Justin McArthur, MBBS, MPH, on Addressing the “Uncomfortable Truths” in Health Care Disparities

In this podcast, Justin McArthur, MBBS, MPH, discusses the changes that need to be made in the research community to encompass a larger representative cohort, how current events will shape the future of neurology, and how the American Neurological Association has responded. 

Additional Resources:

• ANA 2020 Virtual Meeting. American Neurological Association. Accessed July 8, 2020. https://2020.myana.org/
• DiAngelo R. White Fragility: Why It's So Hard for White People to Talk About Racism. Beacon Press; 2018. https://www.amazon.com/White-Fragility-People-About-Racism/dp/0807047414
• McArthur J. Ingrained injustice: the ANA responds. Published online July 1, 2020. Ann Neurol. https://doi.org/10.1002/ana.25836
• Summer conversation series. American Neurological Association. https://myana.org/education/ana-webinars

Justin C. McArthur, MBBS, MPH is a professor in and director of the Department of Neurology at Johns Hopkins University School of Medicine in Baltimore, Maryland, and is the president of the American Neurological Association.

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TRANSCRIPT:

Amanda Balbi: Hello everyone, and welcome to another installment of Podcasts360. I’m your moderator, Amanda Balbi with Consultant360 Specialty Network.

It is well known that racial and gender disparities exist in medicine; for instance, Alzheimer disease affects Black adults differently than White adults and women differently than men. The recent events across the United States have further highlighted racial and gender disparities, allowing for a wider-reaching dialog that spans into the health care field.

Joining us today to discuss health care disparities in neurology is Dr Justin McArthur, who is a professor in and director of the Department of Neurology at Johns Hopkins University School of Medicine in Baltimore, Maryland, and is the president of the American Neurological Association.

Thank you so much for joining us today, Dr McArthur.

To start, what changes need to be made within the research community to address racial and gender disparities?

Justin McArthur: So this is a huge topic and obviously has been brought vividly to light with the events around the killing of George Floyd and other people of color often at the hands of police brutality, and I think the events of the last few weeks have forced many organizations, including both of the organizations that I'm involved with—Johns Hopkins and the American Neurological Association—to self-reflect on what we have done or what we have, in many cases, not done to improve racial and gender disparities within our organizations.

I'm very happy to say that both the ANA and Johns Hopkins have embarked on some—what I hope will be—very positive steps. First, to educate but more importantly, or equally importantly, to create action points that I think truly will have an impact on the elements that have brought us to this point today.

Amanda Balbi: So specifically, when it comes to research, say, for Alzheimer disease, how do you think researchers can be more encompassing when it comes to patient cohorts?

Justin McArthur: I think a great example of that is actually our Alzheimer’s Disease Research Center here at Johns Hopkins, and I'm very proud of the work that Marilyn Albert, who leads that center, has done.

Her group has developed some really robust and quite effective community outreach tools. They have involved the community, including faith communities, and community groups in the process of recruitment and also importantly in designing trials around Alzheimer disease.

It's not simply a uni-directional process; it's a bi-directional process to improve recruitment in improved participation to get information about trials back to the community. Her work has actually been given awards by community groups, and she has very high participation rates among people of color.

Obviously, this pandemic of COVID-19 has changed medicine in many, many ways, not least the application of , and I think there's a great prospect for telemedicine to actually reduce—maybe not eliminate but to reduce—some of the health care disparities that we see in our community.

Clearly telemedicine has the potential to provide greater access to people of color who may not have access to specialists, such as neurologists, who may not have access to neurological trials or neurological clinical research.

And frankly, the only limitation of using telemedicine for neurological research is the continued digital divide that we see in this country between communities that are affluent and have broadband internet and communities like Baltimore where 25% of households in the city do not have broadband internet connections.

So I think that can be fixed and needs to be fixed rapidly and could lead to dramatic improvements I think in health care access, both for clinical care and also for clinical research.

Amanda Balbi: Absolutely. So how do you think a new awareness of racial and gender equality might affect the neurology community as a whole?

Justin McArthur: I suspect a lot of us in the neurological research community have spent the last few weeks learning some very uncomfortable truths about ourselves and trying to move from the state of, if you will, “passive acceptance” to a much more active to playing a much more active role in trying to overcome and defeat, if you will, systemic oppression that clearly exists today.

