Dr. Allison Brashear is our dean of the School of Medicine at UC Davis. She oversees one of the nation's top research academic and medical training institutions with761 full time faculty and across 450 students. She is internationally known for her groundbreaking research and movement disorders, and is an expert in ATP1A3 related diseases, a spectrum of rare neurological diseases. In addition to being a physician, she holds a Master's of Business Administration with a focus in Health sector management, and expertise in health policy, and hospital clinical integration.
Dr. James E.K. Hildreth, Dr. Hildreth is president and CEO of Meharry Medical College and our former dean of the College of Biological Sciences. Dr. Hildreth is internationally recognized for his work demonstrating the importance of cholesterol and specialized membrane regions containing cholesterol in HIV infection. In 2002, Dr. Hildreth became the first African American in the 125 year history of Johns Hopkins School of Medicine to earn a full professorship with tenure in the basic sciences. In July 2005, Dr. Hildreth became director of the NIH funded center for AIDS health disparities research at Meharry Medical College. In 2011, Dr. Hilbert became dean of our College of Biological Sciences here at UC Davis. He was the first African American Dean in our University, which we founded in 1905. In 2015, Dr. Hildreth returned to the Meharry Medical College to serve as the 12th president and Chief Executive Officer of the nation's largest private, independent, historically Black Academic Health Sciences Center.
*Introductions (above) done by Dr. Rebecca Calisi-Rodríguez of UC Davis College of Biological Sciences.
Dr. Brashear and Dr. Hildreth Town Hall video with English and Spanish subtitles can be found here.
Transcript of the questions from students and highlights
Q: We live in a society with a complex array of inequities in which certain groups are disproportionately impacted. Now on top of this, we're faced with a pandemic outbreak. Now, in some ways the pandemic can be this great equalizer, and that it can affect the rich and the poor, educated, not etcetera, alike. However, there are great disparities. My question to you to start us off is, How is COVID-19 pandemic impacting many communities of color disproportionately? and why?
Dr. Hildreth- Sure, so when the pandemic started in China, they were quick to notice that if you had heart disease, hypertension, diabetes, or you smoked, your outcomes are very poor compared to the people who don't and keep in mind that China is a very racially homogeneous nation. So the fact that they were making these observations really spoke to the physiology. We now know that if you have compromised lungs or immune function, and you get COVID-19, or SARS CoV-2 virus, you're not going to do very well. It just happens that in this country for many decades, minority communities have had a disproportionate burden of those diseases, diabetes, heart disease, you name it. We also know that obesity can be a risk factor as well. So when you have living situations that promote virus transmission, you layer on top of that these comorbid conditions. That is why the COVID-19 is just devastating minority communities all over the country, really. So it's the combination of those things. That's making it so terrible.
Q: Absolutely. Can we talk about how those disparities were actually there in the first place? Why are we seeing, why is this only exacerbating what was already existing?
Dr. Hildreth- There are lots of factors that account for that. Many people live in food deserts. They can't get and have nutritious meals. You know, when people have to ride public transportation, they can't do the social distancing that you've heard about to keep themselves protected from the virus. There's poverty, there's poor education. There's the built environment that contributes to it. So there's layers and layers of things that over many years have made the living conditions and health status of minority communities different from what it is, for the majority population.
Dr. Brashear- Absolutely, the issues too, are bad access to care and having been able to get into the system, we've seen that actually with testing and with people coming to see the doctor. So making sure that we have care in all the communities. One of the things UC Davis is committed to is care to getting rid of health inequities and that means having care where you need it, in the format that you need it. And that's been one of the issues in the community is making sure that there's trust and making sure there's access and making sure that the providers are meeting the patient's kind of where they are not just physically but culturally, mentally.
Q: Are there countries that are doing a better job responding to the pandemic and maybe, as an example of better overall health care that don't have these kinds of disparities? Are those numbers coming out? Are they a good contrast from what's going on in some of our communities?
Dr. Hildreth- So let me just say that the United States was slow to respond to the pandemic. We wasted a whole month in February. We knew this was coming in January. And we didn't really take actions until March and so just to be quite honest the national response has been very disappointing. One country that's done an excellent job is South Korea. In a case like this, you want to identify the positives very quickly. Identify all those they've been in contact with, test them all and then make sure you follow those contacts to see what's going to develop the virus. That is one of the reasons why South Korea has one of the lowest per capita infection rates of all the countries. And just think about this. The United States has 670,000 diagnosed cases, out of a worldwide total of 2.1 million. That means that we have 32% of all the cases on the globe. Were only 4% of the total global population. That tells you all you need to know about how well we've done in fighting this virus, we've not done very well.
Dr. Brashear- Yeah, I agree with the president Hildreth and I think that the issue is making sure that we actually get testing out there. There were so many bottlenecks in the testing. So, one day is kits, one day it's media, one day it's swabs. And that is just the process. So we are working on multiple innovative things like 3D printing of swabs and re-processing of PPE and this and that. But you know, each one of those things has multiple possible abilities to get stopped. And then of course, you have to get the patients here and then you have to get the patients the results. I think nationally, we had some corporations that had tests out there and then the tests were done, and took seven to 10 days to result. Which is the important part, if I get a test on Monday and it's negative, but I'm exposed on Wednesday my negative test on Monday doesn't say much when I get symptoms. So not only we're going to have to get tested, but we have to have frequent tests. And then of course, we're going to need to develop the antibody testing. And that's even more crucial. And there's a lot that we don't know about the antibody testing, because it may be that we develop an antibody test, but we're not going to know for sure what that means. You need a little antibody or a lot of antibodies and how long is it going to be and is it neutralizing antibody or not? And then that's going to be luminary data for vaccines.
