESENTATIVE BIOPSY," 680 00:24:34,640 --> 00:24:37,040 IN ORDER FOR A FINDING TO BE 681 00:24:37,040 --> 00:24:38,800 GENERALIZABLE TO THAT ENTIRE 682 00:24:38,800 --> 00:24:40,280 POPULATION. 683 00:24:40,280 --> 00:24:42,440 THIS IS VERY DIFFERENT FROM 684 00:24:42,440 --> 00:24:43,440 APPLICABILITY. 685 00:24:43,440 --> 00:24:44,440 APPLICABILITY, BY THE WAY, IS A 686 00:24:44,440 --> 00:24:48,040 WORD NEVER SEEN IN THE NIH 687 00:24:48,040 --> 00:24:51,200 REVITALIZATION. 688 00:24:51,200 --> 00:24:51,920 APPLICABILITY IS SPECIFIC TO AN 689 00:24:51,920 --> 00:24:53,840 INDIVIDUAL OR THE PEOPLE WITH 690 00:24:53,840 --> 00:24:57,120 SPECIFIC GENETICS OR SPECIFI% 691 00:24:57,120 --> 00:25:01,200 TARGETS. 692 00:25:01,200 --> 00:25:03,560 THIS IS PERHAPS THE MOST 693 00:25:03,560 --> 00:25:04,440 WONDERFUL, GENTLE, SMART MAN I 694 00:25:04,440 --> 00:25:05,640 PERSONALLY HAVE EVER MET. 695 00:25:05,640 --> 00:25:12,320 DAVID IS SATCHER WAS THE 16TH 696 00:25:12,320 --> 00:25:13,720 SURGEON GENERAL OF THE UNITED 697 00:25:13,720 --> 00:25:14,560 STATE AND 11TH ASSISTANT 698 00:25:14,560 --> 00:25:15,600 SECRETARY OF HEALTH. 699 00:25:15,600 --> 00:25:18,640 HE MOVED US INTO THE AREA OF 700 00:25:18,640 --> 00:25:19,280 HEALTH DISPARITIES. 701 00:25:19,280 --> 00:25:21,040 HE BROADENED IT MUCH MORE SO 702 00:25:21,040 --> 00:25:23,600 THAN BLACK/WHITE BUT INTO OTHER 703 00:25:23,600 --> 00:25:24,440 RACES, SOCIOECONOMIC STATUS. 704 00:25:24,440 --> 00:25:26,640 I'M GOING TO SHOW YOU SOME DATA 705 00:25:26,640 --> 00:25:29,120 TO SHOW EVEN GEOGRAPHY. 706 00:25:29,120 --> 00:25:31,880 HE IS THE PERSON WHO YOU'D FIRST 707 00:25:31,880 --> 00:25:37,040 PUT THE TWO WORDS "HEALTH" AND 708 00:25:37,040 --> 00:25:37,720 "DISPARITIES" TOGETHER. 709 00:25:37,720 --> 00:25:42,400 IN MY FORREST GUMP LIFE, I WAS 710 00:25:42,400 --> 00:25:43,840 ACTUALLY IN MONROE WHEN HE SAID, 711 00:25:43,840 --> 00:25:45,120 I WANT TO START CALLING IT WHAT 712 00:25:45,120 --> 00:25:46,640 IT IS. 713 00:25:46,640 --> 00:25:49,240 DISPARITIES IN HEALTH, OR HEALTH 714 00:25:49,240 --> 00:25:55,920 DISPARITIES, AND LET'S SEE SOME 715 00:25:55,920 --> 00:25:57,200 POLITICIANS SAY WE WANT PROGRAMS 716 00:25:57,200 --> 00:25:58,800 TO HEALTH REDUCE DISPARITIES IN 717 00:25:58,800 --> 00:25:59,320 HEALTH. 718 00:25:59,320 --> 00:26:00,960 THE CONCEPT THAT SOME 719 00:26:00,960 --> 00:26:02,280 POPULATIONS, HOWEVER YOU DEFINE 720 00:26:02,280 --> 00:26:04,800 THEM, HAVE DIFFERENT OUTCOMES. 721 00:26:04,800 --> 00:26:08,240 AND POP LAILINGS ARE POPULATIONS CAN BE D EFINED 722 00:26:08,240 --> 00:26:10,440 IN A NUMBER OF WAYS. 723 00:26:10,440 --> 00:26:11,280 NOT JUST RACE. 724 00:26:11,280 --> 00:26:15,040 SEX OR GENDER, AREA OF 725 00:26:15,040 --> 00:26:15,840 GEOGRAPHIC ORIGIN, WHICH IS 726 00:26:15,840 --> 00:26:17,520 DIFFERENT FROM RACE, FAMILY OR 727 00:26:17,520 --> 00:26:19,000 TRIBE, ETHNICITY AND CULTURE. 728 00:26:19,000 --> 00:26:21,320 KEEP IN MIND, ETHNICITY AND 729 00:26:21,320 --> 00:26:22,640 CULTURE INVOLVES SOME 730 00:26:22,640 --> 00:26:24,720 ENVIRONMENTAL INFLUENCES ON HOW 731 00:26:24,720 --> 00:26:26,800 WE GET CANCER. 732 00:26:26,800 --> 00:26:27,800 ITALIANS ACTUALLY SMOKE 733 00:26:27,800 --> 00:26:28,560 CIGARETTES DIFFERENTLY THAN 734 00:26:28,560 --> 00:26:29,840 GERMANS. 735 00:26:29,840 --> 00:26:33,560 AREA OF RESIDENCE. 736 00:26:33,560 --> 00:26:34,440 SOCIOECONOMIC STATUS. 737 00:26:34,440 --> 00:26:37,600 ALL DIFFERENT WAYS OF DESCRIBING 738 00:26:37,600 --> 00:26:38,680 POPULATIONS, AND WE CAN SHOW 739 00:26:38,680 --> 00:26:40,840 DISPARITIES BY ANY OF THESE. 740 00:26:40,840 --> 00:26:43,480 NOW AGAIN, DISPARITIES ARE THE 741 00:26:43,480 --> 00:26:44,840 CONCEPT THAT SOME POPULATIONS DO 742 00:26:44,840 --> 00:26:46,360 WORSE THAN OTHERS. 743 00:26:46,360 --> 00:26:48,720 WORSE CAN BE INCIDENCE OF 744 00:26:48,720 --> 00:26:49,680 DISEASE, IT COULD BE MORTALITY, 745 00:26:49,680 --> 00:26:51,480 IT CAN BE SURVIVAL, IT CAN BE 746 00:26:51,480 --> 00:26:56,840 QUALITY OF LIFE. 747 00:26:56,840 --> 00:26:58,240 HERE I'M GOING TO SHOW YOU AGAIN 748 00:26:58,240 --> 00:27:00,760 SEER DATA LOOKING AT RACE, 749 00:27:00,760 --> 00:27:03,280 BLACKS IN BLUE, WHITES IN 750 00:27:03,280 --> 00:27:04,160 ORANGE, NATIVE AMERICANS, 751 00:27:04,160 --> 00:27:06,440 HISPANICS, AND ASIAN PACIFIC 752 00:27:06,440 --> 00:27:07,840 ISLANDERS, AND THIS IS DEATH 753 00:27:07,840 --> 00:27:12,920 RATE FROM 1990 TO 2017. 754 00:27:12,920 --> 00:27:14,320 NOW YOU CAN SEE THE BLACK DEATH 755 00:27:14,320 --> 00:27:16,000 RATE WAS HIGHER THAN THE WHITE 756 00:27:16,000 --> 00:27:18,480 DEATH RATE, BUT OVER TIME, IT'S 757 00:27:18,480 --> 00:27:23,640 GOTTEN CLOSER AND CLOSER 758 00:27:23,640 --> 00:27:23,920 TOGETHER. 759 00:27:23,920 --> 00:27:25,880 IF ONE IS INCREDIBLY OPTIMISTIC, 760 00:27:25,880 --> 00:27:27,800 ONE CAN IMAGINE A TIME ABOUT 761 00:27:27,800 --> 00:27:28,760 2030, 2035, WHERE BLACK AND 762 00:27:28,760 --> 00:27:30,200 WHITE AND NATIVE AMERICAN DEATH 763 00:27:30,200 --> 00:27:32,160 RATES WILL ACTUALLY ALL KIND OF 764 00:27:32,160 --> 00:27:36,440 MERGE TOGETHER. 765 00:27:36,440 --> 00:27:39,640 WITH HISPANICS AND ASIAN PACIFIC 766 00:27:39,640 --> 00:27:41,320 ISLANDERS AND THEY'D STILL BE 767 00:27:41,320 --> 00:27:41,520 BELOW. 768 00:27:41,520 --> 00:27:43,000 NOW THESE CATEGORIES ARE DEFINED 769 00:27:43,000 --> 00:27:45,600 BY THE U.S. OFFICE OF MANAGEMENT 770 00:27:45,600 --> 00:27:47,640 AND BUDGET EVERY 10 YEARS. 771 00:27:47,640 --> 00:27:50,840 THEY ARE SEWS YOASH POLITICAL 772 00:27:50,840 --> 00:27:53,400 AND NOT BIOLOGIC BY OMB 773 00:27:53,400 --> 00:27:54,040 DEFINITION. 774 00:27:54,040 --> 00:27:56,240 RACE AS DEFINED IN BIOLOGY OR AS 775 00:27:56,240 --> 00:27:58,080 A BIOLOGIC CATEGORIZATION, HAS 776 00:27:58,080 --> 00:28:01,240 BEEN REJECTED BY THE 777 00:28:01,240 --> 00:28:02,880 ANTHROPOLOGICAL COMMUNITY AS 778 00:28:02,880 --> 00:28:03,240 NON-SCIENTIFIC. 779 00:28:03,240 --> 00:28:06,000 SOME CALL IT PSEUDOSCIENCE. 780 00:28:06,000 --> 00:28:08,320 RECENTLY, THE AMERICAN MEDICAL 781 00:28:08,320 --> 00:28:11,520 ASSOCIATION HAS ISSUED 782 00:28:11,520 --> 00:28:16,040 STATEMENTS REGARDING THE 783 00:28:16,040 --> 00:28:19,240 BIOLOGIC -- IT IS INCREDIBLY 784 00:28:19,240 --> 00:28:19,440 BROAD. 785 00:28:19,440 --> 00:28:20,760 AREA OF GEOGRAPHIC ORIGIN, ON 786 00:28:20,760 --> 00:28:21,520 THE OTHER HAND, WHICH IS 787 00:28:21,520 --> 00:28:23,600 DIFFERENT FROM RACE, IS MORE 788 00:28:23,600 --> 00:28:24,680 SPECIFIC AND A LITTLE BIT MORE 789 00:28:24,680 --> 00:28:25,120 SCIENTIFIC. 790 00:28:25,120 --> 00:28:26,800 I'M GOING TO SHOW YOU SOME 791 00:28:26,800 --> 00:28:28,760 EXAMPLES OF AREA OF GEOGRAPHIC 792 00:28:28,760 --> 00:28:32,040 ORIGIN AND SOME GENETIC 793 00:28:32,040 --> 00:28:33,040 DIFFERENCES. 794 00:28:33,040 --> 00:28:39,360 BUT ALZHEIMER'S BUT ADMIXTURE COMPLICATES 795 00:28:39,360 --> 00:28:40,320 BOTH. 796 00:28:40,320 --> 00:28:42,400 I'M REMINDED BY THE FACT THAT 797 00:28:42,400 --> 00:28:46,000 THEY CONSIDERED BARACK OBAMA 798 00:28:46,000 --> 00:28:51,760 BLACK IN 1970 AND WHITE IN 1980. 799 00:28:51,760 --> 00:28:54,920 THERE ARE 109 AREAS OF 800 00:28:54,920 --> 00:28:56,200 GEOGRAPHIC ORIGIN IN AFRICA, 801 00:28:56,200 --> 00:28:57,400 MORE THAN 600 IN EUROPE. 802 00:28:57,400 --> 00:28:58,800 AS WE STUDY MORE, THERE WILL BE 803 00:28:58,800 --> 00:29:00,360 MORE AREAS OF GEOGRAPHIC ORIGIN, 804 00:29:00,360 --> 00:29:01,880 BUT YOU CAN SEE SOME OF THESE 805 00:29:01,880 --> 00:29:03,720 NAMES AND SOME OF THESE AREAS, 806 00:29:03,720 --> 00:29:10,840 AND THIS IS TO SAY THAT -- TO 807 00:29:10,840 --> 00:29:12,240 CALL ALL BLACK PEOPLE AFRICAN IS 808 00:29:12,240 --> 00:29:12,600 WRONG. 809 00:29:12,600 --> 00:29:14,040 BY THE WAY, MOST AFRICAN 810 00:29:14,040 --> 00:29:17,160 AMERICANS ARE ABOUT 20 TO 30% 811 00:29:17,160 --> 00:29:17,440 EUROPEAN. 812 00:29:17,440 --> 00:29:19,240 SO ADMIXTURE IS INCREDIBLY 813 00:29:19,240 --> 00:29:19,720 IMPORTANT. 814 00:29:19,720 --> 00:29:23,800 IT'S NOT WHAT GENES YOU HAVE AS 815 00:29:23,800 --> 00:29:25,520 MUCH AS IT IS WHERE SPECIFIC 816 00:29:25,520 --> 00:29:30,360 GENES CAME FROM. 817 00:29:30,360 --> 00:29:32,080 RACE AS FACTOR IN OUTCOME. 