“People sometimes think that like having had like, you know having had a Black president like changes people like attitudes towards it doesn’t, so…being in med school has made it…ya know, I feel like this is not the first time that I’ve been in like in a white space where I went to graduate school at Georgia Tech, but I feel like it’s been probably the most eye-opening experience when it comes to like educating me about how racism works and how racism is communicated.”
Max Jordan is a medical student in my final year at the Yale University School of Medicine, in New Haven, CT. Prior to attending Yale, he worked as a researcher in the Merryman Mechanobiology lab at Vanderbilt University in Nashville, TN, having earned a M.S. in Bioengineering at the Georgia Institute of Technology, in Atlanta, GA (2015) and a B.S. in Civil and Environmental Engineering (Summa Cum Laude) at Howard University in Washington, DC (2013).
His previous experiences have shaped his academic and extracurricular interests related to medicine. In terms of research, he’s interested in improving the quality of care for people from marginalized and stigmatized groups. This has led him to develop a research thread in addiction medicine since his first year of medical school. Max also interested in how residential and occupational environmental exposures shape people’s health (see civil & environmental engineering background!), and in identifying key levers that can be activated as buffers against the effects of climate change and environmental racism. This has led him to research associations between access to nature and health outcomes, most notably, hypertension in pregnancy, a leading cause of maternal mortality.
In his free time, he hosted and produced a podcast titled “Flip the Script,” focused on elucidating mechanisms behind observed health inequities, and highlighting the work of scholars, physicians and community health workers who make it their priority to address said inequities. He also write about racism in medical education based on personal experiences and observations. These observations have led to me developing a budding research interest in healthcare workforce diversity.
Max likes getting around on his bike and appreciate efficient public transit. Playing tennis is my absolute favorite thing to do.”
Kim Crayton: Hello everyone, and welcome to today’s episode of the #CauseAScene podcast. I have a guest, someone who I do not know. Someone who came across my feed, and I immediately went to his DMs and said, “Hey, would you like to be on the show?” I would like to introduce you to Max Jordan, pronouns or he/him/his. Max, could you please introduce yourself to the audience?
Max Jordan: Kim, thank you so much for having me on your podcast. So yeah, my first name is Max Jordan, last name Nguemeni Tiako. I often go by Max. I am a senior, I guess final year medical student—chronologically fifth year, actually. So I took an extra year to do research on… so today was my sort of first day back into the clinical world of medical school.
I grew up in Cameroon, Yaoundé, in the capital city. I moved to the US 11 years ago. I went to Howard University for undergrad, studied engineering there, went to Georgia Tech and eventually decided to apply to medical school. So I’ve been at Yale in New Haven for the last four years now, basically. Or just about, yeah.
Kim: All right. So we always start this conversation the same way: why is it important to cause a scene? And how are you causin’ a scene?
Max: So, why is it important to cause a scene? I feel like people have different definitions of what’s causing a scene, or causing a scene has a range. I think generally, you know, there are instances where you need to cause a scene because people don’t be actin’ right. Or when things aren’t going the way that they should be going, someone has to go against the grain to address whatever might be going awry or to get things back on track.
You know, Ilhan Omar, AOC [Alexandria Ocasio-Cortez], they’re chiefs in terms of causing a scene, a righteous scene, so I think it’s important, right? We need dissent. We need people who are going to stand up for what they believe is true and what their values are. Especially when perhaps the overall current is not necessarily going in the best of directions.
So how am I causing a scene? I think it depends on the day and depends on the setting. [Kim chuckles]
So I like I said, I’m in medical school. My scenes are subtle, mostly. A lot of my work outside of being just a medical student is centered around health equity, which I feel like more recently, people in medicine have been open to this idea of like, “Oh, we need to make health equity central to our values, to what we teach,” but I feel like it hasn’t always been the case. So from that perspective, I am causing a scene every day with highlighting issues related to health inequities.
So I host a podcast called “Flip the Script.” I interview mostly people who are in the margins of the space of medicine and public health and who’re doing work along the lines of addressing health inequities. I’ve interviewed anthropologists, historians, public health folx, physicians, community health workers. That’s a subtle way of causing a scene, I guess, changing the narrative, changing the conversation around health disparities, both within a space of medicine, but also, I think even among laypeople a lot of people don’t necessarily understand the mechanisms that cause health equity so I wanted to bring that to light.
On the other side of this I write, and in my writing, I do a good bit of calling folx out on their—not individual people, but this system within which we’re working. The most recent thing that I published—I think it was the most recent—I wrote something about all these medical organizations that have been sending out emails and public statements about standing up against police brutality and racism and all this stuff, and I’m just like, “Where were you four years ago when Philando Castile died? Or when Mike Brown died, what is it, six years ago? What has taken you so long? And is this a performance?”
Kim: Corporate Blackface.
