In celebration of the 95th anniversary of the ratification of the 19th Amendment, today’s pic of the week is from the Library’s Manuscript Division of women suffragist leader Alice Paul with other activists of the National Woman’s Party (NWP). On August 18, 1920, Tennessee General State Assembly member Harry T. Burn, at his mother’s insistence, cast the final vote needed to ratify the amendment which gave women in the United States the right to vote. The 66th Congress first proposed the amendment on June 5, 1919, 41 Stat. 362.
This picture below and others like it can be found in the Manuscript Division’s collection, “Women of Protest: Photographs from the Records of the National Woman’s Party.”
Jane Lazarre was pacing the hospital waiting room. Her son Khary, 18, had just had knee surgery, but the nurses weren’t letting her in to see him.
“They told us he would be out of anesthesia in a few minutes,” she remembered. “The minutes became an hour, the hour became two hours.”
She and her husband called the surgeon in a panic. He said that Khary had come out of anesthesia violently — thrashing and flailing about. He told Lazarre that with most young people Khary’s age, there wouldn’t have been a problem. The doctors and nurses would have gently held him down.
“But with our son, since he was so ‘large and powerful,’ they were worried he might injure the medical staff,” Lazarre said. “So they had to keep sending him back under the anesthesia.”
Khary was 6 feet tall. But he was slim.This story is part of a partnership that includes KQED, NPR and Kaiser Health News. It can be republished for free. (details)
“He wasn’t the giant they were describing him as,” Lazarre said.
Lazarre is white. Her husband is black. Lazarre says there’s no doubt in her mind that the medical team’s fear of Khary was because of race.
“I understood, certainly not for the first time, that my son — and my sons both — were viewed as being dangerous, being potentially frightening to people who were white,” she said.
She’s also sure the surgeon didn’t see it that way.
“Like most white people, I don’t think he was conscious of it at all,” Lazarre said.
She and her husband insisted on seeing Khary. They saw right away that he wasn’t angry or violent.
“He was scared,” Lazarre said. She and her husband leaned over and whispered in Khary’s ear: “‘It’s going to be OK, you can calm down.’ And he began coming out of the anesthesia more normally.”
Lazarre first wrote about this experience in her book “Beyond the Whiteness of Whiteness: Memoir of a White Mother of Black Sons.” Though it’s been years since Khary’s surgery, Lazarre says there’s still so much that hasn’t changed.
Racial Disparity In Medical Treatment Persists
Even as the health of Americans has improved, the disparities in treatment and outcomes between white patients and black and Latino patients are almost as big as they were 50 years ago.
A growing body of research suggests that doctors’ unconscious behavior plays a role in these statistics, and the Institute of Medicine of the National Academy of Sciences has called for more studies looking at discrimination and prejudice in health care.
For example, several studies show that African-American patients are often prescribed less pain medication than white patients with the same complaints. Black patients with chest pain are referred for advanced cardiac care less often than white patients with identical symptoms.
Doctors, nurses and other health workers don’t mean to treat people differently, says Howard Ross, founder of management consulting firm Cook Ross, who has worked with many groups on diversity issues. But all these professionals harbor stereotypes that they’re not aware they have, he says. Everybody does.
“This is normal human behavior,” Ross said. “We can no more stop having bias than we can stop breathing.”
Unconscious bias often surfaces when we’re multitasking or when we’re stressed, research shows. It comes up in tense situations where we don’t have time to think — which can happen frequently in a hospital.
“You’re dealing with people who are frightened, they’re reactive,” Ross said. “If you’re doing triage in the emergency room, for example, you don’t have time to sit back and contemplate, ‘Why am I thinking about this?’ You have to instantaneously react.”
Doctors are trained to think fast, and to be confident in their decisions. “There’s almost a trained arrogance,” Ross said.
But some medical schools are now training budding physicians and other health professionals to be a bit more reflective — more alert to their own prejudice.
