The Dr. Hyman Show - Why Cultural Competency Is Key To A Healthy Population

Episode Date: July 31, 2020

Why Cultural Competency Is Key To A Healthy Population | This episode is brought to you Four Sigmatic Black, Indigenous, and people of color are far more likely to get sick and die from the 10 leading causes of death due to a range of factors. Among these is lack of access and the cascading effects of racism, prejudice, stereotyping, and unconscious bias on minority health. And unfortunately, this is a historic problem, with injustices such as the Tuskegee syphilis experiment that started in the 1930s leading to a deep mistrust of the medical system that still lingers in the Black community today.  Dr. Hyman recently explored this history and current practices in the medical system in conversations with Dr. Charles Modlin and Harriet Washington. He also spoke with Dr. Modlin and Tawny Jones about the importance of creating culturally competent healthcare initiatives to remove many of the barriers that perpetuate racial health disparities. Dr. Charles Modlin is a Kidney Transplant Surgeon, Urologist, Executive Director of Minority Health, and the Cleveland Clinic Physician Lead for Public Health. He is the past President of Cleveland Clinic Medical Staff, Member Board of Governors and Board of Trustees. He founded and directs Cleveland Clinic’s Minority Men’s Health Center (MMHC) and in 2003 established Cleveland Clinic’s Annual Minority Men’s Health Fair. In 2011, he was named by The Atlanta Post as one of the Top 21 Black Doctors in America. He graduated from Northwestern University and Northwestern University Medical School, completed a six-year residency in Urology at New York University, a three-year fellowship in kidney transplantation surgery at Cleveland Clinic and joined the Cleveland Clinic Staff in 1996. He is a noted national leader for eliminating health disparities. Honors include appointment to the Ohio Commission on Minority Health by two Ohio Governors, Northwestern University Presidential Alumni Medal, 2007 MLK Community Service Award, Call & Post 100 Top Influential Leaders, Cleveland Magazine Best Doctors, Cleveland Clinic Bruce Hubbard Stewart Humanitarianism Award, and 2015 Black Professional Association Professional of the Year recognition. Harriet A. Washington has been the Shearing Fellow at the University of Nevada's Black Mountain Institute, a Research Fellow in Medical Ethics at Harvard Medical School, a senior research scholar at the National Center for Bioethics at Tuskegee University, and a visiting scholar at DePaul University College of Law. She has held fellowships at the Harvard T.H. Chan School of Public Health and Stanford University. She is the author of Deadly Monopolies, Infectious Madness, and Medical Apartheid, which won a National Book Critics Circle Award, the PEN/Oakland Award, and the American Library Association Black Caucus Nonfiction Award. Tawny Jones is an accomplished Administrator at the Cleveland Clinic. For 19 years, she has served as a well-respected leader, managing patient concentric care initiatives, creating value, and delivering results in quality improvement, efficient resource management, and health system optimization for various clinical departments. Currently, Tawny leads clinical operations at the Cleveland Clinic Center for Functional Medicine where the goal is to establish the efficacy of Functional Medicine and demonstrate its cost effectiveness and its ability to improve health. Her passion for the promotion of preventative health services and community-based interventions gave impetus to the development of several clinical programs. The Functioning for LifeTM shared medical program for chronic disease management is her brainchild and has proven to be a successful model for addressing lifestyle and behavior change. Tawny is also on the African Employee Resource Group Steering Committee and is committed to helping minorities achieve their career goals. Find Dr. Hyman’s full-length conversation, “Why We Have The Worst Health Outcomes Of All Industrialized Nations,” with Dr. Charles Modlin, Dr. Leonor Osorio, and Tawny Jones here:  https://DrMarkHyman.lnk.to/ModlinOsorioJones Find Dr. Hyman’s full-length conversation, “How We Are Poisoning Our Children,” with Harriet Washington here: https://DrMarkHyman.lnk.to/HarrietWashington This episode is brought to you by Four Sigmatic. Right now Four Sigmatic has an  exclusive deal only for Doctor’s Farmacy listeners. Receive up to 39% off on their bestselling Lion’s Mane Coffee bundles. To get this deal, just go to foursigmatic.com/hyman Hosted on Acast. See acast.com/privacy for more information.