Max: That’s my other way of causing a scene. And every once in a while I may ask a question that interrogates the motives behind something that somebody said, or I may just flat out get in the verbal education over racism. That’s… I mean, I try to not get into those; they’re never pleasant but occasionally they happen.
Kim: I take a slightly different… I don’t say I get pleasure from getting into them, but because I run a community that’s largely online, I use that as a very live, very visceral learning experience for folx. So they could… because folx don’t, like you said, “Where have people been?” All of a sudden, everybody’s woke in a pandemic.
Kim: [Laughs] And yet, even in that, they’re gettin’ lazy, you know, they’re not doing what they committed to doing when they first put out their statements or first ran to all these antiracist workshops that they’re no longer… you know, it’s like they’re “Oh, yeah, I got my I got my gold star and I’m done” kind of thing.
And so, I find that—I don’t use John Lewis’s words at all—but to me, these discussions— and they’re really not discussions on my part, because I rarely speak directly to those individuals—but the strategic gaslighting—that’s what the hell I’m gonna call it: strategic gaslighting—that I do enables a community of white folx to start seeing and spotting patterns. And I find it interesting that you have an engineering background as well as medical background because that is very—it’s unique. It gives you a lived experience of being around technology, in whatever form. What kind of engineering were you?
Max: So in college I was civil and environmental. And then I went to grad school, and did bioengineering, and there I was focusing on medical device development and also what is the FDA approval process for those devices? That’s what my thesis was on. So I design two types of devices out of a novel biomaterial, and then I design what would be the approval process for those.
Kim: So, yeah. This speaks to—y’all know I go off on a tangent, and that’s what I’m gonna do right now—because this speaks to why we need to hire people for their lived experiences. We’re no longer creating widgets; I say it all the time. This is a knowledge economy, and your lived experience with creating biomedical devices, goin’ through the process, as well as now being in the hospitals, as we’re going through this mess, you see a lot of things that a lot of people don’t even know that they don’t even know.
And this is the thing that gets me with all the… all these people have these Black Lives Matter statements, all these people want to put “antiracist.” I have never seen so many people reachin’ out to me talkin’ summin about they wanna have an antiracist organisation. You don’t even know what the hell that is; it’s just some term that you’re using.
And to have someone like you, who has been… has the clinical as well as the engineering background, I find it so very interesting. So I don’t know where this conversation’s gonna go, because I find this very unique and I’m excited about this. But could you tell me what your research was about when you took your year off?
Max: So I left New Haven, I went to Penn, and I was… so I have two sort of umbrellas in my research interests. I am interested in drug policy overall, and then I’m also interested in environmental policies.
Kim: What? I’m sorry, What kind of policies?
Max: Drug policy.
Kim: OK, that’s what I thought.
Max: And then my other interest is environmental policy, especially having studied civil and environmental engineering, thinking about how does the environment that we live in, how does the way we design our cities, ultimately impact our health? So the projects that I worked on, one project was looking at tree canopy coverage, residential…
Kim: I was gonna say, I was just gonna say, I just saw some research on that! OK, go ‘head.
Max: Yeah, I was looking at residential tree canopy coverage and as it relates to maternal health.
And then the other project I worked on, I was interested in—we’re obviously in the middle of an opioid epidemic—so I analyzed, basically, how well are we treating opioid use disorder in pregnant women over the last decade or so? Have we gotten better? What are things that we need to improve upon?
Those are my two big projects this past year.
Kim: One of the things that’s really interesting for me, and this is where—you know, folx, that I’m about to connect some dots for you—this is where I challenged a lot of people. So when—I believe that the young woman’s name is Greta, the climate change…
Max: Greta Thunberg. Thunberg? I can’t pronounce her last name.
Kim: Yes. When she came here and everybody was pattin’ her on the back and I called it; I was like, “Oh and you finally have your little—the movement finally has its perfect little white emblem, its white [laughs] vision of what now people can get involved in, because indigenous and people of color have been talkin’ about these things forever. Because these things have been in our communities.
And so when you talk about the trees, one of the things that I recently was reading about—so I’m tyin’ all this together when it comes to red-lining and suburbs and gentrification—and it comes to the fact that in inner cities when you stopped investing in home— if home value’s where you puttin’ all your money; it’s shitty that that’s how we fund our schools—when you when you stop putting that into what was considered the inner city at that time before it became gentrified, there are no trees. There is nothing but concrete. There’s nothing but asphalt. There’s nothing but sun hitting concrete, and there’s rarely any grass, anything. And research has shown that the folx in these communities have higher incidences of asthma, of respiratory issues, of their water not being clean, all these things.
And yet white folx want to celebrate Greta, who lives in a country that does not have these—let me be careful—I’m not going to say she doesn’t… what I’m going to say is: she doesn’t live in these communities. She knows nothing about the lived experience of these communities that have these pollutants and polluters in their backyards, and yet we want to amplify her—because there’s a Hulu documentary that’s comin’ out about her.