818 00:29:32,080 --> 00:29:33,640 FREQUENTLY CONCERN IS EXPRESSED 819 00:29:33,640 --> 00:29:36,280 ABOUT BIOLOGICAL DIFFERENCES IN 820 00:29:36,280 --> 00:29:39,280 TREATMENT OUTCOME BY RACE. 821 00:29:39,280 --> 00:29:41,840 IN MOST CASES, DISEASE, CLINICAL 822 00:29:41,840 --> 00:29:43,400 TRIALS AND SINGLE INSTITUTION 823 00:29:43,400 --> 00:29:44,440 EXPERIENCES, I'LL SHOW YOU A 824 00:29:44,440 --> 00:29:47,360 FEW, SHOW THAT EQUAL TREATMENT 825 00:29:47,360 --> 00:29:49,120 YIELDS EQUAL OUTCOME AND RACE 826 00:29:49,120 --> 00:29:51,080 SHOULD NOT BE A FACTOR IN 827 00:29:51,080 --> 00:29:52,840 OUTCOME. 828 00:29:52,840 --> 00:29:55,880 NOW, RACE SHOULD NOT BE A FACTOR 829 00:29:55,880 --> 00:29:57,960 IN OUTCOME BECAUSE EQUAL 830 00:29:57,960 --> 00:30:01,840 TREATMENT YIELDS EQUAL OUTCOME, 831 00:30:01,840 --> 00:30:03,320 BUT THERE IS NOT EQUAL 832 00:30:03,320 --> 00:30:04,000 TREATMENT. 833 00:30:04,000 --> 00:30:06,520 IT IS RARE THAT A DRUG OR 834 00:30:06,520 --> 00:30:08,280 THERAPY DOESN'T WORK, IT IS 835 00:30:08,280 --> 00:30:09,360 COMMON THAT MINORITIES DON'T GET 836 00:30:09,360 --> 00:30:10,200 THE DRUG. 837 00:30:10,200 --> 00:30:12,760 RACE SHOULD NOT BE A FACTOR IN 838 00:30:12,760 --> 00:30:14,040 OUTCOME, BUT IT VERY FREQUENTLY 839 00:30:14,040 --> 00:30:14,240 IS. 840 00:30:14,240 --> 00:30:16,560 IT SHOULD NOT BE A FACTOR 841 00:30:16,560 --> 00:30:18,000 BIOLOGICALLY, AND IT IS NOT 842 00:30:18,000 --> 00:30:20,080 USUALLY A FACTOR BIOLOGICALLY, 843 00:30:20,080 --> 00:30:24,240 BUT IT IS A FACTOR 844 00:30:24,240 --> 00:30:25,320 SOCIOPOLITICALLY. 845 00:30:25,320 --> 00:30:27,040 THIS IS A NON-CANCER EXAMPLE, 846 00:30:27,040 --> 00:30:29,800 AND THIS IS FROM THE LITERATURE 847 00:30:29,800 --> 00:30:30,480 RIGHT NOW. 848 00:30:30,480 --> 00:30:32,640 WE HAVE FOR THE LAST 20 TO 30 849 00:30:32,640 --> 00:30:35,400 YEARS USED A RACE-BASED ESTIMATE 850 00:30:35,400 --> 00:30:38,680 OF RENAL FUNCTION. 851 00:30:38,680 --> 00:30:40,760 WE'RE STARTING TO REALIZE THAT 852 00:30:40,760 --> 00:30:42,080 THAT RACE BASED ESTIMATE OF REAL 853 00:30:42,080 --> 00:30:44,040 FUNCTION IS WRONG, AND THE END 854 00:30:44,040 --> 00:30:47,240 RESULT OF US ASSUMING THAT BLACK 855 00:30:47,240 --> 00:30:50,040 RENAL FUNCTION IS BIOLOGICALLY 856 00:30:50,040 --> 00:30:52,200 DIFFERENT FROM WHITE RENAL 857 00:30:52,200 --> 00:30:53,960 FUNCTION IS A LARGE NUMBER OF 858 00:30:53,960 --> 00:30:55,440 PEOPLE WHO ARE BLACK WHO WOULD 859 00:30:55,440 --> 00:30:58,880 HAVE BEEN ELIGIBLE TO BE KIDNEY 860 00:30:58,880 --> 00:31:00,320 DONORS HAVE BEEN TOLD YOU HAVE 861 00:31:00,320 --> 00:31:01,440 KIDNEY DYSFUNCTION, YOU SHOULD 862 00:31:01,440 --> 00:31:02,320 NOT BE A DONOR. 863 00:31:02,320 --> 00:31:04,080 NOW, POPULATIONS DO DIFFER, AND 864 00:31:04,080 --> 00:31:06,560 THIS SHOULD BE KEPT IN MIND WHEN 865 00:31:06,560 --> 00:31:11,200 WE STUDY VAIR VARIOUS TREATMENTS. 866 00:31:11,200 --> 00:31:13,040 CYSTIC FIBROSIS, VERY COMMON, 867 00:31:13,040 --> 00:31:14,280 ESPECIALLY IN NORTHERN EUROPE, 868 00:31:14,280 --> 00:31:16,400 THE AREA AROUND DENMARK, THE 869 00:31:16,400 --> 00:31:17,560 NETHERLANDS. 870 00:31:17,560 --> 00:31:18,440 ALCOHOL DEHYDROGENASE 871 00:31:18,440 --> 00:31:19,760 DEFICIENCY. 872 00:31:19,760 --> 00:31:22,840 VERY COMMON IN EAST ASIA. 873 00:31:22,840 --> 00:31:26,280 PORTIONS OF CHINA AND PORTIONS, 874 00:31:26,280 --> 00:31:28,720 NOT ALL, OF JAPAN. 875 00:31:28,720 --> 00:31:32,560 AND PROSTATE CANCER INCIDENCE IN 876 00:31:32,560 --> 00:31:35,920 MEN FROM NORTHWEST SUB-SAHARAN 877 00:31:35,920 --> 00:31:38,120 AFRICA, NOT EAST, NOT SOUTH, BUT 878 00:31:38,120 --> 00:31:39,640 NORTHWEST SUB-SAHARAN AFRICA. 879 00:31:39,640 --> 00:31:42,560 OTHER EXAMPLES OF GENETICS AND 880 00:31:42,560 --> 00:31:45,040 VARIATION. 881 00:31:45,040 --> 00:31:46,280 G6PD DEFICIENCY. 882 00:31:46,280 --> 00:31:48,040 WE ALL KNOW IN MEDICAL SCHOOL 883 00:31:48,040 --> 00:31:51,760 WHEN YOU GET SOMEONE BACK FOR 884 00:31:51,760 --> 00:31:56,040 URINARY INFECTION, YOU ASK ABOUT 885 00:31:56,040 --> 00:32:02,040 G6PD DEFICIENCY BECAUSE CERTAIN 886 00:32:02,040 --> 00:32:03,880 PEOPLE HAVE VARIOUS TYPES WHERE 887 00:32:03,880 --> 00:32:09,240 CERTAIN DRUGS, QUININE OR BACK 888 00:32:09,240 --> 00:32:12,240 BACTRUM, FOR EXAMPLE, CAN CAUSE 889 00:32:12,240 --> 00:32:18,080 A HEMOLYTIC MALARIA. 890 00:32:18,080 --> 00:32:20,600 20% OF PEOPLE WHO LIVE WITHIN 891 00:32:20,600 --> 00:32:23,360 100 MILES OF THE BORDER. 892 00:32:23,360 --> 00:32:32,200 YOU GO 150 CAN KILOMETERS, IF YOU 893 00:32:32,200 --> 00:32:34,640 GIVE THEM THE ANTISEIZURE DRUG 894 00:32:34,640 --> 00:32:39,440 TEGRETOL, THEY WILL GET A FEVER, 895 00:32:39,440 --> 00:32:43,960 HANDS AND FEET START PEELING. 896 00:32:43,960 --> 00:32:48,760 THIS IS NOT THAI PEOPLE, 20% OF 897 00:32:48,760 --> 00:32:50,640 THAIS OR -- IT'S PEOPLE WHO LIVE 898 00:32:50,640 --> 00:33:00,680 IN THAT ONE, THIS IS ALL TO SAY, 899 00:33:00,680 --> 00:33:02,680 WHEN WE LOOK AT RACE, IT'S JUST 900 00:33:02,680 --> 00:33:03,440 TOO BROAD. 901 00:33:03,440 --> 00:33:05,280 BUT THERE ARE DIFFERENCES 902 00:33:05,280 --> 00:33:06,080 AMONGST POPULATIONS. 903 00:33:06,080 --> 00:33:08,040 BY THE WAY, THERE'S A SICKLE 904 00:33:08,040 --> 00:33:13,440 CELL MUTATION FOUND IN GREECE, 905 00:33:13,440 --> 00:33:14,080 SOUTHERN ITALY, MIDDLE EAST AND 906 00:33:14,080 --> 00:33:14,920 SO FORTH. 907 00:33:14,920 --> 00:33:15,880 INDEED IN THE UNITED STATES, 908 00:33:15,880 --> 00:33:17,800 THIS IS HOW WE HAVE THESE RACIAL 909 00:33:17,800 --> 00:33:20,040 BLINDER, WE ALL THINK OF SICKLE 910 00:33:20,040 --> 00:33:21,960 CELL DISEASE AS A BLACK DISEASE. 911 00:33:21,960 --> 00:33:25,560 TRUTH BE TOLD, ABOUT 50,000 KIDS 912 00:33:25,560 --> 00:33:27,160 WILL BE BORN THIS YEAR WITH 913 00:33:27,160 --> 00:33:28,160 SICKLE CELL TRAIT. 914 00:33:28,160 --> 00:33:30,080 8,000 OF THOSE 50,000 AMERICANS 915 00:33:30,080 --> 00:33:32,240 WERE SICKLE CELL TRAIT ARE WHITE 916 00:33:32,240 --> 00:33:33,640 PEOPLE. 917 00:33:33,640 --> 00:33:36,280 NOW, LOOKING AT POPULATIONS AND 918 00:33:36,280 --> 00:33:37,880 DIFFERENCES IN DRUG, YES, THEY 919 00:33:37,880 --> 00:33:39,240 DO EXIST, THEY ARE RARE BUT THEY 920 00:33:39,240 --> 00:33:43,280 DO EXIST. 921 00:33:43,280 --> 00:33:46,920 THE CANCER DRUG USED IN THE 922 00:33:46,920 --> 00:33:51,400 TREATMENT OF COLORECTAL CANCER, 923 00:33:51,400 --> 00:33:52,080 CAPECITABINE, AMERICANS TEND TO 924 00:33:52,080 --> 00:33:53,480 HAVE MORE SIDE EFFECTS FROM THIS 925 00:33:53,480 --> 00:33:54,920 DRUG COMPARED TO EUROPEANS. 926 00:33:54,920 --> 00:33:56,120 IT'S ACTUALLY NOT A RACE THING, 927 00:33:56,120 --> 00:33:57,320 IT'S AN ENVIRONMENTAL THING. 928 00:33:57,320 --> 00:33:59,200 IT'S THE FACT THAT THE AMERICAN 929 00:33:59,200 --> 00:34:02,640 DIET IS VERY HIGH IN FOLATE, AND 930 00:34:02,640 --> 00:34:07,880 FOLATE POTENTIATES CAPECITABINE. 931 00:34:07,880 --> 00:34:10,080 YOU CAN MAKE FOLATE A HARSHER 932 00:34:10,080 --> 00:34:11,440 DRUG BY GIVING IT ALONG WITH 933 00:34:11,440 --> 00:34:11,760 FOLATE. 934 00:34:11,760 --> 00:34:20,040 WE FREQUENTLY GIVE IT WITH 935 00:34:20,040 --> 00:34:21,680 LEUKOVORIN. 936 00:34:21,680 --> 00:34:22,640 AGAIN, POPULATION DIFFERENCES, 937 00:34:22,640 --> 00:34:24,760 IT'S BEEN WELL STUDIED THAT SOME 938 00:34:24,760 --> 00:34:28,560 OF THE TYROSINE KINASE 939 00:34:28,560 --> 00:34:30,320 INHIBITORS, DIFFERENT RESPONSES 940 00:34:30,320 --> 00:34:33,040 IN CERTAIN ASIAN POPULATIONS. 941 00:34:33,040 --> 00:34:35,800 PATIENTS OF ASIAN ORIGIN DO 942 00:34:35,800 --> 00:34:39,600 HARBOR MORE FREQUENT EGFR 943 00:34:39,600 --> 00:34:41,120 MUTATIONS IN CERTAIN AREAS. 944 00:34:41,120 --> 00:34:43,840 THIS IS AN ARGUMENT FOR LEARNING 945 00:34:43,840 --> 00:34:47,520 WHAT THE DRUG'S TARGET IS AND 946 00:34:47,520 --> 00:34:49,440 LEARNING WHAT THE DISTRIBUTION 947 00:34:49,440 --> 00:34:52,720 IN THE TARGET IS IN VARIOUS 948 00:34:52,720 --> 00:34:53,280 POPULATIONS. 949 00:34:53,280 --> 00:34:54,600 PERHAPS ASIAN IS THE WRONG 950 00:34:54,600 --> 00:34:55,680 CATEGORY, PERHAPS WE NEED TO GET 951 00:34:55,680 --> 00:34:58,840 A LITTLE BIT MORE GRANULAR. 952 00:34:58,840 --> 00:35:00,840 THIS RAISES THE ISSUE OF 953 00:35:00,840 --> 00:35:01,480 POPULATION DIVERSITY IN THE 954 00:35:01,480 --> 00:35:02,440 PATHOGENESIS OF VARIOUS 955 00:35:02,440 --> 00:35:04,960 DISEASES. 