Q: Dr. Brashear very recently the UC Davis Medical Center unveiled its own internal rapid testing for the virus. This is the first internal testing in the Sacramento area, which means the tests are run through a machine and the results are generated on site instead of being sent out to a separate commercial lab. Right, so patients could get the results the same day? How in your opinion, is this a possible game changer? and how do I, might we be able to serve communities that are being disproportionately affected with this?
Dr. Brashear- Well, first of all, I would just want the students to know that on March 2, we had a meeting in the conference room virtually in person and about 25 different researchers, clinicians, and the pathology department and no one had ever met anybody. And it turned out that we had a biobank. We were able within a day or two to get IRB approval for the first community acquired specimen, the patient was being actively treated, to get the specimen to get it over to the virology lab to grow the virus, to give it back, so that they could validate the testing. The GMP facility here, supported by SERM is making us media and so we are working. It was a true collaborative effort so that we were able to stand up testing within about 10 days with a small machines that we helped, I think we had help from the College of Biological Sciences and others. And then we were able to get validation and move to the Biogen machine which is now able to do 1000. But it was the most incredible thing I've ever seen. In addition to being able to turn it around to clinical trials within a week. We follow the company for compassionate use. And the compassionate use drug was delivered within 24 hours, the patient got it at 3am. And that's the paper that was just published this past week in the New England Journal where Dr. Stewart Cohen was an author. I've never seen anything in six weeks, mobilize the way our UC Davis community mobilized basic science, California Primate Center, all of the schools, the School of Medicine, the clinical folks to do that. And so the resolve has been just an amazing collaboration. There's been three town halls, the last three Fridays, and there's been 300 people on all the town hall's last three Fridays. So it's been incredible. But, the point is that we've actually saved lives, because we're able to test and so we're able to actually determine when the patient has the disease, and then we can treat them. The other thing is, being able to test means that you can save PPE, cause without that we were going through a lot of PPE, and we're at risk at times of running very low. And so the test really was a game changer. And now we're able to expand the number of tests it's there's a ramp up, and a lot about validation, but it will be able to provide more testing. So now as of this week, we're testing all of the surgery patients. Today, we started testing all the admissions, all of the EDS. And so that means we're able to make our hospital very safe. Because we know when we test people whether or not the test also we can talk about later on, and I'm not a pathologist or laboratory scientists, so but it's, it is 95% specific and 99.9% sensitive, which means that as good as you get for a test.
Q: A student actually had mentioned that they see a lot of celebrities reporting COVID-19 testing results. But there seems to be a lot of people who don't have access. So what is UC Davis Medical Center doing about access for people and maybe Dr. Hildreth can comment as well from his institution.
Dr. Brashear- Right, so we're working with our community partners and to get access to them, we are being able to work collaboratively with the campus with our different physicians out there to get access to the testing. So I think that we're able to do 564 tests a day now, as long as we have enough swabs. So again, it goes back to some of that bottleneck issue. But, you know, today we connected with a variety of different partners to try to bring to meet everybody's need for testing. And that is just the diagnostic test. The next test that will come online will be the antibody test. And that will be able to be run at about 1000 a day.
Dr. Hildreth- I mean, the student raises a very important issue. And there's no doubt that there's challenges with making sure everyone has access to testing. For example, here in Nashville. We're here at Vanderbilt University Medical Centers, which is one of the largest medical centers in the country, right up there with UC Davis. They made their own tests, and weeks before the Public Health Department was testing that test the university tested 10,000 people already because they had the resources and the wherewithal to make their own test. The community that we care about, these are uninsured and poor folks who don't have insurance, they can't go to Vanderbilt because they don't have insurance, right. So we stood up a testing center to test the people in our community but we couldn't do the testing because we couldn't get the supplies. I'm not, you know, embarrassed to tell you that. I made it known to people that I do not understand how a nation that spends $3.5 trillion a year on health care should be scrambling to find swabs and buffers. It just doesn't make any sense. Its just a national failure of an embarrassing scale. I just don't know what else to tell you. Right? Just let that sink in, three and a half trillion dollars that we spend every year on health care, and we're scrambling to find swabs and masks. It's embarrassing.
Q: Dr. Hildreth, what do you believe is holding the country back from mobilizing our efforts and I guess that would relate to supply chain issues, to testing issues. Do you have any insight from your position? I think we'd all like to know that.
Dr. Hildreth- Well, let me just say this, viruses do not respect borders, city borders, county border, state borders. So California might do a great job of controlling COVID-19 virus. But if Washington State and your surrounding states don't you find yourself like where you started from? That's why national strategy was called for in the very beginning to make sure we're all singing from the same sheet of music. And there's no other way to put it, except we don't have a national strategy. If there had been a national strategy, we would all have the same tests that have been validated, all moving in the same direction. So I mean, I don't want to say anything more than that except to say there's been a dramatic failure of leadership in a lot of ways that the states are scrambling to do their own thing, even down to the community level, right. So, that's my thought. Sorry.
