​In the most recent issue of Neurology, Dr. Altaf Saadi and colleagues reveal the disheartening news that African Americans and Hispanic Americans receive lower quality neurologic care than their white counterparts.
 
Analyzing data from the Medical Expenditure Panel Survey from 2006-2013, they found that Black patients were 30% less likely to see an outpatient neurologist even after adjusting for social factors such as insurance coverage.  Hispanic patients were 40% less likely.
 
They looked at neurologic diseases such as stroke, headache, multiple sclerosis, Parkinson’s disease, and epilepsy.  According to the CDC, strokes kill over 130,000 Americans each year, about 5% of deaths. Strokes are also the leading cause of long-term disability.  Furthermore, the risk of stroke is nearly twice as high for Black Americans as opposed to whites. Yet, despite higher rates of stroke, Black Americans are seeing neurologists, the experts on strokes, less.
 
The authors postulate that there are likely simultaneous factors. The first factor they cite is low health literacy. Not only are patients unaware of all the possible follow up care than prevent another stroke or minimize the impact of a recent one, folks might not even recognize the symptoms of stroke, multiple sclerosis, or Parkinson’s disease to begin with.
 
Folks of color are more likely to have their care across more than one healthcare system making it difficult for the primary care doctor, the emergency room doctor, the neurologist, and the hospital doctor to coordinate their care.  If you live in the Southeastern United States, the number of neurologic specialists is far lower than anywhere else in the country.
 
And finally, the impact of implicit bias and stereotyping cannot be underestimated. Though most doctors are well intentioned and would like to be “color-blind” study after study has shown that we have also absorbed the subtle messages that society sends us that folks of color are inferior or less deserving of care. As this study points out, even at high volume specialty sites, Black and Hispanic patients get delayed care compared to whites.
 
But perhaps the most distressing part of this article is that time and resources were put towards it at all.  We already know that Black Americans, Hispanic Americans, Asian Americans, get lower quality care and that they die younger because of it. David Satcher, former Surgeon General reports that from 1991-2000, 880,000 excess deaths could have been averted had the health of Black Americans matched that of whites.
 
In fact, we’ve known this for almost 15 years. In 2003 the Institute of Medicine published a 764-page report that reviewed hundreds of studies. In the report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, they found that even when controlling for factors outside of the hospital system (insurance coverage, location, severity of disease, socioeconomic status etc), disparities remain.  The bottom-line? Not only does racism on a societal level cause people of color to have worse health outcomes, so do the unconscious biases of those working in the healthcare system.
 
In fact, Unequal Treatment already looked at stroke outcomes.
 
We don’t need more studies showing that there are racial health inequities. We already know they exist. The authors of this study assert that this study is groundbreaking because it’s the first “nationwide stud[y] examin[ing] disparities in the use of neurologic care for people with a broad range of neurologic conditions.”
 
Why would there be any reason to think that this data would be any different then the hundreds of similar studies about race and medicine that have been done before?  Furthermore, when it comes to naysayers, why would one more study help them understand if the hundreds of studies before didn’t in the first place?
 
Instead of spending precious resources on reproving what we already know, we should be spending it on trying to address the problem. In fact, implementing projects to close these racial inequities are quite difficult. While many attempts frequently improve outcomes overall, they do not impact the gap at all. Some even act to increase the disparity.
 
For example, we know that colonoscopy rates are lower amongst people of color. One intervention to try to address this is to send electronic messages or letters to patients reminding them when they are due for colon cancer screening. The problem with this is that it doesn’t help my patients who don’t speak English and don’t have access to the internet. At the same time, my white patients will find this useful at a much higher rate.  While the intervention might improve colonoscopy rates across both groups, it will improve it more in the white group, thus actually making the disparity larger.
 
Addressing health inequity is not an easy task.  Research is supposed to help us solve problems that we don’t know how to fix not tell us stuff we already know. We would be better off spending research time and money on finding solutions as opposed to “rediscovering” the same problem over and over again.

​While it has been mildly entertaining to watch Trump’s healthcare plan draw criticism from liberals and conservatives, that’s only a thin silver lining to the unconscionable piece of garbage that the has been named the American Health Care Act.  While conservatives have been concerned that the insurance coupons are simply more entitlement programs to the poor (which in it of itself is confusing as vouchers has been a longstanding strategy for the Republicans), the reality is that the bill is actually an entitlement program to the already rich and powerful.
 
Healthcare analysts estimate that 10-20 million Americans will lose health insurance under this plan. The populations that stand to lose the most? Low-income Americans, our elders, and women.  What’s going unsaid is that rich men, stand to gain the most.
 
The American Health Care Act touts the same fiscal bullshit that has never helped the average American: deregulation and tax cuts.  The fact is that tax cuts to the wealthy never “trickle down.” It’s so crazy that we even tout “trickle down” as a reasonable option.  Why would we think that under-resourced Americans with the cards stacked against them should get a trickle?!
 