956 00:35:04,960 --> 00:35:05,920 THE IMPLICATION OF THESE 957 00:35:05,920 --> 00:35:07,920 FINDINGS IS THAT AREA OF 958 00:35:07,920 --> 00:35:10,800 GEOGRAPHIC ORIGIN MAY INDICATE 959 00:35:10,800 --> 00:35:13,200 DIFFERENT GENETIC BACKGROUNDS 960 00:35:13,200 --> 00:35:17,680 AND COMMON DISEASES THAT MAY 961 00:35:17,680 --> 00:35:18,800 UNFLEUNS CLINICAL OUT COME AND 962 00:35:18,800 --> 00:35:20,200 RESPONSE TO THERAPY. 963 00:35:20,200 --> 00:35:22,040 CLINICAL STUDY OF MOLECULAR 964 00:35:22,040 --> 00:35:22,600 TARGETED THERAPIES SHOULD 965 00:35:22,600 --> 00:35:23,600 INCLUDE A DIVERSE POPULATION AND 966 00:35:23,600 --> 00:35:25,000 SCIENTISTS SHOULD BE ON THE 967 00:35:25,000 --> 00:35:26,040 LOOKOUT IN THINKING ABOUT THESE 968 00:35:26,040 --> 00:35:27,080 THINGS. 969 00:35:27,080 --> 00:35:33,560 THE STUDY OF BLACK VERSUS WHITE 970 00:35:33,560 --> 00:35:34,520 OUTCOMES IN THE PAST IS 971 00:35:34,520 --> 00:35:35,600 INCREASINGLY MOVING BEYOND THE 972 00:35:35,600 --> 00:35:39,560 BLACK AND WHITE AND 973 00:35:39,560 --> 00:35:40,280 SOCIOECONOMICS. 974 00:35:40,280 --> 00:35:41,480 WE HAD SOMETHING CALLED THE 975 00:35:41,480 --> 00:35:42,360 BLACK AND WHITE STUDY. 976 00:35:42,360 --> 00:35:43,360 WHEN WE LOOK AT ECONOMICS, 977 00:35:43,360 --> 00:35:44,440 HOWEVER, I WANT YOU TO LOOK AT 978 00:35:44,440 --> 00:35:48,320 THE PERCENT OF PEOPLE IN THE 979 00:35:48,320 --> 00:35:49,920 UNITED STATES WHO LIVE UNDER THE 980 00:35:49,920 --> 00:35:53,520 POVERTY LEVEL. 981 00:35:53,520 --> 00:35:55,440 9% OF WHITES, THAT TRANSLATE 982 00:35:55,440 --> 00:35:56,440 INTO 17 MILLION PEOPLE. 983 00:35:56,440 --> 00:35:59,960 21% OF BLACKS TRANSLATES INTO 984 00:35:59,960 --> 00:36:00,240 8 MILLION. 985 00:36:00,240 --> 00:36:05,440 17% OF HISPANICS TRANSLATES INTO 986 00:36:05,440 --> 00:36:05,760 10 MILLION. 987 00:36:05,760 --> 00:36:06,840 MANY PEOPLE DON'T REALIZE THERE 988 00:36:06,840 --> 00:36:08,680 ARE MORE POOR WHITES IN THE 989 00:36:08,680 --> 00:36:09,640 UNITED STATES THAN THERE ARE 990 00:36:09,640 --> 00:36:11,600 POOR BLACKS. 991 00:36:11,600 --> 00:36:13,880 CANCER INCIDENCE DISPARITY DUE 992 00:36:13,880 --> 00:36:14,840 TO DIFFERENCES IN ENVIRONMENT 993 00:36:14,840 --> 00:36:16,920 ARE INCREDIBLY IMPORTANT. 994 00:36:16,920 --> 00:36:18,920 THAT'S DIET, EXERCISE, SMOKING 995 00:36:18,920 --> 00:36:21,640 AND ALCOHOL USE, POLLUTION. 996 00:36:21,640 --> 00:36:23,640 CANCER OUTCOME DISPARITIES, ON 997 00:36:23,640 --> 00:36:24,640 THE OTHER HAND, ARE DUE TO 998 00:36:24,640 --> 00:36:26,600 DIFFERENCES IN ACCESS TO QUALITY 999 00:36:26,600 --> 00:36:27,880 CARE AND UTILIZATION OF 1000 00:36:27,880 --> 00:36:31,600 AVAILABLE CARE. 1001 00:36:31,600 --> 00:36:33,240 THEY ARE MUCH MORE INFLUENCED BY 1002 00:36:33,240 --> 00:36:37,280 SEWS YOASH ECONOMICS. 1003 00:36:37,280 --> 00:36:37,680 SOCIOECONOMICS. 1004 00:36:37,680 --> 00:36:39,480 HERE WE HAVE BRITISH DATA, THEY 1005 00:36:39,480 --> 00:36:42,160 ARE VERY GOOD AT THEIR 10-YEAR 1006 00:36:42,160 --> 00:36:45,560 CENSUS AS DEFINING PEOPLE AS 1007 00:36:45,560 --> 00:36:47,000 AFFLUENT AND DEPRIVED. 1008 00:36:47,000 --> 00:36:49,640 THEY HAVE AN INDEX WHERE 1 IS 1009 00:36:49,640 --> 00:36:51,440 VERY AFFLUENT AND 7 IS VERY 1010 00:36:51,440 --> 00:36:51,720 DEPRIVED. 1011 00:36:51,720 --> 00:36:53,840 THEY SHOW THE FIVE-YEAR SURVIVAL 1012 00:36:53,840 --> 00:36:56,400 OF THE AFFLUENT FOR ALMOST EVERY 1013 00:36:56,400 --> 00:36:57,760 CANCER, ALL THE MAJOR CANCERS, 1014 00:36:57,760 --> 00:36:59,080 IS BETTER THAN THAT FOR THOSE 1015 00:36:59,080 --> 00:37:00,080 WHO ARE DEPRIVED. 1016 00:37:00,080 --> 00:37:03,840 IN THE UNITED STATE, AND THIS IS 1017 00:37:03,840 --> 00:37:06,120 NCI INTRAMURAL DATA, PEOPLE WHO 1018 00:37:06,120 --> 00:37:08,760 LIVE IN COUNTIES THAT HAVE 1019 00:37:08,760 --> 00:37:12,040 PERSISTENT POVERTY HAVE A MUCH 1020 00:37:12,040 --> 00:37:14,040 WORSE OUTCOME IN TERMS OF 1021 00:37:14,040 --> 00:37:15,840 MORTALITY SINCE THE YEAR 2000 1022 00:37:15,840 --> 00:37:17,720 COMPARED TO PEOPLE WHO LIVE IN 1023 00:37:17,720 --> 00:37:19,080 WEALTHIER COUNTIES. 1024 00:37:19,080 --> 00:37:22,880 JUST LOOK HERE AT ALL KEAN CANCERS, 1025 00:37:22,880 --> 00:37:24,760 THE DOTTED LINES ARE THE HIGH 1026 00:37:24,760 --> 00:37:26,640 INCOME COUNTIES, THE SOLID LINES 1027 00:37:26,640 --> 00:37:28,440 ARE THE WEALTHIER COUNTIES, AND 1028 00:37:28,440 --> 00:37:32,080 THESE DECLINES ARE DECLINES IN 1029 00:37:32,080 --> 00:37:34,040 AGE STANDARDIZED MORTALITY RATE 1030 00:37:34,040 --> 00:37:34,680 PER 100,000. 1031 00:37:34,680 --> 00:37:38,960 PEOPLE WHO LIVE IN THE WELFARE 1032 00:37:38,960 --> 00:37:40,320 COUNTIES HAVE A MUCH GREATER 1033 00:37:40,320 --> 00:37:41,440 DECLINE IN MORTALITY COMPARED TO 1034 00:37:41,440 --> 00:37:43,560 PEOPLE WHO LIVE IN THE 1035 00:37:43,560 --> 00:37:44,040 NON-WEALTHY COUNTIES. 1036 00:37:44,040 --> 00:37:46,560 MORE ON THAT, AGAIN, AND I 1037 00:37:46,560 --> 00:37:47,440 SHOULD JUST POINT OUT, I'M NOT 1038 00:37:47,440 --> 00:37:48,640 GOING TO SPEND A LOT OF TIME ON 1039 00:37:48,640 --> 00:37:50,120 THIS, THIS IS TRUE FOR VIRTUALLY 1040 00:37:50,120 --> 00:37:53,000 EVERY DISEASE. 1041 00:37:53,000 --> 00:37:54,840 NOW LOW SES AND LACK OF 1042 00:37:54,840 --> 00:37:56,080 INSURANCE IS ASSOCIATED WITH 1043 00:37:56,080 --> 00:37:58,440 HIGHER STAGE OF DIAGNOSIS FOR 1044 00:37:58,440 --> 00:37:59,800 VIRTUALLY ALL CANCERS. 1045 00:37:59,800 --> 00:38:03,520 FOR ADULTS, THE AFFORDABLE CARE 1046 00:38:03,520 --> 00:38:05,880 ACT ORO'BAMA CARE IS ASSOCIATED 1047 00:38:05,880 --> 00:38:07,080 WITH REDUCTION IN DISPARITIES. 1048 00:38:07,080 --> 00:38:09,840 THERE HAVE BEEN DOCUMENTED 1049 00:38:09,840 --> 00:38:11,920 REDUCTIONS IN STAGE OF DIAGNOSIS 1050 00:38:11,920 --> 00:38:15,440 AND IMPROVEMENTS IN OUTCOME, BUT 1051 00:38:15,440 --> 00:38:17,040 UNFORTUNATELY, OBAMACARE IS 1052 00:38:17,040 --> 00:38:19,560 CAUSING AN INCREASE IN STATE BY 1053 00:38:19,560 --> 00:38:21,520 STATE DISPARITIES AS WE LOOK AT 1054 00:38:21,520 --> 00:38:24,600 STATES THAT HAVE IMPLEMENTED 1055 00:38:24,600 --> 00:38:26,080 DOING BETTER THAN STATES WHO 1056 00:38:26,080 --> 00:38:31,480 HAVE NOT IMPLEMENTED MEDICAID 1057 00:38:31,480 --> 00:38:35,760 EXPANSION DOING WORSE. 1058 00:38:35,760 --> 00:38:37,400 THE POOR, INCLUDING POOR WHITES, 1059 00:38:37,400 --> 00:38:38,600 ARE MORE OFTEN PRESENT WITH 1060 00:38:38,600 --> 00:38:39,360 DISTANT DISEASE. 1061 00:38:39,360 --> 00:38:41,040 THEY'RE LESS LIKELY TO RECEIVE 1062 00:38:41,040 --> 00:38:41,720 RADIATION. 1063 00:38:41,720 --> 00:38:43,440 WHEN THEY RECEIVE RADIATION, THE 1064 00:38:43,440 --> 00:38:44,800 QUALITY IS POOR, IN TERMS OF 1065 00:38:44,800 --> 00:38:46,080 AIMING OF THE BEAM, POOR PEOPLE 1066 00:38:46,080 --> 00:38:47,920 ARE MORE LIKELY TO BE TREATED 1067 00:38:47,920 --> 00:38:49,040 WITH LOWER ENERGY OLDER 1068 00:38:49,040 --> 00:38:52,320 RADIATION THERAPY MACHINES IN 1069 00:38:52,320 --> 00:38:52,760 THE UNITED STATES. 1070 00:38:52,760 --> 00:38:54,240 HERE YOU HAVE SOFT TISSUE 1071 00:38:54,240 --> 00:38:56,920 SARCOMA, WHICH IS LARGELY A 1072 00:38:56,920 --> 00:38:58,080 PEDIATRIC DISEASE. 1073 00:38:58,080 --> 00:38:59,640 THOSE WHO HAVE PRIVATE 1074 00:38:59,640 --> 00:39:02,560 INSURANCE, THEIR SURVIVAL 1075 00:39:02,560 --> 00:39:05,000 PROBABILITY IS HERE ON THE SOLID 1076 00:39:05,000 --> 00:39:07,480 LINE OVER TIME, THIS IS 200 1077 00:39:07,480 --> 00:39:09,600 MONTHS, AND THE DOTS LINE, LOW 1078 00:39:09,600 --> 00:39:11,160 INCOME, OR WITH PUBLIC 1079 00:39:11,160 --> 00:39:13,200 INSURANCE, SURVIVAL PROBABILITY 1080 00:39:13,200 --> 00:39:16,840 IS MUCH LESS. 1081 00:39:16,840 --> 00:39:18,480 SOCIOECONOMICS IS INCREDIBLY 1082 00:39:18,480 --> 00:39:20,080 IMPORTANT. 1083 00:39:20,080 --> 00:39:20,800 THERE'S INCREASING UNDERSTANDING 1084 00:39:20,800 --> 00:39:23,720 OF THIS FOR CANCER CAUSATION, 1085 00:39:23,720 --> 00:39:25,800 EVEN ITS EFFECT ON GENOMES AND 1086 00:39:25,800 --> 00:39:26,200 BEHAVIOR. 1087 00:39:26,200 --> 00:39:29,840 I'M GOING TO SHOW YOU SOME DATA 1088 00:39:29,840 --> 00:39:31,800 ON WHERE SOCIOECONOMIC STATUS 1089 00:39:31,800 --> 00:39:34,320 ACTUALLY ULTIMATELY TRANSCENDS 1090 00:39:34,320 --> 00:39:35,560 INTO CHANGING AND HOW CANCER 1091 00:39:35,560 --> 00:39:39,240 EXPRESSES ITSELF GENOMEICALLY. 