Q: What both of you think about the role of healthcare, academic healthcare institutions and healthcare in general and sort of pushing, sort of future planning for this kind of thing. I mean, obviously, there's economics involved in how you supply your hospitals and your staff. How do you navigate that, especially given what we're experiencing at the moment
Dr. Brashear- So I think this is the role of academic medicine. I think that academic medicine here is gonna figure out how to get the tests, how to get this out to the communities that are so desperately in need. And I think they're going to figure out how to treat this. And if we, it has just reset the importance of the schools of medicine and the health systems across the country. And it just has been absolutely amazing. The collaboration with pharmaceutical companies with schools, the UCS are I mean, I've talked to the UC Dean's now every week, all the deans of the schools of medicine talk once a week across the country at five o'clock pacific time. You know, I defer to my colleague here, but I've never seen anything like it.
Dr. Hildreth- I mean, it's true, it’s not just here in the United States, but there's been a global reaction by scientists all over the world. Not quite like anything we've seen, even at the National Institutes of Health, they virtually shut down NIH, and the only people working there are working on COVID-19. Everybody else is working from home. So I think the scientific world and a medical healthcare world has responded appropriately. But there's still a role for the National Government to provide the resources and wherewithal. So we're all working together. Because, you know, having 50 states doing different things and a pandemic, is not what you want. I mean, we need to be coordinating our efforts, otherwise, the virus is just going to keep popping up. And that's not what we want. So that's what I mean by national strategy.
Q: I'm just gonna Follow up and Dr. Hildreth's point. So another student had asked about more of a global response and their question was. Does the UN have some more appropriate role here but just like you were saying, Dr. Hildreth, you don't want 50 states with 50 different policies. We've got hundreds of countries around the world that are also involved in controlling viral spread. So is there a larger global role and given that the UN is not going to our administration just tried to withhold money from the World Health Organization?. What is the future of a global health effort here?
Dr. Hildreth- So ideally, what we want, we want a global surveillance system so that when a virus or any other pathogen when pandemic potential pops up, it can be controlled, contained and you know, sequestered. That can only work if countries are cooperating with each other, right?. We can't be calling each other names, we can’t be pointing fingers. One thing that really made me cringe was when this was called a Chinese virus. Viruses do not have nationalities, okay? This virus could have shown up in a lot of different places. I'm just saying that when politics gets in the way of science and medicine, it always creates problems and people die. So we do need a global strategy that requires us to cooperate with other nations and not do what we're doing. I'll leave it at that.
Dr. Brashear- To that, there's a great science article. The last name is Lipsitch, it came out in Science Week and it talks about the transmission and I think this idea that we're going to suddenly wake up and life's gonna go back to where it was is not accurate. And this really talks about this need to figure out how to manage this, it's really unnerving to think about that but we're not gonna have life is not going back to normal in a month.
*Reference for Lipsitch article: https://science.sciencemag.org/content/early/2020/04/24/science.abb5793
Dr. Brashear- Even if it does, a bunch of people will be sick, right, Dr. Hildreth?
Dr. Hildreth- That's right. So, the difference between the past two Coronavirus pandemics, the one that happened in 2002 SARS, then in 2012, we had the Middle East Respiratory Syndrome (MERS). Those two viruses required animals as vectors, civet cats for SARS and camels for MERS. We are the vector for this virus. That's why the world becomes so small wherever we go, we take the virus with us. That's why global strategy and a national strategy is so important, because we are the vector. It doesn't depend upon an animal intermediate. And that's what makes this so different. And the world has become so small because within a matter of hours, you can be on different continents, you know, taking the virus with you. So yes, we need a global strategy, or we need a global surveillance system to make sure that we suppress these kinds of things before they have a chance to spread around the globe.
Q: So the student points out this, the pandemic has sort of stressed our healthcare system in general, and raised the issue of physicians and other health care work workers forming unions to basically use their collective strength to strengthen safety for themselves and the healthcare system in general. I hadn't thought about organizing labor and healthcare for that system for that reason, but maybe you guys have thought about it or have opinions or views about that kind of thing.
Dr. Brashear- Oh, so what I have not seen those things, I have seen concerns about PPE. I've seen incredible generosity, UCSF to send a team of, I believe 20 people to New York and on my email are some UC Davis physicians who have volunteered to go but I do think it points out how the frontline staff, nurses, everybody is potentially exposed and how we need to take care of the family. That is all the employees. You know, we've had people who have become positive, not just doctors, not just nurses across our health system, we still have a very small number. But we are taking care of them. And we are working day and night to make sure that everybody has all the PPE that they need. And that we have easy access to testing so that we can test all the patients and all the employees that need it quickly, and then be able to get on top of it. We're a little village and then there's the whole world and we are working hard to make sure that we keep our village very, very safe.
Dr. Hildreth- The other thing that needs to be pointed out here is that, we need to keep in mind that nothing like this has happened in our lifetimes. This is something no one expected how to deal with, right? And so our healthcare system, I call it our sick care system, because you go to it when you're sick. Is not about health, in fact, lots of organizations have estimated that healthcare only represents 10% of being healthy, the rest of his behaviors, where we live, what we do. So if we took 10% of that three and a half trillion dollars invested in actual public health, we could have had a small army of public health epidemiologists to deploy in this case, we don't have that because we have a sick care system, not a health care system. So that's another thing to keep in mind. But please know that we've not seen anything like this. So we just weren't prepared for it on other levels.