Places like the University of Texas Medical School at Houston, the University of Massachusetts, and the University of California, San Francisco now include formal lessons on unconscious bias as part of the curriculum.
New Approach Teaches Students To Recognize Bias — And Slow Down
At UCSF, all first year medical school students take a workshop led by Dr. Rene Salazar, who coaches other members of the medical team, too.
“A lot of folks come to San Francisco thinking, ‘Oh it’s such an open-minded place, there are no biases here,'” he tells a class of newly arrived pharmacy residents. “That’s not true. You’re going to see this in every hospital. It’s going to be an issue.”
What Salazar wants these students to talk about isn’t other people’s biases, but their own. And not just the biases they know they have. But the ones they don’t know — or don’t believe — they have.
“Like it or not, all of us hold unconscious beliefs about various social and identity groups,” he says to the class. “Many times we think about bias and unconscious bias — they are incompatible with our conscious values, right?”
Before the class, students were asked to take an implicit association test, a series of timed computer tests that measure unconscious attitudes around race, gender, age, weight and other categories. Salazar asks who wants to share their results.
The students study their fingernails.
Salazar clears his throat.
“Well, I can share with you my story,” he says.
When he took the test for the first time, it showed that he had a preference for whites — or a bias against African-Americans. Research shows that 75 percent of people who take the race test show an automatic preference for whites.
“I was struck,” he tells the students. “Particularly being in the health professions and wanting to serve diverse communities, to learn that I had these biases — it was a bit disheartening.”
So he began to explore where these biases came from.
“I grew up in south Texas — 99 percent Mexican-American. Mostly Latino. In my high school, we had one black student,” he tells the pharmacy residents. “And so, up until age 18, you can imagine, a lot of my ideas — a lot of my attitudes, a lot of my beliefs — about folks who were black came from what? The media.”
A student named Amanda raises her hand. She asked that we not use her last name because she’s afraid that what she learned about herself could harm her career.
Amanda explains to the class that her parents made their way to the U.S. from Iran, and settled in Marin County, north of San Francisco. She took the version of the test that measures bias against Muslims, and another on light and dark skin tone.
“I kind of went in thinking that these are two areas that I would probably not have a bias, and that’s kind of why I chose them,” she said.
But the results were not what she expected.
“It was like, actually, ‘You’re biased and you don’t like brown people and you don’t like Muslims,'” she said. “Which is interesting for me — because that’s, kind of, the two things that I am.”
Traditional Diversity Training Didn’t Work — And Sometimes Backfired
The UCSF curriculum is based on a training program designed by Howard Ross, the diversity consultant. He says he developed the new “unconscious bias” approach to sensitizing people to their own predjudices after realizing that the traditional diversity training he was doing in the ’80s and ’90s wasn’t working.
“People who seemed to have transformative responses to those [earlier] trainings, to have that kind of ‘aha’ moment — particularly people in the dominant group, [of] whites, men, heterosexuals — often, if you talk to them a month or two later, they actually felt quite wounded by the experience,” Ross said. In some cases, he adds, participants seemed to become more defensive and hardened in their biases after those early trainings, not less prejudiced.
A 2007 study described in the Harvard Business Review examined diversity training programs at more than 800 companies over 30 years, and the results underscore Ross’s point. Overall, such programs seemed to do nothing to change people’s prejudices or improve diversity. Instead, in some cases, they reinforced bias.
“What happens is, ultimately, we feel bad about ourselves, or bad about the person that made us feel that way,” Ross said.
So rather than making people feel bad or awkward, Ross and Salazar say that, more than anything, they want people to accept that having biases is part of being human.
“You know we all have them,” Salazar tells his class in San Francisco. “It’s important to pause for a second and normalize this. And be OK with this.”
Salazar emphasizes that unconscious bias can’t be eliminated, but it can be managed.
“So how do we address our bias? What do we do?”
One student says, “Slow down.”
“Yeah,” Salazar responds. “A trick that I use is that I pause before I walk in, take 10 seconds even, 15 seconds, just to try to clear your mind and go in with that clean slate.”