1092 00:39:39,240 --> 00:39:41,040 PROSTATE CANCER, EVERYONE KNOWS 1093 00:39:41,040 --> 00:39:43,240 TWOFOLD INCREASE RISK OF DYING 1094 00:39:43,240 --> 00:39:44,080 FROM PROSTATE CANCER FOR BLACK 1095 00:39:44,080 --> 00:39:46,320 MEN IN THE UNITED STATES. 1096 00:39:46,320 --> 00:39:49,120 FACTORS THAT WE KNOW ARE 1097 00:39:49,120 --> 00:39:51,440 INVOLVED IN THIS INCLUDE 1098 00:39:51,440 --> 00:39:52,240 INCREASED AGGRESSIVENESS OF 1099 00:39:52,240 --> 00:40:01,440 TUMOR RELATED TO THE MED BOLG METABOLIC 1100 00:40:01,440 --> 00:40:05,320 SYNDROME, HIGH CARBOHYDRATE 1101 00:40:05,320 --> 00:40:07,200 DIET, MORE COMMON IN BLACKS THAN 1102 00:40:07,200 --> 00:40:09,240 WHITES, HIGH BODY MASS INDEX. 1103 00:40:09,240 --> 00:40:10,480 EPIGENETICS OF PROSTATE CANCER 1104 00:40:10,480 --> 00:40:12,000 IS A FIELD OF OPPORTUNITY FOR 1105 00:40:12,000 --> 00:40:13,640 YOUNG PEOPLE THINKING ABOUT WHAT 1106 00:40:13,640 --> 00:40:15,040 TO PUT IN THEIR CAREER. 1107 00:40:15,040 --> 00:40:16,680 HERE WE HAVE SOME ASSESSMENTS OF 1108 00:40:16,680 --> 00:40:17,040 CLINICAL TRIALS. 1109 00:40:17,040 --> 00:40:20,080 NOW THIS IS SOMEWHAT INSPIRED BY 1110 00:40:20,080 --> 00:40:22,160 THE NIH REVITALIZATION ACT, AND 1111 00:40:22,160 --> 00:40:23,680 THIS IS A GOOD THING, I THINK, 1112 00:40:23,680 --> 00:40:25,440 AND WE SHOULD TAKE THIS AND 1113 00:40:25,440 --> 00:40:28,280 CARRY THIS BALL. 1114 00:40:28,280 --> 00:40:30,520 YOU SEE IN A NUMBER OF STUDIES 1115 00:40:30,520 --> 00:40:32,320 WHERE THEY TOOK 1116 00:40:32,320 --> 00:40:33,080 MULTI-INSTITUTIONAL -- THIS IS 1117 00:40:33,080 --> 00:40:34,840 NOT CLINICAL TRIAL, THIS TOOK 1118 00:40:34,840 --> 00:40:36,400 LARGE NUMBERS OF MEN TREATED IN 1119 00:40:36,400 --> 00:40:40,040 A NUMBER OF INSTITUTIONS, GOOD 1120 00:40:40,040 --> 00:40:43,880 PLACES THAT STUDY PROSTATE 1121 00:40:43,880 --> 00:40:45,680 CANCER, THEY LOOKED AT 188 BLACK 1122 00:40:45,680 --> 00:40:50,040 MEP COMPARED TO 1474 WHITES, WHO 1123 00:40:50,040 --> 00:40:53,000 GOT TREATED WITH RADICAL PROS TA 1124 00:40:53,000 --> 00:41:00,840 TECT 1125 00:41:00,840 --> 00:41:03,680 PROSTATECTOMY AND THEY FOUND NO 1126 00:41:03,680 --> 00:41:05,320 DIFFERENCE IN BIOCHEMICAL 1127 00:41:05,320 --> 00:41:05,640 OUTCOME. 1128 00:41:05,640 --> 00:41:14,000 THIS STUDY, BLACK MEN HAD BETTER 1129 00:41:14,000 --> 00:41:16,720 SURVIVAL VERSUS WHITE MEN. 1130 00:41:16,720 --> 00:41:20,560 AGAIN, THIS SHOWS YOU -- THIS 1131 00:41:20,560 --> 00:41:22,640 WAS THE HAZARD RATIOS. 1132 00:41:22,640 --> 00:41:24,240 UNADJUSTED AND IN MULTIVARIATE 1133 00:41:24,240 --> 00:41:25,360 MODELS. 1134 00:41:25,360 --> 00:41:30,480 BLACK MEN ACTUALLY DID SLIGHTLY 1135 00:41:30,480 --> 00:41:32,880 BETTER WITH TREATMENT. 1136 00:41:32,880 --> 00:41:38,040 COMPARISON OF RESPONSE TO 1137 00:41:38,040 --> 00:41:38,880 DEFINITIVE RADIOTHERAPY FOR 1138 00:41:38,880 --> 00:41:40,520 LOCALIZED PROSTATE CANCER IN 1139 00:41:40,520 --> 00:41:42,160 BLACK AND WHITE MEN. 1140 00:41:42,160 --> 00:41:47,400 HERE, A LARGER TRIAL, 1630 BLACK 1141 00:41:47,400 --> 00:41:49,160 MEN, 7200 WHITE MEN WITH MEDIAN 1142 00:41:49,160 --> 00:41:51,440 FOLLOW-UP OF GREATER THAN 10 1143 00:41:51,440 --> 00:41:52,560 YEARS, ALMOST 11 YEARS. 1144 00:41:52,560 --> 00:41:54,720 BLACK MEN WERE LESS LIKELY TO 1145 00:41:54,720 --> 00:41:56,240 DIE OF PROSTATE CANCER AFTER 1146 00:41:56,240 --> 00:41:58,240 TREATMENT AND THERE'S NO 1147 00:41:58,240 --> 00:41:59,200 SIGNIFICANT DIFFERENCE IN ALL 1148 00:41:59,200 --> 00:42:04,240 CAUSE MORTALITY. 1149 00:42:04,240 --> 00:42:05,440 NOW, THERE'S AN ASSOCIATION 1150 00:42:05,440 --> 00:42:06,600 BETWEEN RACE AND RECEIPT OF 1151 00:42:06,600 --> 00:42:07,240 DEFINITIVE TREATMENT. 1152 00:42:07,240 --> 00:42:09,760 I THINK YOU'RE GETTING MY GIST 1153 00:42:09,760 --> 00:42:10,080 HERE. 1154 00:42:10,080 --> 00:42:11,640 EVEN IN PROSTATE CANCER, YES, 1155 00:42:11,640 --> 00:42:13,360 BLACK MEN ARE MORE LIKELY TO 1156 00:42:13,360 --> 00:42:16,000 DEVELOP IT, BUT ONCE DIAGNOSED, 1157 00:42:16,000 --> 00:42:19,040 AT EVERY STAGE EQUAL TREATMENT 1158 00:42:19,040 --> 00:42:20,360 YIELDS EQUAL OUTCOME, BUT THERE 1159 00:42:20,360 --> 00:42:23,440 IS NOT EQUAL TREATMENT. 1160 00:42:23,440 --> 00:42:24,840 THAT NEEDS TO BE A FOCUS. 1161 00:42:24,840 --> 00:42:27,480 MUCH MORE SO THAN SUBSET 1162 00:42:27,480 --> 00:42:31,960 ANALYSIS IN CLINICAL TRIALS NOW. 1163 00:42:31,960 --> 00:42:33,040 NOW THERE IS RACIAL DIFFERENCES 1164 00:42:33,040 --> 00:42:34,600 IN DEVELOPING PROSTATE CANCER. 1165 00:42:34,600 --> 00:42:37,960 THE INCREASED RISK COULD BE -- 1166 00:42:37,960 --> 00:42:40,640 AND THERE DOES APPEAR TO BE 1167 00:42:40,640 --> 00:42:42,600 INCREASED RISK AMONG MEN WITH 1168 00:42:42,600 --> 00:42:44,040 GENETIC LINKAGE TO NORTHWESTERN 1169 00:42:44,040 --> 00:42:44,920 SUB-SAHARAN AFRICA. 1170 00:42:44,920 --> 00:42:47,200 NOT EAST AFRICA, NOT SOUTH 1171 00:42:47,200 --> 00:42:49,840 AFRICA, BUT NORTHWESTERN 1172 00:42:49,840 --> 00:42:55,520 SUB-SAHARAN AFRICA. 1173 00:42:55,520 --> 00:42:58,120 WHILE THE RACIAL DIFFERENCES IN 1174 00:42:58,120 --> 00:42:59,720 RISK OF DEVELOPING PROSTATE 1175 00:42:59,720 --> 00:43:00,920 CANCER, EQUAL TREATMENT YIELDS 1176 00:43:00,920 --> 00:43:03,080 EQUAL OUTCOMES AND THERE IS NOT 1177 00:43:03,080 --> 00:43:03,600 EQUAL TREATMENT. 1178 00:43:03,600 --> 00:43:04,640 LET'S LOOK AT BREAST CANCER. 1179 00:43:04,640 --> 00:43:08,320 THESE ARE THE NUMBER OF IN 2019 1180 00:43:08,320 --> 00:43:09,960 WHICH CALL THE LAST YEAR OF 1181 00:43:09,960 --> 00:43:12,240 NORMAL TIME THAT I CALL COVID. 1182 00:43:12,240 --> 00:43:12,800 THESE ARE AMERICAN CANCER 1183 00:43:12,800 --> 00:43:13,440 SOCIETY ESTIMATES FOR DIAGNOSIS 1184 00:43:13,440 --> 00:43:15,240 AND DEATH. 1185 00:43:15,240 --> 00:43:18,000 THERE'S BEEN 40 TO 50% DECLINE 1186 00:43:18,000 --> 00:43:21,040 IN RISK OF DEATH SINCE 1990. 1187 00:43:21,040 --> 00:43:23,560 I'VE SHOWN YOU THIS ALREADY, THE 1188 00:43:23,560 --> 00:43:25,240 BLACK/WHITE DISPARITY IS GREATER 1189 00:43:25,240 --> 00:43:26,640 TODAY THAN IT HAS EVER BEEN, AND 1190 00:43:26,640 --> 00:43:28,240 IT DIDN'T EXIST BEFORE WE KNEW 1191 00:43:28,240 --> 00:43:30,640 HOW TO SCREEN AND TREAT FOR 1192 00:43:30,640 --> 00:43:30,840 THIS. 1193 00:43:30,840 --> 00:43:32,520 THIS IS THE BLACK/WHITE 1194 00:43:32,520 --> 00:43:33,360 DISPARITY. 1195 00:43:33,360 --> 00:43:36,040 IF YOU INTEGRATE ALL OF THIS, 1196 00:43:36,040 --> 00:43:38,000 THERE'S A 40% DECLINE IN RISK OF 1197 00:43:38,000 --> 00:43:39,920 DEATH SINCE 1990. 1198 00:43:39,920 --> 00:43:42,320 40% DECLINE IN RISK OF DEATH FOR 1199 00:43:42,320 --> 00:43:43,840 THE UNITED STATES AS A WHOLE, 1200 00:43:43,840 --> 00:43:45,840 AND THE UNITED STATES WAS VERY 1201 00:43:45,840 --> 00:43:50,760 HOMOGENEOUS INTERESTINGLY IN THE 1202 00:43:50,760 --> 00:43:51,080 1980s. 1203 00:43:51,080 --> 00:43:53,040 BUT SINCE 1988 OR SO, THESE 1204 00:43:53,040 --> 00:43:55,360 PURPLE STATES HAVE HAD A 20 TO 1205 00:43:55,360 --> 00:43:58,960 29% DECLINE AND THE DARK BLUE 1206 00:43:58,960 --> 00:44:04,840 STATES HAD A 44 TO 501% DECLINE. 1207 00:44:04,840 --> 00:44:06,640 IT'S MOVING INTO THE RICH/PORE 1208 00:44:06,640 --> 00:44:08,720 AND EVEN MORE SO IN THE 1209 00:44:08,720 --> 00:44:10,480 MISSISSIPPI VERSUS 1210 00:44:10,480 --> 00:44:11,040 MASSACHUSETTS. 1211 00:44:11,040 --> 00:44:14,040 YOU'VE SEEN THIS BEFORE. 1212 00:44:14,040 --> 00:44:15,640 THERE ARE SEVEN STATES WHERE 1213 00:44:15,640 --> 00:44:17,600 BLACK/WHITE MORTALITY 1214 00:44:17,600 --> 00:44:19,440 DIFFERENCES ARE NO LONGER 1215 00:44:19,440 --> 00:44:20,000 STATISTICALLY SIGNIFICANT. 1216 00:44:20,000 --> 00:44:20,840 HERE IN THE UNITED STATES TODAY, 1217 00:44:20,840 --> 00:44:22,640 WE HAVE THE GREATEST DISPARITY 1218 00:44:22,640 --> 00:44:26,000 OVERALL FOR BLACKS AND WHITES, 1219 00:44:26,000 --> 00:44:27,440 BUT THERE'S SEVEN STATES WHERE 1220 00:44:27,440 --> 00:44:28,960 BLACK/WHITE DIFFERENCES ARE NO 1221 00:44:28,960 --> 00:44:30,040 LONGER STATISTICALLY 1222 00:44:30,040 --> 00:44:31,440 SIGNIFICANT. 1223 00:44:31,440 --> 00:44:33,120 INDEED THERE ARE 12 STATES WHERE 1224 00:44:33,120 --> 00:44:35,520 WHITE WOMEN HAVE A HIGHER RISK 1225 00:44:35,520 --> 00:44:37,240 OF BREAST CANCER DEATH COMPARED 1226 00:44:37,240 --> 00:44:38,880 TO BLACK WOMEN WHO LIVE IN 1227 00:44:38,880 --> 00:44:41,680 MASSACHUSETTS. 