Q: Back to Hildreth, You mentioned that in some ways, we're better off to deal with a pandemic now, learning what we learned from that, but in other ways we are not. Would you mind expanding a bit on that for us?
Dr. Hildreth- Sure. So in 1918, the physician didn't even know that it was a virus, right. They didn't even know it was a virus they knew it was an infectious agent. Some even thought it was a bacterium. There were no drugs available, penicillin didn't get discovered until 1928. No antibiotics, no antivirals. They did do the physical separation, they did the social distancing, and all of that. And even doing all those things still 50, between 50 and 100 million people died around the world. Now, we are in a situation where the Chinese scientists posted the genome of the virus and within one month of them doing so, three companies had a vaccine candidate ready to go. Imagine this that you post the genome sequence, in less than a month later, there are three copies of a vaccine that would normally take years and years and years. And that just shows you how far we've come with the power of big data. And, you know, molecular modeling and all of that. So in a lot of ways were much better prepared than they were in 1918. But it doesn't appear that way. Why? because there's no coordination. There's no rhyme or reason to some of this. It'd be a lot more effective if we're all singing from the same sheet of music. I hate to sound like a broken record, but that's what's missing here.
Dr. Brashear- I agree and what we've seen as a result is much of this grass roots, so grass roots getting PPE, state school going with each other. I mean we, that is just incredible that these different health systems in different states are having to go off and try to find these things when we really should be focusing on care of the patient and advances. So we're trying to build an airplane in mid flight. And then we're actually trying to get a build of a supersonic rocket also, in which we have vaccines and drugs. Meanwhile, in mid flight, we're just trying to get the blocking and tackling done. It's an unprecedented time for medical students to or people who are going into medicine. When I went to medical school, my first year, there was one lecture on this disease that seemed to be affecting gay men, and no one knew what it was. Then when I graduated 1987 I was an intern. I did internal medicine. I'm a neurologist. But I did internal medicine for the entire year at our City Hospital in Indianapolis and cared for the first intubated patient with HIV. By the time I was a neurology resident, we had drugs and now no one is admitted, and no one really dies anymore. And it is a manageable disease. I have seen it in all of the TV commercials where people's virus load is undetectable. I mean, it's unheard of. However, that is now compressed into like, a couple of weeks. I mean, it's just incredible.
Q: Some of the students are wondering about how this pandemic might influence medical schools plans for recruiting doctors and healthcare workers in the future. Obviously, they're thinking about graduating and moving on. So maybe some discussion from you guys about what they can foresee changing their past due to this pandemic, if they're pre health or thinking about healthcare.
Dr. Hildreth- If we're lucky, we won't have to deal with something like this for another, three decades, maybe another hundred years. I don't think that's going to be the case. But I'm just saying that. Keep in mind how extraordinary this thing is, and if we get back to normal with the right team, maybe we won't have to deal with this. But I do think there's an urgent need for physicians to understand public health better and to know that, there are some questions that need to be asked or don't often get asked, even if you are a surgeon for God's sakes, there are things that contribute to health that have nothing to do with some of the things that we learned about and I just wish more physicians understood the social determinants of health, because they're so very important. And I think that one thing that will come out of this is maybe there'll be more emphasis and training on those things. That would be a great thing to come out of this. But I'm hoping they won't have to deal with this in their career, wouldn’t that be great?
Dr. Brashear- I trained in Indiana and was there for many years and then spent 15 years in North Carolina. I joined UC Davis nine months ago as Dean. And one of the things that attracted me was the emphasis on healthcare disparities and the diversity of the class and students that I met or some of the most powerful stories when I came through. So, we are committed to expanding the number of primary care and we're committed to making sure that students are also serving the communities for which they come from. So that is incredibly important and now, UC Davis School of Medicine is ranked number seven in the country, primary care and number 40 and research of all the medicals by US News and World Report. The class is incredibly diverse and has been increasingly diverse over the last couple of years. So I think that is a commitment that UC Davis has. There is a commitment to to increase some of the class size. One of the issues is going to be we really trying to figure out how to teach medical students and over the last couple of weeks, the double AMC Association of American Association of medical colleges, we've had to struggle with students, where do you teach students in the middle of a pandemic and having enough PPE and everything so our students are coming back here in a couple of weeks and fourth years are now grads are graduating virtually some of the things that positions you know, they're kind of rites of passage, are getting in, and you're going to figure out where you can go be an intern that turned out to be virtual. There'll be no graduations for them some of them may be matching in some of these communities that are very hard hit. It is going to be a very interesting time to be a student and going into medical school and graduating from medical school and what I've actually coached them is to be present. And learn because that's how you learn to be a good doctor is to be present in the moment and to soak up whatever experience you have because this is an unprecedented time in medicine. I've never seen anything like it.
Dr. Hildreth- I want to point out one thing, that the medical schools are doing all they can to meet the need for new physicians. Their estimate is between 50,000 and 90,000 additional doctors over the next couple of decades. Our challenge is, we might increase the number of medical students that we can train but that also needs to be matched by an increased number of residency slots that they can go into. And so that's a huge issue. And that's where the government could play a big role by funding more residency slots. That would help tremendously as we grow the number of students but know that that's one of the issues that they share and all of us are dealing with is trying to make sure the residency slots keep up with the number of students.
Q: This is a question about contact tracing specifically about digital contact tracing. So what do you guys see as the ethical issues surrounding this technology? We've been hearing a bunch about how China dealt with digital contact tracing. How does this affect the population who doesn't have access to the internet and smartphones?
