This is Roswell. Rookie by Roswell Park Cancer Institute. European opinion or your total options. Your host him -- welcome back to Roswell on this are continuing in comprehensive look at all aspects of cancer care treatment diagnosis and research. From a comprehensive source right here at Roswell park. Cancer institute in Buffalo, New York I'm -- Wenger good morning and today we're talking about. Life threatening cancer disparities and we'll explain what that means we've got a great guest in studio here from Roswell park. Doctor Willie -- the third he is an associate professor in the department of urology. And the office of cancer health. Disparities research always a great conversation with you doctor underwent thanks for being here with two more -- and then thank you for inviting me enjoy their talks this is something different. You know we spent a lot of time with you talking. About cancer treatment of cancer and in different programs that Roswell. Has 22 helped treat the patient and and help the community. Who won't. Life threatening cancer disparities can you give me an explanation and definition. It is short and summary. -- say is disproportionate. Any inequity in care. That in the situation where he can leave to someone Diane disproportionately so what does that mean. You have a cure for a disease some people give it some people don't go -- don't get it back from. From the disease don't get the treatment. The institute. Of medicine back in 2003. Going back a few years but in 2003. They've they had a report and it said this quote. Racial and ethnic minorities tend to receive a lower quality of healthcare then non minorities. I read it to someone last night and they setback in their care and early -- you know and in 2013 is this true. Without question. There isn't over preponderance of evidence that shows that. And how has played out is this that blacks disproportionately. Guys to unequal treatment by about 83000. Additional us. So 83000 additional where people die each year because of inequities. In health care treatment. Are -- into an awful lot of the wives of this and I think you know you know a lot of the that the wise both. You know from from a research and maybe you know from all of the the reading that you do of reports and and creation of reports on your own. But you have a personal story that I think you can share with us that really lays this out and I think dramatically demonstrates. How. Add this situation can be and and I guess is yes. Sorry I'm Rory and oracle through the American journal public -- Basically described me my experience in the top. Medical sooner. Which I -- name. I Juan. Slipped on ice. The back injury. Did not go to doctor -- hospital for some time until one day I woke up and couldn't walk. And I remember lying there on the floor between my. Halfway between the bathroom in my bed. And contemplating which direction I was gonna go away and they -- me -- -- life here but since I was in my closet and when my closest smell. But so my friend asked -- -- Huckabee just a local hospital. And I said that -- conflict in these respective today. She's -- weren't talking Grasso serves in my second stint surgeon on my forehead and Gary TOB disrespect to. She says I guarantee you won't. We go to hospital. It is brought into emergency room. Again -- loss in my left leg since three loss among look like. And and they basically refused to give me pain medication. Until I receive a -- next race. Which a player X ray would show nothing and I knew that and I asked -- -- -- he slipped and I exercise sales and car accident. So how many broken bones is our view this and in an MRI. To distinguish that would refuse to even give me pain medication. To make a long story short course he did an exam when my eyes close and of course I didn't 23 loss Les -- can be. -- for very long time and -- -- couldn't feel it moral loss couldn't -- moment what would drop. Which are all that's an emergent situation and in many cases the treatment. The treatment for that is an emergency surgery or at least a minimal with steroids so the need to be done. But instead. Finally to make a long story short the doctored resident. Tells the attending with -- hero says he says that he's he's a hero says he says he's a doctor claims that he's the doctor. You know and it turns out that the American position -- And said well you know he is doing what he's talking about and I was able to -- pain medication however I never got an MRI appropriate timing. I didn't get referred to appropriate people. They receive the proper care. Now -- another. Urologist of mind. Randomized him -- his -- -- he. To the same BR with the exact same complaint. He was in -- we've seen by the top neurosurgeons. And take it to the operating room. Which is part he was in the top notch care and care should receive that I wasn't seeing medical sooner too highly professional individuals. Coming to an institution with the same symptoms can be treated drastically -- -- Your physician here it is highly respected. Cancer center cancer research institute. You know everybody. Who's African American is not mean is this happening every day in your in your estimation. Yes. I would say his party -- reread it now the question is why right now is openness that was my next question to. And how well. Whoa whoa. The wise are really do too far. Perceptions -- reality -- implicit. You know stereo typing an implicit racism compared explicit racism so we think -- Explicit racism you know when you. See people don't like blacks I don't want to living next to me and is very. Over and and on the surface of their reality. But -- things as how we think about people. In ways that we may not necessarily understand. -- so what are amoeba that. You see you're you're walking down the street. And there and you pass an individual was worn talking -- their running. He politely stop for you can't pass -- you don't think there rob you know the key thing about you know hold on to your person you want me. In the new quota on the street and someone -- the exact same -- does it actually thing. And you grab onto your purse that's because of it implicit so conscious stereotyping. That's done. No one's immune to that. Our education doesn't protect us from. So therefore now you're -- hospital now you're