It’s too early to know if these new types of trainings that explore unconscious bias are actually having any effect on what goes on in the exam room. Participants fill out evaluation forms after the class, and these anecdotal self-reports are often positive. But, so far, there have been no formal studies to measure if anything in patient care has actually changed.
“What happens when that door closes? What happens in the interaction when I can’t see the patient and the doctor talking?” Salazar said. “That’s a little hard to capture.”
Still, UCSF is betting the technique will help. Salazar and other leaders believe the younger generation of health care providers could help shift medicine — by learning early how to keep their own biases in check.
Ninety-year-old former President Jimmy Carter announced Thursday morning that he’s being treated for melanoma, and the cancer has been found in his brain and liver.
My reaction: “Melanoma? Isn’t that supposed to start with weird spots on your skin?”
I turned to Dr. Elizabeth Buchbinder, melanoma expert at Dana-Farber Cancer Institute. Our conversation, lightly edited:
So is our popular conception of melanoma — odd, mole-like things on sun-hit skin — not consonant with reality?
So often, when people think of skin cancer, they think of the more traditional basal cell, squamous cell, where you go in to the dermatologist, they cut it off, maybe you need to get a little bit of liquid nitrogen, or something else, but really, once they’ve done that, the risk in terms of it affecting your survival or anything else is very low. They’re really very controllable cancers.
Melanoma is kind of the exact opposite of that. It’s the real bad actor among the skin cancers, because melanoma likes to get into the blood and spread. It likes to go anywhere it wants in the body. Some of the places it likes to particularly go are the liver and the brain. It can also go into the lungs and other areas of the body. It’s kind of the ‘bad boy’ of the skin cancers; it’s definitely a bad actor in terms of cancers in general, but then also in terms of skin cancers as a group.
And you can have melanoma without ever having seen a spot?
First of all, melanomas predominantly arise on the skin and are most commonly associated with sun or UV exposure. However, they can arise in areas of the skin that never see the sun. They can also arise on other membranes that are not visible; for example, the inside of the mouth or the inside of the intestine. They can also arise within the eye.
Although most of them arise on skin that are seen, some melanomas may arise on the skin and never necessarily be detected. We have a fair rate of what’s called ‘unknown primary,’ where we never find that skin spot, and one of the thoughts is that that skin spot either has been attacked by the person’s own immune system and kind of gotten rid of, or that something else has happened; it’s been scraped off or itched, or who knows? It just never was found. So there’s some rate of that.
And so what is the cutting-edge of melanoma research and treatment now?
Melanoma treatment is so exciting right now. The real, real cutting-edge is basically using the immune system to fight the cancer itself. What we’ve known for a long time is that the immune system has a relationship with cancer, and sometimes can keep it from growing or prevent new cancers from forming, but often the cancer kind of overcomes that somehow. And what’s happened with new treatments and with new research and understanding of how the immune system works is we’ve been able to use medications to make the immune system attack the cancer.
What’s so exciting about that is once the immune system starts attacking the cancer, it continues to do so. So just like as a kid when you’re vaccinated against mumps you’re not going to get mumps for the rest of your life, if you get that immunity going, there’s a chance that the cancer can be controlled not just for a brief amount of time, but for five years, 10 years, ongoing. And so what we’re seeing with some of these new immune therapies is what are called ‘durable responses,’ where people respond well to the treatment initially, but then continue responding without the cancer coming back. So very, very exciting.
So have you actually moved the dial on what could be called a cure rate?
In cancer, we’re always afraid to say cure, because we always think it could come back and then we really haven’t cured it.
But we definitely have. A lot of people ask about the prognosis in cases like former President Carter’s, and it’s very hard to say, because if he has a great response to immune therapy, there’s the potential that he could go on to live many, many more years. And so it’s really changed the landscape for melanoma, and we’re hoping, as these treatments are tested more and more, for cancer as a whole. Because they’re seeing success in other cancers, like lung cancer and bladder cancer, which is really exciting as well.