- I think we need to be innovative in how we do contact tracing. We obviously don't have the thousands and thousands of people to go out and knock on doors. But I also think we're gonna have to be mindful of how we do it. And I think also, there is an issue that not everybody has a smartphone, for example, not everybody has a computer. And that I think, is a challenge because I think we need to, we need to address those things before we just say everybody was a smart I'm gonna get tested and access. And that's how we're going to do it. I just think there's lots of questions out there about it.
- So, I mean, I totally agree. And one of the things that we're trying to do is recognizing that not everyone has a smartphone or cell phone. We need a small army of actual people, right? And, there's no getting around it. We need a small army of trained volunteers or paid folks to go out and do this. Because otherwise we're going to miss something if we don't do it that way. For the very reason that you said that not everyone is, has a technology that we can tap into. We're writing an app that can be downloaded onto a phone so that people can follow their symptoms and do all of that. You may have read about a study in London, they had 1.5 million people put an app on their phones, and every morning they would record their symptoms and other kinds kinds of information. And by doing that, they were able to determine that loss of smell and taste was a powerful predictor of people were going to get COVID-19 long before other symptoms showed up. So the technology can be very powerful and useful. And we were going to try to do that here in Nashville with our Assessment Center.
Q: As a fellow hard working woman and mother in science right now, I want to ask your opinion on inequities women may face in light of our pandemic. So in general, it's well documented that working moms bear on average, the expectation of childcare. Dads partners out there are certainly more involved in their children's lives more than ever. All right, my husband's amazing, but right now to make some space for working moms at this moment, how do you think the pandemic may be disproportionately affecting the sexes and why?
Dr. Brashear- So the, we started a call on March 2, same day we had that meeting and the very first thing came up was childcare for our residents and it is reshaping families and I think putting an extra burden on people, particularly women, who are oftentimes the caregivers and working and I am worried about the stress of on families and individuals who are working from home and teaching school to their kids and doing all those things. I think that's going to be when we, I kept talking early on about coming out the other side. And now I'm really realizing there is no other side. And we're talking about the new normal is the term I've adopted. But I do think that the US, we have been worried about domestic violence and other things that are going to come out mental health, we've had a lot of focus on wellness and we had a town hall. A couple of them on things you can do for wellness and 300 people were on it. So that I think is a thing I am, I urge people to be physically distant but socially connected. And I think that's even more important for women who are oftentimes in medicine, not always represented. It's only, you know, particularly in the leadership roles and our medical students now I'm so pleased that UC Davis is the third year in a row has over 50% women. And I think it's the third or fourth year in a row that medical students are across the country are women. So, but it is incredibly important that everybody support their colleagues and we start our calls every day at 7am with kind of the the good news or shout out's or thank you's and think that is something that's gonna hold us all in good just to add.
Q: I guess I can follow up a little bit on that whole challenge of navigating. Being a professional, a lot of our students are facing graduation as seniors and they're looking forward to that there was already a nervous and anxious time for them anyway. And now they're looking into what looks like an economic recession if not worse. And I guess from the perspective, from where you guys sit, what should they be looking at? I think Dr. Hildreth already mentioned something about thinking more about public health related careers, so maybe you can give them some professional advice looking forward.
Dr. Hildreth- Well, I'm going to give them the advice I give to all the people that I mentor, which is at the end of the day. You got to do what you're passionate about. I would just be guided by whatever passion that you have. And certainly being a physician is just a great way to serve others and feel fulfilled. But there are a lot of other ways to do that as well. I think some of the biggest heroes and all of this are folks like Dr. Burks, who is on the President's Task Force giving guidance related to public health and how to approach this. So for me, the most important thing is doing the thing that you're really passionate about. And I think to do anything other than that, you'll spend a life asking what if, and who wants that. So my advice is to pursue your passion is hard. I mean, medical school is really hard. It's not an easy thing to do and get through. But if that's really what you want to do, you got to go for it. But I just want to say that I wouldn't necessarily make some drastic decisions about changing directions based on a pandemic, because again, this might be a once in a lifetime. We hope is gonna be a once in a lifetime thing we have to deal with. So my advice is to follow your passion.
Dr. Brashear- Absolutely I agree. I think, you know, really, I like the word lead in to kind of this, experience and follow what your heart says. One of the things you probably will find is there are many ways to serve people. That may be in as a physician, as a PA, as a nurse, as a frontline responder. I've been so impressed with the interviews I've seen in the media of the frontline responders. It takes everybody to take care of the patients that's so no when, no time ever had medicine been more of a team sport. It's really just palpable and the team is everybody, and it's the basic scientist, is my colleagues on the UC Davis campus, they are part of my team. It is the nurses, it is the people who clean the hospital, it is every single person that is really working 24/7 to get this under control. And I would just figure out what gets you up in the morning. Because somewhere in there, you're going to find a way that you can plug in.
Q: From your perspective, running medical schools, what areas of change might they advocate for? And maybe even if you don't mind dipping your toe into the political spectrum here a little bit? What you did we have an election coming up?
