I have always admired Dr. Eve J. Higginbotham. She is the Vice Dean and Professor of Ophthalmology at the Perelman School of Medicine at the University of Pennsylvania, and I consider her both a friend and professional colleague. I sat down to interview her about Diversity in Leadership last year, but I wanted to share a letter she wrote following the death of George Floyd and the ensuing public outrage and awakening we are now seeing. Thank you to Eve for being such a vocal leader. I will be sharing more on my thoughts about how leaders need to be responding to the current moment next week.
My heart is broken. As a community, I know we share the pain of what our nation is experiencing at this time. The disproportionate impact of COVID 19 on communities of color was only the beginning of this angst, as we recognize that these disparities in illness reflect structural inequities in our nation. The deaths of Breonna Taylor and Armaud Arbery were added reminders of the basic belief held by some individuals that black lives do not matter. Then, on the evening of Memorial Day, a video appears that should disturb all of us to our core, the brutal and horrible death of George Floyd, painfully being executed under the knee of an officer. Now the entire world knows just how devalued black lives are in the country. It is a visual reminder that this is a country that is not a just, fair, and civilized society.
As a democracy, we share a social contract that we will share values and abide by a code of laws. That code was broken under the crushing pressure of police officer’s knee and thus, the protests continue day after day. In previous times, we had national leaders who could articulate unifying messages, to immediately act constructively, to reaffirm our core values, and renew the social contract. Based on the actions of government leaders on June 1, we are either headed towards a military state or for those of us, who remain hopeful, we will emerge a better society, infused with renewed purpose and a refreshed, revised agenda.
I am reminded during this difficult time of the phrase, “to whom much is given, much is required.” As professionals, we have had opportunities that few others will ever realize. We also have responsibilities as medical professionals, in our roles as healers and scientists. Thus, using our gifts, our opportunities, our blessings, what can we do to help craft the alternative path to the one that national leaders appear to endorse. How can we emerge as a better society?
Each of us will need to seriously reflect on this specific question. To get you started, here are a few thoughts to consider. First of all, reflect on your own biases and recognize that we all have biases. I once thought that this was a given, a concept shared by most, however there are many who believe they have no biases which is impossible given the society in which we live, as described above. I start here because once one begins the process of mitigating bias, your thought processes are rebooted to consider other ways to view relationships and the world. For example, the world could easily detect the bias in the interpretation of the first autopsy report of George Floyd, which found no evidence of asphyxiation. Most of us quickly knew that this conclusion was a biased interpretation of findings considering that Mr. Floyd expressed his own diagnosis minutes before passing when he stated, “I can’t breathe.” The initial report noted other chronic conditions that contributed, likely heart disease within the list. However, Mr. Floyd did not complain of chest pain in those final moments, but difficulty breathing! Thus, it was no surprise that a family sponsored autopsy affirmed asyphyxiation as the cause of death.
The example of Mr. Floyd’s autopsy report reminds me of the biased “science” of Samuel Morton and his attempts to create a ranking for the skulls he filled with seeds to measure their volumes. This misguided experiment haunts our society to this day. It reminds of Benjamin Rush, who recruited African Americans to care for patients who were seriously ill with yellow fever because of perceived immunity to the disease. This perceived immunity continues to haunt us today based on initial beliefs among some individuals that believed that African Americans were immune to COVID 19. Of course, we know now that this previous understanding is ludicrous. While we cannot erase the misguided findings of these physicians and scientists, we can document an alternative narrative based on data, refreshed understanding of the impact of previous practice, and a new paradigm to understand pathophysiology and care for patients without using the framing put forward by Morton centuries ago.
As the title suggests, my heart may be broken but I remain sustained by hope. The chant “Keep Hope Alive” encouraged me to get up every day “to fight the good fight” in the 60s and the 70s, and I hear that same phrase now in this moment. As a biomedical scientific community, we have to move away from the use of “race” as defined by Morton which was erroneously captured as a biological construct. I was hopeful when the Human Genome Project was completed, demonstrating that we are 99.9% the same, however, the practice unfortunately continues to be still trapped in an outdated mindset. Certainly we need to discuss the institutionalized racism that contributes to the health and disease, however the term “race” should remain a social construct and not a biological construct. We need to remove “race-corrected” risk factors and therapeutic strategies and distill the key contributors to disease down to specific biologically measurable findings. In my own discipline of ophthalmology, the best example is the use of central corneal thickness to define who is likely to develop glaucoma among ocular hypertensives, and not simply the phenotypic presentation of a patient. Thus, one can examine an African American patient with thick central corneas and ocular hypertension and follow that patient rather than immediately treat. Each discipline has similar examples, and thus there is the opportunity to reframe the interpretation of findings in an unbiased way.
Yes, I am hopeful that this next generation of physicians and scientists will be forever transformed by these last several weeks and at the very least move the practice of medicine and scientific discovery to a more equitable platform. Besides voting in every election, these are just a few of the actions we have within our grasp. By implementing a new way of thinking and acting upon that reframing, we can expect to arrive at a new plateau, where black lives matter, and renew the social contract for everyone.
Eve J. Higginbotham, SM, MD