Similarly, Medicaid block funding. Not only does Trump want to repeal the Medicaid expansion, he wants to move to block funding. That means that states will get a hunk of money without any guidance or regulation on how it must be spent.  Legislators will have free reign to redefine who qualifies for Medicaid without any accountability towards making sure that our most disenfranchised communities get coverage.  People of Color, Women, those who suffer from mental illness, these are groups that have never gotten what they deserve out of the goodwill from those in power.
 
The bottom-line is that deregulation always benefits those in power.  For those white, middle-class Americans that voted for Trump because you wanted to “drain the swamp?” This is the opposite and it’s just proving what the rest of us knew all along: Donald Trump is a rich, white man. He is the definition of the swamp. In fact, that swamp used to be a beautiful pond until people like Trump polluted it in order to build their fortunes.
 
Healthcare costs continue to be the number cause of bankruptcy.  Under the Affordable Care Act, the credit amount that citizens got towards buying insurance was based on the actual cost of insurance in their local market.  Under Trump’s new plan, everybody gets a flat rate voucher that is a pittance compared to actual premium costs.  The result? American’s can’t afford health insurance and that only exacerbates this bankruptcy problem.
 
Furthermore, the Republicans are abusing their power in the most fiscally unethical way possible. When it will benefit them to deregulate, they do. But where’s their precious deregulation when it comes to Women’s health? Republicans don’t like Planned Parenthood, so bam, like the bully on the elementary school playground, they’ve banned ALL funding to Planned Parenthood despite the fact that most Planned Parenthoods don’t even perform abortions.
 
But I won’t waste my breath citing facts. Our current administration has no regard for them and freely synthesizes “alternative facts” in the blink of an eye.  We elected a ruthless businessman to lead a corrupt military-industrial-congressional complex. It’s no surprise that the result is a healthcare plan that won’t actually improve the health of the average American.

It’s the weekend after Thanksgiving and for once, I’m not scheduled to work at the hospital. Yet, on Friday evening I found myself fastening my badge to my clothes and walking into the Intensive Care Unit.
 
One of my most beloved patients, Ms. Chhem is passing away.  I’ve come to say goodbye.  It’s not a complete surprise as she’s had serious chronic medical issues for years, but after being part of her care team for a countless number of prior hospitalizations, it’s hard to believe that this will be her last.
 
When I first met her five years ago, I was shocked at the number of hospitalizations she had survived.  Her chart identified her as a refugee from Cambodia with significant psychological trauma, two kinds of hepatitis from poor healthcare, and end-stage kidney disease requiring dialysis three times a week. She had low health literacy, few resources and didn’t speak English. I was terrified to be the young doctor in charge of coordinating her care and keeping track of all the pieces that inevitably get lost in our complex medical system.
 
Of course, in real life, she was nothing like the chronically ill patient her chart suggested.  Despite the physical and emotional trauma her life had brought, she was always upbeat, laughing, and ready to experience life’s next moment.   Or perhaps it was because of that trauma that she learned that this was the only way to cope.
 
During our visits her delightful pragmatism grounded me in what otherwise seemed like an impossibly chaotic healthcare plan.  Our last visit had only been only 72 hours ago.  As I walked into the exam room she had erupted into laughter, jumped up, and grabbed my hands with both of hers in greeting. It was a relaxed visit. Ironically, for once I was feeling good about her medical care. All of the loose ends I had been trying to resolve had recently been tied up.
 
So despite being familiar with intubated patients, it was jarring to see Ms. Chhem, the same woman who just a few days ago was relating to me the hilarity of coping with recently misplaced dentures, as a patient, intubated, sedated, and surrounded by machines and IV drips.  Death doesn’t impact me the way it used to when I first became a doctor, but I still choked up as I held her hand and said goodbye. 

Media coverage of the Standing Rock protests against the Dakota Access Pipeline has been hopelessly myopic. Certainly environmental justice, police brutality and the violation of sacred burial grounds are important topics, but no one has addressed the larger systemic issues at play: Native American treaty rights and how their handling portends dismally for the everyone else. Even the most self-centered and politically apathetic must realize Pastor Martin Niemöller’s warning that it’s only a matter of time before even the most mainstream of society are persecuted.

To truly appreciate the full significance of the face-off at Standng Rock, one has to understand understand the historical context of this struggle, which has seen supporters from 300 Indian tribes lining up to back the Sioux People.
Every person in the United States has the right to clean water, but for Native Americans, that right is two-fold. The treaties that set up Indian reservations were not simply land ownership agreements. The terms actually dictated a broader set of terms. This includes not just land, but also the obligation to protect tribal property and assets; in other words, natural resources such as clean water.