What happened to all the little brown and indigenous people from all over the world who’ve been screaming about this? Where is their voices? Where did they get amplified? They don’t! And so when you saw all the the news that was comin’ out after her visit here, the white media couldn’t help itself: It was “Greta and others.” It was like, “What? Whoa, where did this come from?”
Why can’t these individuals with the lived experience of this stuff be the ones that tell you—because I’m living with the asthma, I’m living with the respiratory issues, I’m living with a food desert. So I am what now they call obese because the only place I can get food is from the Dollar Tree, or a QuikTrip, whatever the case may be. It’s really insidious that folx don’t see, that it takes folx like you and I to sit somebody down and basically shake the shit out of them and like, “Come on, wake up!” [Laughs]
One of the arguments I was having when Bernie [Sanders] was still in the—and I don’t know how you feel about this and we can talk about this—when Bernie was still in the race was, everybody’s thing was—if you were against it—”Well, you don’t believe in Medicare for all.” I was like, “Come on! Wait a minute, people.”
Most people believe that folx should have health care. But when your candidate won’t talk about race, how the hell can he talk about Medicare for All when our current medical system is fundamentally rooted in white supremacy and harmin’ Black and brown people? And no one could have that conversation with me? I was like, “I don’t care… I need you to have that conversation. How are you gonna stop Black infant and women mortality rates?” Because that’s rooted in white supremacy. “How are you gonna…”
I’m sure as a medical student, there’s absolutely nothing in your books that says Black people have a thicker epidermis than white people, but medical students believe that shit. So where the hell is that comin’ from? That needs to be addressed. You know, it’s like all these things that are inherently racist about the medical system, and no one wants to talk about it. They all want to just throw the, “Oh, I have this Black Lives Matter…”—like you were sayin’—”we wanna change,” but you’re not talking about the problems.
So talk to me about what that’s like to be in it, because I’m just on the outside looking in. [Laughs]
Max: Yeah, I think that there’s a mix. I was actually just havin’ this conversation not long ago. You mentioned the thick skin part, right? So these are findings from a study that was done at the University of Virginia; I think around 2016 is when it was published. A significant number, or a concerning number of participants in the study did hold these very obviously debunked beliefs about Black people. But they were the minority, and I actually think that is less an issue as opposed to a general lack of empathy, that people just don’t grant us the same empathy.
And it’s hard to tease out whether that is necessarily associated with the belief that we have thicker skin so we don’t feel pain as much, or whether it’s simply because you’ve had limited contact with Black people, you’ve absorbed all these racist, just generally notions about Black people being the boogeyman, and so is that’s why you might feel less empathy for Black people? For me as a med student it’s always a little hard to tease out, as I look at the data and also observe behaviors. I was like, “Well obviously, like you’re not an idiot. You don’t…”
Kim: OK, so I’ma stop you right there. I’ma stop you right there. For one reason; I don’t wanna go past this. Did you hear, folx? Did you hear? He said he looks at the data and also observes behavior. He uses mixed methods. He’s not relying only on quantitative data—which tech just loooooves—and gives no value to qualitative data, which helps to explain the data you have. So I wanted to—because I’m always havin’ that conversation—so I’m happy you said that without me prodding it or anything, because it is important that people understand when you tell me, “Oh, we have the data,” my questions become: who decided what questions to ask? Who asked the questions? Who answered the questions? Who got to evaluate the questions? All these things are about qualitative, and no one wants to have those conversations.
But I just wanted—I do this because my audience is largely white folx and I need them to understand—you just set it up perfectly for me to say, “See, people in the space are using qualitative data, mixed methods.”
And also, before you get started again, I really want to hit on the opiate thing, because that’s your background, and it says so much about why Black people didn’t get caught up in the opiate addiction in the beginning. How we’re in it now is because of illegal… we weren’t prescribed opioids because we weren’t—our pain is never believed. So I just… go ‘head.
Max: Yeah, I was saying that, looking at data but also observing behaviour, I’ve seen people doubt somebody who’s Black whether their pain is serious or are they fakin’ it, even if it’s someone who’s here for a sickle cell pain crisis, there’s just the stereotype around pain medication seeking behavior that is often ascribed especially to Black and brown patients.
But I also watched the people who uphold these stereotypes or just go along the flow, and it’s like, “You’re not an idiot. You don’t think I have thicker skin, right?” So based on that, what I draw from that it’s more of a matter of the activation of the stereotypes and the racism that people hold in their mind, and it’s almost contagious; when people witness those who are above them propagate negative attitudes towards Black patients it carries forward. In fact, this has been studied. Medical students who have witnessed their educators express negative views or make negative comments about Black people are less likely to want to serve minority patients, are less likely to want to work in underserved communities.
