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#103: Black Hearts Matter

Published on
June 14, 2022
Show notes

In Episode 103, Quinn & Brian ask: Why do so many more Black people die after heart transplants than everybody else?

Our guests are: Dr. Hasina Maredia and Dr. Errol Bush, who recently published a paper in the American Heart Association’s journal, “Circulation: Heart Failure.” Their paper concludes that “young Black recipients have a high risk of mortality in the first year after heart transplant, which has been masked in decades of research looking at disparities in aggregate.”

Sorry for the spoilers, but that’s really just the beginning. The decades of systemic failures that allowed this to happen — and, most importantly, the steps we can take right now to improve these wildly disparate healthcare outcomes for young Black people — are the real meat of this story, told by two incredibly inspiring people.

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Transcript

Quinn:

Welcome to Important, Not Important. My name is Quinn Emmett.

Brian:

And my name is Brian Colbert Kennedy.

Quinn:

This is science for people who give a shit.

Brian:

Ooh, I like that.

Quinn:

Mm-hmm (affirmative)

Brian:

We give you the tools that you need to fight for a better future for everyone that contact straight from the smartest people on earth and the action steps you can take to support them.

Quinn:

That's right. Our esteemed guests who, for some reason, keep coming back are scientists, doctors, nurses, journalists, authors, engineers, farmers, investors, activists, educators nonprofit directors, astronauts, even a reverend.

Brian:

Astronauts and a reverend. Wow. By the way, this is your friendly reminder that you can send questions, thoughts, and feedback to us on Twitter at Important, not imp or email us at questions@importantnotimportant.com. You can also join tens of thousands of other smart people and subscribe to our free weekly newsletter at importantnotimportant.com.

Quinn:

That's right. Brian, this week, boy, I was really excited to get into this one and then it was a thousand times better than I could have even hoped.

Brian:

So good.

Quinn:

Brian, this week we're asking it's very specific, why do so many more black people die after heart transplants than everybody else?

Brian:

I don't know. Thankfully we-

Quinn:

I mean, you do know now because we already recorded it, but I get the point. Yeah.

Brian:

Thankfully we have two wonderful people on the podcast today that will answer that question. Our guests today are Dr. Hasina Maredia and Dr. Errol Bush. They wrote the paper, they're eager to talk about it and we honestly learned so much.

Quinn:

So much. So inspired once again. Folks, you can find out the answer to our big question and all of the ways that you can help out up next. You ready?

Brian:

Let's listen.

Quinn:

Okay. Our guests today are Dr. Hasina Maredia and Dr. Errol Bush. Together we're asking why it's so dangerous for black people to have their hearts replaced. Dr. Maredia and Dr. Bush, welcome.

Dr. Hasina Maredia:

Thank you for having us.

Dr. Errol Bush:

Thank you. Nice to meet you.

Quinn:

Absolutely.

Brian:

Nice to cyber meet you over the internet also. This is going to be very, very great. If we can get started by maybe each of you just giving us a quick who you are and what you do. Dr. Maredia, yeah?

Dr. Hasina Maredia:

Yes, I am currently in residency. I'm in my first year, just finished medical school at Hopkins back in May right during the pandemic's [inaudible 00:02:42]. I'm in internal medicine, so I work in the inpatient wards as well as do a little bit of outpatient time. In my free time, on the weekends that I do have, I work on research and the project we'll talk about today was one of the projects I started when I was a first year med student.

Quinn:

You have free time?

Dr. Hasina Maredia:

I ask myself that all the time, but I'd say it's very tough, but occasionally.

Quinn:

I was going to say, wow. Dr. Bush, what's your story for the people?

Dr. Errol Bush:

So I'm Errol Bush and I've been at Hopkins for a little over five years now. I'm the Surgical Director of Lung Transplantation and Advanced Lung Disease. I finished my training in 2013 at University of California, San Francisco was on faculty for a while before being recruited to come to Hopkins to lead the program here. My interest has really been in lung transplantation outcomes and trying to sort out some of the disparities that we see in transplantation care. That's one of the projects we'll talk about today.

Quinn:

Awesome. So, what you're saying is, is lung transplant wasn't enough for you? You had to branch out?

Dr. Errol Bush:

That's correct. In my spare time.

Quinn:

It's so weird that we keep talking to people that are just like Brian.

Brian:

Exactly like me.

Quinn:

Same CV, same aspirations. That's good.

Brian:

Thanks for that Quinn. Thank you, doctors very much. Then just a quick reminder to everybody and for you two. Our goal on the show is to provide some quick context for our question or our topic for the day, and then we'll dig into action oriented questions and what everyone out there listening can do about what's going on. That sound good.

Dr. Hasina Maredia:

Sounds great.

Quinn:

Awesome. Dr. Maredia, Dr. Bush we do like to start with one important question, something to set the tone a little bit, and remember, you're here for a reason. Instead of saying, tell us your life story, if you could each answer why are you vital to the survival of the species?

Dr. Hasina Maredia:

That is a very deep question to start off with.

Quinn:

it is.

Brian:

Setting the tone here.

Quinn:

What they were finally... Yeah, exactly. One day we're actually going to do a compilation of everybody's answers. Some of them are amazing, but they all start with laughing.

Dr. Hasina Maredia:

Well, I'm glad I'm with the majority on that. I think I'll frame this as I think the work that we do is definitely very vital for the betterment of our species for improving the planet as we know it. I think as physicians or as researchers, or as both of us physician researchers, I think we're doing science in particular epidemiology to better understand these massive disparities that have been going on for years and years, if not decades in our health system and advocate using our science for justice and more health healthcare equality. I think that for me, what's gratifying is being able to do that at the microscopic level with patients individually. Then also being able to have more far reaching outcomes with doing things on a larger scale with these large data sets that we've been working with.

Dr. Errol Bush:

Now I have to follow Hasina?

Quinn:

See? Not so hard.

Dr. Errol Bush:

I went into medicine because I wanted to help people, which is a pretty much what many people say when they're interviewing for medicine and going into this field. But even at a young age, my parents who were very religious, my father is a pastor, just really instilled in me to give back to the community. I didn't come from a family that had a wide variety of means by any chance. It was really give back with what you have. So whether that's sort of giving someone a hug or once you have resources you can contribute. So I've obviously developed a great technical skill and then I can offer someone lung transplantation, but I think it's really my duty to figure out what else I can do outside of that. So trying to make people be able to get better health care, to have a better life. If I'm able to participate in those things, then I feel like I've returned my duty and that I'm a happier person.

Quinn:

Well, yeah, again, it seems like you're just not doing enough.

Dr. Errol Bush:

I know. Need 26 hours in a day.

Quinn:

Exactly. Oh, gosh, I hear you.

Brian:

That does not sound terrible.

Quinn:

I hear you. Yes, that's exactly me. Thank you, Brian.

Dr. Errol Bush:

What about you?

Quinn:

We're very proud of what we do, we joke, but, I always say, when my children grow up and ask, when climate change had in public health and all the antibiotics fail, what are they going to say? I'll say, "I had a podcast." So pretty excited. Awesome. So I'm going to just do the world's quickest little context for everybody out there, a little lowest common denominator, so that we're all on the same page before we get into this thing. Sometimes this is more philosophical, sometimes it's incredibly nerdy. Today's kind of just a quick, a bit of both of that.

Quinn:

We recognize that Brian and I, we try to feel like we have done a better job at least over the past a year and a half of transparently recognizing and leading with the fact that we are two white men in America today who are very privileged on a number of fronts. That's becoming more clear by the day. So, before we get into outcomes, which is a bit of what your research was focused on, or output of the results of what happened, I want to talk about inputs and how we get to a place like this, how we got here. But not just what happened in the hospital to make these results so skewed, because these things can be complex.

