番茄社区

In this exclusive clip from an Instagram Live interview, Jeremy Faust, MD, editor-in-chief of 番茄社区, discusses the aftereffects of the Supreme Court's decision to strike down affirmative action in college admissions, as well as the importance of diversity in medicine and research, with Utibe Essien, MD, MPH, of the University of California Los Angeles, and Ijeoma Opara, PhD, LMSW, MPH, of Yale School of Public Health in New Haven, Connecticut.

The following is a transcript of their remarks:

Faust: Let's start with the issue, right? Representation matters. For the person who's just coming into this conversation, why does representation matter in medicine? I want you both to answer this, but I'll start with Dr. Essien.

Essien: Why does representation matter? We see all these hashtags and we talk about it a lot, but I'm a scientist, as you mentioned, and so the data is really where the story is here.

We know that, for example, counties that have more Black physicians have lower mortality rates in Black populations in those counties. We know that patients who have a doctor that looks like them are more likely to actually want to receive both preventive and more acute care management -- so vaccinations for the flu, more willing to undergo heart surgery.

We saw this play out during the COVID pandemic where we had really large populations who literally couldn't even communicate with their provider because they weren't speaking the same language. We saw this, I think, particularly hit Latinx populations in states like we were all in, in Massachusetts and Boston on the East Coast and here in California.

So this matters; it matters to be able to actually, literally save lives. I'm hopeful that some of what we'll be talking about today will be able to get to some solutions as well.

Faust: Yeah. And I know that Dr. Opara, you're really heavily invested in that representation pipeline. Tell us a little bit about that.

Opara: To agree with everything he's saying and more, representation is so important to me. I'm not a physician, but I work with physicians. I believe heavily in interdisciplinary approaches to be able to solve complex health problems.

As a public health professor, I go above and beyond to make sure my lab is diverse, to make sure that young Black girls, young Black boys can see themselves in places like Yale and other universities doing the type of work that I'm doing, if not more. It's important because when we think about researchers -- who are doing work with Black people -- that don't look like us, you don't understand our lived experiences.

As a Black woman, I can connect with another Black woman or another Black girl more than anyone else, because I have that lived experience as being a Black girl at one point. Also, I'm invested in seeing their health outcomes increase and seeing their health outcomes remain positive, mainly because of that cultural competency that just naturally I have.

So I think with representation, too, we can't become what we don't see, right? Growing up, I never met I think until I was probably an adult -- and when I say adult, I mean like past grad school -- that I even came across the first black doctor. And I had to seek that out. I never came across a black professor until I was getting my PhD, you know, and I just got my PhD not that long ago.

We have so far to go. But it was important, it is important for me to be able to see those types of people that look like me because I'm able to aspire to be in those spaces because I have an opening. I have people that look like me, that can speak my language, and that understand our experiences.

Faust: I just wanted to also reflect on what you both said, which is about the idea of representation in the clinical and research space, right? That, obviously, I think has two immediate, really obvious impacts that I think most people understand straight away.

Mentorship and role models. So if you want the pipeline to work, you have to have people like you all who people can say, "I want to be that person." That's number one. I think that's pretty obvious to people. And two, I think as you said, there's a piece of like -- how come I'm the patient, but nobody looks like me who's actually treating me? That can put a distance between medicine and patient, or research and patient. So those things are obvious.

I think that what people often forget is, people like me, like what can I do? The answer is to recognize how enriched my practice has been by having been around a community of not just the old boys network that it was 50 years ago, right? I'm a better doctor to my patients of color than I ever would've been if I was trying to wing it out of a book. That just doesn't work. And so I just have gratitude that that value was in place early enough that I know docs and researchers like you guys, because it actually helps me bridge that gap with my patients.

So it's really important, I think, for people like me -- the white guy -- to recognize what an immense amount of progress we've been the beneficiaries of by living now as opposed to then. And we don't want to go back.

In that realm, [there's] not great news, the Supreme Court said affirmative action, as it stood for admissions, can't be relied upon. Are we already feeling this?

Essien: It's a great, and again, important question. I think your phrasing of "we don't want to go back" is an interesting one, because I'm wondering who the "we" is there. I think a lot of people do want to go back, but I think the "we" in this room, the IG Live room, don't, right?