seeing in -- and what ever so conscious perception -- you. Of that individual basis point anything it can be based upon ginger can be based upon their -- he could be based upon our trapped there for unattractive there. These are all things that we talk and we have these self conscious ideas and thoughts about. And race is at the top of that from my perspective so now all of a sudden you have an exchange with someone. And you believe in -- with when the evidence does not support that. This like he's a drug seeker seeking pain medication once told once individual realized. That I knew things about medication and stuff like that his perception is -- -- -- -- -- -- these -- -- professional his -- -- all of this proves. Then he says drug seekers so why would he know. How to do this unless he's been in the ER doing this before compared to he does this because he's a position he's been trained. To know what he's talking. Let me ask -- -- least from your perspective if you went through medical school you went through all this that that that training to get to the of this stature in the position that you're in right now. This clearly isn't what you and your colleagues. Are taught and trained for this instance that you you lay out here in in your own personal life. So the training. Gives us the knowledge to know how to treat certain diseases. However what happens is that how we interpret information. Is based upon his troubles to filter and air filter we have no control. And -- even understand how what's influencing decisions so if you brought in. In positions in the room and you say to you ever behave this way do you do this. They were all uniformly say you know because it stands against their their conscience the reefs. It stands against everything they believe however you have. Thousands of articles that show otherwise. Right that every day this is happening in ways it was are things can -- wouldn't give you vignettes. Of blacks and whites males and females in the scenarios the exact same and you decide what treatment -- you recommend and then you see that you recommended different treatment based on race -- It's that you started don't know why did you well actually. You did. Not because you're evil human being but because that filter and how that impacts your decision making now in Iraq with people. We haven't been -- to move beyond. So it's not in the training that you receive. And it's really not I would I would certainly. Presumed to be true. The policy of the facility and in your case you were at or any facility it's implicit within the person that is responsible for the care. In the new drugs is implicit now there are cultures. That it institute one institution it fuels that. In ways that I think the losers you begin to address that. And sometimes you can swallow. Communal black -- in the staff. Let's look at your student ratios look at some of these things we don't know the literature and yet that's gonna have people think with time but -- Yes right now I think that religion truly supports that is an implicit thing with Indian visual. But before we move onto another article on ask you this it is there any credence to. Does does well I'll wait. Patients receive. Better care from a -- position does an African American patients receive better care from an African American position. The world I live and I don't care I want the best here. And that's always been the premise here Roswell at -- and that is an. Excellent question. And if you look at studies where you. Political Concord oops I mean that the positions -- the patient's way. The positions black. The pieces black and this -- accordance with the race are the same. That plays out evenly yes quite it's better care black positions based upon literature. Concrete black and white pieces pretty much to see. Why positions based upon the leisure treat black patients differently. It's. Fascinating to me let's move onto another article that was published. In the journal of of social issues we spend so much time in this program you've been in this studio and we've we've talked about various aspects of cancer and we talk about the outcomes and and why certain people get cancer biological genetic issues. You know could be physical you know our environment. But now today we're learn a lot of us myself for learning that social political economic all these factors come into play. And it really I think is is shocking and I think in many cases there in all cases it's sad. Agree with that so. As we talk about this so there are sold to determine it's -- hell. Where you live how wealthy you wore your race or age. Or gender play into your overall -- However in this article we talked about how this race in -- impact the treatment that you receive. So you're diagnosed with this disease. It's we're trained to use. Partially that Aziz -- into our -- and you race. You know low risk of death. And we have a treatment based upon your risk of death and so on and so -- and you expect that when very race but the words of support that it does. To a point that even when you start talk about the use of breast cancer receiving chemotherapy. Is now don't just as black limitless like they received chemotherapy but when he receiving less likely receive proper doses of the Q there. Under dosage which music base military chemotherapy. And get it -- minutes of lord knows which means that it impacts their recurrence of the disease. And it's Jennifer -- What was that looked at several different ways enough -- -- -- so we can look at this and with specific disease sites you've -- breast cancer and -- -- another his prostate cancer. Yes so prostate cancer. And what you see there which is clear so men with. Low risk disease there is no racial disparity there are all treatment. As the risk of death but recent for the greater cancer increases through the disparity wines that says men with high grade cancers. Blacks are -- to be less likely on to their white counterparts to receive. Definitive therapy now -- interest in black were high -- cancer. Is less like receive definitive therapy compared to white with moderate -- kids. Interest things. After they were talking about what we're turning life threatening cancer disparities you are listening. To Roswell on this and that is doctor -- Underwood associate