Quinn:

I try to fully understand the machinery for so many of these things. Again, whether it's something like climate change or clean energy transmission, or battery storage, or something like this. It means working hard to dial things down to first principles. Which I'm really trying to study and get better at. So all the fundamental building blocks, the immovable pieces of a machine of a problem and we'll get into those. Again, just to say things out loud, systemic racism is a choice, and it has been a choice for 400 years. Those choices made primarily by people who look like Brian and I, have purposefully deprived black people among many others, but predominantly black, and indigenous people historically, of the ability to live healthy lifestyles.

Quinn:

The tenets of a healthy lifestyle include clean, available, and affordable water. It's got to be all three. Clean, available and affordable food, clean air, affordable housing, an equitable education, bedrooms and school rooms that aren't overheated and healthcare and insurance in case your health fails and jobs that pay a living wage. Those are the table stakes for the 21st century. If you don't have affordable access, for example, to really any of the above, any combination of above, your health is going to suffer. When your health suffers, if you have chronic illnesses, you may eventually end up in the hospital. Sometimes that means depending on your conditions or combination of them, how long you've been suffering or something you might have inherited, it might mean having something replaced, an organ replaced. And sometimes that means your heart.

Quinn:

Unfortunately the danger doesn't end once your heart is replaced. It's not the cure, all as we've discovered through your work. So today, I want to focus on why it's so dangerous for black people to have their hearts replaced. So Dr. Bush, you alluded to, I know you work primarily in the lungs, but if you guys could, again, just to provide a little more context for folks. Can you briefly provide a little context for our listeners about what exactly goes into an organ transplant, in this case, specifically heart transplant? So a little bit about how you're selected or you qualify for one, pre-op requirements, what happens during the surgery and what's required afterwards? Because I think this will really help paint a picture for everybody when we start to talk about all the other things that go into it.

Dr. Errol Bush:

Yeah. Thanks Quinn. I think you hit the nail on the head here. So organ transplantation is a very complex operation. It involves a very prolonged and time course in terms of health care, as well as the resources that are needed in order to help take care of the person. But what you've also mentioned is that even getting into the health system could be a barrier for some people. I think the first the first issue is that we have to understand what these barriers are to getting health access. As you mentioned, that blacks may have a higher predisposition to certain ailments and particular with heart transplant. We know blacks have higher incidents of heart, sorry, of hypertension, high blood pressure or diabetes. And those diseases when they manifest, their manifesting a lot earlier in African-Americans and it makes them have much severe heart disease. That may cause their hearts to fail at a younger age compared to the majority population.

Dr. Errol Bush:

When that happens, the person then needs to seek medical care. There may be barriers in seeking medical care, even if it's their primary care physician, someone needs to be able to leave their job in order to go to seek that medical attention. That primary care person has to have an interest. Even though it's their duty to take care of these patients, they have to not have a bias against that person and their social situation in order to help take care of them. Then when they realize that they have such a severe problem, that their heart is failing, they then need to be referred to a more specific specialist, like a cardiologist or heart failure cardiologist that can try to optimize and save their heart before it gets so severe that it really needs a heart transplant.

Dr. Errol Bush:

Once it's decided that they need a heart transplant, then it's another transplant system that they need to get through. So they have to have someone who respects them and cares for them enough to refer them on to transplant. That can be a potential barrier to getting people in the door on time, but then once they're in the transplant system, then it's really a multidisciplinary system. So they're the surgeons, they're the heart physicians, they're nutritionists, social work, physical therapy, a wide host of different professionals that they will see that person and evaluate them. Then we have to hope that everyone is non-biased. So they don't have what we call implicit bias. That even though they think they don't have a bias from what they've been trained by seeing in the media, they have these preconceived notions that black people may not do as well with the heart transplant. So they may not get referred or they may be considered not a candidate because of these preconceived biases.

Dr. Errol Bush:

But we do hope that this multidisciplinary team, which actually has a sort of a checks and balance system where we decide early on, well, these are our inclusion criteria. Meaning that, if you meet these criteria, then you would qualify for a heart transplant as long as you don't have exclusion criteria, which are criteria that we're going to say, absolutely, we're not going to offer you a transplant. Even though we have these sort of check boxes that we can check and make sure that you're a candidate or not, there are some other things that we've seen in the literature that's not necessarily a part of that system. Something as simple as having children.

Dr. Errol Bush:

So if you're an African-American woman having children it can be considered a detriment to your candidacy versus a white woman with children, that's considered an asset. Well, those boxes aren't on our list of inclusion-exclusion, that gets back to what I mentioned about implicit bias, because that will sort of in the back of one's mind will influence their decision to give someone the chance to receive a heart transplant. Then you have the surgery itself. The surgery is very complex. Basically heart transplant, you take out the old heart with the with the assistance of the heart lung bypass machine, and then you replace that old heart with the new heart.

Dr. Errol Bush:

A heart transplant actually has really good outcomes. There are about 3,500 heart transplants a year. Last year, there were actually 3,600 and a pretty good survival, where most people that undergo a heart transplant, well, we should be expected to live at least 12 years after their heart transplant. Those outcomes, aren't the same or aren't nearly as good with lung transplant, but for heart transplant, you would expect people to have a good outcome. But yet what our study shows is that, and what other studies have shown, blacks don't enjoy the same luxury of good outcomes after a heart transplant.

Dr. Errol Bush:

What we've identified first here is that, in the first year African-Americans are more likely to not survive to more likely have these problems. We really need to focus on what can we do during that first year that may be able to help rescue some people that would die under our current system. That's really the problem here. We don't know what these issues are or what the resources are needed in order to help rescue these people. Our job here is really to figure it out so that we can change for the better. In one sentence or less.

Quinn:

No, that's, one sentence or less, perfect. I can't imagine. One of my favorite games is when we had a guy a year or so ago who figured out how to basically pull drinking water out of thin air. One of my favorite questions for Brian is, where would you start that project? What would be your first step? So I feel like open heart surgery is along those lines. So you mentioned again, just so people have the full context, before we get into exactly how black folks like you said, don't enjoy the same outcomes because of a variety of factors. What is involved again, briefly in that first year? What would typically be involved for the, I know this is ridiculous, but the average heart transplant patient after they leave the hospital?

Dr. Errol Bush:

Yeah. You know, that's a great question. I basically think of transplant, whether it's heart transplant or any of the other organs of two main sets of risk factors. The first risk factor is the surgery itself. Something as challenging as a heart transplant, there can be a lot of complications related to the surgery, but if you're able to get out of the hospital, then you're subject to another set of potential complications. And really these complications are either infection or rejection. And because we have to try to prevent your body from rejecting the organ transplant, we have to give you immunosuppressive agents. These drugs are very rough on the body. They can affect other organs like your kidneys, but they also make you more prone to infection. So it's a fine balance between trying to prevent your organ from rejecting and trying to prevent you from having an infection.

Dr. Errol Bush:

So after sort of that first two, three months after surgery, you're really trying to fight against infection or losing your graft through rejection. That's really where a carer would need to focus, I think. And how we tailor our immunosuppressant agents, as well as our followup care. There are lots of follow-up appointments right after a discharge. The further out you get from transplant, the less frequently you need to be seen by your healthcare physician. But early on, we are really making medication adjustments and trying to again, prevent rejection. That again, I think is where we can really focus our efforts.

Quinn:

Okay. That's all super helpful. Brian, do you have any other questions about the actual sort of logistics of the thing before we continue?