Communities of privilege have either not been aware of or not wanted to be aware of fully, and so this process is really beautifully exampled in a book called White Fragility, which talks about the issues that White communities of privilege or White communities of advantage have in facing up to racism even accepting that racism exists. Until we do come to that self-realization that racism is here, racism needs to be actively overcome by communities of advantage, nothing will really change.

Amanda Balbi: This brings up the point of unconscious bias. Can you talk a little bit about that and how providers can overcome it?

Justin McArthur: Absolutely. So again, I'm certainly not an expert in this area, and I'm still learning many of the facets around unconscious bias or implicit bias.

I would say there's some controversy as to whether implicit bias training, which many institutions, including my own, require now for leadership positions, whether they actually work. And I think we need to approach these kinds of efforts with scientific rigor and look at the outcomes of this training.

I think there’s the potential, not necessarily to do harm, but not to do as much good as perhaps we think implicit bias training is doing. And so I would really encourage implicit bias training to be done, to be professionalized, and to be examined in terms of its outcomes.

That's one statement about implicit bias. The second is, again, I think we all have a responsibility and as neurological researchers to actively and consciously examine what we're doing, and that has to begin with a process of self-education and self-realization so that we are much more knowledgeable about how we come across to other people, particularly people of color; how we treat people of color in everyday life; and how we begin to dialogue about these issues.

There's a language that is just like any language that needs to be learned, so that we can accurately and effectively communicate about these issues. I'll fully admit, up to now, I have not necessarily learned that language, and I still don't feel fluent in the language that we need to be transparent about addressing these problems.

Amanda Balbi: Absolutely. I’m sure providers across the country are dealing with that challenge as well. So in your opinion, how might the protests and other current events happening nationwide affect careers in the field and career development?

Justin McArthur: I'm not sure that we're seeing yet how the protests are affecting careers and career development, except that people in leadership, including myself, I think are recognizing that organizations, like the ANA and to some extent like Johns Hopkins, have not been exemplars necessarily of equality, equity, and equal opportunity for all.

We're trying to fix that; it cannot be fixed overnight. I think the efforts that we're trying to make need to be done with great care and with a great deal of thought and by soliciting ideas not only from people of color, but from everyone who's involved in these organizations so that it truly can be a participatory process.

Some immediate steps the ANA and Johns Hopkins Department of Neurology are taking are we've embarked on what we call a “summer conversation series.” So instead of Grand Rounds this summer, we will have seminars and webinars on social justice once a week through the summer to begin the process of self-education.

At the American Neurological Association meeting in October, which will be held virtually, of course, because of COVID-19, we will have a 5-hour symposium on social justice issues, implicit bias, and the facts around implicit bias training.

We will have speakers focusing on systemic oppression as it pertains to neurological research and neurological research communities. We've also embarked on a series of steps to endow a lectureship in the name of Dr Audrey Penn, who is the first and only Black woman president of the American Neurological Association. She has agreed to lend her name to this endowed lectureship, which will be at the annual meeting each year, beginning with this year.

We're also preparing what we call an IDEAS Task Force. IDEAS standing for inclusion, diversity, equity, anti-racism, and social justice. That was coined at the University of Rochester, and I think it really encapsulates a lot of the ideas that we're trying to strive for in organizations such as the American Neurological Association.

What we're planning to do is to use this to make absolutely sure that leadership across neurological research, neurological education, that leaders in academic neurology are truly educated in the issues of social justice, that they're committed to the principles of inclusion and diversity, and to fostering an anti-racist professional environment. And again, I think what we're trying to do is shift from a passive stance to a much more active stance with regard to these issues.

Another element that will be focusing on is really access to neurological care. We believe, as an organization, that no one in our society should be denied full access to our health care system because of poverty, medical literacy, or discrimination. The ANA will be sponsoring and promoting the work of health care disparity researchers and the idea that everyone is entitled to quality neurological health care.

Amanda Balbi: Great. Thank you again for speaking with me about this important topic today.

Justin McArthur: Well, it's been my pleasure to be here. And this is such an important topic, and I really want to emphasize that we need to shift to a much more active stance to fight systemic oppression.