1228 00:44:41,680 --> 00:44:44,080 AND THERE HAS HAS BEEN THIS 1229 00:44:44,080 --> 00:44:46,040 INCREDIBLE EMPHASIS ON SCREEN, 1230 00:44:46,040 --> 00:44:46,440 SCREEN, SCREEN. 1231 00:44:46,440 --> 00:44:47,720 I DON'T HAVE TIME TO GO INTO IT 1232 00:44:47,720 --> 00:44:48,240 FULLY. 1233 00:44:48,240 --> 00:44:49,880 I JUST WANT TO POINT OUT THERE'S 1234 00:44:49,880 --> 00:44:53,200 DATA THAT SHOW THAT A LARGER 1235 00:44:53,200 --> 00:44:57,960 PROPORTION OF THOSE WHO DIED, 1236 00:44:57,960 --> 00:45:00,280 THE 45,000 OF THOSE WHO DIE FROM 1237 00:45:00,280 --> 00:45:02,880 BREAST CANCER, 21 TO 27% DIE 1238 00:45:02,880 --> 00:45:03,840 BECAUSE THEY DON'T GET 1239 00:45:03,840 --> 00:45:06,040 APPROPRIATE TREATMENT AFTER 1240 00:45:06,040 --> 00:45:06,320 DIAGNOSIS. 1241 00:45:06,320 --> 00:45:07,600 IT'S ONLY ABOUT 10% WHO DIE 1242 00:45:07,600 --> 00:45:10,320 BECAUSE THEY DIDN'T GET 1243 00:45:10,320 --> 00:45:10,600 SCREENED. 1244 00:45:10,600 --> 00:45:12,080 SO I LIKE TO SAY THERE'S AN 1245 00:45:12,080 --> 00:45:15,120 UNDEREMPHASIS ON GETTING PEOPLE 1246 00:45:15,120 --> 00:45:16,240 ADEQUATE CARE. 1247 00:45:16,240 --> 00:45:18,920 A SUBSTANTIAL NUMBER OF PEOPLE, 1248 00:45:18,920 --> 00:45:21,120 BLACK, WHITE, AND POOR, DON'T 1249 00:45:21,120 --> 00:45:22,800 GET APPROPRIATE SURGERY 1250 00:45:22,800 --> 00:45:25,200 CHEMOTHERAPY HORMONES IN 1251 00:45:25,200 --> 00:45:26,960 RADIATION. 1252 00:45:26,960 --> 00:45:30,120 MARROW JOE LUN WAS ONE OF MY 1253 00:45:30,120 --> 00:45:31,440 FELLOWS AT EMORY, AND WE 1254 00:45:31,440 --> 00:45:33,720 PUBLISHED THAT IN ATLANTA, 1255 00:45:33,720 --> 00:45:35,840 7 1/2% OF BLACK WOMEN WHO GOT 1256 00:45:35,840 --> 00:45:38,560 SCREENED AND DIAGNOSED WITH 1257 00:45:38,560 --> 00:45:39,440 BREAST CANCER DIDN'T GET TREATED 1258 00:45:39,440 --> 00:45:40,920 IN THE FIRST YEAR. 1259 00:45:40,920 --> 00:45:42,800 IT'S 3%, BY THE WAY, OF WHITE 1260 00:45:42,800 --> 00:45:45,280 WOMAN, ALL POOR, ALL 1261 00:45:45,280 --> 00:45:45,920 DISENFRANCHISED FROM THE SYSTEM. 1262 00:45:45,920 --> 00:45:50,080 THEY DIDN'T GET ADEQUATE 1263 00:45:50,080 --> 00:45:50,440 TREATMENT. 1264 00:45:50,440 --> 00:45:52,840 IN MILITARY DATABASES, BY THE 1265 00:45:52,840 --> 00:45:54,400 WAY, THERE'S TREMENDOUS DATA 1266 00:45:54,400 --> 00:45:55,400 THAT SHOWS THAT BLACKS AND 1267 00:45:55,400 --> 00:45:56,360 WHITES ARE ACTUALLY GETTING 1268 00:45:56,360 --> 00:45:57,640 CLOSER AND CLOSER TOGETHER. 1269 00:45:57,640 --> 00:45:59,120 THE BLACK/WHITE DISPARITY OF 1270 00:45:59,120 --> 00:46:00,960 WOMEN WHO GO TO A WALTER REED 1271 00:46:00,960 --> 00:46:02,400 ARMY HOSPITAL IS FAR DIFFERENT 1272 00:46:02,400 --> 00:46:06,560 FROM THAT IN THE UNITED STATES. 1273 00:46:06,560 --> 00:46:08,400 VERY INTERESTING, A WOMAN WHOSE 1274 00:46:08,400 --> 00:46:09,840 HUSBAND RETIRED AFTER 20 YEARS 1275 00:46:09,840 --> 00:46:12,120 IN THE MILITARY, HER RISK OF 1276 00:46:12,120 --> 00:46:13,840 DYING FROM BREAST CANCER, FAR 1277 00:46:13,840 --> 00:46:16,840 LOWER THAN HER SISTER THAT MIGHT 1278 00:46:16,840 --> 00:46:18,800 LIVE IN SOUTHWEST D.C. . 1279 00:46:18,800 --> 00:46:20,120 THERE'S TALK ABOUT ESTROGEN 1280 00:46:20,120 --> 00:46:21,200 RECEPTORS, TRIPLE NEGATIVE 1281 00:46:21,200 --> 00:46:21,560 DISEASE. 1282 00:46:21,560 --> 00:46:23,600 IT IS TRUE THAT 24% OF BLACK 1283 00:46:23,600 --> 00:46:24,840 WOMEN AND 12% OF WHITE WOMEN IN 1284 00:46:24,840 --> 00:46:26,320 THE U.S. HAVE TRIPLE NEGATIVE 1285 00:46:26,320 --> 00:46:29,680 DISEASE. 1286 00:46:29,680 --> 00:46:31,520 IN IS JUST THE AMERICAN CANCER 1287 00:46:31,520 --> 00:46:33,240 SOCIETY'S GRAPH OF THE RACIAL 1288 00:46:33,240 --> 00:46:36,040 DIFFERENCES IN VARIOUS TYPES OF 1289 00:46:36,040 --> 00:46:36,920 BREAST CANCER. 1290 00:46:36,920 --> 00:46:38,240 NOW, FEW, BY THE WAY, APPRECIATE 1291 00:46:38,240 --> 00:46:39,840 THAT WHILE 24% OF BLACK WOMEN 1292 00:46:39,840 --> 00:46:42,400 HAVE TRIPLE NEGATIVE DISEASE, 1293 00:46:42,400 --> 00:46:44,040 THE BIG BLACK/WHITE DISPARITIES 1294 00:46:44,040 --> 00:46:45,880 ARE IN TREATMENT OF ESTROGEN 1295 00:46:45,880 --> 00:46:48,720 RECEPTOR POSITIVE NON-TRIPLE 1296 00:46:48,720 --> 00:46:49,840 NEGATIVE DISEASE. 1297 00:46:49,840 --> 00:46:52,320 IT'S THE 76% OF BLACKS WHO DON'T 1298 00:46:52,320 --> 00:46:56,040 HAVE TRIPLE NEGATIVE DISEASE WHO 1299 00:46:56,040 --> 00:46:56,960 ARE GETTING INEFFECTIVE THERAPY 1300 00:46:56,960 --> 00:47:00,280 OR MORE LIKELY ARE GETTING 1301 00:47:00,280 --> 00:47:01,240 INEFFECTIVE THERAPY, I SHOULD 1302 00:47:01,240 --> 00:47:02,520 SAY, WHICH ENDS UP MEANING THAT 1303 00:47:02,520 --> 00:47:03,760 THEY'RE MORE LIKELY TO HAVE A 1304 00:47:03,760 --> 00:47:05,160 BAD OUTCOME. 1305 00:47:05,160 --> 00:47:07,360 SOCIAL DEPRIVATION STUDIES IN 1306 00:47:07,360 --> 00:47:10,640 EUROPE OVER THE LAST 25 YEARS 1307 00:47:10,640 --> 00:47:12,840 HAVE SHOWN THAT POOR WOMEN IN 1308 00:47:12,840 --> 00:47:14,360 EUROPE ARE MORE LIKELY TO HAVE 1309 00:47:14,360 --> 00:47:15,240 TRIPLE NEGATIVE DISEASE. 1310 00:47:15,240 --> 00:47:18,680 WITHOUT THE BLINDERS OF RACE IN 1311 00:47:18,680 --> 00:47:20,040 SCOTLAND, WHERE THERE ARE VERY 1312 00:47:20,040 --> 00:47:21,240 FEW BLACK PEOPLE, THEY REALIZE 1313 00:47:21,240 --> 00:47:22,920 THAT POOR WOMEN, OR WOMEN WITH A 1314 00:47:22,920 --> 00:47:24,240 HISTORY OF POVERTY, ARE MORE 1315 00:47:24,240 --> 00:47:26,520 LIKELY TO HAVE TRIPLE NEGATIVE 1316 00:47:26,520 --> 00:47:27,840 BREAST CANCER IN THEIR 40s AND 1317 00:47:27,840 --> 00:47:28,360 50s. 1318 00:47:28,360 --> 00:47:29,240 THEY'VE BEEN ABLE TO CORRELATE 1319 00:47:29,240 --> 00:47:31,120 IT WITH OBESITY, THEY'VE BEEN 1320 00:47:31,120 --> 00:47:32,640 ABLE TO CORRELATE IT WITH 1321 00:47:32,640 --> 00:47:35,560 DIETARY DIFFERENCES, ESPECIALLY 1322 00:47:35,560 --> 00:47:38,240 WEIGHT GAIN AND HIGH 1323 00:47:38,240 --> 00:47:40,800 CARBOHYDRATE DIET IN CHILDHOOD. 1324 00:47:40,800 --> 00:47:42,320 INTERESTINGLY, WEIGHT GAIN FROM 1325 00:47:42,320 --> 00:47:46,720 BIRTH UNTIL THE EARLY TEEN YEARS 1326 00:47:46,720 --> 00:47:47,920 INCREASES RISK OF BREAST CANCER 1327 00:47:47,920 --> 00:47:51,320 IN ONE'S 40s AND 50s AND 1328 00:47:51,320 --> 00:47:51,480 60s. 1329 00:47:51,480 --> 00:47:53,280 IT HAS DO WITH THE AGE AT WHICH 1330 00:47:53,280 --> 00:47:57,200 A WOMAN STARTS MENSTRUATING. 1331 00:47:57,200 --> 00:47:58,520 REPRODUCTIVE PATTERNS ARE ALSO 1332 00:47:58,520 --> 00:47:59,280 IMPORTANT. 1333 00:47:59,280 --> 00:48:01,240 WOMEN WHO HAVE LOTS OF CHILDREN 1334 00:48:01,240 --> 00:48:02,800 AND THEN DON'T BREASTFEED ARE AT 1335 00:48:02,800 --> 00:48:06,120 HIGHER RISK OF TRIPLE NEGATIVE 1336 00:48:06,120 --> 00:48:06,360 DISEASE. 1337 00:48:06,360 --> 00:48:08,040 THESE ARE ALL SOCIOECONOMIC 1338 00:48:08,040 --> 00:48:09,560 THINGS, AND WHEN WE LOOK AT THEM 1339 00:48:09,560 --> 00:48:13,480 BLACK VERSUS WHITE, WE 1340 00:48:13,480 --> 00:48:14,480 FREQUENTLY, BECAUSE OF OUR OLD 1341 00:48:14,480 --> 00:48:15,880 WAY OF THINKING, START THINKING 1342 00:48:15,880 --> 00:48:17,240 THIS IS BECAUSE THEY'RE BLACK. 1343 00:48:17,240 --> 00:48:19,520 THIS IS WEIGHT GAIN FOR BLACK 1344 00:48:19,520 --> 00:48:23,040 WOMEN VERSUS WHITE WOMEN VERSUS 1345 00:48:23,040 --> 00:48:24,440 BLACK MEN AND WHITE MEN. 1346 00:48:24,440 --> 00:48:27,160 YOU CAN SEE OVER THE LAST 40 1347 00:48:27,160 --> 00:48:29,480 YEARS OR SO INCREASING OBESITY 1348 00:48:29,480 --> 00:48:32,120 IN EVERYONE BUT ESPECIALLY IN 1349 00:48:32,120 --> 00:48:34,480 BLACK WOMEN. 1350 00:48:34,480 --> 00:48:35,480 SUBSTANTIAL NUMBERS OF PEOPLE 1351 00:48:35,480 --> 00:48:38,640 GET LESS THAN OPTIMAL CARE. 1352 00:48:38,640 --> 00:48:42,040 WE'RE STARTING TO TALK ABOUT 1353 00:48:42,040 --> 00:48:43,000 EQUITY AND JUSTICE. 1354 00:48:43,000 --> 00:48:46,560 NOW LET'S TALK ABOUT NOT JUST A 1355 00:48:46,560 --> 00:48:48,120 PAPER ON HOW IN CHICAGO THEY'VE 1356 00:48:48,120 --> 00:48:50,320 ACTUALLY CHANGED THE NUMBERS FOR 1357 00:48:50,320 --> 00:48:51,800 BLACK WOMEN WITHIN THE LAST 20 1358 00:48:51,800 --> 00:48:54,240 YEARS. 1359 00:48:54,240 --> 00:48:56,000 IN COLORECTAL CANCER, HERE ARE 1360 00:48:56,000 --> 00:48:56,440 THE NUMBERS. 