Brian:

I can't believe, this is somebody's job to do this. This sounds so stressful. I'm over here sweating, just listening to you, but in a great way. It's very exciting to learn. I'm a little bit interested in, just out of curiosity, you mentioned I think you said last year 3,600 heart transplants. Do you have any, you were saying that most of them were successful. What does that mean, numbers wise as well? How many people lasted those extra 12 years or whale?

Dr. Errol Bush:

First year survival's like 91, 92% of people after a heart transplant will make it to one year. So that's pretty good. For the 10 year or sorry, the 12 year survival when I said most people, so about 50% of people will make it to 12 years, which means a lot of people. Almost 50% more will last longer than those 10 to 12 years. That is really a phenomenon that is enjoyed by many of the organs, heart, liver, kidney. Kidney, we expect you at least 20 years of survival after an organ transplant. I don't want to make this about lungs, but obviously it's also my specialty. But whereas when we see with lung transplant, we would only expect people to get to six years after a lung transplant.

Dr. Errol Bush:

There are different reasons that affect different organs of why and how survival does so well or poorly in the case of lung transplantation. And again, that's what I think our resources and research needs to focus on, how we can do this better. One of the things Brian, you mentioned it seems very stressful and so we try to make it easier and consistent amongst our teams to have a protocol for what we're going to do immediately after transplant, or if someone starts rejecting another protocol for what medication we were going to start as a team. That's great to have a protocol and try to standardize it, but what's different and where I think there could be issues with African-Americans and other ethnicity is that we usually shoot for a particular medication having a drug level that is of a of a target level. We have that same target level for every one of our patients. So it's not changed based on your ethnicity.

Dr. Errol Bush:

We're trying to put everyone into the same box. Yet, we know that the way that different ethnic enzymes function, your race would be associated with how quickly or how slowly you're going to digest that particular drug. If we know that different ethnicities digest the medications differently, why is it that we give everyone exactly the same drug level? Maybe that's what's contributing to why we see differences in outcomes. Maybe African-Americans are more immuno suppressed with the same drug level and so we need to decrease that amount of immunosuppression or vice versa. But we really just don't know and that's where we're really just seeing the tip of the iceberg. But as you've alluded to, and have highlighted here, we know that there's a problem, and now what are we going to do to fix it?

Quinn:

The last piece of context I would love is, again, you've alluded to specifically how this is quite the interdisciplinary affair from pre-op to afterwards. I don't know if there's an available number on this, but I imagine that the resources to do this heart transplant are not available everywhere. Do you have any sort of concept on how available heart transplants are nationwide? I guess if there's X number of hospitals, what percentage or something like that?

Dr. Errol Bush:

That's a great question. I don't know the specific numbers. I do know organ transplantation is performed in very specialized centers. Heart transplantation is definitely not performed in every hospital. It's usually kind of more in major cities, at big academic institutions, though it doesn't have to be at an academic institution, but I think what you're getting at is that those resources then become more limited. That should be a disparity on its own. So someone who lives in a more rural area and they have heart failure, how do they get to sort of the big city where this big heart failure center can be?

Dr. Errol Bush:

Heart transplantation, isn't the only solution to heart failure. There's a lot of medications that that can be attempted in the therapeutic way at first, and then some other devices that may bridge to either heart transplantation or even recovery. But you do have to have access to to that center in order to in order to receive those or even be considered for those therapies.

Quinn:

Sure. Yeah. Again, I think about like you said, the disparities and how they just add up the further you go down the funnel, and yeah, I imagine discovering if you live in a more rural area, this is another hurdle you'd have to get over. At the same time, I remember we talked about somewhere, I don't have the exact statistic in front of me, but it was pre COVID. I believe the research was from pre COVID that in Los Angeles, folks going through the public health system waited something like 80 plus days to see a specialist. That there were a high number of deaths because of that. Just thinking that basically, even if you do live in a place with a number of large hospitals, like Los Angeles with Cedars and UCLA, et cetera that doesn't guarantee anything really.

Quinn:

So just trying to think about that sort of pyramid of disparities, like you were saying.

Brian:

Everything's going great in Los Angeles guys. Dr. Maredia, I want to dig further into who is being affected here. You mentioned young people being part of your research. I think it's easy to think all heart disease, probably a decent percentage of older folks, but they're not actually the ones having issues here, right, at least as documented in your paper. So what have you figured out, what's going on with young black people and heart transplants and why, why is it happening?

Dr. Hasina Maredia:

Yeah, I think the results were also very surprising to us as well. I think surgical complications or complications from procedures tend to affect older recipients more. So it was very surprising to us that it was the young recipients and that indicative looking at disparities research, which was known in cardiac transplant outcomes, that we didn't really know what subgroup it was. It was kind of just a overall disparity that was established. We didn't know whether there were subgroups within black recipients who were driving the disparity, which we found was the case with young recipients.

Dr. Hasina Maredia:

If we look at the age 61 to 80, there wasn't a significant difference in outcomes. Over time, the disparities have actually narrowed in the older age categories, but persisted in the younger age category. So we ultimately don't know why I think that will be the next step is why are these young recipients at higher risk? But I think some of the things that were motivating us in looking at disparities by age was potentially young recipients as Dr. Bush mentioned, have significantly fewer resources. I think that being in this age group in general, I think there are adherence issues. When you're young, you may not fully understand, feel invincible with your health when you're not feeling poorly and it's hard to remember to take your medications.

Dr. Hasina Maredia:

I will be the first to admit that I'm not perfect with remembering either, and I don't have complicated medical history compared to heart transplant recipients. So I think that's a big issue that needs to be addressed. I think that as technology changes and this 18 to 30 age group are essentially millennials, and I think being able to improve adherence for them, whether it's through technology like reminders or apps that can encourage them to take medications on time or to seek out care and to educate them better is definitely an important area to explore more.

Dr. Hasina Maredia:

Social and economic disparities, we looked at that as well in the study and insurance differences between black recipients and non-black recipients as well. There's a lot more private insurance in the non black recipient group. I think insurance difference, it's hard to capture what's fully covered, but I think having poor insurance coverage definitely could be a driving factor as well. But the surprising thing was that even if we controlled for these socioeconomic differences, differences in college education, the disparity still persisted, it didn't budge.

Dr. Hasina Maredia:

This has been seen in prior research too. I think it's hard to fully capture. Some of the things that you mentioned Quinn with having access to clean, affordable water and all of these other things aren't fully captured in some of these variables, which makes it hard. But a lot of studies, and one in particular that I was reading about was looking at maternal morbidity after pregnancy for black women compared to non-black women.

Quinn:

I mean, sorry to interrupt. I remember reading those two wonderfully transparent and brutal interviews with both Beyonce and Serena Williams about their experiences.

Dr. Hasina Maredia:

Right, exactly. Yeah. Just as a context to some of that. College educated black woman had twice the risk of dying after delivery compared to white women with less than a high school education. Which is really remarkable to think about that even educational attainment and income don't necessarily eliminate these healthcare disparities. So there's something much larger with the systemic racism in our healthcare system to address.

Quinn:

So that's interesting. I wonder if we can think about that for just a minute and I guess digging into that, but also talking about both of your roles in this. I guess talking about how just the black experience in general with medicine now, which we can't ignore. I mean, you can talk in isolation, pre COVID or post COVID or whatever it might be, but we also have to include it because, I'm not sure if you guys read Ed Yong at the Atlantic, who's just a wonderful science writer who kind of came out of a sabbatical to do a lot of writing over the past year and wrote this wonderful sentence I keep coming back to, about how COVID was the flood that exposed all the existing cracks in our systems.

