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Racism is a malignancy: Ibram X. Kendi reflects on his cancer experience

11/04/2020, Cancer Letter

by Alexandria Carol

After receiving a stage 4 colon cancer diagnosis, author Ibram X. Kendi sought consultation at two hospitals located a mile apart.

The first hospital served white and wealthy people. The second treated Blacks and the working class.

At Hospital 1, a doctor told Kendi that surgery was an option. At Hospital 2, the option of a life-saving surgery was not presented.

At the rich and white hospital, the surgeon was thorough. “He looked not only at my CT scan, but had an MRI done, studied the MRI, and decided that technically, he could go in and do surgery. Of course, he wanted more shrinkage in order to do that,” Kendi, professor of history and international studies, and director of the Boston University Center for Antiracist Research, said Oct. 26 during the virtual annual meeting of the American Society for Radiation Oncology. 

“After I saw him, I had a consult with the surgeon at the hospital that I was getting treatment at—and this was a hospital that primarily served working class people and Black people. And the surgeon did not look at the MRI—[he] looked at the CT and decided that there was pretty much nothing that he could do, and basically told me as much in the meeting,” said Kendi, also a columnist at The Atlantic, correspondent with CBS News, and author of four books, including How to be an Antiracist and Stamped from the Beginning: The Definitive History of Racist Ideas, said during the keynote talk.

Kendi’s books are widely read in oncology (The Cancer Letter, Aug. 7, 2020).

Kendi’s cancer is in remission, and the experience changed his perception of medical care. How could he receive life saving treatment at one hospital, but not another?

“I mean, a doctor needs more information—why would he not look for more information?” Kendi said. “It really showed me the stark differences at two hospitals, with the same case, that were about a mile away.”

At the ASTRO meeting last week, Kendi was in conversation with Curtiland Deville, clinical director of radiation oncology at Johns Hopkins Kimmel Cancer Center at Sibley Memorial Hospital and associate professor of radiation oncology and molecular radiation sciences with Johns Hopkins Medicine, about learning to be anti-racist, and applying that to oncology.

 

Anti-racism in cancer care

The experience has given Kendi a life-and-death vantage point on health disparities. Oncologists should address racism in the same way they respond to cancer—treat it as a disease rather than a way of being, Kendi said.

“Let’s compare it to cancer. If Americans commonly viewed—when an oncologist came in and told them that they have cancer, and let’s say, if a person believed that they were saying that cancer is essential to who they are—as opposed to—this is a disease that at some point you developed, certainly, you may have a genetic predisposition to it. But it’s not necessarily your fault,” Kendi said.

“It’s not something that is essential to you. I think if people have that belief, it would be much harder for oncologists to do their jobs—because people would be like, ‘No, I’m not fundamentally that way,’—but I think people have a common knowledge that when someone diagnoses them with cancer, they’re saying they have a disease, they’re not saying that they can’t be treated.”

People view racism as an attack term, an identity, that it’s “like tattooing an R-word on my forehead,” Kendi said. “That is all part of the reason why people are very hesitant to acknowledge the ways in which they are being racist—and in order to be anti-racist, we have to acknowledge when we are being racist.”

How can oncologists help to support anti-racist efforts? First, it would help to understand what racism looks like.

“Every single one of us, no matter the color of our skin, no matter our background, no matter who we love, need to recognize that in many ways we were born into a country with racist ideas raining on our heads,” Kendi said. “The more we have an understanding of anti-racist ideas, and the more we strive to be anti-racist, the more we’re going to treat people equitably in our everyday lives without even necessarily knowing it.

“It’s important to recognize that the opposite of racist is not not-racist. The opposite of a racist is anti-racist—and if a racist idea suggests racial hierarchy, that certain racial groups are superior or inferior to others in certain ways, then an anti-racist idea suggests that the racial groups are equals.”

 

How to diversify the field

Radiation oncology is coming to grips with a lack of diversity in its ranks.

study by Christina Chapman et al. reported that women and traditionally underrepresented minorities in medicine—Blacks, Hispanics, American Indians, Alaska Natives, Native Hawaiian, and Pacific Islanders, account for 33.3% and 6.3% of radiation oncology residents, respectively.

Women and underrepresented minorities are also underrepresented at the resident trainee level compared with their proportions as medical school graduates, at 48.3% and 15.6%, respectively. Women are better represented among medical oncology fellows, at 45.0%, whereas underrepresented minorities account for 10.8% of medical oncology fellows.

The study found “there is no trend toward increased diversification for female or URM trainees over 8 years, suggesting underrepresentation is not diminishing.”

Creating a diverse pipeline could mitigate inequality in the field, Kendi said.

“How you consider a student to be qualified is absolutely sort of critical—but even then, I think that everyone can essentially be like a college football coach, in that when college football coaches feel as if there is a pipeline problem, what they do is they create the pipeline,” Kendi said. “Whether it’s creating and supporting high school football in their state—they think of very deliberate ways to create a vertically integrated pipeline that could lead to them. Everyone can engage in that type of work, for any type of people that are underrepresented in your group.”

Recently, The Cancer Letter published the results from a survey that assessed diversity in the leadership of academic cancer centers. The survey, conducted in collaboration with AACI, found that—of the 78 directors of cancer centers who responded—two in nine are non-white, and two in 13 are women (The Cancer Letter, Oct. 10, 2020).

Those in leadership aren’t the only ones who can make change happen.

“Every single one of us has the power to recognize, in our specific unit, in our specific hospital, in our specific community—potential policies that are creating inequity and even injustice, racially,” Kendi said.

To do this, oncologists need to ask themselves—“What are the groups, or what are the individuals that are challenging those disparities?” Kendi said. “What can I do to support that move, that organized move against racist policies? Every single one of us has the power to do that.”

Asked to address mistakes institutions make while attempting to address health, inequity and workforce diversity, Kendi said:

“There’s a perspective that part of the cause of racial health inequities, or let’s say, a certain racial group being underrepresented, is their behavior. The common belief about racial health disparities, even within the healthcare community, is it’s the result of racism and behavior—and so what happens is, if you believe it’s partially behavior, then you develop programs, let’s say, that are typically expensive, to civilize and develop people—when that wasn’t even the problem to begin with.” 

If you want to put a dent in racism, you need to get beyond blaming the victim. You need policies.

“You’ve talked about where things like pipeline and enrichment programs may not do enough, or there’s sort of an over-focus just on that,” Hopkins’ Deville said.

“That type of program, especially if it’s focused on enhancing the skills of individuals, or even the mentality of individuals within the program—these programs are conceived of as programs that help the community. At best, they help the individuals in the program,” Kendi replied. “There’s this constant blame, in which the people are behaviorally deficient, as opposed to their ways in which policies are excluding people or taking people out. Policies and instituting policy change helps communities, programs help individuals.”

Copyright (c) 2020 The Cancer Letter Inc.

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