1361 00:48:56,440 --> 00:48:59,160 THESE ARE THE DEATH RATES, BLACK 1362 00:48:59,160 --> 00:49:01,360 VERSUS WHITE, THE DISPARITY IS 1363 00:49:01,360 --> 00:49:02,360 GETTING BETTER FOR BLACKS AND 1364 00:49:02,360 --> 00:49:03,640 WHITES, AND IT'S REALLY GETTING 1365 00:49:03,640 --> 00:49:07,440 CLOSER AND CLOSER FOR EVERYONE. 1366 00:49:07,440 --> 00:49:08,680 HERE YOU SEE IT FOR WOMEN, HERE 1367 00:49:08,680 --> 00:49:11,200 YOU SEE IT FOR MEN. 1368 00:49:11,200 --> 00:49:12,960 NO DISPARITY IN THE 70s, WE 1369 00:49:12,960 --> 00:49:14,400 LEARNED TO SCREEN AND TREAT, NOW 1370 00:49:14,400 --> 00:49:17,880 THERE'S A DISPARITY. 1371 00:49:17,880 --> 00:49:23,040 50% DECLINE SINCE 1980 IN THE 1372 00:49:23,040 --> 00:49:23,360 UNITED STATES. 1373 00:49:23,360 --> 00:49:26,720 THE U UNITED STATES WAS VERY 1374 00:49:26,720 --> 00:49:29,040 HOMOGENEOUS IN 1980, NOW WE'VE 1375 00:49:29,040 --> 00:49:32,840 GOT A 12 TO 31% TEE KLEIN IN DECLINE IN T HE 1376 00:49:32,840 --> 00:49:36,040 PURPLE STATES. 1377 00:49:36,040 --> 00:49:38,240 A 56 TO 63% IN THE DARK BLUE 1378 00:49:38,240 --> 00:49:38,680 STATES. 1379 00:49:38,680 --> 00:49:40,280 AGAIN, WHAT SEPARATES 1380 00:49:40,280 --> 00:49:48,320 MISSISSIPPI FROM MASSACHUSETTS? 1381 00:49:48,320 --> 00:49:51,440 THIS IS JUST TO SHOW INSURANCE 1382 00:49:51,440 --> 00:49:52,840 MATTERS. 1383 00:49:52,840 --> 00:49:55,240 THE STAGE ONE IN RED, STAGE TWO 1384 00:49:55,240 --> 00:49:56,640 IN BLUE, THE DIFFERENCES MEAN 1385 00:49:56,640 --> 00:49:59,400 THAT THOSE WHO ARE UNINSURED OR 1386 00:49:59,400 --> 00:50:02,160 GOT MEDICAID AFTER DIAGNOSIS ARE 1387 00:50:02,160 --> 00:50:03,720 MORE LIKELY TO NOT DO WELL OVER 1388 00:50:03,720 --> 00:50:04,040 FIVE YEARS. 1389 00:50:04,040 --> 00:50:08,200 THIS IS FIVE YEAR SURVIVAL. 1390 00:50:08,200 --> 00:50:11,680 AND YES, YOU'RE BETTER OFF 1391 00:50:11,680 --> 00:50:13,680 HAVING STAGE TWO COLORECTAL 1392 00:50:13,680 --> 00:50:15,640 CANCER WITH INSURANCE THAN STAGE 1393 00:50:15,640 --> 00:50:16,480 ONE WITHOUT INSURANCE. 1394 00:50:16,480 --> 00:50:18,040 KIM RHODES HAS SHOWN US, AND 1395 00:50:18,040 --> 00:50:21,840 THIS EVEN BLEW MY MIND, THE 1396 00:50:21,840 --> 00:50:26,080 HOSPITAL THAT YOU GO TO AND THE 1397 00:50:26,080 --> 00:50:27,280 HOSPITAL -- IS REALLY IMPORTANT. 1398 00:50:27,280 --> 00:50:30,880 IN CALIFORNIA, SHE WAS ABLE TO 1399 00:50:30,880 --> 00:50:33,000 SHOW THAT AFTER COLORECTAL 1400 00:50:33,000 --> 00:50:34,320 SURGERY, BLACKS AND HISPANICS 1401 00:50:34,320 --> 00:50:38,480 AND POOR PEOPLE WERE LESS LIKELY 1402 00:50:38,480 --> 00:50:40,680 TO HAVE ADEQUATE PATHOLOGY SUCH 1403 00:50:40,680 --> 00:50:43,480 THAT BLACKS WHO WERE UNDERSTAGED 1404 00:50:43,480 --> 00:50:45,240 WHO WERE CALLED STAGE II WERE 1405 00:50:45,240 --> 00:50:47,360 JUST AS LIKELY TO RELAPSE AS 1406 00:50:47,360 --> 00:50:49,280 WHITES WHO WERE CALLED STAGE 1407 00:50:49,280 --> 00:50:49,640 III. 1408 00:50:49,640 --> 00:50:52,240 IT'S BECAUSE THE BLACKS WERE 1409 00:50:52,240 --> 00:50:53,640 UNDERSTAGED. 1410 00:50:53,640 --> 00:50:55,440 KIM IS A SURGEON, SHE SAID I 1411 00:50:55,440 --> 00:50:59,600 NOPA THOL GISTS ARE I 1412 00:50:59,600 --> 00:51:01,240 KNOW PATHOLOGISTS ARE NOT 1413 00:51:01,240 --> 00:51:02,360 RACIST, WHO'S GOING ON HERE? 1414 00:51:02,360 --> 00:51:03,560 SHE WAS ABLE TO FIGURE OUT 1415 00:51:03,560 --> 00:51:05,480 BLACKS WHO HAVE COLORECTAL 1416 00:51:05,480 --> 00:51:06,720 CANCER, BECAUSE OF INSURANCE AND 1417 00:51:06,720 --> 00:51:08,040 OTHER THINGS, ARE MORE LIKELY TO 1418 00:51:08,040 --> 00:51:09,640 BE TREATED IN HOSPITAL THE, 1419 00:51:09,640 --> 00:51:10,880 WHERE THE PATHOLOGIST HAS SIX 1420 00:51:10,880 --> 00:51:12,240 CASES TO DEAL WITH A DAY, 1421 00:51:12,240 --> 00:51:13,080 WHEREAS WHITES IN A HOSPITAL 1422 00:51:13,080 --> 00:51:15,320 WHERE THE PATHOLOGIST HAS TWO 1423 00:51:15,320 --> 00:51:18,320 CASES TO DEAL WITH A DAY. 1424 00:51:18,320 --> 00:51:21,800 HUGE, HUGE DIFFERENCES IN 1425 00:51:21,800 --> 00:51:22,600 QUALITY OF TREATMENT. 1426 00:51:22,600 --> 00:51:24,640 I'M GOING TO WIND UP BY JUST 1427 00:51:24,640 --> 00:51:26,600 NOTING THAT COLLEGE EDUCATION 1428 00:51:26,600 --> 00:51:30,440 LOWERS RISK OF CANCER DEATH 1429 00:51:30,440 --> 00:51:31,560 DRAMATICALLY. 1430 00:51:31,560 --> 00:51:32,760 YOU GIVE A COLLEGE EDUCATION TO 1431 00:51:32,760 --> 00:51:35,000 A BLACK MAN, HIS RISK OF DYING 1432 00:51:35,000 --> 00:51:36,440 FROM CANCER GOES DOWN BELOW THAT 1433 00:51:36,440 --> 00:51:37,680 OF THE AVERAGE WHITE MAN IN THE 1434 00:51:37,680 --> 00:51:38,280 UNITED STATES. 1435 00:51:38,280 --> 00:51:43,120 HERE YOU CAN SEE LESS THAN OR 1436 00:51:43,120 --> 00:51:44,520 EQUAL COLLEGE EDUCATION, RATE OF 1437 00:51:44,520 --> 00:51:47,240 DEATH, VERSUS COLLEGE EDUCATION. 1438 00:51:47,240 --> 00:51:48,600 NOW, AS I LEFT THE AMERICAN 1439 00:51:48,600 --> 00:51:50,640 CANCER SOCIETY, I CHALLENGED THE 1440 00:51:50,640 --> 00:51:51,440 EPIDEMIOLOGISTS WHO DO THOSE 1441 00:51:51,440 --> 00:51:55,040 ESTIMATES OF NUMBERS EVERY YEAR, 1442 00:51:55,040 --> 00:51:56,440 HOW MANY PEOPLE WOULD DIE IF 1443 00:51:56,440 --> 00:51:57,880 EVERYBODY HAD THE RISK OF DEATH 1444 00:51:57,880 --> 00:52:00,800 OF A COLLEGE-EDUCATED PERSON? 1445 00:52:00,800 --> 00:52:02,120 THERE'S NOT A NEW DRUG, NOT A 1446 00:52:02,120 --> 00:52:02,880 NEW TREATMENT. 1447 00:52:02,880 --> 00:52:06,480 THIS IS IF EVERYBODY GOT WHAT 1448 00:52:06,480 --> 00:52:08,360 COLLEGE-EDUCATED PEOPLE GOT. 1449 00:52:08,360 --> 00:52:12,280 WHAT I CAME BACK WITH IS, 1450 00:52:12,280 --> 00:52:13,600 THERE'S 468,000 INSTEAD OF 1451 00:52:13,600 --> 00:52:15,360 600,000 WOULD DIE IN A GIVEN 1452 00:52:15,360 --> 00:52:17,600 YEAR. 1453 00:52:17,600 --> 00:52:19,040 132,000 DEATHS WOULD BE AVERTED 1454 00:52:19,040 --> 00:52:21,040 IF EVERYBODY GOT WHAT 1455 00:52:21,040 --> 00:52:22,640 COLLEGE-EDUCATED PEOPLE GOT. 1456 00:52:22,640 --> 00:52:26,920 AND THAT INCLUDES A LOW SMOKING 1457 00:52:26,920 --> 00:52:39,480 RATE. 1458 00:52:39,480 --> 00:52:41,000 BLACKS ARE MORE LIKELY TO SUFFER 1459 00:52:41,000 --> 00:52:45,560 FROM DISPARITIES, BUT WHITES 1460 00:52:45,560 --> 00:52:48,000 NUMERICALLY OUTPACE THEM. 1461 00:52:48,000 --> 00:52:49,160 WHEN WE TALK ABOUT DISPARITIES 1462 00:52:49,160 --> 00:52:51,160 BY STATE, THIS IS UTAH VERSUS 1463 00:52:51,160 --> 00:52:52,920 KENTUCKY FOR DEATH RATE. 1464 00:52:52,920 --> 00:52:55,440 WE NEED TO START THINKING ABOUT 1465 00:52:55,440 --> 00:52:56,440 DIFFERENCES IN PREVENTION, 1466 00:52:56,440 --> 00:52:58,080 DIFFERENCES IN SCREENING, 1467 00:52:58,080 --> 00:53:01,240 DIFFERENCES IN DIAGNOSTICS AND 1468 00:53:01,240 --> 00:53:01,880 TREATMENT, NOT JUST DIFFERENCES 1469 00:53:01,880 --> 00:53:05,000 IN BIOLOGY AMONGST THE RACES, AS 1470 00:53:05,000 --> 00:53:08,080 WE START MOVING TOWARD -- MORE 1471 00:53:08,080 --> 00:53:09,440 TOWARD SOCIAL JUSTICE AND MORE 1472 00:53:09,440 --> 00:53:10,880 TOWARD FIGURING OUT WHAT THE 1473 00:53:10,880 --> 00:53:12,880 REAL PROBLEMS WITH AND 1474 00:53:12,880 --> 00:53:15,720 OVERCOMING THE REAL DISPARITIES. 1475 00:53:15,720 --> 00:53:17,440 THE IMPORTANCE OF RISK 1476 00:53:17,440 --> 00:53:20,080 REDUCTION, I CANNOT 1477 00:53:20,080 --> 00:53:20,440 OVEREMPHASIZE. 1478 00:53:20,440 --> 00:53:21,520 WE NEED TO ALSO IDENTIFY THOSE 1479 00:53:21,520 --> 00:53:24,240 WHO ARE MOST IN NEED, THOSE WHO 1480 00:53:24,240 --> 00:53:27,560 NEED EDUCATION, WHO NEED 1481 00:53:27,560 --> 00:53:28,840 CULTURAL CHANGE, THE ROLE OF 1482 00:53:28,840 --> 00:53:32,240 MENTAL HEALTH AND OTHER THINGS, 1483 00:53:32,240 --> 00:53:34,440 AGAIN, IDENTIFY WHO NEEDS WHAT. 1484 00:53:34,440 --> 00:53:38,640 SOMETIMES IT WILL BE BLACKS IN 1485 00:53:38,640 --> 00:53:40,000 BALTIMORE OR D.C. , SOMETIMES IT 1486 00:53:40,000 --> 00:53:41,640 WILL BE WHITES IN APPALACHIA OR 1487 00:53:41,640 --> 00:53:44,600 WHITES IN MISSISSIPPI AND THE 1488 00:53:44,600 --> 00:53:45,440 SOUTHERN UNITED STATES. 