Quinn:

The factors here are really manifold. You've got only 5% of doctors are black. Like you just mentioned, some of these maternal mortality rates are stunning, and then you have the spotlight coverage of experiences like Serena Williams and Beyonce. I mean, these women are incredibly successful and very wealthy black women, and it didn't matter for them. Serena in particular, talked a lot about how the doctor just didn't listen to her reports of pain. Like you said, I remember seeing that a CDC stat, something like three to four times likely to be risk of pregnancy related deaths as white women in average. There's so much research into black patients pain being ignored, less likely to receive pain medication. On the other side, of course the black community has very brutal history with the American medical profession.

Quinn:

I mean, the last pandemic was 1918, black people couldn't even go to white hospitals. We have Tuskegee which went on for decades, AIDS and everything in between. So I'm curious during a time of this pandemic, which is still ongoing, even if it's getting a little better. We've seen black and brown populations more likely to both get the virus because of living and working conditions, and a lot of the things we've talked about. They're more likely to be hospitalized, they're more likely to die.

Quinn:

I'm curious how you guys feel about, both sides, about the pressure that black physicians, which are so few and nurses are under and have been under and on the other hand and how that applies to things like the pre-op and post-op experiences with something like a heart transplant. On the other hand, what else we can do to help the black population trust medicine, and for example, the vaccine?

Dr. Errol Bush:

Yeah, Quinn, you've highlighted a lot of issues there.

Quinn:

Sorry, that was a lot, but I'm always trying to think about the layers to all of this.

Dr. Errol Bush:

I guess my response would be so obviously as a black male myself and being in a big academic institution, we often talk about a phenomenon called the black tax and it's, as you progress throughout your academic career there are fewer and fewer people that look like you. In order for you to make it, you have to make it. Meaning, we oftentimes feel that we have to work twice as hard as the majority that are in our same position, even to just be recognized for the same jobs that we did, that they would have done, but we don't get the credit. On that level, just even to progressing your career, you have to work really hard. The tax part of black tax is that, because there are so few black people, the higher you go, you also, every time you need a more diverse committee or diverse sort of group in order to solve some issue, if you're the only black person, you're always the one that's chosen.

Dr. Errol Bush:

By doing that, you're putting more work on that person in order to participate in those committees. Obviously we want to do it, but we also have our career and other duties that have been given to us. So it just really becomes very taxing even that portion of just how you get through your day to day and academia. Then the other question you asked about, how can we help the African-American community? I mentioned how I went into medicine, I really want to help people. I want to give back to the whole community, but especially the African-American community. In order to do that, I have to have the time to be able to sort of be engaged with the community and tell them about my experience. Certainly we come up with these opportunities where we might invite high school students and college students to come into the hospital and to see what it's like. But what they really need to be able to see are other physicians that have made it that look like them.

Dr. Errol Bush:

You mentioned that there are only 5% of doctors in this country that are African-American and the even more sad part of that, well, only 2% of the doctors are African-American males. There's the other pandemic that's going on is that African African-American males have such a shortened life expectancy that's lost to other violence within the community. And so there's a lot of systemic issues that play a part in decreasing the African-American trust in the healthcare system. They don't see people that look like them, so they automatically distrust. That person may not have their best interest, or they may not understand their culture or that pain is the same, whether you're black or white. That black people don't have a higher pain tolerance, which is ridiculous, right? But that is a myth that was spread several decades ago and has been perpetuated.

Dr. Errol Bush:

I think Hasina kind of reminded me with this project because my age puts me in the third oldest age category. I like to think that I'm a young person.

Brian:

Me too Errol.

Dr. Errol Bush:

But that makes me think about the fact that, well, how can I identify with this younger cohort? Again, it's if I'm in this third oldest age group, I must have these sort of preconceived messages that I've gathered over the years. It's hard for this medical system that's so old and established, to really look back at itself and say, well, these things we really need to change, unless someone highlights it to you. Because otherwise you think, well, that's normal, right? The first step is talking about it as you're doing here, and then the second step is we need to understand what interventions we can do and how we can do it, or install those interventions most quickly and in an effective manner, such that we can, again, help rescue people, improve healthcare, improve the life of of everyone.

Quinn:

Doctor, I wonder if you can just spend a little more time on sort of your personal side of things. One of our earliest guests and inspirations for the show and heroes is this incredible Marine biologist, Dr. Ayana Elizabeth Johnson. She is outspoken about the ocean and climate, and her experiences as a black woman in America. And she wrote a piece for the Washington Post this summer in the middle of everything, titled "I'm a black climate expert, racism derails our efforts to save the planet."

Quinn:

I just want to read a quick quote here, because you talked about the black tax and how you see fewer black people and how it can be exhausting to have to kind of constantly qualify. She wrote, "Tony Morrison said it best in a 1975 speech. The very serious function of racism is distraction. It keeps you from doing your work. It keeps you explaining over and over again, your reason for being. As a marine biologist and policy nerd, building community around climate solution is my life's work, but I'm also a black person in the United States of America and I work on one existential crisis, but these days I can't concentrate because of another."

Quinn:

I wonder if you can speak to that a little bit about because you mentioned the other existential crisis, the other pandemic, which is black life expectancy, especially for black men. Which was actually getting better pre COVID and now it's sent back to something like a six years difference on average. I know that's actually exasperated in some places. So if you don't mind, I wonder if you can gauge a little bit with that in your experiences and whether just seeing more black doctors is sort of our superficial thing that could make [crosstalk 00:39:28]

Dr. Errol Bush:

I think having more African-American physicians on the surface it may seem superficial, but it's very important. Now, I just think that our youth are discouraged. They don't feel like there's anything that they can do that will make a change. That the outcome is still going to be the same. When you look at sort of what is spawned our recent sort of riding and race matters, the relationship with policemen, especially for black men that you're not given the benefit, shouldn't even be considered the benefit of the doubt, but you're already assumed to be guilty and you're going to be shot if you don't listen. It just gets very frustrating that yes, we have to deal with this issue when we're trying to also advance other causes and it's not getting better.

Dr. Errol Bush:

So for our young African-American children and other underrepresented minorities, when you're faced with a social environment where you just seem like you can't get ahead, and that everyone's trying to keep you down, it gets very daunting and discouraging. So what we need is for our young underrepresented minority children to feel encouraged. There should be more programs that are trying to get people into science and technology sort of classes and give them opportunities. There are lots of children out there that have the talent to do whatever tasks they're challenged with, but they just don't have the opportunity to demonstrate their talent. That they're automatically presumed that they're not going to be able to do it, or they're in an environment where their schools don't have the resources in order to allow them to do those things.

Dr. Errol Bush:

Right now, it's this never ending cycle that people can't get ahead. But if we have more African-American physicians and underrepresented physicians, then children can see that it is possible. I look at when our Vice-President, Kamala Harris, actually was elected, right? Everyone sort of erupted, I think and especially for underrepresented minorities, but I think most of our country also saw the benefit and the advantage of this for women as well as race. People didn't even dream of being in that position before and now that they see that someone's done it, then it can happen.

Quinn:

Well, I appreciate your perspective on that. Thank you.

Brian:

Wow, Dr. Maredia, coming back to those fundamental health issues that can lead to heart disease, many of which can be inherited, when we did some research, we saw a statistic that said that 22% of organ recipients are black. Meanwhile, only 13% of the population is black. If black people in particular and mostly black young people as we discussed, are facing these hurdles on organ transplants, that means about a quarter of organ recipients are at risk for much worse outcomes when you've both mentioned that the outcomes should be pretty good. Do you feel like your recent work has received as much attention as it should and what are the next steps for both of you?