Coming up on this episode of The Doctor's Pharmacy. A lot of people in the black community are really fearful of going to the doctor and they're fearful that the doctor is going to use them as a guinea pig. And that really contributes to a lot of the healthcare disparities that we see. Hey everyone, it's Dr. Hyman here. Starting the morning right is such a key piece to feeling great throughout the entire day and doing the things you love. Now I bet most of you can relate to waking up and eating a cup of coffee before you feel fully functional and I've definitely been there myself. But I started a new routine every morning and now it's something I

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I'm excited to share an exclusive offer from Four Sigmatic that is just for Doctors Pharmacy listeners. Receive up to 40% off on their best-selling Lion's Mane Coffee Bundle Thank you. on their regular website. So go to foursigmatic.com slash hymen. That's F-O-U-R-S-I-G-M-A-T-I-C.com slash hymen. This is a really incredible deal. So it's the perfect time to branch out from your regular morning cup of coffee and try Four Sigmatic's mushroom blend that can enhance your brain power, energy, and your immune system throughout the whole day. Now let's get back to this week's episode. Hi, I'm Kea Perot at one of the producers of the Doctors Pharmacy Podcast. The coronavirus pandemic has shed light on the massive health disparities that have long existed in our society. Black, indigenous, and people of color are far more likely to get sick and die from

the 10 leading causes of death due to a range of factors. Among these is lack of access and the cascading effects of racism, prejudice, stereotyping, and unconscious bias on minority health. Earlier this year, Dr. Hyman spoke with colleagues at the Cleveland Clinic and medical ethicist and award-winning author Harriet Washington about these issues. We're here at the Cleveland Clinic in Cleveland. There's many Cleveland Clinics. Our first guest is Dr. Charles Modlin,

who's been a great partner with us at the Center for Functional Medicine. So, Dr. Modlin, what's your sense of what the reasons for the disparities are in the African-American community? So, you know, you touched on lack of access to quality care. I mean, that's a huge one. There's also a lot of distrust that many African Americans and minorities have about going to the doctor.

We've all heard of the Tuskegee syphilis experiment. Can you just give a background on what that is? So that was where the Department of Health and Human Services, the Public Health Service, Department of the United States, that was back in the 20s or 30s. I forget the exact decade. Where they actually treated roughly about 800 men, black men.

It went up until the 70s. Yes, right. They followed several hundred men, black men, who they knew had syphilis. Because they wanted to study the natural consequence of untreated syphilis in this patient population. And during that time period... And they had penicillin. They could have cured them, but they didn't. Oh, yeah. They actually had the cure. The cure was available. They could have cured these men.

And actually, during that time period, the men suffered. Many men died, and they actually passed this disease to their partners. And the word got out in terms of what was going on. And that spread across the black community in terms of what was going on, the experimentation. And so that still resonates amongst the black community and other minority communities. That whole story of Henrietta Lacks is also a resident of that. Exactly. You know, experimentation.

And so a lot of people in the black community are really fearful of going to the doctor and they're fearful that the doctor is going to use them as a guinea pig. And that really contributes to a lot of the health care disparities that we see because a lot of the medications on the market have been developed and designed and tested just in white people, especially just in white men. Right. In particular, a lot of disparities that we're talking about actually exist in women also. Distrust of the medical system in the black community came up again in Dr. Hyman's conversation with Harriet Washington. So what happens is that the concern among African Americans about food issues is often

not publicized by the news. It often remains under the radar. Or even worse, it's mischaracterized. I lecture frequently, not only to medical schools and medical ethics institutions, but also to communities. And it is actually the most frequently cited issue. So what are the conversations? I'm not even speaking about food issues for the most part, but it always comes up immediately. So what are the conversations you're hearing?

Well, there's a lot of understanding. First of all, there's a lot of concern about the importance of eating well and maintaining health on one's own because many people have justified trust issues with the medical establishment and frankly want to avoid it as long as they can. I don't think that's the right approach, but I understand why they think that. For people who don't know why, the history of the Tuskegee experiment was essentially... Not really Tuskegee, actually. It's everything else.

Oh, really? That's a whole other conversation. Just quickly for those who don't know this. My book, Medical Apartheid, actually focuses on that. Yeah. There's a long history of abusive medical research with African-Americans and the focus on Tuskegee, but the other studies were actually much worse

and were very dense. I have 15 whole chapters. Wow. Only one of them mentions Tuskegee, but the other studies were actually much worse and were very dense. I have 15 whole chapters and only one of them mentions Tuskegee. And not only in the past, but in the present, there are present day issues. There's one going on right now that I'm involved in, in Baltimore, of course, happening in Baltimore, where we have young black men who are being actively recruited into studies without their knowledge, where they're going to be forced into hypothermia as treatment for gunshot wounds. Wow. Yes, really chilling.

Anyway, these concerns mean that many African Americans seek to avoid getting sick, avoid the healthcare system, and they focus very heavily on food as a way of doing that. And so they often come with very precise questions to me that I can't answer. But they're concerned about not only eating the right things, but even concerned about brands. The brand of the bottled water they drink is like, the last talk I gave, which didn't deal with nutrition at all, I was asked by a knot of people who are taking notes, which brand of bottled water should they eat?

