Fight Like Chadwick

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On Aug. 28, 2020, the world heard the news that actor Chadwick Boseman had died at the age of 43 of colon cancer. Boseman was known for his role as King T'Challa in Marvel's "Black Panther." He also portrayed iconic Black figures such as James Brown, Thurgood Marshall and Jackie Robinson. Boseman’s death came as a shock because he did not publicly disclose his stage 3 diagnosis and four-year fight. His death not only raised awareness of colon cancer, but also the health care disparities Black people face.

Colon cancer is curable if caught early. It most commonly affects people who are 50 and older, but in 2018, the American Cancer Society (ACA) changed its guidelines to advise people to start regularly screening at 45 because of the steady rise in the number of young people diagnosed. Yet, Boseman died of colon cancer at the age of 43, before the recommended screening age.

Black Americans have the highest death rate and shortest survival rate from colorectal cancer of any racial group in the U.S. There are a lot of reasons for it, but one of the most important ones is late diagnosis. By the time we get to a doctor, it's too late.

Our Wise Ones this week are two guys literally working to save our lives. Dr. Italo Brown is an emergency medicine physician and clinical instructor at Stanford University Hospital. He’s been on the front lines treating people with COVID-19 over these last few months. Jahmil Lacey the founder of TRAPMedicine, a nonprofit that focuses on using barbershops to help address the health inequities of Black men and boys. He’s currently in medical school, and he joined to talk to us as he just got out of class.

You had this cultural icon in our community, as a result of his roles in a number of films, but also like he's one of us. He went to a Historically Black College/university (HBCU), Howard University. He navigated his way through Hollywood. He took on roles that really depicted us in a very positive light. And when I found out that one, he was diagnosed when it was already stage 3 cancer means he had been impacted by this for a while before he found out and he decided to just live. — Jahmil Lacey

Dr. Brown says the very act of having to advocate for yourself to get an earlier screening is an example of systemic racism. You can walk into a provider's office and say, “I think I need to get a colonoscopy,” says Dr. Brown, “and they say, you don’t need a colonoscopy because they don't understand the way that it decimates the people in our community. They don't understand that fear plays a factor and how much it actually took for a person to get to the point where they were OK with asking their doctor for an exam.” Dr. Brown says when Black patients are dismissed by doctors that are biased, it can lead to what he calls medical distrust.

As Black men, we often have to maximize the time that we have in this physical realm. And we don't have the luxury of being able to say, “In five years, I want to see myself here.” We're living for today. A lot of us are living for this hour. And so it's just a reminder for me to just live. And it's also a reminder that regardless of how much money you make, how much education you acquire, Black people are always at risk because of racism. — Jahmil Lacey

As 30-somethings, Lacey and Dr. Brown say their insurance company won't cover a colon screening, even if they asked for one because the recommended age for testing is 45. They would have to pay out-of-pocket. According to the ACA, there’s nothing to stop insurers from covering the tests starting at age 45, and some are likely to do so, but at this time insurers are not required to (and some might not) cover the cost of colorectal cancer screening before age 50.

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“What I've been told is to just lie,” says Lacey. “We're at the point now where we have to lie about our symptoms in order for doctors to to do their proper due diligence to ensure that we don't have cancer. And that is a problem.” Dr. Brown says he's had similar experiences. “Unfortunately for Black patients, you spend more of your time trying to convince somebody that your complaints are real and you are authentic in your desire to have increased health literacy — not because you're trying to con or game the system.”

Here are some tips from our Wise Ones on how to advocate for yourself in the doctor's office:

1. “What would you say to your family member?”
“This is a question that I use and that I share with a lot of my patients or people who I would consider under informed. Put it on the physician, as if they were talking to a family member, because they often forget and they create that distance — whether it is emotional fatigue or fatigue from seeing too many patients and are tasked with making complex decisions. So if I'm walking in a room and I'm with a doctor, and I don't feel like the doctor is 100% giving me the attention that I need or deserve, I would say, “If I were your family member, what would you say to me? How would you approach this?” — Dr. Italo Brown

2. #BlackDoctor

“We have to acknowledge that there's a power differential immediately when a patient approaches a doctor. There's a knowledge gap, there is a resource gap, and there's an access gap. We have to acknowledge that that gap exists and patients need to know that they are just as empowered as the physician. This physician cannot make any decisions about your care that you don't consent to. If people don't have access to a Black doctor, go on Instagram, type in “Black doctor.” Find the first Black doctor you see and just direct message them and just ask them questions.” — Jahmil Lacey

Note: We’re not advocating for people to get legitimate health care via Instagram, but rather, see if you can find a Black doctor that you can eventually see regularly or can help you get the care you need.

3. Pressure your benefits provider for access to providers of color

“For folks who are employed, you can also apply pressure upstream on your benefits groups to demand that they provide you with people who have access to providers of color. You can ask that. You can request that they provide you with strategic plans on how they're going to increase their provider panel of color. You can also request that they try to put in place navigators who can help you with some of these tougher questions. For example, imagine trying to plan end-of-life care for a family member. That's difficult, especially within the Black community. And that will turn a very clear spotlight on the blind spots in lack of equity that exists within the corporate structures of the jobs that we work.” — Dr. Italo Brown

4. Vote

Study after study shows the clear association between civic engagement and health outcomes. A lot of what we're talking about are decisions that have been made at an executive level and at the legislative level.

Lastly, Lacey wants to emphasize that Boseman did not give in to cancer; he kept fighting for his life. “Despite every advancement in medicine, this is just where we are. I think about health disparities and how they impact Black people no matter how much money we have, no matter how much fame we acquire. We are always at risk. And my message to people is to fight like Chadwick.”

Episode transcript can be found here.

Episode Guests:
Jahmil Lacey, founder/CEO of TRAPMedicine
Italo Brown, MD, MPH, Policy Advocate & Emergency Medicine Physician and Chief Impact Advisor of TRAPMedicine

TRAPMedicine — (Trust, Research, Acces and Prevention) — Shifting the praxis, narrative and culture of men's health through the barbershop.

Information about insurance coverage for colorectal cancer screenings per the American Cancer Society.

Click here to register to vote.

Recommended Reading:
The power and politics of the black barbershop by Jason Parham
Why Barbershops May Be Key to Improving Black Men's Health by Alice Park
Africans Mourn Chadwick Boseman: 'A Great Tree Has Fallen' by Ifeanyi Nsofor
Medical Apartheid by Harriet A. Washington
Killing the Black Body by Dorothy Roberts
Body and Soul: The Black Panther Party and the Fight against Medical Discrimination by Alondra Nelson
The Deepest Well: Healing the Long-Term Effects of Childhood Adversity by Nadine Burke Harris
Examining Tuskegee: The Infamous Syphilis Study and Its Legacy by Susan M. Reverby
The Immortal Life of Henrietta Lacks by Rebecca Skloot

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Collective Grief & Healing: Nap Ministry Spotify Playlist curated by Tricia Hersey-Patrick