So I think it isn’t so much about people just believing wrongly held notions. Yes, those people do exist, but I think generally there’s the contagious nature of biases and lack of empathy granted towards Black people. All of that is obviously rooted in people’s prior experiences; many of them have basically gone to segregation academies, never had a Black friend before. [Kim laughs] The only images of Black folx that they know, or— and and I’m generalizing here—the only images of Black people—that many know—are negative. And it doesn’t help… and people sometimes think that, “Oh having had a Black president [Kim laughs] changes people’s attitudes.” It just doesn’t.
Kim: You know for a fact it doesn’t. [Laughs]
Max: Right, right. Being in med school has made it… I feel like this is not the first time that I’ve been in a white space—I went to graduate school at Georgia Tech—but I feel like this has been probably the most eye opening experience when it comes to educating me about how racism works and how racism is communicated.
Kim: Yeah, it’s insidious, and again, like you’ve just articulated, it’s not written down anywhere, it’s an observed behaviour that people pick up these things, and when they don’t challenge ’em, they become ingrained and it gets passed on from one generation of doctors to the next generation of doctors.
Max: Yeah, we call that a silent curriculum, literally; you’re right, it’s silent, and it’s like…
Kim: Oh wow! OK! That makes sense.
Max: It’s not the official curriculum, it’s silent, but people do adopt it, yeah.
Kim: So, what have you… ’cause I think the article, the tweet that got my attention—lemme get to it—was about… you were responding to someone who said, “COVID-19 is disproportionately affecting Black African Americans and other minority companies.” And he had just gotten off a Zoom call.
Kim: Yeah, communities. And he had just gotten off a Zoom call. And you kinda let him have it. [Laughs]
Max: Oh god, yes. So Francis Collins, he said, “COVID-19 is disproportionately affecting African Americans and other minority communities.” He got on a Zoom call with the Congressional Black Caucus to discuss why and how the NIH can address this. And I was like, “Oh, really?”
Kim: OK, so I’ma stop you right there, ’cause if you could see his [Max’s] face, [both laugh] you could see the skepticism and the sarcasm in your tone, in your face. Go ‘head.
Max: OK, this is why I said this, right? Francis Collins, director of NIH. So not not long ago, I think it was the fall.
Kim: I’ll stop you right there. What does the NIH stand for?
Max: Sorry. National Institute of Health. So that’s the branch of the federal government that does a lot of funding research across academic institutions and even non-profit. Basically funding science, founding science. Among others—there is the National Science Foundation—but NIH focuses on health-related research.
There’s a study that came out, and I think one of the reasons why the study was done in the first place is that there’s ample evidence that Black scientists are—I think—half as likely to get their grants funded. So both at the junior and senior level, Black faculty, be it in clinical or medical or basic science or you name it, they’re not as likely to get funded for their work.
And so they were like, “Oh, why is that? What are the reasons?” And so they went and investigated, and one of the things that they found is 1) that Black scientists are more likely, when you think about health, are far more likely to submit grants that want to focus on community health, addressing racial disparities, and basically those things are the lowest scored. They’re the least funded topics from the NIH. So people who want to study community health, health equity, patient-centered methods in terms of clinical care.
There are other things that are really poorly funded, like acute—they look at keywords, right? “Ovary” was a keyword. So basically women’s health, right? So they look at the things… so it’s almost like if you do health equity work, you’re far less likely to get funded. But then, on top of that, what they find out is among the people who do health equity work, white people are more likely to get funded than Black people.
Kim: [Sighs] Yes, the people without the lived experience. Yup, that’s why we keep running to Robin DiAngelo and her fuckin’ “White Fragility” instead of all the Black women who have written books on how to address racism. But that’s a whole ‘nother interview. Go ‘head. [Both laugh]
Max: I sure haven’t read that book.
Kim: Please don’t. [Both laugh]
Max: So white people who study health equity work are more likely to get funded, and so there was this question as to whether the difference within that realm is rooted in the chosen methods. Like what methodologies are Black scientists more likely to adopt or to propose in their projects versus white scientists. They haven’t quite gotten to the root of…
Kim: [Laughs] Because we know what the root—they don’t wanna name the root. [Laughs]
Max: So when I saw that, I was like, “OK, it’s really interesting that you that you want to try to identify…” I mean now, in the middle—the pandemic is now, it’s happening, right? What are you going to do as NIH director? No shade, I mean sure, NIH met with the Congressional Black Caucus, but the reasons as to why these disparities are occurring are so glaringly obvious. The NIH is one of many institutions that contribute to us not making progress on addressing health disparities through their funding mechanism.