professor. In the department of urology and office of cancer health disparities research here. At Roswell park let's for a moment doctor -- -- talk about. Socio economic status I hate. From the outside looking in would assume socio economic status. The first well you can address the fact that socio economic status matters with cancer care. But does it matter win all races. That that's a great question. So why am here because concludes our question is who praises. So. Are poor black and poor white person equal. The answer -- that is no. Or poor -- black is worse off than an -- away. It's some of that has to do with -- and in many cases that we refrain that poor whites in some cases are better off. In the middle class or even professional black in some regards you know this how they're treated in this system. And I think -- the original hour we -- sort of shows that. Because you -- considered me -- hires so she can access but yet the Kiernan are received. Was what you would expect someone less than them or question or even. You'd expect no -- to be treated the way I was treated regardless of race or socially -- access. So having said that no we're not equal. Now. Does social economic status matter overall and yes in answer is yes. And that's throughout the world and you look at UK's TC -- Poor people in Iraq with all systems differently in the rules of over. Yes yes strapped and some of that. Is due to resources. And some of that. And it's access to resources knowledge and understanding but some -- this bears down Harley treated. To so rarely treated and how people respond that I would assume they eat it to -- someone. And a lower socio economic status would not have the access to the treatment in the screening that a lot of us might have. Who are you know but you know we talks much about insurance in this day and age if you know it's pretty much a requirement for for treatment and in in many facilities the exact. What would not just that so let's say you have a job and you have insurance and you work Monday through Friday during the day. But everything that's what things are done. So. I can take off work. -- -- stuff -- my doctor's office and he -- he indicated exam -- aren't they pick on prescription. What is an individual get to do that so they say well yeah you can take operative but we don't you know you happy. You lose money for that time -- your boss so you know you can have that time off because we need to be here. In the checkout line at you know some story. So yes although we have insurance they still don't have access because -- not -- accessible to them. You know it's good to be acceptable available accessible these are some things we talk about -- yes. And those in certain strata have manipulated -- -- access care behind having it take it beyond having health insurance. In a minute I wanna talk about what in individual patient who's African American can do. To protect their interest and make sure that they're getting the best quality care that they can -- anybody should be able to get. But I want from use some thoughts on what can simply be done. You know is an umbrella to try to change this time. Walt. I think we have to truly acknowledges. That that is happening. Begin to look at institutions. Very carefully. And look at the culture of the institution and and and define. How care is delivered. The leadership of the institutions have to make it clears that we treat every one this provide an educator now we know there's going to be some variation -- care delivery based upon. Acceptable things but one. Acceptable -- this race unacceptable thing -- race another unacceptable things yes yes the social economic stats another unacceptable things and they're not acceptable. So for based upon that we're going to do with that. Secondly. We have the begin to truly miss -- indeed the resurgent wave beyond those of us who study this right we talk about it but the public. Has no real knowledge. Because it's not at the top you know we talk public key differences in all of those sort of things and for a lot of money and when notices wait a minute. You mean because people were treated there who -- your system in 3000 people die each year. -- So the people in democracy. In this greatly. Because it makes us not agree. Period we can't beat -- and act and act and that's beyond having health issues although health insurance is important to reach and one has access. So. At the top in these -- fundamental change in our house. As individuals. We have -- be ruled consumers of health care. Listen. If you are not treated well in a place you should not only let them know it -- you should let everyone know. So that they don't go there. Period because of the disrespect that you mysteries -- and it's like any other company restaurant. Airlines everyone else is under that scrutiny but in health care system we're not. And we actually should be. You know back in the days so to speak -- remember when you just handed your care over. To a position you know whether it's at a place like Roswell or possibly you know a standard hospital or your own primary position. In what I've been told. Now is that you take charge of your health care you need to take charge of your own health care. And I think that's an important message here in particular for this you know part of the population we're talking about an African Americans take charge of your health care. -- -- -- -- sort of point I was trying to bring home just like we take charge of finding the other product health care is a product. And organizations are paid for delivering a product and are subsidized for delivering a product. And if you don't like the product and you should take your business elsewhere and you should. Do what you would do for any other restaurant you went there you like the service you received like you were treated them like the outcome. You would not go and you tell your family members and everyone else not to go. You're highly regarded and skilled position. Here in the emergency room you know what's going. You know be if it was longer conscious you know through the you know the decisions that are being made in you know whether they're right. Iran for the most part. I would know that. I'm not an actor I'm not gonna know whether the MRI is a better thing for me than the