Dr. Hasina Maredia:

I think that's a great question. I think being able to be on this podcast has been a great way to showcase and educate a wider audience about our work. I think we've been very humbled and appreciative of the attention that it has received and continue to hope that it'll spur additional research projects, I think get to the crux of why this has been happening now that we've sort of moved the needle on figuring out where this disparity is. I think concrete things that we're hoping, moving forward, can be done is having trials and having studies that are focused specifically with this high risk group, to be able to look at the nuances. I think they're big data. I love being able to analyze and ask these questions with a large end value that gives us great results and understanding of what's going on at the national level. But one of the disadvantages is we don't have sort of the nuanced specific clinical data that we need and the experiences that these individuals are going through.

Dr. Hasina Maredia:

So I think the next step is being able to understand at a microscopic level, the experiences that these young black recipients are having, what are the barriers to their care? What is their experience with our flood healthcare system that we can rectify moving forward?

Brian:

Are you going to be furthering this research yourselves, you all in?

Dr. Hasina Maredia:

I think we need have a multi-disciplinary group.

Brian:

Maybe more people?

Dr. Hasina Maredia:

Yeah, definitely more people I think.

Brian:

Can the two of you just make [crosstalk 00:44:32], I don't understand.

Dr. Hasina Maredia:

My personal skillset is in epidemiology and looking at big data and being able to identify these trends that have gone unnoticed. I think while I'm very attached to this project as Dr. Bush knows, I've been working on it for five years now. It's been like such a rewarding experience and I definitely do want to push it forward and do other studies that can further reduce disparities, identify disparities. I think the clinical studies is a completely different skill set and we hope that our colleagues can help us in that direction as well.

Quinn:

Does it make you feel better or worse that everyone on Twitter as an epidemiologist no? Do you feel like that's supportive of your occupation?

Dr. Hasina Maredia:

Especially with the COVID outbreak, it has definitely turned everyone into an epidemiologist. I'm glad that there's interest and there's a better appreciation for the importance of it. So I will take it in stride, but I think that there can be a misinterpretation of data and studies, especially with these COVID vaccines and other studies.

Dr. Errol Bush:

Yeah. Well, we definitely need our epidemiologists colleagues to help us with these big data sets. Hasina's being very humble. She did mention working on this for four or five years, but you know, she did this as a medical student and it's very hard to have any free time when you're a medical student. But to take on a project as big as this and to get it to the stage where it's actually published. I mean, the reason why it took four to five years, there are lots of doubters who the first time she submitted this said, "No way, that can't be true. You need to go back and look at the numbers, get some updated numbers." So of course Hasina went back and got updated numbers, guess what? It's still true and now it's even more true.

Dr. Errol Bush:

But our whole group and we have a great team that is part of this project and we collaborate at Johns Hopkins, that's made of the epidemiologist surgeons, clinicians, students, grad students post-docs and we call it sort of the ERGOT Lab, the epidemiology research group of organ transplantation. This is a really big think tank with lots of minds that we think about these problems of disparities, whether it's socioeconomic, geographic other healthcare disparities, and we look at these data sets to try to figure out, is there a problem? What is the problem and when does the problem happen?

Dr. Errol Bush:

This is a great study that Hasina was able to bring to fruition and that we've known for decades that African-Americans do worse in heart transplantation. We still don't know why, but at least what we got out of this study is that there's a one-year period that's a very early in their care, the first year that we can try to focus our research on. I mean, if you're thinking that people usually live for 20 years after a heart transplant, it's very hard to look at that whole 20 year period and try to say, okay, we're going to make a change here. But now we've given the clinicians and policymakers a finite period where we can look at it, we can devote our resources to it. We can implement clinical studies and clinical trials to address these disparities and try to design some policies that can help resolve these disparities.

Dr. Errol Bush:

Resolving disparity, some people may think, well, that's only going to affect the black people, but it actually affects the whole system. Heart transplantation as a whole will learn from from these new interventions and new policies. Everyone will increase their survival, it's probably applicable to other organs and as a healthcare system will really benefit by this research and investment of resources.

Quinn:

It's a lot to do. Again, you guys have been working on this for so long Dr. Maredia, I mean, five years, that's amazing. That's on top of all of your day to day work. Again, we can't ignore what has happened over the past 12 months, which again was basically, I like to think of it as the world's worst pop quiz. How prepared were we for this moment in time? The answer is, not very well. It's 2021, we're coming off this just crushing blow to public health. Right? One that seems like it was inevitable considering the systemic issues we have spent so long constructing. These systems that we have designed.

Quinn:

If you were both starting over and I know you've just talked about this incredible think tank, and now I want to be like on your text message thread with these people, because it sounds so awesome. Being so fully aware, like you said, we've always known that black people their outcomes are not as good for heart transplants, right? But even being more specifically aware we have all these other places where we've failed. I'm curious if you would change anything about your career directions, your research directions or if it's opened your mind to other things that we need to tackle? Looking outwards a little bit, where else specifically do you feel like public health needs help for the people who are coming up or the people we're thinking of pivoting a little bit?

Dr. Hasina Maredia:

I can try to answer that. I think with the timing that I did this study and I wanted to look at disparities and epidemiology research starting on an undergrad, I did a global health project. I've traveled to Pakistan, Tanzania, and then are also worked on research on Samoan obesity and disparities there. So I think that passion for disparity started back then, influenced this project for sure, is what inspired me to start it. Then I think my career path when in med school, we explore all these different specialties. I didn't end up doing surgery or cardiology, I'm actually in a completely different direction, dermatology. Which you might think like, how does one end up doing something so different? But I think even in dermatology, I've been able to apply this passion towards disparities. There are so many disparities we don't really understand in dermatology as well.

Dr. Hasina Maredia:

If you will open a dermatology textbook, all of the lesions that are seen are all on white skin. And if you look at the infectious disease section, then you'll start to see black skin. It's such a huge racial bias in the way that even medical education is done for, or this particular specialty. I think it applies to other specialties as well. So being mindful of that, being cognizant, when I go through my training for dermatology starting July, being aware that of differences in the way that skin lesions look on patients of color, different experiences that black women have with their hair, just because the different treatments and the different styling of black hair and how that can lead to alopecia is something that applies even in dermatology as well.

Dr. Hasina Maredia:

So even though I have changed my trajectory, I think that this mindset of wanting to be able to make medicine inclusive, make sure that there's health, equity and equality in health care still applies even in this different direction I've pursued.

Quinn:

That's awesome. Like you said, it, I mean, you can find areas that need help or have just a legacy of built-in biases everywhere really. So whether it's dermatology or cardiology, I mean, it feels like you could close your eyes and spin around and pick something that needs excavation. Dr. Bush, any thoughts on that where you've looked around and gone, boy, we could really, again, clearly everywhere, but anything that's become more aware to you recently?

Dr. Errol Bush:

Yeah, no, I think it's like you said, it's really everywhere. We don't have to look far, just day-to-day relations within the hospital. Just with your colleagues that may say something that's insensitive and not necessarily correct. So I think I'm very relieved by our new sort of government transition. I think as a society, things can potentially get better. I think this current presidential committee or committee is really more involved and are more interested in diversifying and to not separating sort of the masses into sort of pro and con and that we're all going to work together. That's really how we can get better.

Dr. Errol Bush:

We have to be willing to, even if it's uncomfortable, we have to be able to look at ourselves and our systems and to identify any problems and then address those problems. It may take some time to fix the problem, but if we never start working on it, we're never going to fix it. And I agree, every medical specialty will have disparities. I'm sure other professions and specialties outside of medicine have these disparities, but again, the resolution is universal. You have to identify the problem and then start addressing it.