1489 00:53:45,440 --> 00:53:47,280 AS WE'VE MOVED BEYOND RACE, 1490 00:53:47,280 --> 00:53:49,520 THERE'S STILL AN EMPHASIS ON 1491 00:53:49,520 --> 00:53:50,920 POPULATION DIFFERENCES, WHICH I 1492 00:53:50,920 --> 00:53:52,600 THINK ARE GOOD. 1493 00:53:52,600 --> 00:53:55,720 THE EMPHASIS SHOULD CENTER ON 1494 00:53:55,720 --> 00:53:57,040 EPIGENETICS, GENETICS AND 1495 00:53:57,040 --> 00:53:58,840 ENVIRONMENTAL INFLUENCES THAT 1496 00:53:58,840 --> 00:54:00,760 INFLUENCE GENETICS, AND THE 1497 00:54:00,760 --> 00:54:04,040 EMPHASIS NEEDS TO CENTER MORE ON 1498 00:54:04,040 --> 00:54:06,120 PROVISION OF ADEQUATE CARE. 1499 00:54:06,120 --> 00:54:07,440 SO THANK YOU VERY MUCH. 1500 00:54:07,440 --> 00:54:09,960 IT'S A PRIVILEGE TO BE HERE. 1501 00:54:09,960 --> 00:54:11,480 AGAIN, DR. SCHECHTER, 1502 00:54:11,480 --> 00:54:13,640 DR. GOTTESMAN AND DR. WANJEK, 1503 00:54:13,640 --> 00:54:14,760 IT'S REALLY AN HONOR TO BE ABLE 1504 00:54:14,760 --> 00:54:19,600 TO GIVE THIS TALK. 1505 00:54:19,600 --> 00:54:24,160 >> THANK YOU, DR. BRAWLEY, FOR 1506 00:54:24,160 --> 00:54:26,560 THE SUPERB TALK. 1507 00:54:26,560 --> 00:54:28,360 THERE WERE SEVERAL QUESTIONS 1508 00:54:28,360 --> 00:54:31,040 THAT I'D LIKE TO BEGIN TO RELAY 1509 00:54:31,040 --> 00:54:32,240 TO YOU IF I MAY. 1510 00:54:32,240 --> 00:54:33,680 >> SURE. 1511 00:54:33,680 --> 00:54:37,800 >> ONE QUESTION WHICH SPEAKS TO 1512 00:54:37,800 --> 00:54:42,960 THE LAST POINT YOU MAKE, IF IT'S 1513 00:54:42,960 --> 00:54:44,280 THE QUALITY OR AMOUNT OF CARE 1514 00:54:44,280 --> 00:54:47,800 THAT'S THE MAJOR FACTOR AMONG 1515 00:54:47,800 --> 00:54:49,880 THE DIFFERING GROUPS, IS THERE A 1516 00:54:49,880 --> 00:54:52,160 DIFFERENCE, FOR EXAMPLE, BETWEEN 1517 00:54:52,160 --> 00:54:54,320 THE OUTCOME IN CANADA AND THE 1518 00:54:54,320 --> 00:54:57,320 UNITED STATES WHERE FACTORS DUE 1519 00:54:57,320 --> 00:55:00,280 TO COST AND AVAILABILITY OF CARE 1520 00:55:00,280 --> 00:55:02,800 SHOULD BE LESS BECAUSE OF THE 1521 00:55:02,800 --> 00:55:05,280 GENERALIZED HEALTH SYSTEM THAN 1522 00:55:05,280 --> 00:55:07,600 IN THE UNITED STATES OR IN 1523 00:55:07,600 --> 00:55:08,840 EUROPEAN COUNTRIES AS WELL? 1524 00:55:08,840 --> 00:55:11,360 >> WELL, OVERALL OUTCOME, SO IF 1525 00:55:11,360 --> 00:55:13,840 YOU'RE LOOKING AT THE ENTIRE 1526 00:55:13,840 --> 00:55:14,840 POPULATION, BETTER IN CANADA 1527 00:55:14,840 --> 00:55:17,440 THAN IN THE UNITED STATES. 1528 00:55:17,440 --> 00:55:20,640 NOW, THAT BEING SAID, CANADA IS 1529 00:55:20,640 --> 00:55:25,360 MUCH BETTER AT PROVIDING AVERAGE 1530 00:55:25,360 --> 00:55:28,240 CARE TO THE AVERAGE HUMAN BEING. 1531 00:55:28,240 --> 00:55:32,840 IF YOU HAVE AN UNUSUAL DISEASE, 1532 00:55:32,840 --> 00:55:36,760 YOU'RE BEST OFF IN THE UNITED 1533 00:55:36,760 --> 00:55:38,080 STATES WITH GOOD INSURANCE AND 1534 00:55:38,080 --> 00:55:39,520 SOMEBODY LIKE OTIS BRAWLEY TO 1535 00:55:39,520 --> 00:55:41,320 GUIDE YOU THROUGH THE SYSTEM. 1536 00:55:41,320 --> 00:55:45,480 MUCH MORE SO THAN IN CANADA. 1537 00:55:45,480 --> 00:55:51,240 BUT IN IF YOU HAVE AVERAGE GARDEN 1538 00:55:51,240 --> 00:55:51,840 VARIETY ILLNESS, YOU'RE BETTER 1539 00:55:51,840 --> 00:55:52,680 OFF IN CANADA. 1540 00:55:52,680 --> 00:55:54,360 AND BECAUSE OF THE OBESITY ISSUE 1541 00:55:54,360 --> 00:55:55,640 IN THE UNITED STATE VERSUS THE 1542 00:55:55,640 --> 00:55:57,320 REST OF THE WORLD, YOU'RE LESS 1543 00:55:57,320 --> 00:55:59,200 LIKELY TO GET SICK IN CANADA. 1544 00:55:59,200 --> 00:55:59,720 >> OKAY. 1545 00:55:59,720 --> 00:56:02,560 THANK YOU. 1546 00:56:02,560 --> 00:56:07,600 A SECOND QUESTION THAT CAME IN 1547 00:56:07,600 --> 00:56:09,080 EARLY, ONE LISTENERS ASKED 1548 00:56:09,080 --> 00:56:10,440 WHETHER THE DIFFERENCE IN 1549 00:56:10,440 --> 00:56:11,840 ASSUMPTIONS ABOUT YELLOW FEVER 1550 00:56:11,840 --> 00:56:14,120 IN COLONIAL TIMES WAS RELATED TO 1551 00:56:14,120 --> 00:56:17,840 THE FACT THAT PEOPLE UNDERSTOOD 1552 00:56:17,840 --> 00:56:20,040 THAT YELLOW FEVER HAD COME FROM 1553 00:56:20,040 --> 00:56:22,080 AFRICA AND THOUGHT THAT THERE 1554 00:56:22,080 --> 00:56:24,520 WAS A DIFFERENCE IN THE -- 1555 00:56:24,520 --> 00:56:27,120 BECAUSE OF THE ORIGIN OF THE 1556 00:56:27,120 --> 00:56:29,840 DISEASE RATHER THAN BECAUSE OF 1557 00:56:29,840 --> 00:56:32,520 THE NEW GENETIC U.S. SEPTEMBER 1558 00:56:32,520 --> 00:56:35,800 IBILITIES. 1559 00:56:35,800 --> 00:56:37,520 GENETIC 1560 00:56:37,520 --> 00:56:37,920 SUSCEPTIBILITIES. 1561 00:56:37,920 --> 00:56:38,440 DOES THAT CONTRIBUTE -- 1562 00:56:38,440 --> 00:56:39,280 >> I'M NOT SURE. 1563 00:56:39,280 --> 00:56:40,800 AT THAT TIME THERE WERE A LOT OF 1564 00:56:40,800 --> 00:56:42,320 PEOPLE THAT THOUGHT PEOPLE COULD 1565 00:56:42,320 --> 00:56:43,960 GIVE YELLOW FEVER TO OTHER 1566 00:56:43,960 --> 00:56:46,120 PEOPLE, THEY DIDN'T UNDERSTAND 1567 00:56:46,120 --> 00:56:47,120 WHAT VIRUSES WERE AT THAT TIME. 1568 00:56:47,120 --> 00:56:49,440 KEEP IN MIND, WALTER REED, A 1569 00:56:49,440 --> 00:56:51,520 CENTURY LATER, IN THE LATE 1570 00:56:51,520 --> 00:56:52,720 1800s, WOULD FIGURE OUT THAT 1571 00:56:52,720 --> 00:56:54,040 YELLOW FEVER IS CARRIED BY A 1572 00:56:54,040 --> 00:56:57,200 MOS. 1573 00:56:57,200 --> 00:56:57,720 MOSQUITO. 1574 00:56:57,720 --> 00:56:59,360 SO I'M NOT SURE WHAT THE ANSWER 1575 00:56:59,360 --> 00:57:02,000 TO THAT IS, BUT THERE HAS ALWAYS 1576 00:57:02,000 --> 00:57:03,440 BEEN AND I'M SURE EVEN BEFORE 1577 00:57:03,440 --> 00:57:06,160 THE YELLOW FEVER EPIDEMIC, I 1578 00:57:06,160 --> 00:57:07,800 CAN'T DOCUMENT IT, THIS BELIEF 1579 00:57:07,800 --> 00:57:13,240 IN BLACK/WHITE DIFFERENCES IN 1580 00:57:13,240 --> 00:57:14,120 BIOLOGY. 1581 00:57:14,120 --> 00:57:16,760 >> LET ME ADD A THIRD QUESTION. 1582 00:57:16,760 --> 00:57:19,040 MY OWN THAT I THOUGHT AFTER YOUR 1583 00:57:19,040 --> 00:57:22,240 TUESDAY TALK AS WELL AS TODAY, 1584 00:57:22,240 --> 00:57:24,320 YOU MENTION OFTEN THE EFFECT OF 1585 00:57:24,320 --> 00:57:28,040 OBESITY ON CANCER INCIDENCE AND 1586 00:57:28,040 --> 00:57:28,480 OUTCOME. 1587 00:57:28,480 --> 00:57:29,840 DO YOU BELIEVE THAT THE OBESITY 1588 00:57:29,840 --> 00:57:34,520 IS CAUSAL RATHER THAN A 1589 00:57:34,520 --> 00:57:34,840 CORRELATION? 1590 00:57:34,840 --> 00:57:37,920 IS THERE A BIOLOGICAL MECHANISM 1591 00:57:37,920 --> 00:57:44,200 TO EXPLAIN THE LIKELY EFFECT OF 1592 00:57:44,200 --> 00:57:45,440 OBESITY ON ANY DIFFERENT 1593 00:57:45,440 --> 00:57:45,680 CANCERS? 1594 00:57:45,680 --> 00:57:47,520 >> THERE ARE WEEK-LONG 1595 00:57:47,520 --> 00:57:48,320 CONFERENCES WHERE PEOPLE ARGUE 1596 00:57:48,320 --> 00:57:50,200 ABOUT THE MECHANISM WHERE 1597 00:57:50,200 --> 00:57:54,760 OBESITY CAUSES CANCER. 1598 00:57:54,760 --> 00:57:55,960 THERE'S CERTAINLY REALLY GOOD 1599 00:57:55,960 --> 00:57:56,960 CORRELATION IN HUMANS AND 1600 00:57:56,960 --> 00:58:00,600 THERE'S LABORATORY DATA IN 1601 00:58:00,600 --> 00:58:02,200 ANIMALS THAT OBESE ANIMALS ARE 1602 00:58:02,200 --> 00:58:03,760 MORE LIKELY TO HAVE CANCER. 1603 00:58:03,760 --> 00:58:06,480 SOME OF THE THEORIES ARE OBESE 1604 00:58:06,480 --> 00:58:11,920 PEOPLE HAVE MUCH MORE INNATE 1605 00:58:11,920 --> 00:58:14,040 INFLAMMATION AND INFLAMMATION 1606 00:58:14,040 --> 00:58:15,120 CAN CAUSE CANCER. 1607 00:58:15,120 --> 00:58:17,640 OBESE PEOPLE HAVE HIGHER 1608 00:58:17,640 --> 00:58:19,200 CIRCULATING AMOUNTS OF INSULIN, 1609 00:58:19,200 --> 00:58:24,560 AND INSULIN IS A GROWTH FACTOR 1610 00:58:24,560 --> 00:58:26,640 THAT HELPS BLOOD VESSELS TO GROW 1611 00:58:26,640 --> 00:58:27,720 INTO AN ESTABLISHED TUMOR. 1612 00:58:27,720 --> 00:58:29,240 THERE'S THOUGHT THAT PERHAPS 1613 00:58:29,240 --> 00:58:31,560 SOME PEOPLE, BECAUSE OF OBESITY, 1614 00:58:31,560 --> 00:58:33,760 MAY HAVE IMMUNE SYSTEMS THAT ARE 1615 00:58:33,760 --> 00:58:35,840 IMPAIRED AND WE KNOW THAT PART 1616 00:58:35,840 --> 00:58:37,600 OF THE WAY THAT WE PREVENT 1617 00:58:37,600 --> 00:58:42,280 GETTING CANCER IS IMMUNE CELLS 1618 00:58:42,280 --> 00:58:43,240 ATTACKING EARLY CANCER CELLS 1619 00:58:43,240 --> 00:58:44,200 AND, THEREFORE, THEY CAN'T 1620 00:58:44,200 --> 00:58:46,720 BECOME A TUMOR. 1621 00:58:46,720 --> 00:58:48,240 I THINK THE DATA IS FAIR ENOUGH 1622 00:58:48,240 --> 00:58:50,560 TO SAY THAT OBESITY DOES CAUSE 1623 00:58:50,560 --> 00:58:50,880 CANCER. 1624 00:58:50,880 --> 00:58:53,720 IT'S NOT REALLY OBESITY, IT'S A 1625 00:58:53,720 --> 00:58:54,840 THREE-LEGGED STOOL. 1626 00:58:54,840 --> 00:58:56,040 IT'S ENERGY IMBALANCE. 1627 00:58:56,040 --> 00:58:57,640 TOO MANY CALORIES, NOT BURNING 1628 00:58:57,640 --> 00:58:59,640 OFF ENOUGH CALORIES, AND STORING 1629 00:58:59,640 --> 00:59:01,040 TOO MANY CALORIES. 