Nancy Krieger did a study—Nancy Krieger is a superstar epidemiologist at Harvard—and she found out, for instance, in terms of NIH funding granted towards matters of health disparities, the ratio between studies that look at genetics versus studies that look at social determinants of health is 500 to 1. There is this disproportionate focus on identifying very basic science-related root causes of health disparities, health inequities, and not so much a focus on the social conditions that we know are significant, if not huge, drivers of these health inequities. So when I see that, I’m like…
Kim: And as you’re talkin’ about that, it sounds so—it’s so insidious. It is so insidious, because you have one of the main organizations that you said, that funds research, being a gatekeeper to the vital research that we need to make decisions and to move forward, and instead of actually getting the fuck out the way, they wanna have an exploratory [laughs] discussion, when the research is already out there. And this goes again to why I challenged Medicare for All, because no one wants to talk about the elephant in the room; it is white supremacy; it is racism; it’s anti-Black; it’s all of these things that no one wants to talk about, that if we talked about those extenuating circumstances, those lived experiences—as you said, those are the ones that don’t get funded—that stuff is in there. And stuff it…
Max: Although I will say…
Kim: And that stuff is a direct… what am I tryin’ to say? Is in opposition to the narrative.
Max: Yeah. Although I will say Medicare for All, having a Universal Health System, would be beneficial in terms of addressing some of the inequities that we’re seeing. Not all, but the inequity is within the healthcare system.
Kim: But see, no. My point is: yes, people, health care is—I believe—is a right. And yet when you politicize that—because I live in a state that decided to get out of the Affordable Care Act, I can’t afford insurance because I didn’t get the Medicare, they didn’t extend Medicare. I qualify for it because I’m, you know, a struggling business. But I don’t have health insurance because I can’t afford 8 and 900 dollars a month. So unless you’re gonna talk about that stuff… and then it’s about understanding why those systems were put in place. Why, in certain states those limitations were made, we need to talk about all of that.
Max: Yeah, agreed. Recently, Missouri just voted to expand Medicaid, but before then, it was exactly 14 states that had yet to expand Medicaid, and obviously, they are run by Republicans.
Kim: So that was my issue. So it’s not the fact of the plan of everybody needs healthcare; I look at, hell, everybody in the UK has health care and it’s still racist as shit. [Laughs]
Max: Yeah, even amid COVID-19, the Black folx in the UK are also more likely… yeah. Honestly, healthcare is only one piece of the pie. There’s this CDC infograph that suggests or shows that health care—and by health care, I mean the interaction that you and I would have with the health care system: getting vaccines, going to doctor, blah blah blah—it’s only like 10 to 20% of this whole equation, but I don’t even like to necessarily put a number on it because I think of it as a system. Healthcare functions with housing. It’s all…
Max: It’s like gears, you know, nuts and bolts.
Max: In some instances, healthcare may only be 1%, and in some others, like if you’re homeless, healthcare can only do so much. It’s like so, so, so vital in that condition.
Kim: And that’s the thing we need to think about: systems. And that’s what we talk about systemic and not just the silos.
Max: Right. Exactly.
Kim: I want to take us back, ’cause I want to make sure my audience gets it. Max just connected the dots about a system, and yet, he’s told us that the NIH, this is the work that is less funded. The answers we need is the work that’s not getting funded.
Max: Right? Yeah, It’s tough out here.
Kim: [Laughing] Man, it is… ugh. One of the things I wanted to talk about since I have a Black physician on, is—’cause I’ve been sayin’ this, and I’m always sayin’ something that people consider controversial and to me is just common sense—’cause you brought up CDC; it’s gonna be hell getting people in marginalized communities to take any kind of vaccine ’cause this whole system is… mmm… any trust that these communities had is…
Max: It’s just withering away.
Kim: Oh, it’s gone. I’m not gonna say withering away. I’ve had several conversations with people in my family, and I’m just like, “You know what? I’m going to stay in the house,” because I just… I just… [Kim is at a loss for words]
I can’t say it started with this administration, because I just really want to make people understand, ’cause everybody wants to throw it on Trump because they want to get back to the status quo.
Max: That’s long gone, yeah.
Kim: We’re not tryin’ to get back to the status quo, but what I can tell you is: this administration has shone a spotlight on all the ways that we just get fucked. And the fact that science—I feel like I’m in the medieval times, I’m like, “What the hell are y’all doing?!” [Laughs]
Max: So yeah, it’s interesting, right? This is, as you say, this is not new. Medical mistrust has deep, deep, deep roots. The medical field has been an accomplice in oppression of Black folx for centuries. There were physicians who were instrumental in the freaking transatlantic slave trade. The history is so long. We could talk about so much of the medical experimentation that was done on Black folx; I’m thinkin’ about the Tuskegee Experiment, which is one of the most popular things that got talked about, or those doctors at Johns Hopkins stealing Henrietta Lacks’s cells. And those are the two big events I could talk about, but there’s so many more.
Kim: I often share the one about—oh, yeah, woooo, sterilization—but I often share the one about the slave owner who experimented on the Black women…
Max: Ah, Marion Sims, who was considered to be the father of gynecology.
Kim: Yesss, yess!