X. How does someone. Take charge when we don't really have the ability to do better than knowledge base to do that. I think that -- That's an excellent question. And and and in some regard some of it is an outrageous that bill. You can feel that there's something wrong things don't really make sense. Secondly. As providers as someone who's from this community and African American community. And others is up to us to begin to educate people. Begin to be a resource. For others the sort of -- -- I mean you know what they're currently doesn't make sense. And also I mean if I were a leader in the African American community I would have a list. You know that we can be on the website there's places you go to where you're treated fairly you -- -- not care if you're not on that list are you know than. And people question why not on the list. I'm not I'm not a minister -- politics in my community community W. Are -- that health care community I would say that that I hear you saying. You know to get out to that mass populace were doing a small part here with this this program today. But I do think that that's a challenge moving forward is how do you tell everybody -- you're looking at the shock I think in my face this morning. I'm -- when I was reading through these two notes. Last night I mean I have my eyes were wide you know I was you know -- it really is in my opening research and shocking to me and if it's shocking to me it's shocking I think to most of of the population out there is this something you think about every day. Unfortunately yes and in many regards as -- as a hope professionals and researchers to sort of -- studies. As a citizen in the United States looking to win Iowa or something and a that I live with. And in many regards and trying to navigate. The system. And improve the system for all because if you improve the system for the least of these you mean you improve it for the best of things. Russell has some programs in place to two you know help address this problem helped diminish. Cancer disparities if you could. Kind of address some of those in in how they work and you know what people need to know about them. So the the sort of office of health disparities which directors that is and their maroon Ph.D. And who Levi. And Ontario different. -- -- Ross isn't peace the researchers well Ontario firms on staff there. -- -- put together a lot of programs with some community advocates as well. That's been that we believe the very hopeful. You can provide information when it's -- now you know program. -- a comprehensive. Evidence based education about prevention and early detection and treatment of disease. And you can participate units in -- and also going negated a training certificate. Afterward was which I think is great we were patient navigation program so if you come in here is a new patient we have navigators who help navigate through so to speak. Who commit system to assure that you get the care that you need her -- -- we. And then we have researches health care quality. And we try to improve quality throughout the rock the institute. You also well on the community too with the you mention now you know in -- and now I know where you were Roswell reaches out. Into us and training right exactly sort of you can educate others. Now also you know we have our. Prostate cancer early detection programs that we do here to. Accuser for a cure. Which is done by Cleveland Ross -- an Ontario offered. And commando group which is a group of African American president cancer survivors. We and that's with support of Russell or. We have our our program audit you. The -- Stevie -- prescreen this world these are free reduce income and education being breast cancers so that. So the goal is to be apart communities educating people and engage people's we can assure that we improve their opening up. One other thought I wanna get from you and this might take a little bit of five here but. Where are we now. Verses. Say ten years ago with this issue are we better. Are we worse. We about the same and where do you see it gone down the road. I think we're -- saying it. In one regard and that is the direct implications of what's going -- I think we're better because we have a greater -- you -- researchers understand -- -- or start to describe this thing very differently. Where we're going. I think. Because once medical systems are responsible for the -- homes. Of -- their piece of cartilage. That responsible for outcomes and patient population regardless of race gender and yes yes. That's -- game changer you know so people criticize that when I saw on us that this is going to be very important to changes because once you're responsible. Then you have this -- -- part of my survival because of me for now what's really going on here and if -- problem that you gonna eliminate that as. You know we hear a lot about racial disparities in our community we -- a lot about certain aspects of -- a lot of it also just gets. Kind of slid under the door under the rug so to speak. This is -- we need to hear about more because I think as shocked as I am the rest of the the you know our western new York community and I think the rest of our culture here in the country would be shocked. Extremely shocked and me and I think that -- goals against the grain of what we see we believe. Form our religious perspectives or more interest ironic perspective from our nationalism. You know again our country the only strongest or weakest link. And for us to be a great nation we have to assure that every individual. Have access to certain basic fundamental things and that life liberty -- pursuit of happiness here. And we can have life. -- Thanks for the open discussion I really appreciate it eye opening indeed. Appreciate it is always it's doctor really Underwood. He is a position here Russell park associate professor in the department of urology. And the office of cancer health disparities. Research if he'd like to reach Roswell park you can always do so toll free at 877. Ask our PCI. That is 8772757724. Or visit the website at Roswell park don't. -- Listen to Roswell this Sunday mornings at 630 young WB yeah. Rocky by Roswell Park Cancer Institute your team opinion for your total options on line at Roswell this god of war. Hanging. And hanging do you. Then.