1630 00:59:01,040 --> 00:59:03,080 THE STORAGE IS JUST ONE LEG OF 1631 00:59:03,080 --> 00:59:05,240 THE THREE LEGGED STOOL. 1632 00:59:05,240 --> 00:59:09,400 AND INTERESTINGLY, WITHIN THE 1633 00:59:09,400 --> 00:59:11,560 NEXT FIVE YEARS OR SO, BECAUSE 1634 00:59:11,560 --> 00:59:12,640 SMOKING RATES IN THE UNITED 1635 00:59:12,640 --> 00:59:14,520 STATES HAVE GONE DOWN SO 1636 00:59:14,520 --> 00:59:16,000 DRAMATICALLY, ENERGY IMBALANCE 1637 00:59:16,000 --> 00:59:17,120 WILL BE THE LEADING CAUSE OF 1638 00:59:17,120 --> 00:59:18,840 CANCER IN THE UNITED STATE, AND 1639 00:59:18,840 --> 00:59:20,640 IT ALREADY IS FOR CERTAIN 1640 00:59:20,640 --> 00:59:21,560 SUBPOPULATIONS LIKE HISPANIC 1641 00:59:21,560 --> 00:59:22,720 WOMEN. 1642 00:59:22,720 --> 00:59:26,440 >> IS THE OBESITY EFFECT SIMILAR 1643 00:59:26,440 --> 00:59:28,680 FOR MOST OF THE MAJOR DIFFERENT 1644 00:59:28,680 --> 00:59:30,800 KINDS OF CANCERS? 1645 00:59:30,800 --> 00:59:32,200 >> THERE ARE ABOUT 12 CANCERS 1646 00:59:32,200 --> 00:59:35,160 THAT ARE LINKED TO OBESITY. 1647 00:59:35,160 --> 00:59:37,000 THERE ARE 18 CANCERS, BY THE 1648 00:59:37,000 --> 00:59:38,120 WAY, LINKED TO SMOKING, BUT 1649 00:59:38,120 --> 00:59:42,240 THERE ARE 12 CANCERS LINKED TO 1650 00:59:42,240 --> 00:59:42,560 OBESITY. 1651 00:59:42,560 --> 00:59:43,560 AMONG THEM ARE SOME OF THE 1652 00:59:43,560 --> 00:59:44,360 MAJORS. 1653 00:59:44,360 --> 00:59:45,840 THE FIVE MAJOR CANCERS THAT 1654 00:59:45,840 --> 00:59:46,680 EVERYBODY WORRIES ABOUT BECAUSE 1655 00:59:46,680 --> 00:59:50,000 THEY'RE 50% OF DEATHS ARE, NOT 1656 00:59:50,000 --> 00:59:54,320 IN ORDER, LUNG, COLON, BREAST, 1657 00:59:54,320 --> 00:59:56,120 PROSTATE, AND PANCREAS. 1658 00:59:56,120 --> 00:59:58,760 AND EVEN LUNG CANCER IS LINKED 1659 00:59:58,760 --> 01:00:03,480 TO SOME DIETARY ISSUES, BUT THE 1660 01:00:03,480 --> 01:00:06,440 OTHER FOUR ARE MORE LINKED TO 1661 01:00:06,440 --> 01:00:08,080 OBESITY THAN AS LUNG CANCER. 1662 01:00:08,080 --> 01:00:09,640 BUT LUNG CANCER IS LINKED TO 1663 01:00:09,640 --> 01:00:11,600 SOME DIETARY ISSUES LIKE LOW 1664 01:00:11,600 --> 01:00:13,640 FRUIT CONSUMPTION. 1665 01:00:13,640 --> 01:00:16,720 >> OKAY. 1666 01:00:16,720 --> 01:00:19,240 I CAN JUST ADD ONE FURTHER 1667 01:00:19,240 --> 01:00:23,240 QUESTION OF MY OWN. 1668 01:00:23,240 --> 01:00:24,440 DOES THE ASSUMPTION THAT WENT 1669 01:00:24,440 --> 01:00:30,440 INTO THE TUSKEGEE STUDY OF 1670 01:00:30,440 --> 01:00:31,640 GREATER RESISTANCE TO THE 1671 01:00:31,640 --> 01:00:34,040 DISEASE AMONG THE BLACK 1672 01:00:34,040 --> 01:00:36,560 POPULATION CHANGE AT ALL YOUR 1673 01:00:36,560 --> 01:00:38,280 FEELING ABOUT THE ETHICAL NATURE 1674 01:00:38,280 --> 01:00:41,120 OF THAT STUDY, EITHER AT THE 1675 01:00:41,120 --> 01:00:42,880 BEGINNING OR AT SOME POINT IN 1676 01:00:42,880 --> 01:00:47,440 ITS CONTINUATION, WAS THERE AN 1677 01:00:47,440 --> 01:00:49,000 ETHICAL TRANSITION THAT OCCURRED 1678 01:00:49,000 --> 01:00:49,320 AT SOME POINT? 1679 01:00:49,320 --> 01:00:51,360 >> WELL, I DO THINK THERE WAS -- 1680 01:00:51,360 --> 01:00:55,240 I THINK THERE WERE ETHICAL 1681 01:00:55,240 --> 01:00:58,280 CHALLENGES THROUGHOUT THE ENTIRE 1682 01:00:58,280 --> 01:00:58,640 STUDY. 1683 01:00:58,640 --> 01:00:59,760 INFORMED DECISION-MAKING AND 1684 01:00:59,760 --> 01:01:01,720 INFORMED CONSENT ARE CONCEPTS 1685 01:01:01,720 --> 01:01:04,640 FROM THE 1950s. 1686 01:01:04,640 --> 01:01:05,800 SO I CAN'T HOLD IT AGAINST THEM 1687 01:01:05,800 --> 01:01:07,440 THAT THEY DIDN'T DO INFORMED 1688 01:01:07,440 --> 01:01:11,240 CONSENT IN 1930, 1931. 1689 01:01:11,240 --> 01:01:12,240 I CAN HOLD AGAINST THEM THAT 1690 01:01:12,240 --> 01:01:14,760 THEY LIED TO PEOPLE TO GET THEM 1691 01:01:14,760 --> 01:01:17,400 TO PARTICIPATE IN THE TRIAL. 1692 01:01:17,400 --> 01:01:19,880 NOT TREATING PEOPLE WAS 1693 01:01:19,880 --> 01:01:23,120 CERTAINLY VERY REASONABLE IN THE 1694 01:01:23,120 --> 01:01:23,320 1930s. 1695 01:01:23,320 --> 01:01:25,040 SO I CAN'T HOLD IT AGAINST THEM 1696 01:01:25,040 --> 01:01:30,280 THAT THEY DIDN'T GIVE PEOPLE 1697 01:01:30,280 --> 01:01:31,720 MERCURIALS, WHICH TURNED OUT NOT 1698 01:01:31,720 --> 01:01:34,560 TO BE HELPFUL ANYWAY AND 1699 01:01:34,560 --> 01:01:36,280 ACTUALLY HARMFUL, BUT THERE WAS 1700 01:01:36,280 --> 01:01:37,840 PENICILLIN IN THE 1940s, AND I 1701 01:01:37,840 --> 01:01:39,240 CAN CRITICIZE THE PEOPLE RUNNING 1702 01:01:39,240 --> 01:01:41,360 THE TRIAL IN THE 1940s FOR 1703 01:01:41,360 --> 01:01:42,480 HOLDING BACK ON PENICILLIN. 1704 01:01:42,480 --> 01:01:45,440 SO THERE WERE ALWAYS ETHICAL 1705 01:01:45,440 --> 01:01:46,640 PROBLEMS THERE, AND THERE WAS 1706 01:01:46,640 --> 01:01:48,640 ALWAYS A LACK OF DISRESPECT, BUT 1707 01:01:48,640 --> 01:01:51,240 IT GOT WORSE IN THE 1940s, 1708 01:01:51,240 --> 01:01:55,960 50s AND 60s. 1709 01:01:55,960 --> 01:01:57,920 AS YOU MIGHT HAVE HEARD, IT 1710 01:01:57,920 --> 01:01:59,120 WASN'T JUST WHITE PEOPLE WHO ARE 1711 01:01:59,120 --> 01:01:59,640 TO BLAME. 1712 01:01:59,640 --> 01:02:01,760 THERE WERE BLACK PEOPLE WHO 1713 01:02:01,760 --> 01:02:03,720 CONDONED THE STUDY, THERE WERE 1714 01:02:03,720 --> 01:02:05,360 BLACK PEOPLE WHO WORK ON THE 1715 01:02:05,360 --> 01:02:08,040 STUDY FROM THE TUSKEGEE 1716 01:02:08,040 --> 01:02:08,640 INSTITUTE. 1717 01:02:08,640 --> 01:02:11,840 THEY'RE ALL TO BLAME FOR THIS. 1718 01:02:11,840 --> 01:02:13,480 INCLUDING THE LYING TO PEOPLE IN 1719 01:02:13,480 --> 01:02:15,960 THE 1930s. 1720 01:02:15,960 --> 01:02:21,080 THE IRONY IS THE STUDY WAS 1721 01:02:21,080 --> 01:02:24,440 WRITTEN BY AND DESIGNED BY 1722 01:02:24,440 --> 01:02:27,600 PEOPLE WHO LITERALLY WANTED TO 1723 01:02:27,600 --> 01:02:29,880 PROVE THAT MY BIOLOGY IS 1724 01:02:29,880 --> 01:02:31,640 EQUIVALENT TO YOUR BIOLOGY. 1725 01:02:31,640 --> 01:02:33,280 THAT THERE IS NO BLACK BIOLOGY 1726 01:02:33,280 --> 01:02:34,160 OR WHITE. 1727 01:02:34,160 --> 01:02:39,040 THESE PEOPLE ARE TRYING TO PROVE 1728 01:02:39,040 --> 01:02:40,360 THAT BLACK PEOPLE DESERVE SOME 1729 01:02:40,360 --> 01:02:41,520 ATTENTION IN TERMS OF SYPHILIS, 1730 01:02:41,520 --> 01:02:45,440 BUT THAT DOES NOT OVERCOME SOME 1731 01:02:45,440 --> 01:02:47,760 OF THE OTHER LAPSES. 1732 01:02:47,760 --> 01:02:50,040 >> AND IN THIS SERIES, WE'VE HAD 1733 01:02:50,040 --> 01:02:51,440 SEVERAL LECTURES ON EUGENICS, 1734 01:02:51,440 --> 01:02:55,200 AND I COME AWAY FROM SOME OF THE 1735 01:02:55,200 --> 01:02:56,320 LECTURES WITH, AGAIN, THE IRONY 1736 01:02:56,320 --> 01:02:58,000 THAT I THINK MANY OF THE PEOPLE, 1737 01:02:58,000 --> 01:02:59,360 ESPECIALLY IN THE LATE 19TH 1738 01:02:59,360 --> 01:03:01,680 CENTURY OR THE VERY EARLY 20TH 1739 01:03:01,680 --> 01:03:03,240 CENTURY, THOUGHT THEY WERE DOING 1740 01:03:03,240 --> 01:03:09,040 GOOD THINGS BY ADVOCATING 1741 01:03:09,040 --> 01:03:10,440 GENETIC CHANGES AND THE 1742 01:03:10,440 --> 01:03:13,280 POPULATION CONTROL OF 1743 01:03:13,280 --> 01:03:14,280 REPRODUCTION AND THE LIKE, BUT 1744 01:03:14,280 --> 01:03:19,520 AT SOME POINT, AGAIN, AS 1745 01:03:19,520 --> 01:03:20,520 EUGENICS PLAYED OUT, THE 1746 01:03:20,520 --> 01:03:21,600 TRANSITION OCCURRED THAT IT WAS 1747 01:03:21,600 --> 01:03:24,880 NOW MORE UNETHICAL THAN ETHICAL. 1748 01:03:24,880 --> 01:03:26,640 THERE'S A SIMILARITY IN THESE 1749 01:03:26,640 --> 01:03:27,200 TWO ASPECTS. 1750 01:03:27,200 --> 01:03:28,280 >> VERY MUCH SO. 1751 01:03:28,280 --> 01:03:29,960 VERY MUCH SO. 1752 01:03:29,960 --> 01:03:32,880 >> BUT I THINK IT'S ALMOST 1753 01:03:32,880 --> 01:03:35,680 5 AFTER 1:00. 1754 01:03:35,680 --> 01:03:38,680 I THINK -- I WANT TO THANK YOU 1755 01:03:38,680 --> 01:03:40,040 ON BEHALF OF THE NIH IN GENERAL, 1756 01:03:40,040 --> 01:03:42,800 THE NIH OFFICE OF HISTORY IN 1757 01:03:42,800 --> 01:03:44,080 PARTICULAR, AND WE VERY MUCH 1758 01:03:44,080 --> 01:03:46,400 ENJOYED YOUR TALK, AND WE'LL 1759 01:03:46,400 --> 01:03:48,040 RELAY TO YOU ANY FURTHER 1760 01:03:48,040 --> 01:03:50,120 QUESTIONS THAT WE RECEIVE. 1761 01:03:50,120 --> 01:03:50,400 THANK YOU. 1762 01:03:50,400 --> 01:03:51,000 >> THANK YOU SO MUCH. 1763 01:03:51,000 --> 01:03:52,720 IT WAS A REAL PRIVILEGE TO GIVE 1764 01:03:52,720 --> 01:03:53,480 THIS TALK, AND IT'S WONDERFUL TO 1765 01:03:53,480 --> 00:00:00,000 MEET YOU.