Quinn:

That sounds very rational.

Brian:

Too rational. Yeah. We need some rationality after the four years. Let's get into our action steps. That's one of our main goals with our newsletter and our podcast, action steps that our listeners can take to support you two and your mission with their voice and their dollar. So let's chat about that. Let's start with their voice. What would you say are some big, actionable and specific questions that we should all be asking of our representatives in an effort to support your mission?

Dr. Hasina Maredia:

Yeah. I think that, I love that you and your podcast with these concrete steps that we can do regardless of what profession we are in. I think with local representatives, our study was funded by the lab that Dr. Bush mentioned ERGOT Lab, has funding from the NIH. Two different grants that helped run the lab and the mentors who taught me how to code and to do the analysis and mentored us both with epidemiological approach. I think that it was very heartbreaking in the last administration when funding was cut from science. I think as constituents asking our local representatives to be mindful of funding for science and being able to ensure that agencies like NIH, CDC are adequately funded so that we can keep fueling these huge think tanks like Dr. Bush mentioned, and having these groups that are able to look at big data or do other research addressing disparities is critical.

Dr. Hasina Maredia:

So I think when we're looking at who we're voting for, being mindful of local representatives who are in support of making sure that science is well funded, I think is one big step. Then I know you have a lot of scientists are listening to the podcasts as well, and I think a New England Journal of Medicine article just came out a couple of days ago. The first step they said is actually documenting these disparities. It's traditionally been discussed in editorials and commentaries, but we need concrete data. Our project has shown to document the disparities and how wide reaching they are with actual outcomes for black recipients is also another step to take.

Dr. Errol Bush:

Yeah, I agree with everything Hasina said. I think Quinn, you mentioned earlier in the podcast about sort of disparities with underrepresented minorities in COVID. So because COVID is the now, it's very fresh in all of our policy makers minds to approach them now and to say, "We want to get rid of these healthcare disparities. How is it that we are tolerating this?" We even get reports of sort of the rich people going to the more impoverished areas where the vaccine is available and taking those vaccines from the lower socioeconomic which is further accentuating the disparity.

Dr. Errol Bush:

But I think because it's fresh in everyone's mind now that this is the time for everyone, majority and minority, to reach out to the policy makers and to say, let's make a change, let's enact something now that can help to resolve these disparities.

Quinn:

Right, because that's the thing, the virus SARS-CoV-2 two which produced this disease, COVID to which this was a novel virus. We were all susceptible to it, but at the same time, there were large, large demographics of people of which we have built generations and generations of health disparities and wellness and lifestyle disparities many of which are inherited and that can be either medicinal or it could be socioeconomic, right? From heart disease to housing that made COVID more dangerous for people who are not white. This is the moment to look at those things and say, these people didn't just die of COVID, right? These two people didn't have to get it. We have to deal with these systemic things and we have to start from the bottom up. We have to deal with why is this this way? Why does this have to be this way? Why have we decided this?

Quinn:

So, but like you said, I'm, I'm excited about the current direction certainly. I hope they listen and I hope they're ready to do a lot of this work. It seems like the folks that are assembling are ready to do that. So all we can do is keep pushing. What about their dollar? Are there any specific besides donating to local campaigns, state campaigns, federal campaigns, are there specific organizations that support work like the work you guys are doing in lieu of directly improving socioeconomic situations or access to heart transplant surgery hospitals? Are there groups that are working to improve these things that people could either volunteer with or contribute to in some way?

Dr. Errol Bush:

Yeah, definitely. It was a great month for our publication to come out in February, which was African-American history month, as well as the American Heart Association, our heart failure month as well. So those two organizations, so the American Heart Association is a great organization that supports the betterment of heart cardiovascular outcomes. It has actually made it one of their mission to decrease disparities amongst all of these heart and vascular specialty. So I think that's one way.

Dr. Errol Bush:

We also have talked about during this session the few African-American physicians that are there, especially black men. There's a Black Men in White Coats of movement that's going on as well as the documentary, but which is reaching out to the community and trying to instill in the community the sense of courage and encourage them that a career in medicine is achievable and possible. I think supporting that movement would be great as well, because again, we need to really diversify medicine and we're going to have to start at a young level to reach out to those young children and tell them that it is possible and show them the way. Because once they're sidetracked into other opportunities if you will at such a young age, then they're lost. It's hard to come back and recover from taking a path that is not that is not conducive to a career in medicine.

Quinn:

I love that. That's exactly the specificity we're always looking for. When folks are like, well, call your congresspeople. I'm like, "No, no, no, I need phone numbers. I need a script." Our community's awesome about taking action, whether it's folks who are just activists marching in the street for the first time, or it's again, policy makers, scientists, CEOs, investors, whoever it is. They're up for doing the hard work, but at the same time, we try to make it as specific and easy for them to take as possible so that it will be impactful. Because the more people that actually do it, the better chance we have of fixing this place up.

Dr. Errol Bush:

I should also mention that our research can also be privately funded. Our research lab, and looking at further investigating these disparities, so we have our development office that can definitely speak with someone at Johns Hopkins if those are willing to hear about the other projects that we're doing and where we're going to go from here and how those resources could be further used to help us get to the answer.

Quinn:

Awesome. Absolutely. Brian tag that for yourself when you're ready to contribute.

Brian:

Deal.

Dr. Errol Bush:

Thank you.

Quinn:

Brian, bring us home here if you could.

Brian:

Oh my God, of course. We just have a few more questions. I know we've kept you for long enough, and thank you so much for being here. So we have, I think Quinn we've changed it from lightening round to now is just [crosstalk 01:02:42]

Quinn:

They're fun quick questions. I couldn't come up with a better name.

Brian:

So anyway, if you're ready.

Quinn:

Doctors for each of you, when was the first time in your life, when you realized you had the power of change or the power to do something meaningful?

Dr. Hasina Maredia:

This is also a great deep question.

Quinn:

You're welcome.

Dr. Hasina Maredia:

I actually really resonated with the story that Dr. Bush mentioned at the beginning. My father actually said the same exact thing that was mentioned to Dr. Bush by his dad. Both of my parents were farmers in India. Never had a chance to go to college. No one in the family has, so I've been the first to go to college. Even in high school, my dad was like, "You don't need to have a lot to help people." I think it's profound to be able to help people when you don't have as much and that's just as impressive when you're able to do that. He's definitely walked the walk. He works at a restaurant along with his brothers and no matter how he's doing, he's always looking out for people. I always find out from other people that things that he's done to help them.

Dr. Hasina Maredia:

I think that that was the moment where I was like, wow, he hasn't had the opportunity to go to college or have literally any education formally, and yet he's been able to make such a huge impact in people's lives. I think that's where I started to realize what a huge responsibility I have since I do have this privilege to go to college here. Then I went to Brown for undergrad and a phenomenal place that changed my way of thinking and it really empowered me to find the tools and specifically here, the epidemiological toolkit to empower me to make an impact in the scientific community that's special.

Quinn:

That's special. That's great. I look forward to visiting your father's restaurant at some point.

Dr. Hasina Maredia:

Definitely. You're welcome to. He'd love to have you, if you're ever interested.

Quinn:

Oh yeah, we'll make it happen. Dr. Bush?