Dr. Hildreth- I'll just say this. There are three pillars to medicine. You know, there's the art of medicine, the science of medicine, and the business of medicine. And the business of medicine has come to dominate, really, the other two. And what we need in this country is to get back to a better balance. I refer to the art of medicine is that connection you make as a musician with your patient, and I'm sure that the dean will agree with me that, at least in some settings, you'll have 30 minutes or less, to interact with a patient. And, you know, it's hard to form a relationship or to connect to the patient. And before my mother passed, she will complain that when she was went to the doctor, he'd be looking at his screen, and never really looked at her. And I think that what he was done was making sure he checked all the boxes to get paid for services, as opposed to worrying about what was. So I just think that we got to find a way to bring the art of medicine back into it, because for a lot of us, that's what attracted us to medicine in the first place. And we just gotta find, we got to find a better balance, and I don't know how to do that. But I just think that that's one of the problems that we need to address.
Dr. Brashear- I agree entirely. You know, we have pushed the envelope. So for example, telemedicine has changed overnight. Our visits went from 10 a day to over 1000 a day. And so things are gonna change with medicine and what we need to do is insist But that changed, it's gone for the good doesn't go back and that the continued exponential, so rapid approval of drugs, partnerships across institutions and with industry and changing things so that they're patient centered, which is what telemedicine, for example is being able to remote consent people. There's a whole litany of things, but we have to make sure that we do not go back. And then we have to fix the public health crisis, which is this but it's also untreated diabetes, obesity, hypertension, and smoking. I came from Winston Salem, North Carolina, and you know, smoking is bad... we have to change all of those things, because those are the things that are also putting people at terrible risk for this disease and many others.
Q: So it sounds like some of that comes back to access when we talk about public. And I know that's where we started this conversation. So some of the students were asking me about other countries models for healthcare. And you can pick your favorite one. So I'm just curious if you guys look out there and see examples that we should be paying attention to, in terms of improving or finding a better balance in our healthcare system.
Dr. Hildreth- I think they all have issues. I mean, clearly like in the UK, anyone who needs medical care can get it but sometimes there's a long waiting list. And that can cause frustrations for people. And if you look at us, just to go back to what I said earlier, we spend more than the next 10 countries behind us combined. On health care, but we don't rank in the top 10. And that's because we don't have enough focus on health as opposed to attending to sick people. My prayer is that we find a way to direct some of those resources to childhood, health and wellness, because a lot of things that we do when kids or kids have bearing when they get to be adults, and to me that would be one of the best investments we can make is to try to reduce the adverse childhood experiences aces them, as they call them, the payoff would be tremendous in terms of saving on health care, or sick care down the road. So from my perspective, we kind of just need to be more attended to health and prevention as opposed to taking care of people who are sick. That's, what I think we need to do.
Dr. Brashear- We need to make sure people also have access to primary care and you know, so not everybody has a car. Not everybody, not every community has enough physicians. And I even know I'm a specialist. I am a huge fan of primary care because they're the quarterbacks and then go out to the to the special teams like myself. And I think that we need to really put an emphasis on that and there is a disparity in financial reward for primary care and we need to figure out how to fix that it's expensive to go be a doctor, we need to figure out how to fix that. We have many challenges to do, and we need more residency slots and as a congressional issue, a Medicare funding issue.
Q: Along those lines, long lines of health disparities, it's not always about poverty, right? There have been multiple studies that show that you can have someone that's very poor with no resources, who might be white and then somebody who's very rich and might be black, and why, and yet the black person get sick with more resources. So it's not just about poverty, other things play a role, such as constant stress in the environment, microaggressions and so on. I was wondering if you might both be able to speak to that how that may be affected in general in general medicine and then in light of this pandemic.
Dr. Hildreth- Well, we know for sure that stress can dampen the immune system and how it functions. So it's not unusual for people under constant stress to be beset with some things that otherwise they wouldn't. And there's no denying that in our country still there is an issue related to race and what you look like. There have been a number of studies to show that if you have two individuals, one black, one white, same income, same level of education, all of that they go to the doctor, the white person is more likely to get the best treatment plan as opposed to the African American. And the evidence is starting to accumulate that even in COVID-19 testing, with kids being limited. There's some evidence that African Americans were turned away from testing much more than and that's a problem we got to find a way to deal with because it carries over into all the other aspects of our daily lives, and it affects our health. Think it affects the health of the nation when not all of us have the same opportunity to be healthy as everyone else. So, I don't know, there are structural challenges in all of this, that I don't profess to know how to fix, but they're there and they need to be addressed. And the longer we we ignore them and don't address them, they'll just get worse and worse. And I think the pandemic has just uncovered that on a lot of layers.
Q: Do you think that the pandemic can end up being kind of a pry bar to get government candidates, political office holders to actually address these healthcare disparities? Or do you think, I'm a little worried given some of the things that everyone has said and the fact is, this is a rare occurrence pandemics don't come about very often that will go back to business as usual. Is this an opportunity? You know, couched in a pandemic, that we can actually make progress by using it as an argument for better health care, better access, more less inequity in the system.