Furthermore, the Snyder Act of 1921 delineated that the federal government is also obligated to provide health care to federally recognized tribes. While this typically takes the form of providing clinics and health insurance through Indian Health Services, ensuring clean water is obviously a basic tenant to providing basic public health care.

So when the Sioux who live on the Standing Rock Indian Reservation demand that their source of clean water is protected, it’s not simply a matter of basic human rights, but also a contractual financial obligation.

But the bigger concept at play here is that the 56.2 million acres of land that are identified as reservation land (at totally of only about 2% of the United States), are actually held “in trust.”

Most of us don’t know what that means. In life experience of the average American, you either own something or you don’t, but a “trust” is something in between. Some rich children have an idea. It’s similar to the “trust funds” that wealthy people set up for their children. The money is named to them and for their use, but with active management and significant restrictions on its use. Only at least with rich kids, at a certain age, the trust money usually is given to them outright and they can spend it however they see fit. That will never happen for the lands held in trust for Native Americans.
​
What that means on a practical level is that even if a specific tribe has rights to the land of reservation, it’s only in the setting of the high regulation from the Bureau of Indian Affairs.

SEATTLE, WA -- Ever since moving to Seattle it’s become clear to me that though most of its inhabitants identify as liberals, the dominating white culture enables a culture of armchair liberals. When it comes to LGBT rights, Seattle will stand up, but when it comes to addressing issues that actually threaten the comfortable, largely white and privileged population of the Seattle, it’s another story.

In 2015, the Washington State Supreme Court started fining the state government $100,000 a day for continuing to underfund K-12 public education. In 2011, after a 9 month investigation, the Civil Rights Division of the United States Department of Justice sued the Seattle Police Department for a "pattern of excessive force” that violates the US Constitution and federal law.

This year, Washington has a second chance to address police brutality and in compliance with international human rights laws.

As it currently stands, Washington has some of the most feudal police use of force laws in the country. It is essentially impossible to prosecute a police officer for murder. As it is currently written, Washington law states that if a police officer kills someone, as long as they acted “without malice and with a good faith belief that such act is justifiable,” they are immune to prosecution. King County Prosecutor Dan Satterberg stated, “This almost perfect defense to a mistaken use of force has kept police officers out of court as defendants."

In fact, according to an analysis done by the SeattleTimes, from 2005 to 2014, 213 and thirteen people were killed by police officers in Washington and only 1 has been prosecuted.

Earlier this year, House Bill 2907 was considered which would have struck the “malice” clause from the state law, but it wasn’t even voted on. Frustrated with the lack of action from politicians, an activist group called Washington for Good Policing have proposed Initiative-873, which if passed, will strike the “without malice and with a good faith belief” from state law. The initiative will need over 250,000 signatures to get placed on the ballot for general voting.
Ironically, the legislation uses the term “peace officers” to denote law enforcement officers.
​
While the Black Lives Matter movement has drawn attention to the racism that continues to lead the murdering of innocent black citizens in this country and the destructive American system of mass incarceration of Black Americans, it’s worthwhile to note that the Washington police officers have targeted more than Black Americans. In 2015, Antoni Zambrano-Montes, an unarmed, Mexican man was shot at 17 times by police officers while running away with his arms raised in the air. He was dead at the scene.

It's been difficult to know how to cope with the mass murder in Orlando. It's an amalgamation of emotion:
Personal safety as a queer person. Heartbreaking loss of human life. Frustration and anger around the politicking and continued lack of gun control. I go to conferences all over the country all the time. I go to a gay club in every city. I was just in Orlando! It triggers all the emotions that surface when abortion clinics, another issue close to my heart, are targeted with violence.

As I imagined the victims, other queer people of color, I reflect on the compounding difficulties of being a minority within a minority.

Today I've found some comfort by celebrating the amazing QPOC culture. What straight people don't understand is how important gay clubs are. Movies and TV portray it as a social gathering place at best and sex craved debauchery at worst - but it's so much more than that. The community that is formed; the self-actualization and validation that is often found nowhere else; the political organizing. When I think of gay clubs I think of empowering warmth (except when it's dominated by all white people, then sometimes I feel angry). And so naturally I could not help but think about Voguing.

This, of course, triggered a whole new group of cascading emotions. I felt proud of the culture that Voguing created. But I also felt sadness that such a vibrant community come under attack. I felt anger at the way that Voguing has been appropriated.

Straight folks just don't get it.  Even wikipedia, my trusted source and salvation during medical school, doesn't capture the emotional and communal importance of Voguing in their article.  Nor does it discuss how artists like Madonna and documentary artist, Jennie Livingston, have benefited from Voguing as its not clear what trickle down benefits the original communities experienced.

That being said, overall, as I watch some of my favorite Voguing videos on YouTube, I feel inspired and somehow calmed. It reminds me of the strength of our community and that even in the bleakest of times, we will rise again and celebrate ourselves. And mostly I feel gratitude that the generations, specifically in this case black and latino POCs, that have come before me (who have faced so much more than I have personally as a QPOC) have role-modeled such courage and beauty.