So melanoma is a little bit like the poster child for the new immune therapies?
It really is. I think it has the highest rates in terms of response. We’ve actually been doing immune therapy for many years in melanoma, even before these newer agents came along, partly because there weren’t a lot of other option in melanoma treatment.
So maybe that could also be an effect of Carter’s announcement, that it will bring even more attention to the very promising nature of these immune therapies. I know you can’t comment on his case directly, but we can assume he’s going to be getting them, right?
I think I read in one of the reports that he is getting something that is enhancing his immune system.
I think the other area of melanoma treatment that’s also very exciting — but these days is kind of falling to the second tier in a way — is the targeted therapies, where we actually look at genetic changes in the cancer itself and use drugs that attack those genetic changes. But the immune therapy, because of those long-term responses, is really what people tend to be starting as front-line. So it makes sense that that would be exactly where they start in terms of his treatment.Related:
On Monday, August 3, 2015, Robert R. Newlen, chief of staff for the Library of Congress moderated a discussion between renowned photojournalist Bob Adelman and retired executive director of the American Civil Liberties Union (ACLU) Ira Glasser in the Library of Congress Mumford Room. Newlen expressed his high regard for Adelman and Glasser’s life-long commitment to social justice and civil rights, noting Adelman’s talent for artistically capturing social justice movements in photographic form and Glasser’s 34 years of service at the ACLU.
At the start of the program, Newlen asked the guests to describe the impetus of their 1991 book, “Visions of Liberty: The Bill of Rights for All Americans.” The book features Glasser’s in-depth historical account of the Bill of Rights beginning with its origins in the 1215 Magna Carta and an examination of individual liberties protected by the Bill of Rights (freedom of religion, speech, religion, fair legal proceedings, and racial equality), along with Adelman’s poignant photographs.
Glasser shared that it was Adelman who approached him about writing the text for the book. They both recognized this as a unique opportunity to commemorate the 200th anniversary of the Bill of Rights while sharing the compelling story of the struggle for human rights. Glasser explained that he hesitated initially because he was working 95 hours a week for the ACLU, but finally agreed and saw how Adelman’s photographs could “illustrate that which words cannot.”
During the program, a sampling of Adelman’s photographs were shown to the audience. There were photographs of civil rights leader Martin Luther King Jr. during the March from Selma to Montgomery, along with Adelman’s emotionally gripping photograph of African-American protesters enduring the overwhelming force of water hoses turned on them by police and firemen at Birmingham’s Kelly Ingram Park. Adelman recalled the brutality of the scene, and Glasser discussed the illusion that racial discrimination was occurring only in the South. He described how labor unions in the North were used as a “racial exclusion instrument” because blacks and other minorities were not permitted to join, which hindered them from employment opportunities.
Glasser also discussed how Jackie Robinson, the first African-American major league baseball player, created a new sense of humanity when he joined the Brooklyn Dodgers in 1947: for the “first time blacks and whites were clapping, hugging and rooting for the same thing in public,” he said. In addition to Adelman’s photographs from the civil rights movement, his photographs of the women’s rights protests of the 1970s, along with anti-war and gay rights demonstrations, were shown. Adelman said he “photographed things he cared about,” and as a photojournalist “you have to be mindful about how you interpret photographs,” he said.
Glasser concluded the program by sharing that over the course of his career, he has often heard whites share that they were not personally responsible for the racial discrimination that occurred during the civil rights era. He acknowledged that this may be true, but said he reminded them “they benefited from the discrimination,” and therefore they have a “moral obligation to care about equality for everyone.” Glasser and Adelman both acknowledged that the struggle of liberty for all is an on-going struggle.
The program was presented in conjunction with the Library’s exhibition, “The Civil Rights Act of 1964, A Long Struggle for Freedom.” Co-hosted by the Library’s Prints and Photographs Division, its Interpretive Programs Office and the Law Library of Congress, this event was made possible by a generous donation from Roberta I. Shaffer.