Dr. Errol Bush:

Yeah, I would say for me, it's in addition to sort of the childhood experiences, but the first time I did a lung transplant independently and that sort of resonate, I always remember the first person I did a lung transplant on as well as the first time I did a lung transplant in a adolescent. It's rewarding because one, you've helped them get this gift of life. It's going to totally change their life and their expectancy, but you don't realize until you do it, how much it affects them. So even if it's an older person, then they have children and grandchildren that they were going through this in order to be able to see sort of their child's graduation or something.

Dr. Errol Bush:

Then when you transplant someone that's at a much younger age, that they had their life interrupted by some organ failure, and they still have many goals that they wanted to achieve in their life. By them having a successful transplant, they are now able to go and achieve those goals. So I've had people after transplant go on to graduate from school, go on and get married, and then they invite us to come to their wedding because it was something that their parents thought they were never going to live long enough in order to even get married with certain diseases. It's obviously a very self-gratifying, but it's very rewarding and appreciated by the patients themselves and for many of their generations to come that you've touched.

Dr. Errol Bush:

We'd be remiss not to mention that transplantation only happens by a donor and a donor's family being gracious enough to allow at a time when they're grieving that someone had to die in order for a transplant to occur. That is a truly amazing gift. For me, just being part of this whole transplant experience where donors lives, recipient lives, my life, my family life, it's all affected by that one special incident where everything comes together and that's truly amazing, and why I went into transplantation obviously.

Quinn:

Well that' very special. Thank you for sharing that. Like you said, it's the second order effects. It's not just the person you're operating on in this moment and giving them this period of time. It's the life events they get to take part in. It's the people who get to keep having them in their life. That is pretty special. That's awesome. Also everybody, organ donor, just check the box.

Brian:

It's so easy to check the box.

Quinn:

By the time it comes up, you won't have to worry about because you're toast and you'll know you have helped somebody. It's fantastic. It's the easiest thing. Doctors, who is someone in your life that has positively impacted your work in the past six?

Dr. Hasina Maredia:

I'll let Dr. Bush take this first.

Dr. Errol Bush:

Okay, no problem. You said in my work or in my life? [crosstalk 01:07:52]

Quinn:

You know what? You can expand it however you need to.

Dr. Errol Bush:

Yep. For me, my career has definitely been matured and advanced by our chief of surgery here, Robert Higgins, Dr. Higgins. He's the first African-American to chair a department at Johns Hopkins. He's a phenomenal surgeon. He's also transplant based. But when he came to Hopkins, about six years ago, it was his mission to diversify surgery at Hopkins. He has really taken that to heart there. It's not just racial diversification, we have lots of women that are obviously very well qualified and technically gifted better, also leaders in that department of the different divisions and it's and our department is much better because of this. So we have now fresh ideas coming in from all walks and all sort of representation within a department and it's better.

Dr. Errol Bush:

I say that Dr. Higgins' philosophy has really championed me wanting to stay at Hopkins and to keep doing the great work, even when I feel like there's a black tax that I have to participate in all these things. Because when you get to see the fruits of that effort, that other people are working with you, we're all working together and you get to see change, then it's worth it. People get discouraged when they keep trying and they don't see change. That's what we're really trying to address here. Let's show them change, show the young children that it's possible to be whatever you want to be in life and we'll support you. Then it becomes a much easier task to get to our end goal.

Brian:

What a wild idea, right? The more diverse the governing body, the happier everybody is. It seems cookie.

Quinn:

It seems crazy. It seems crazy, I don't know. Brian last two.

Brian:

Did we get an answer from Dr. Maredia though?

Quinn:

Did we do that? Oh, we didn't, I'm a monster. I'm a monster, please.

Dr. Hasina Maredia:

We switched up the order on this slide.

Quinn:

I know, you got to stop doing it to me. I can only do so much.

Dr. Hasina Maredia:

I think that in the last six months, like taking the question very literally I've been in my first year of residency. So first year being a doctor after graduating. It's been a lot. I've been doing research when I have the time-

Quinn:

Again, in your "free time."

Dr. Hasina Maredia:

Right. But I think that the last six months have really been about becoming a good doctor, knowing my style as a physician and the kind of impact that I want to make on patients. I think because of that, my grandfather, who, unfortunately, he passed away the same day this paper was published earlier this month, I was his primary family contact when he unfortunately had an accident right in the midst of COVID. I was his primary family contact and got to see healthcare from the lens of the patient's family side. There were a lot of great things that physicians did that I've been trying to emulate. Then a lot of flaws in the healthcare system that I've seen through my grandfather's experience. I think because of him, I'm definitely a better doctor now.

Dr. Hasina Maredia:

He didn't speak English, doesn't understand any of the mainstream Indian languages either because we're from a village. Because of COVID a lot of issues with visitation policy. His accident was in April and so at that time there were no visitation policies. Nobody could understand him and I tried to advocate, but I wasn't able to be with him in the hospital because of the policy. Unfortunately there was quite a delay in understanding that he was declining within a matter of hours. Ultimately ended up going to the O.R., needed three different surgeries. Unfortunately he had complication after complication. I think that it gave me a lens into some of the barriers you face with race, for sure, but also with language barriers and other barriers that I hadn't really fully recognized.

Dr. Hasina Maredia:

Now, on the other side, as the doctor, I'm very cognizant of making sure that I go the extra mile and understand all of these different disparities that patients' families face to prevent this from happening in the future.

Brian:

Thanks so much sharing that.

Quinn:

Our condolences, and thank you for sharing that.

Dr. Hasina Maredia:

Thank you.

Quinn:

Obviously deeply personal and it matters, not every case is going to be a grandfather from a village who doesn't speak much less English or Spanish, but even like you said, the mainstream Indian languages. But we talked for a few minutes about how historically black people aren't listened to about pain or whatever it might be. This is the literal definition of not being listened to because someone can't and what do we have to do to consider those things? Like you said, that's an extreme example, but it's your grandfather and it's always someone's grandfather and that matters.

Dr. Hasina Maredia:

And health literacy broadly as well, there's so much low health literacy in a lot of communities. I think that's important to take into consideration as physicians.

Quinn:

Absolutely. Absolutely. Well, thank you for sharing that. All right, Brian.

Brian:

All right, last two or three, I don't know. Who knows?

Quinn:

We're almost done, I swear to God.

Brian:

Just kidding. We love to learn this because it is so important, especially, my God, considering what the two of you do. What is your self-care? What do you do when you feel overwhelmed, you need some you time?

Quinn:

See, no, you can't say research for all these answers. You got to say something else. It's enough.

Dr. Hasina Maredia:

I think my loved ones will stay the same, that now you do need to take a break from this. Medicine can be a bubble at times, in a lot of fields, but in medicine, especially very focused, very motivated and it can be a very stressful environment. I think getting out of that bubble... I have the resource of none of my family members are in medicine. I think it's very grounding when I am able to spend time with them, spend time with social media for my family's restaurant. I think that's always a grounding experience kind of helps me connect with life outside of medicine. It's been helpful for the restaurant for sure, but also helpful for me in my self care and being able to decompress.

Quinn:

I love that the social media manager for the restaurant, this makes me so happy.

Brian:

It's incredible.

Quinn:

Brian can't even log into our Twitter.

Dr. Hasina Maredia:

[crosstalk 01:14:54]

Quinn:

Please, 100%.

Brian:

Did you say doctor that your father's restaurant was in Houston also?

Dr. Hasina Maredia:

In Houston, yes. It's called August restaurant.

Brian:

With the recent insanity there-

Dr. Errol Bush:

You should give the address.

Quinn:

It's 100% going in the show notes.

Brian:

Oh my God, of course. I want to see your social media world.

Quinn:

The whole thing.