Max: Yeah. Yeah, there’s so many of those and so it gets passed down through generation as lore. People won’t necessarily tell you why—I mean, some people will—but people won’t necessarily point to the very thing that makes them not trust. They’re just like, “Uh-uh, we don’t trust the government’s vaccine.” [Kim laughs]
I tell you, over Christmas break—I said earlier, I grew up in Cameroon, but my family here in the US is mostly Black American from DC and North Carolina. So basically, my uncle, who’s my dad’s oldest brother, married into a Black family here. And so they have taken me as one of theirs, so I spend every holiday with them. And so over Christmas break, I’m at this table with four generations of Black women, all the way down to my cousin, who’s a freshman in college in Georgia, in Atlanta. And I’m like, “OK, it is Christmastime, have y’all gotten your flu shot?” Everybody’s like, “Hell no, I ain’t neva got no flu shot a day in my life.” I’m like, “Wait a minute. What are you talking about? I need you to get your flu shot.” [Kim laughs]
And they’re like, “Nope, nope, nope.” It ends up being literally your typical Christmas dinner family fight, [Kim laughs] and we’re fighting over the flu shot. It wasn’t even a real fight, it was just me trying so hard to convince my kinfolk, like, “Yo, I need y’all to get your flu shot because I have seen people die of the flu. This is no joke, right?” But they’re just like, “Nope, nope, nope. I don’t trust it. I don’t trust the government.”
And it’s telling, and people often think that this mistrust is rooted in, “Oh, people not being educated.” And I’m like, “No.” In this family that I speak of, my aunt’s a lawyer. She has a JD from Harvard University.
Kim: That’s the thing! Exactly! We know more about the history of our shit than anybody does. [Laughs]
Max: Yeah. It’s not only… education is not the only element of it. There’s deep-seated, passed down generation to generation… I mean, the only reason why two people at the table have gotten it, my aunt is a respiratory therapist. And so she works in healthcare, she has to get her flu shot. And then Gramma Pookey is elderly, and so my aunt who’s a respiratory therapist, she’s not playin’ around with her momma walking around, not getting a flu shot. She’s like “You’re old, you’re getting a flu shot ’cause the flu really does kill.”
Kim: And I’m gonna have to take care of you, you get sick.
Max: Right. But everybody else was like, “Nope, nope, nope. Not gettin’ a flu shot. Not gettin’ a flu shot.” And there’s such deeply seated mistrust.
Kim: And that’s just a flu shot that they’re asking people to do every year.
Max: Every year.
Kim: Now you’re talkin’ about a COVID vaccine that no… woo! The level of lying, [laughs] the level of just absolute…. and it saddens me, it absolutely saddens me, ’cause all I can tell for my old folx is, “I need y’all to stay in the house. I just need y’all to stay in the house.” [Laughs]
Max: Well, I also do need folx to… [scoffs] OK, so this is hard, right? I’m in medical school, I believe in science.
Max: And so this is a tough conversation. So here’s the thing: if we don’t participate in vaccine trials… so I’m gonna use another vaccine example: HPV [Human papillomavirus]. That’s the vaccine that’s supposed to prevent cervical cancer. So Australia has managed to eradicate cervical cancer from its population because everybody as a teenager is getting the HPV vaccine. I got issued the vaccine before I turned 26, praise the lord. I mean, it’s not just cervical cancer, HPV also causes oropharyngeal cancer. So—what’s the name?—Michael Douglas had oropharyngeal cancer. Word has it, it was from Catherine Zeta Jones. We’re not gonna get messy…
Kim: No, no, we gonna talk about it. He said he got it from eatin’ his wife’s pussy. That’s what he said. [Laughs]
Max: Exactly, right? That is a common way for men to get it, and there is no test, by the way, right? Women can get the PAP smear. There’s not a way of testing for—there’re three strains of HPV that are known for causing cancer—we don’t have a test for that in men. But here’s the thing: there’s a study that showed that the strains of HPV that are more commonly found among Black girls, or Black teenagers, are not as hardly targeted by the vaccine that is being circulated. Why is that? Things like that, you think about who were the participants in the vaccine trial, right? So if we do not participate in the scientific process, we will get left out of the effectiveness of treatments.
Max: …we get left out of the effectiveness of treatments, ultimately. I’ma use another example. So, kidney transplant, right? Or any transplant, for that matter. Black folx have the highest rates of chronic kidney disease, so we’re most likely to require a kidney transplant. And then genetics play into this, so the best person to give you a kidney is probably somebody in yo family.
There is a drug out there that is otherwise a fantastic drug called Tacrolimus, we’ll call it “Tac.” The way you dose this medication, you dose on what we call the trough, the bottom—as opposed to the peak—you dose based on the trough. And so it turns out—because again, there were so few Black people in the trial—so evidence now is suggesting that Black people are quote unquote “super metabolizers” of this medication. And to an extent, Asian people are too.
So basically, often times you have Black folx who, if you’re gonna put a Black person on Tacrolimus, there is a small chance—we’re not gonna do the race essentialism thing here where we’re just gonna assume that every Black person is gonna be a super metabolizer of Tacrolimus. In fact, why do we call the Black people the “super metabolizer” or “hypermetabolizer”? And why are the white people…
Kim: The default, the normal.