Dr. Hildreth- So Dr. Kaplan, this comes down to a very simple question from my perspective that is value all life. And one of my biggest fears, to be quite honest with you, you might recall in the earliest days of the HIV pandemic, when in 1981, in the summer of 1981, there were reports of young gay white men getting diseases and infections they shouldn't get as young, healthy young men. Same thing on on the east coast. And because of the political and social construct at the time, the resources needed to address HIV was not coming, because it was thought it only affected gay, white men. And being gay was not something that was looked on favorably by society at the time. So what would happen if it starts to appear that COVID-19 is devastating brown and black folks and poor folks, but was not that big of an issue for the majority of population. What do you suppose what happened in our USA, given where we are? So one of my biggest fears is that if this turns out to be a problem like HIV was, and in the early 80s, mid 80s, whatever, we'd be having those same kinds of conversations, and that would be so that would just be really, really bad. But given where we are, as a nation, we're watching what is happening. To me, that's a real possibility. Some of the things that I've hear, I've heard people say, or leadership roles makes me cringe. I mean, so I'm hoping that this will be a wake up call, especially to young people, that if you don't like the situation, and I don't want to talk politics, but I will say this every vote matters. If you don't like the way things are, please go to the polls and make your voice heard. That's one way that we can change the trajectory where we are right now is for people that have voices heard or by, you know, getting out and voting.
Q: From your perspective, from where you sit, how do we hold leaders and I guess that could run the gambit from university presidents to governors? You know, how do we hold them accountable, so that we don't run into a similar situation and have them begin to address some of these inequities? And I guess I'm asking from your perspective, our students can't, you know, they're not sitting in your seats and they're not wearing your shoes, but what can what can you do in your positions if you think.
Dr. Brashear- On mine, I thinking about being a leader is you find the very best people to be on your team and you let them do their job, and you elevate and bring out all the talent. I have been incredibly impressed about in the beginning of our conversation about what happens when we put a bunch of people in a room and kind of made, took the rules away and timeframes away. So the IRB was working 24 seven and people just blossomed and became leaders of teams and the teams became incredibly nimble and effective. And that's what I think as leaders we owe the community, the school, the institution, entry to be able to do and do that in any environment. This has just been an environment that is really called for expeditious, nimble innovation 24/7. But I hope that it shows people you're going to talk to Angela Hacks who here think that a couple weeks and, you know, we gave her unfettered opportunities and what that group of multiple investigators did was, nothing short of amazing in terms of getting things done, and that's what I think leaders have to do.
Dr. Hildreth- I agree. And I've been very encouraged to watch some of the governor's how they've stepped into the role of other a vacuum or a void that was created by the lack of national leadership. So you have to give some of the governor's a lot of credit, even some of the mayor's who took it upon themselves to do what's right. And I really applaud that. And I think that's what leadership is about. I agree with the team. You try to find the best people for the roles you have. And you give them the resources they need. And what I do is I get out of the way, because if you've chosen the right people around you, you know, you just get out of their way and watch the magic happen, right? And I wish that place for this pandemic, but not so much. But anyway, I think that's what we need. That's what we want. And in terms of holding the leaders accountable, the elected officials, at least you hold them accountable by going and vote and voting. I mean, I think it comes back to that, that if you're not happy with the leadership we have, you have to change it and how you change it is you make your voices heard, right. It seems to me that some of them, that's the only thing they care about. I mean, I know they're not all like that I shouldn't, you know, just throw it all into that category. But that matters. It matters for your voices to be heard, because that's how change happens in our political system. But I have to say that some of the governors are just during an amazing job to me from our perspective, of listening to the science, making decisions based on science and putting the resources where they need to be, and that's what we want, what more could we ask for? So I have to say I take my hat off to those who've done that.
Q: The student raised issues how scientists in general had been pushed back on climate change, for example. So have you guys been experiencing pushback and sort of how you've been dealing with pandemic locally?
Dr. Brashear- Now, no pushback whatsoever. At UC Davis, we've got the support of Chancellor and the provost and all the leadership and it's been absolutely tremendous. No, I have not seen any pushback and anything that we've got an app or has been delivered expeditiously.
Dr. Hildreth- We certainly have not had any pushback from that perspective. And in fact, I was asked to be a part of the mayor's COVID-19 task force to try to make the science understandable to the people in this region. And I've been trying to do that. So I think there's a hunger, at least in this pandemic for people to know what's really going on. There's a lot of misinformation out there. So to the extent that we can get the factual information out there, I think it helps. But this all comes down to to one thing, can we, why would we want to reopen? The quote unquote, economy? If it means 10s of thousands of people are going to die? Do we value the, which is more? So it all ties into the same thing, right? I don't think that people disbelieve the science of climate change the applications of doing what we need to do to address it means the loss of billions of dollars for some folks. So again, it's politics, clashing with science and knowledge and doing the right things to preserve life. And again, it comes down do we do we treasure life value life equally? If the answer was yes. A lot of things that we were doing will be done differently. That simple as that.
Q: What about the occurrences of structural racism and healthcare being taught is being taught in medical schools. Is there a push to teach medical students about the problems healthcare is facing? So the inequities can begin to be addressed?
Dr. Hildreth- Excellent. Yes, the answer is yes. But I think the LCME and the dean can correct me if I'm wrong, but I think that one of the requirements for accreditation now is that medical students must learn about some of the social aspects of medicine, including implicit bias, and all of those things. So I think there is a recognition that it is a problem. And it's part of the curriculum. Now most of the medical schools have not, and the dean might have something to add to it.
Dr. Brashear- I absolutely agree. And it is key to our teach our medical students but also give them the experiences so that they can be out in the community and see what needs to be changed. So they're absolutely as you know, we we need to continue every day to begin to learn about people's biases. And again, this pandemic's shines a light on that, sometimes, unfortunately, a bright light on, on some things that people are saying that incredibly unfortunate and just seeing some of the stuff that's on the news is just terribly unfortunate that not everybody's getting the care that they need, and we have not fixed that over. Since it was the beginning of January when the virus became known. And there were warning signs and, you know, this crisis could have been much less than it is now. The numbers that have gone up over the last week are just unbelievable.