I could talk about the sanctity of queer nightclubs. Queer nightclubs are to queer civil rights as black southern churches are to black civil rights.

I could point out that Donald Trump’s asinine statements about Muslims and a radicalizing second generation are exactly the kind of ignorant bigotry that spurs these sorts of hate crimes to begin with.

I won’t though, because we all know that this has already been done and will continue to be done until this devastating event’s emotional significance is reduced to meaningless babble on repeat.

However, what has yet to come is the inevitable discussion about the mental state of Omar Mateen and the role that might have played in the shooting. Already, there is foreshadowing of this discussion as journalists report those around him describing him as “bipolar” or “erratic.”

I’m nipping it in the bud. We cannot go down that path. It’s distracting and unproductive because mass shootings are not just about mental health. Of course, mental health plays a role, but guess what plays an even larger role? GUNS.
​
Liberal and conservative politicians alike focus on mental health as a strategy to avoid discussing the true heart of the gun control debate. 

Women’s health advocates were uniformly jubilant on March 30, 2016 when the FDA updated its labeling for the medication, mifepristone. Mifepristone, sold under the brand name Mifeprex by Danco Laboratories, is commonly referred to as “the abortion pill.” It is used in combination in the United States with misoprostol to provide medical abortions. Medical abortions account for nearly a quarter of all abortions and over a third of all abortions before nine weeks of gestation.

Raegan McDonald-Mosley the chief medical office of Planned Parenthood described the change as “a significant step forward for science, for women, and for health care providers.” Vick Saporta, the president of the National Abortion Federation said that she was “delighted” by the change. Amy Hagstrom Miller, the president of Whole Women’s Health, the plaintiff in the case against Texas HB2, stated “[the] label change…is a significant advancement for women in the United States.”

Their elation is understandable. In an era of illegal and misleading smear campaigns and aggressive TRAP laws (“Targeted Regulation of Abortion Providers"), the FDA announcement is a welcome victory. Since 2010, states have adopted 345 abortion restrictions, an unprecedented number of assaults on women’s health.

​Much like expensive red wines, many Facebook relationships, and Kanye West’s psychological state, the case of Texas House Bill No. 2 is complicated.
 
Last week the Supreme Court heard oral arguments for Whole Woman’s Health v Hellerstedt, one of the most pivotal cases in abortion law in decades. The plaintiff seeks to strike down Texas House Bill No 2, commonly referred to as HB2, legislation that was passed in 2013.  It’s legislation that, under the guise of protecting the health of Texan women, has actually endangered their well being by restricting access to abortion services in Texas.
 
It will set a dangerous legal precedent if found constitutional. Not only will it impact abortion access, it could change the way we practice all of medicine.

The conviction of Peter Liang is the best thing that has happened to Asian Americans since the Immigration and Nationality Act of the 1960s. It’s also an embarrassingly example of how bewildered the minds of some Asian Americans are when it comes to race.
 
The conviction is a much-needed wake up call to those who have been brainwashed to believe the model minority myth. It’s clear evidence that white America still views Asian Americans as “other.” The “Blue wall of silence” does not cover yellow.
 
Peter Liang’s conviction makes painfully obvious three crucial facts that are necessary to understand the racial circumstances of Asian Americans. (1) American racism includes Asian Americans. (2) Through intentional legislation and campaigning, the white majority has utilized the educational and financial privilege of a portion of Asian Americans to convince society that racism is no longer an issue. (3) Asian Americans themselves have fallen prey to this message, driving a wedge between the Asian American community and other communities of color and weakening our collective power to change the status quo.
 
The model minority myth has led much of America to believe that through hard work and an unwavering dedication to academic achievement, Asian Americans have achieved the true American dream, supposedly showing that it is not systemic racism but lack of adherence to American work ethic that holds back other communities of color.
 
While the falsehoods that make up the model minority stereotype and its toxic impacts are too complex and numerous to unpack in their entirety here, exploring a few the issues is necessary.  A key misunderstanding is the origin of stereotypes. While most of us recognize that stereotypes are generalizations that cannot be applied to any one individual, we also believe that they spring from a small grain of truth.  They represent a generalization of a true trend in behavior or characteristic that is common amongst a group of people.
 
What this line of reasoning fails to capture is that frequently these behavioral trends are not inherent, but a group of people all responding to a uniform external pressure. For example, the disproportionate number of black athletes in the NBA does not represent an inherent racial ability anymore than the disproportionate number of white athletes in the NHL does. It’s a reflection of the networks and opportunities available to black males in this country. Under the same social restrictions, many black men come to the same conclusion: the only way to make it is to become a professional athlete and the only sports available are basketball and football.