Or they'll talk about the fact that they avoid meat, that they have a vegan diet, and they also avoid dairy. I mean, they're very, it's very meticulous. It's very precise. And there's a great deal of concern about this. But I've noticed that it typically doesn't get addressed in the news media. And I'll leave any of you to speculate by why that would be, but it's something that you don't see addressed in other.

You have to be in the community to see and hear this. Dr. Monlin further explained this in his conversation with Dr. Hyman, and you'll also hear from Dr. Hyman's colleague, Tawny Jones, who leads clinical operations at the Cleveland Clinic Center for Functional Medicine. You have to be culturally sensitive, culturally competent. You have to establish a relationship, you know, with the community. And so I just want to emphasize that you have to be very careful in terms of how you engage the community because you could actually do more harm.

Yeah. And, you know, you could really, you have to be able to resonate with the community. You know, it says nobody cares how much you know until they know how much you care. That's right. So that's very, very important. Yeah, racially and ethnically sensitive is my first step in creating programs in our community and creating programs for our providers. Because I think about the patient experience first.

The patient is always paramount. Yes. You know, for, I know we were trained at the Cleveland Clinic. The patient is our North Star. So it's the most important person that walks through our doors. And so when I think about that, I want them to reclaim their life. I want them to have access to a program that makes them feel comfortable coming into. And I think this is where the community-based talks, where we get out front in front of these individuals and start to

share very candidly, share this information and say, you know, this is the number of patients that have died as a result of this. And let me tell you how that could have been prevented and really have an opportunity for them to share in that conversation. We don't see that in our communities. We'll do a health fair where we have one, you know, one snapshot in time where we bring that information to them. And then, you know, months or another year will go by before we get back in front of those individuals. And I think that this needs to be a more concerted effort where it's ongoing. There should be weekly meetings, whether it's at the church, whether it's at the community

center, whether it's, you know, in a space where they feel comfortable going to, where we can share all of this information in a way that they understand it. You know, health literacy is real, so they don't necessarily receive it well from physicians, but we're the community workers who can help with this. Those, you know, coaches or individuals who are just inspired to be in the health space and who want to, you know, partner with healthcare organizations. So, you know, you recently started with the Center for Functional Medicine, this program at Langston Hughes with the very underserved African-American community. Can you tell us how that's going, what the response has been? Because I think people say, oh, people don't really want to get better. They just like the way that they're going and they

don't like, maybe they know already what to do. They're just not doing it. What happened? One kudos I will give to the Cleveland Clinic is it has a strong footprint in its community and it is really focused on community-based initiatives to help improve the health and provide self-preventative measures and teaching and education for individuals that we would either serve out there we're going to serve in here in the hospital settings so one way or the other yeah so we can take a pre-emptive strike and do it the right way or we can see them on the back end. And I think we prefer the former.

How are those people responding in that group? Very well. These individuals at Langston Hughes come back every week. And this is a 10-week program, but they have made the commitment because we are, one, removing the barriers, and we're creating a space where it's very comfortable for them to come in and learn. We're not using terminology that would be offensive to them. We're not. And we're not. How do you make sure I don't?

We're not putting information in front of them, you know, 12 syllable words that they would have no idea. go over their laboratory testing because you hear H1C and you hear hemoglobin and you hear lipid panel and you hear all of these terms and it's just overwhelming. And you think, oh my God, is that bad, good or indifferent? But you don't want to ask your doctor because you feel like, well, he'll think I'm stupid. And so, you know, we have those social stigmas that we carry around with us. So I don't want to do that. But in this space, we just assume that we carry around with us so i don't want to do that but in this space we just assume that we're going to start everybody at square one and let me tell you what a hemoglobin a1c does to your health let me tell you what a lipid people and they are striking to watch them they're so immersed in this conversation and they're like oh my god for years i've been wondering

what a lipid path that's what that means And they're doing it and their blood sugars are dropping and their blood pressure's dropping, their weight's dropping, they feel better. That's awesome. Yeah. Educating healthcare providers on the historical and current day practices that exasperate racial health disparities is an important step in creating a healthier population overall. If you'd like to learn more about any of the topics in today's episode, I encourage you to listen to Dr. Hyman's full-length interviews with his colleagues at the Cleveland Clinic, as well as his conversation with Harriet Washington. If you enjoyed this episode, please consider sharing it with a friend and leaving us a comment below. Thanks for tuning in. Hi, everyone.

I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their find a practitioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare

practitioner, and can help you make changes, especially when it comes to your health.