Q: Dr. Hildreth was mentioning about sick care in our country, and so the student was wondering, the emphasis or the balance between health versus sick care in the US is a contrast by another healthcare system somewhere else that does a better job. So are there examples out there? I think a lot of our students are looking for answers and they're looking abroad. You know, are there better systems out there? And I obviously I can tell where this comes from media, but but do you guys have some perspective on how to get that balance better? Are there examples out there?
Dr. Hildreth- Well, this is gonna sound a little bit odd, but part of our problem is something is an old idea that kept medicine from becoming modern in the United States something called American exceptionalism where we thought that we were stronger than, better than smarter than. So we're slow to adopt some of the scientific principles of medicine back in the turn of the century after the Revolutionary War. So, to me, part of our problem is that we, the big we seem to think that we know better, we do better, we are better, when in fact there are some countries have spent a lot less on health care and a much better outcomes and are healthier than we are. I've already mentioned we're not even in the top 10 of healthy countries based on certain methods. Why should that be? I mean, you know, I don't understand that. And the reason is, we don't pay attention to public health. We only pay attention to people when they're sick. If we invested some time, money and energy, especially in children, and children who don't live in certain zip codes, that would reduce the cost of health care for everybody. And all of us, we would be healthier. So I hate to sound like a broken record, but that's what it comes down to. Can we just invest in beard as an investment? Not as a,i don't know It's, we need to invest in the well being of people when they're specially when they're young. For example, in some cities in this country, the obesity rights in kids is, is unbelievable. And we all know that they're being set up for diabetes and all kinds of other things when they get older. Is that acceptable? It must be because we're not doing anything about it. But that's what I mean by if we just had a focus on public health, especially for people when they're young, we could change the trajectory of healthcare. or health in this country permanently. But that's a political thing. And politics gets in the way medicine science. And that's you know. So for students who,
Q: If you had designed a course on healthcare, global healthcare systems, what would you be putting in your curriculum? How would you be showing students that, oh, here's a system that does it right in this way, or here's a system that does it right and another way, and maybe maybe you don't know all the healthcare systems across Europe? I don't know. So I think that's what students are kind of craving some example they can point to and say, Ah, that works, or at least it works better.
Dr. Hildreth- I think it's fair to say that none of the systems are perfect. They all have their limitations and drawbacks But one of the things that I do have that we don't have most of them is that no one has to worry about whether they'll get taken care of if they get sick, or they'll go bankrupt if they get sick. And so, one great improvement we can make. And I'm not advocating for single payer system, or anything else. Anyone in the United States of America will get sick, deserves to be treated, as far as I'm concerned. And how we achieve that? I don't know. But I think that's one thing that we should be trying to figure out how to do that. And I hope that we will. But the thing you might know more about other healthcare systems than I do. And let me just point out one other thing. We are establishing partnerships with Universities in Africa and other places. And I can tell you, some of their outcomes for certain things are better than ours. And they don't have the fancy machines and technology that we do yet somehow. In terms of have, you know, low birth weight children, kids and maternal death after giving birth to children, somehow they have better outcomes than we do and we don't, they don't have all the fancy technology and equipment. So maybe we should be looking into how they do things, and not be so arrogant to think that because they are who they are that they have to teach us something. So I'm sorry,
Dr. Brashear- No, no, I agree with everything you said I would actually challenge students to think about outcomes as much as mentioned, because, and continuous care. So, the care of the patient, when they're in and out of the hospital, that whole continuum, you know, like a stroke patient, for example, a patient coming in to have a stroke. We give them TPA, we give and we spend all this money, and then we send them home. With prescriptions, but they don't know if I had gas to go get it, they don't have a caregiver. They don't know when their next appointment is. And oh, by the way, we don't see him for three months to check their blood pressure, et cetera. And so, you know, being outcome driven as healthcare writ large providers, I think is is imperative. And then you can actually say, well, the money you're spending is aligning with the outcomes. So we're really good at saving lives. Mine as a neurologist in stroke, for example, but we're not so good in lowering the risk factors for those things that for the stroke, and so that's one thing I think is really important in some countries. I think do that better. That's lower cost. Not as much, you know, the underlying disease processes.
Q: When you when you have a public healthcare system where there's less barriers of getting in early for health care as opposed to sick care, then you're going to be ahead of that curve. And does that seem consistent with what you guys are thinking and will help our students?
Dr. Hildreth- Absolutely, you're right, and people show up in the emergency room for care. And taking care of someone in an emergency room a lot of times, is nine times or 10 times more expensive than if they had a primary care doctor who could have seen them in another setting.
Dr. Brashear- So that's one thing that this crisis has given us, it's really put a light on the need for telemedicine and 24/7 care, particularly primary care. So, you know, we didn't want all these patients coming into the emergency room to get screened for flu/COVID and had to be very creative and set up other ways to do that. Those are things we need to hard code now into our systems. telemedicine, other hard code. So, but boy, we've got a lot of work to do. And for everybody that's interested in any type of medicine or science right now. Wow, this is like the time to be in, in medicine of any type and science of any size. Because well I mean, things are moving so fast and it's so very exciting. And you can make such a big difference.