Dr. Hasina Maredia:

I would love to, if you're ever in Houston, you have to let us know. It's very fun for us to introduce people from outside of Houston to our [crosstalk 01:15:21]

Quinn:

In a heartbeat, in a heartbeat. Once this whole little pandemic's over, it's happening. Dr. Bush, what do you do when you're overwhelmed? Ice cream? What's the story?

Dr. Errol Bush:

I must admit COVID has been hard on me because one of the things my family and I love to do is travel. It's been really hard. We like to travel sort of getting on planes for a really long time. I think the reason why that is, is because usually, I can't be reached on a plane. Every other part of my life, wherever I go, someone's still going to call me. The kids are like, "You're not even on call." When I'm on the plane, it's just me, my family, we watch movies or eating and having fun. I think we've only been able to travel maybe twice now, but it's really hard. So when this is over and we can travel more, I think that's what we'll get back into.

Dr. Errol Bush:

Otherwise, during the pandemic, I really just been spending time with my family. My schedule is so unpredictable. I have two young boys, seven and five-year-old who are very active. I love to do things with them. Trying to spend time with them whenever I can. They're so active in sports, soccer, gymnastics, they're all over the place. When I can make their events is amazing. Otherwise, we're just playing in the backyard.

Quinn:

I love that. I get it. My boys are the exact same age but I've also got a girl shoved in between them. I get it. Spending time with them has really been the biggest bomb to this whole thing.

Brian:

How upset were you Dr. Bush when they started offering Wi-Fi access on planes? [crosstalk 01:17:11]

Dr. Errol Bush:

Leave me alone, get me out of here.

Brian:

My one last-

Dr. Errol Bush:

Well at first, because I think you had to pay usually. Then at first, at least the airline I was on, the text messages didn't come through, so it didn't really matter. But now they figured out, yeah, now text messages come free. You can text, or [crosstalk 01:17:34]

Quinn:

What'll I have to do?

Dr. Errol Bush:

It is getting ridiculous, yeah. At least when we're flying to China, usually going over some range where Wi-Fi all of a sudden drops off for whatever reason, even though they tell you it works the whole time.

Quinn:

I just want to be there. I want to just circle that area.

Brian:

Can we just go in circles above this space pilot? All right, I think it's really is the last one now. What is a book that you have read, each of you, this year that has maybe opened your mind to a topic that you haven't considered before, or just change your thinking in some way? We have a really great list of recommendations from all of our guests. I mean, we put them all up online and available for all of our listeners.

Dr. Errol Bush:

I don't get to read nonmedical stuff very often, but one of the books and actually the movement that I mentioned earlier Black Men and White Coats, there's a book as well. In this book, it shares the stories of different black men going through their journey into medicine. One of the things that I really enjoyed about this book is one, knowing that there are other black men out there that are like me and that have had varying sets of challenges getting into medicine. But usually, it's all kind of summarized into simply someone, there was a challenge getting recognized and getting the education that you needed, being discouraged along the way, not being supported because people don't see you as that particular type of profession. Then once you get into the profession, having to continue to work hard.

Dr. Errol Bush:

It's sad that many of us have similar stories but it's rewarding to know that so many other people have made it through this arduous process and that we can make it and that that once they make it, that they'll they'll be successful. Again, it's once they succeed then for the generations behind us seeing that it is possible, we can come from different backgrounds and make it, and that's very rewarding.

Quinn:

Awesome. Thank you for sharing that. That is man, exemplary. How you have time for anything is beyond me. That's awesome. Hasina?

Dr. Hasina Maredia:

I think one of the books that is very relevant to our work and also that I think people outside of medicine would really enjoy is the Immortal Life of Henrietta Lacks. Henrietta Lacks was a patient at Hopkins. I'm forgetting the exact year, but she had cervical cancer and cells were taken without her knowledge or her consent. Now these cells, they were found to be essentially a mortal. They were able to replicate and a bunch of projects were able to be done with her cells and this was all without her knowledge, without any compensation to her family. A ton of modern medicine has emerged from it, including some of the research with the COVID vaccines as well. I think it's eye opening in terms of some of the injustice that has done away with black patients, at well-known institutions like our own, Hopkins, and being able to understand some of the reasons why there is a lot of distrust with the medical system is because of a lot of things like this, like Tuskegee trials that you mentioned as well. I think it's a great read for people in and out of medicine.

Quinn:

Awesome. Yeah, it is a special one. I believe they made a movie with Oprah, I think?

Dr. Hasina Maredia:

I think that was in the works.

Quinn:

Got you.

Dr. Hasina Maredia:

I did actually see her in person when she came to film, but I don't know that it was actually, yeah-

Quinn:

Amazing. Yeah, we'll definitely include the book. It's pretty incredible. Both just on the technical scientific front, but then also again, like you said, the lack of permission and, and knowledge in any of that stuff and where it's going, is pretty unfathomable. But got to address it. Guys, this has been incredible. Can our listeners stalk you on the internet, follow you online? Is there somewhere a Twitter or where the project lives, something like that?

Dr. Hasina Maredia:

Definitely. My handle is @HMaredia on Twitter.

Quinn:

Beautiful. Dr. Bush?

Dr. Errol Bush:

I'm Errol Bush MD.

Quinn:

Awesome. Awesome.

Brian:

Easy-Peasy.

Quinn:

[crosstalk 01:22:16] too many people-

Dr. Errol Bush:

Because I'm in that third age demographic, I just got on Twitter two months ago. So please follow me. I don't have many followers. I'm working on it though.

Brian:

Done deal.

Quinn:

Oh, luck.

Dr. Hasina Maredia:

Honestly, same. Same, even though I'm in the first category.

Quinn:

Yeah. I mean, just eons between you two.

Dr. Errol Bush:

I did see Quinn that you followed me today, so thank you.

Quinn:

Yeah, absolutely. I'm trying to help where I can. At least I can do for it for an old person like yourself. Guys, thank you so much for your time today, for your candor, for the thought you've put into this and obviously all of the work you've done. Not just this research, but on a day to day basis and Hasina, everything you're going to do clearly Dr. Bush is nearing the end of his career, with his late stage, but thankfully there's a future out there. We'll try and keep Brian out of your way where we can. We look forward to visiting Houston and hitting up the restaurant. Oh my God, so excited. If we get anything else out of this conversation-

Brian:

Where we'll get in touch with you after this for some stuff, please give us the name of it and the address like Aero side and all that stuff so we know. Okay?

Dr. Hasina Maredia:

For sure.

Quinn:

Awesome. Well, thank you guys so much.

Dr. Hasina Maredia:

Thank you so much for having us. This was a lot of fun.

Quinn:

Thank you for putting up with us. Thanks to our incredible guest today and thanks to all of you for tuning in. We hope this episode has made your commute or awesome workout or dish washing or fucking dog walking late at night, that much more pleasant. As a reminder, please subscribe to our free email newsletter at importantnotimportant.com. It is all the news most vital to our survival as a species.

Brian:

You can follow us all over the internet. You can find us on Twitter at importantnotimp.

Quinn:

Just so weird.

Brian:

Also, on Facebook and Instagram at importantnot important, Pinterest and Tumblr, the same thing. So check us out, follow us, share us, like us, you know the deal. Please subscribe to our show wherever you listen to things like this. If you're really fucking awesome, rate us on Apple podcasts. Keep the lights on, thanks.

Quinn:

Please.

Brian:

You can find the show notes from today, right in your little podcast player and at our website importantnotimportant.com.

Quinn:

Thanks to the very awesome Tim Blane for our jamming music, to all of you for listening and finally, most importantly to our moms for making us. Have a great day.

Brian:

Thanks guys.

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