I'm talking to a number of individuals who are applying to medical school right now or are applying to residency, and there was a really interesting conversation I had with this young Black woman early in her career applying to medical school who was not considering applying to a medical school in her state because she was worried about what the repercussions of this affirmative action ruling would be and whether she would actually be able to get in and if it was worth the hundreds-of-dollars application fee. And if she did get in, if there would be conversations around how she could be supported as a Black woman.

And so [that's] one anecdotal case, but you expound that across the country and you wonder how this is really going to impact not even just the people who decide to pursue this field, but the future of our workforce. It's something that we've been talking about since before the ruling came out.

And again, I'm really concerned about how we're going to be able to continue to diversify the workforce with policies like that in place.

Opara: Yeah. Just to add to that, and one point I do want to make, Jeremy, before I even answer that question, is that I do think it's important for men like you to be in these spaces and to support your patients in that way. I'm grateful for it and I think it's beautiful that you're taking the time to be humble and learn from other physicians of color, from researchers of color, because it goes a long way.

To go back to the affirmative action question, I personally think it may be too early to even see on my end, right? In public health, at least I can speak for my department within the Yale School of Public Health, we are really dedicated to making sure that diverse voices and people are in the room or in the classroom doing this work. We know that we can't go far if we don't prioritize diversity in public health, and we can argue in medicine too. So we are still continuing to go through the admissions for PhD candidates, for MPH candidates, etc.

But I have talked to students who reached out to me and said, "I want to apply to this program. Am I going to feel safe in these spaces?" And I try to assure them like, "At least in my department, you will. In my department, you will." You know what I mean?

So I could speak for my department and stuff, but I don't think people realize how it is a problem that high school students are seeing, middle school students are seeing, and it is really getting into their minds about whether they can fit into these spaces, but they absolutely can.

I think if we just continue prioritizing the value of having diverse populations, I'm hoping that we can undo that. But I don't know, I've lost so much hope, I'll be honest with you. But I think that this has to be an effort that we have to lead and really support.

Faust: You said something like some people do want to go back, and it's interesting because I'm sure there are people -- their worldview doesn't really make any sense to me and I know it doesn't make sense to you -- but I actually think a lot of people are in a different category when they look at these things. They think that they believe that it's a good thing to have a diverse workforce, or maybe they do believe that, but they just think that the way that we've achieved that or have made progress is counterproductive or that there are problems with affirmative action as a solution to it.

My viewpoint, and I want to hear what you both think, is that it matters so much the outcome. That we have clinician leaders and research leaders like you. That you can't just take something away and not replace it with something that's going to bring the outcome that we need, which is for this research to be done or these clinicians to be present.

So do you think that there are people out there who -- am I right -- they think they want the diversity, but they think that affirmative action isn't the way to get there?

Essien: Yeah. I think that probably is the case. And I think a lot of that conversation comes from a lack of a historical perspective, right? The reasons why affirmative action existed were because of the centuries-long unequal access to education in our country that still exists in many places.

I grew up in New York City -- greatest city in the world, obviously no bias -- but we had a segregated public school system in the early nineties, and we probably still until today have. That's in, again, this super diverse city, much less around the rest of the country.

So to come up with policies to help to address the inequities that existed for centuries, for about 40 years I think, we had affirmative action. And even prior to 2023, we were trying to reverse it. It just doesn't really make sense.

Our data has suggested that states that actually got rid of affirmative action actually literally resulted in lower rates of underrepresented-in-medicine students to go into medical school. We had a policy that was established to address the historical inequities. When we get rid of the policy -- it actually doesn't work in certain states -- and we decided to get rid of it at a broader level.

So I appreciate, definitely, the nuance that comes from when you use those two words together and how political it can be and triggering it can be for a lot of people, but it was a policy that worked in some places and I think had a lot of opportunity to do more.

It's the same conversation that we're having right now around DEI. We're seeing offices of diversity, equity, and inclusion shut down around the country. We're seeing leaders in those spaces being quieted in the work, that effort that they're doing. It's very possible that in 30 or 40 years we'll be having conversations around the Supreme Court making decisions about DEI efforts and us being really curious about where this came from and how did this start.

So I think we really do have to be aware and take caution in some of these conversations that we're having.

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