Race and Medicine

Race and Medicine

Issue: February 2021
Source: Healio interview
Disclosures: Gray reports no relevant financial disclosures.
February 25, 2021
5 min read

Change requires visibility, action and trust

Issue: February 2021
Source: Healio interview
Disclosures: Gray reports no relevant financial disclosures.
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In 2020, health and health care disparities across our country could not be ignored. And while much was exposed, little was resolved. We must work together to make 2021 a year of action – action toward health equity.

We can start with colon cancer. It took two prolific actors, Chadwick Boseman, age 43, and Natalie Desselle-Reid, age 53, and more than 50,000 other Americans from us in 2020.

Darrell Gray II, MD, MPH, FACG
Darrell Gray II

This is a call to action to those in the entertainment industry to partner with the medical and science communities to get the message out and to be champions for colorectal cancer awareness, prevention and screening. Both of these African American celebrities were rightfully private about their fights against colon cancer, but their public deaths offer a great opportunity to increase the visibility around this preventable disease.

We don’t know the particulars of their medical or family histories. What I do know is this is happening too often. To too many young people.

We know that African Americans have the highest incidence of colorectal cancer and higher death rates than other racial and ethnic groups. But there are far too many people of all races dying of colon cancer.

The Celebrity Effect

Twenty years ago, after losing her first husband Jay Monahan at age 42 to colon cancer, media maven Katie Couric televised her colonoscopy experience. After publicizing it and normalizing that experience, we saw a boost in colorectal cancer screening nationally. The well-studied “Katie Couric Effect” gives evidence behind the importance of such celebrity engagement and messaging.

Time will tell if we have a repeat effect with celebrities like Will Smith, who posted a video blog about his experience getting a colonoscopy. It was a journey that he walked through with his concierge doctor, Ala Stanford, MD, who explained the basics and answered the very practical questions Smith asked.

During his experience, Smith was found to have a tubular adenoma.

As the nearly 20-minute video has now been viewed 3.5 million times on YouTube, it is something that will likely save lives. We need more voices like his, more visibility in the celebrity sphere showing the importance of preventive health measures.

The leveraging of stardom does not have to stop with personal experiences. Those in the limelight can normalize discussing family history as well. My friend Candace Henley, a colon cancer survivor and Founder of The Blue Hat Foundation, says “Family secrets kill families.” She commonly asserts that not sharing family history can be dangerous and detrimental.

Perhaps that’s why some celebrities like Terrance Howard have been vocal about their family history. He lost his mother, Anita Williams, at age 56, to colon cancer and has since served as a spokesman for the CDC’s Screen for Life campaign and ambassador for Stand Up to Cancer. His openness with sharing his family history and his personal steps to prevent colon cancer sets an example to the rest of the world.

Re-building Trust, Cultural Connection

It’s been said that “change happens at the speed of trust.” One of the things that has become clear amid COVID-19 is how central trust is to any conversation about health. Although the public may trust preventive health messaging from celebrities, it is equally, if not more, important that they trust health care providers who are in a position to offer preventive health services such as colorectal cancer screening.

Unfortunately, the institutions of health care and research have not always demonstrated their trustworthiness. Thus, while many focus on the mistrust of minority communities, the conversation should instead center on the trustworthiness of the medical community. It was the medical community who failed to earn the trust of so many of their patients over time. Examples of unethical, biased and racist actions, particularly against patients from communities of color, have led to significant medical mistrust.

Fortunately, many health care providers are working hard to prove themselves trustworthy partners in the community. Some have heeded the call to be more visible with targeted messaging to communities of color.

Rachel Issaka, MD, MAS, Folasade May, MD, PhD, and I created a light-hearted social media campaign targeting African Americans who are age-eligible for colorectal cancer screening. As one example, we paired images from Different Strokes, The Jeffersons, Good Times, and Soul Train with messaging like “If you rushed home to watch one of these shows as a kid, it’s probably time for a colonoscopy.”

It was a playful way to bring awareness to the issue and leverage social media platforms to increase visibility of these issues. Leveraging social media platforms in ways that people can understand, in ways that people can relate to the issue and in ways that make it personal can impact a community, building not only awareness but trust. More recently, in the wake of Chadwick Boseman’s death, African American gastroenterologists from across the country delivered a public service announcement that was disseminated via social media – Facebook, Instagram, Twitter and YouTube – and that went viral.

And for those who’ve expressed fear, concern and questions about undergoing a colonoscopy, one of several evidence-based screening methods, I created a YouTube video demonstrating the procedure that now has over 850,000 views and more than 170 comments.

All these examples highlight opportunities for partnership between the medical, science and entertainment communities to validate truths and dispel myths around preventive health and specifically colorectal cancer screening.

The truth of the matter is that many people often seek health information from what’s available online, whether through a Google search, Twitter feed or TikTok video. When they do so, they are less likely to comb the published scientific literature than they are seek out the opinions of those they trust. It’s important for us to leverage that power and that viewership to, in turn, empower communities around healthy lifestyles and important preventive measures around colorectal cancer screening.

There are organizations that have been thoughtful around how to do what we are discussing in regard to partnering the medical and scientific community with the entertainment industry. Organizations like Fight CRC with Angie Davis, Stand Up to Cancer led by Sung Poblete, and GI societies such as the American College of Gastroenterology led by David Greenwald, MD, are working to do these things. It will take more though.

A Goal of Health Equity

To what end? Health equity. Health equity aims to ensure everyone has a just and fair opportunity to attain the highest level of health possible. That means that some communities need more investment than others. That also means that we have to tailor resources and messaging to those communities.

What I would like to see in 2021 is us investing the resources. As a nation, as a community of scientists and health professionals, as a community of patients, and a community of those who do have spotlight and visibility, we need to make the investment of our time, talent and financial resources toward health equity.

This goes beyond just talking about it. We can’t continue to just observe these disparities - observing people of color including African Americans dying of CRC and then also dying disproportionately of COVID-19.

As we reflect on 2020 and how COVID-19 took a magnifying glass to the pre-existing and ongoing disparities that disproportionately burden communities of color, we have to invest in the solutions. We have to invest in achieving health equity.