Max: Right, like hypometabolizer. But either way, there is a chance—it’s not a prescribed situation—but there is a chance that as a Black person on Tacrolimus, you end up needing nearly twice as much Tacrolimus as a white person. But the problem with that is, it is also toxic and then can cross the blood-brain barrier when it reaches high doses. And it also is nephrotoxic, as in it could cause acute renal failure.
So imagine, this drug that is meant to prevent rejection of a graft, rejection of a brand new kidney that you just got, can also cause failure of the same kidney in the way that it’s currently meant to be dosed. And so the way around it is that recently, they designed a new medication that’s meant to be extended release so that it won’t be hypermetabolized for people who are hypermetabolizers. But we didn’t know about it until we saw people doing poorly on Tac, and had the trials included more Black people…
Kim: And this is a reason why I was excited when the Apple watch came out. This is why I did get excited when the Apple Watch came out, because they introduced it with—it was five clinical trials when they first introduced it; I can’t remember what they were—but that was what I was really excited…
Max: It was something about ventricular defibrillation, yeah.
Kim: Yeah. Because I really got excited because clinical trials have been for the elite anyway; you had to know about ’em, your doctor had to know about ’em. It wasn’t for your everyday person, and now…
Max: Yeah, it’s not easy to participate in the clinical trial, right? They require you to show up to the clinic, time and time and time to get more labs… yeah, it’s not easy. [Laughs]
Kim: So I really thought this would be a gateway into getting more people…
Max: People interested in participating in a scientific process.
Kim: Yes, participatin’ in—and yet then you have to deal with how these companies, how these people are usin’ data, [laughs] and that’s a whole ‘nother thing. You know, there’s a trust issue.
Max: Right. I mean, it’s messy. It’s very messy.
Max: But I’m telling you, if we don’t participate in the scientific process, we will get left out.
Kim: No, I get it. I absolutely get it. I absolutely get it.
Max: But it’s not on us, right?
Kim: That’s what I was about to say, ’cause what will happen is we’ll get shamed for not doin’ that, and don’t do that shit to people who have a fuckin’ lived history of being treated like… yes!
Max: Of being abused.
Kim: Exactly. Of being abused. Exactly.
Max: There are folx who are doing this well, who are doing community-based participatory work where you have community health workers whose job is to be that bridge, so that it’s culturally informed. It’s not just a random person from the university, and be like, “Oh, yeah, we’re to experiment on you,” or whatever, right?
Kim: Yeah, ’cause they’ve built relationships in the community, people trust them, they have psychological safety. And yet you have the CDC changing, making proclamations or whatever based on pressure from the government. It’s like, what the… [laughs]
Max: Let me tell you something: this is the problem with political appointees. The head of the CDC is appointed by the President of the United States, and so is the head of HHS [US Department of Health and Human Services]. A lot of these agencies that are truly meant to be nonpartisan; they are ultimately political appointees. Even though the current head of CDC is a physician, he is a conservative physician. In the 1980s, during the AIDS epidemic, he was among those who were screaming, “Abstinence is the way.” He is not to be trusted from that perspective. And so you’re right, pressure from the government—I mean, I have been so, so disappointed in the CDC. I used to swear by the CDC, and I’m not kidding when I say this.
Kim: Yes! And that’s what I’ve heard, people who’re in the city, [Atlanta, where the CDC is headquartered] they’re like, “That used to be the pride and joy of the city.” And now we’re just like, “What the hell?”
Max: And I tell you, when I got into the flu argument wit’ my family, my whole thing was always, “Look y’all, this is from the CDC.” [Kim laughs] I used to get on the CDC’s website, but not even as a person in healthcare, ever since the CDC—first of all, they messed up in so many ways, and I’ve been thinking a lot about this. I told you, I write a lot. There’s a piece to be written about how the CDC has made it even more difficult for people like me who are in healthcare, that have a bridge to Black communities…
Kim: Yes. To do your damn job.
Max: To do my job as a bridge, as a science communicator, as a translator of the science for my folx, even my family. I don’t even—I hope that there will be a time again where I will feel way more comfortable with what I see on that website. I mean, it’s not all bad; don’t get me wrong. But for instance, one day the CDC was telling healthcare workers to wear bandanas if they’re running out of PPE [Personal Protective Equipment], and I said, “You have got to be kidding me.” We know the evidence on bandanas is not good. Why are you… you’re the… the CDC is sort of like the mothership. And so…
Kim: Had a wonderful reputation. [Laughs]
Max: The guidelines that the CDC is putting out should never be like, “OK, well, shit. Shit is hitting the fan, so y’all just have to do what you gotta do, put a bandana on.” That’s what the CDC told us! I said, “Hold on. Wait a minute.”
Kim: [Laughing] You know what, every man for himself.
Max: Literally! I said, “Hold on.” And then there was an outcry among the healthcare community. Nurses, nursing unions filed the OSHA [US Occupational Safety and Health Administration] complaint about this PPE stuff…
Kim: And what people don’t understand—and someone broke this down when the recent changes about testing and if you don’t have symptoms, you don’t have to… And it took someone to break it down because it’s even more insidious than that, right? Insurance companies follow the CDC guidelines, and this was gonna be a way for them not to pay for testing and that people were gonna have to pay for their own test even if they were asymptomatic.
Max: I want to say, though, let me stop you there. If you’re asymptomatic, you’re not seeking testing, like no one in their right mind would be seeking it, so I don’t think that was necessarily a way for insurance companies to get away from…
Kim: No no no, I’m not sayin’ that they were doin’ it, I’m just sayin’ that burden of payin’ for that was gonna be put now on…
Max: I mean, those tests are really cheap, honestly. Yale just put out a test that costs $4 to make, the saliva test that the NBA sponsored. They’re not that expensive. So I think when the CDC was like, “Stop testing asymptomatic people,” it was like, “We’re givin’ up. Throw in the towel,” like Tyrese said, ’cause the purpose of testing asymptomatic people is to get ahead of transmission.
Kim: Exactly, that’s what I thought! [Laughs]
Max: Right, but I think they’re just like, “Listen, throw in the towel.”
Kim: We’re gonna be in into this shit well into 2021. Good god almighty.
Max: Don’t tell me that, ’cause I got a graduation ahead of me. [Laughs]
Kim: Yes sir. Yes sir, that’s on you! [Laughing]
Max: Yeah, there’s so many different things…
Kim: I don’t see myself travelin’ until at least spring of 2021.
Max: Listen, I’m about to look into this vaccine trial because I’m hoping that maybe—I mean what’s her name—it’s a Black woman that’s leading the vaccine development at NIH. Kizzmekia Corbett, Dr. Kizzmekia Corbett; she has a PhD in vaccinology. And some of the conversation early on was that potentially there might be—there was this question of could there potentially be an emergency release of the vaccine specifically for healthcare workers? I’ma be first in line if that shit—I mean, excuse my language—I’ma be…
Kim: Oh, you gotta… that shit, go ‘head. [Laughs]
Max: I’ma be first in line. I just told my roommates yesterday—we started cleaning our place ’cause we’re finished moving in—I said, “We’re throwing a rager when that vaccine comes out.” [Laughs] “We’re all getting vaccines, we’re like… alright.”
Kim: [Laughs] This has been a great conversation. We’ve kind of gone all over the place, which I love. Is there anything you would like to say before you leave?
Max: Huh. This is a tough one. I want people to—your lay audience—to become more acquainted with the different things are caused, what we see in terms of health inequities. What I have found, just navigating the Internet—both among Black, white lay people, but also among folx in health care—is that people tend to misattribute the causes of disparities to one thing versus the other. When again, we talked about things being—it’s a system, right?
When Chadwick Boseman died at 43, rest in peace, I was super heartbroken and I got on Twitter and everybody started yelling, “Black men, go get your colonoscopy. He was diagnosed at 39. I don’t care if you’re 30. Go get your colonoscopy!”
I was like, “Hold on y’all. That’s not how this works.” We don’t know enough about Chadwick, we don’t know whether he carried the gene. We have no clue whatsoever. But I think sometimes we can be really quick to extrapolate and attribute the risk, or the things that happened to one thing. Especially in the space of health. Like you hear that Beyonce had to have an emergency C-section, and we’re immediately blaming it on medical racism. And I’m like, “We don’t know, we do not have the data.” We only heard that Beyonce had an emergency C-section because one of the baby’s heart rate dropped. And, boom, people are like, “Oh, yeah, medical racism. Even Beyonce can’t escape.”
These huge leaps that sometimes we make are counterproductive, especially when we only have one data point. So I just invite folx to, again, look at the data, look at the behavior, like we talked about earlier, as opposed to just anecdotes.
Kim: And also, there’s a difference between causation and correlation. [Laughs]
Max: And correlation, yeah, exactly. So to that effect, I invite folx to check out my podcast, that tries to break down mechanisms from history, anthropology, sociology, epidemiology in clinical care; we try to break down mechanisms that explain how we got here in terms of health inequities in different arenas. It’s “Flip the Script,” and the handle is @flipscriptpod on Twitter. And you can follow me on Twitter, @MaxJordan_N, that’s me.
Kim: And I will include all of these links, these Twitter links in the show episode. All right.
Max: This was great. This is fun.
Kim: Thank you so much for being on here. As I told you, two Black folx on here is gonna go like… [laughs]
Max: Right. I was like, “Oh, shit, it’s 7:00 already. I gotta watch [inaudible] with Monica.”
Kim: Oh, yeah, at 8:00, yes.
Max: Exactly. You already know.
Kim: Thank you. Have a wonderful day. Bye bye.
Max: Thank you. All right, bye bye.