October 14 | 2020
I’m a Black, Genderqueer Medical Student: Here’s My Hard-Won Wisdom for Students and Educational Institutions
Elle Lett is an M.D.-Ph.D. Candidate in Epidemiology at the University of Pennsylvania. Their work focuses on intersectionality, specifically engaging transgender/gender minority and racial/ethnic minority communities. They hold a bachelor’s degree in Molecular and Cellular Biology from Harvard College and a master’s degree in Biostatistics from Duke University. They plan to pursue residency training in Emergency Medicine and use health services research and social epidemiology to motivate policy changes that help achieve health equity for marginalized populations in the United States.
Twitter: @madblqscientist
Advice follows for how to improve higher education for marginalized communities.
Photo by Vasily Koloda on Unsplash
This article is part of the magazine, "The Future of Science In America: The Election Issue," co-published by LeapsMag, the Aspen Institute Science & Society Program, and GOOD.
In the last 12 years, I have earned degrees from Harvard College and Duke University and trained in an M.D.-Ph.D. program at the University of Pennsylvania. Through this process, I have assembled much educational privilege and can now speak with the authority that is conferred in these ivory towers. Along the way, as a Black, genderqueer, first-generation, low-income trainee, the systems of oppression that permeate American society—racism, transphobia, and classism, among others—coalesced in the microcosm of academia into a unique set of challenges that I had to navigate. I would like to share some of the lessons I have learned over the years in the format of advice for both Black, Indigenous, and other People of Color (BIPOC) and LGBTQ+ trainees as well as members of the education institutions that seek to serve them.
To BIPOC and LGBTQ+ Trainees: Who you are is an asset, not an obstacle. Throughout my undergraduate years, I viewed my background as something to overcome. I had to overcome the instances of implicit bias and overt discrimination I experienced in my classes and among my peers. I had to overcome the preconceived, racialized, limitations on my abilities that academic advisors projected onto me as they characterized my course load as too ambitious or declared me unfit for medical school. I had to overcome the lack of social capital that comes with being from a low-resourced rural community and learn all the idiosyncrasies of academia from how to write professional emails to how and when to solicit feedback. I viewed my Blackness, queerness, and transness as inconveniences of identity that made my life harder.
It was only as I went on to graduate and medical school that I saw how much strength comes from who I am. My perspective allows me to conduct insightful, high-impact, and creative research that speaks to uplifting my various intersecting communities. My work on health equity for transgender people of color (TPOC) and BIPOC trainees in medicine is my form of advocacy. My publications are love letters to my communities, telling them that I see them and that I am with them. They are also indictments of the systems that oppress them and evidence that supports policy innovations and help move our society toward a more equitable future.
<p><em>To Educators and Institutions</em>: <em><strong>Allyship is active and uncomfortable.</strong></em> In the last 20 years, institutions have professed interest in diversifying their members and supporting marginalized groups. However, despite these proclamations, most have fallen short of truly allying themselves to communities in need of support. People often assume that allyship is defined by intent; that they are allies to Black people in the #BLM era because they, too, believe that Black lives have value. This is decency, not allyship. In the wake of the tragic killings of Breonna Taylor and George Floyd, and the ongoing racial inequity of the COVID-19 pandemic, every person of color that I know in academia has been invited to a townhall on racism. These meetings risk re-traumatizing Black people if they feel coerced into sharing their experiences with racism in front of their white colleagues. This is exploitation, not allyship. These discussions must be carefully designed to prioritize Black voices but not depend on them. They must rely on shared responsibility for strategizing systemic change that centers the needs of Black and marginalized voices while diffusing the requisite labor across the entire institution. </p><p>Allyship requires a commitment to actions, not ideas. In education this is fostering safe environments for BIPOC and LGBTQ+ students. It is changing the culture of your institution such that anti-racism is a shared value and that work to establish anti-racist practices is distributed across all groups rather than just an additional tax on minority students and faculty. It is providing dedicated spaces for BIPOC and LGBTQ+ students where they can build community amongst themselves away from the gaze of majority white, heterosexual, and cisgender groups that dominate other spaces. It is also building the infrastructure to educate all members of your institution on issues facing BIPOC and LGBTQ+ students rather than relying on members of those communities to educate others through divulging their personal experiences. </p><p>Among well-intentioned ally hopefuls, anxiety can be a major barrier to action. Anxiety around the possibility of making a mistake, saying the wrong thing, hurting or offending someone, and having uncomfortable conversations. I'm here to alleviate any uncertainty around that: You will likely make mistakes, you may receive backlash, you will undoubtedly have uncomfortable conversations, and you may have to apologize. Steel yourself to that possibility and view it as an asset. People give their most unfiltered feedback when they have been hurt, so take that as an opportunity to guide change within your organizations and your own practices. How you respond to criticism will determine your allyship status. People are more likely to forgive when a commitment to change is quickly and repeatedly demonstrated.</p>
<blockquote>The first step to moving forward in an anti-racist framework is to compensate the students for their labor in making the institution more inclusive.</blockquote>
<p><em>To BIPOC and LGBTQ+ Trainees: </em><em><strong>Your labor is worth compensation and recognition</strong></em><strong>.</strong> It is difficult to see your institution failing to adequately support members of your community without feeling compelled to act. As a Black person in medicine I have served on nearly every committee related to diversity recruitment and admissions. As a queer person I have sat on many taskforces dedicated to improving trans education in medical curricula. I have spent countless hours improving the institutions at which I have been educated and will likely spend countless more. However, over the past few years, I have realized that those hours do not generally advance my academic and professional goals. My peers who do not share in my marginalized identities do not have the external pressure to sequester large parts of their time for institutional change. While I was drafting emails to administrators or preparing journal clubs to educate students on trans health, my peers were studying. </p><p>There were periods in my education where there were appreciable declines in my grades and research productivity because of the time I spent on institutional reform. Without care, this phenomenon can translate to a <em>perceived</em> achievement gap. It is not that BIPOC and LGBTQ+ achieve less; in fact, in many ways we achieve more. However, we expend much of our effort on activities that are not traditionally valued as accomplishments for career advancement. The only way to change this norm is to start demanding compensation for your labor and respectfully declining if it is not provided. Compensation can be monetary, but it can also be opportunities for professional identity formation. For uncompensated work that I feel particularly compelled to do, I strategize how it can benefit me before starting the project. Can I write it up for publication in a peer-reviewed scientific journal? Can I find an advisor to support the task force and write a letter of reference on my behalf? Can I use the project to apply for external research funding or scholarships? These are all ways of translating the work that matters to you into the currency that the medical establishment values as productivity.<br></p>
<p><em>To Educators and Institutions: </em><em><strong>Compensate marginalized members of your organizations for making it better</strong></em><strong>.</strong> Racism is the oldest institution in America. It is built into the foundation of the country and rests in the very top office in our nation's capital. Analogues of racism, specifically gender-based discrimination, transphobia, and classism, have similarly seeped into the fabric of our country and education system. Given their ubiquity, how can we expect to combat these issues cheaply? Today, anti-racism work is in vogue in academia, and institutions have looked to their Black and otherwise marginalized students to provide ways that the institution can improve. We, as students, regularly respond with well-researched, scholarly, actionable lists of specific interventions that are the result of dozens (sometimes hundreds) of hours of unpaid labor. Then, administrators dissect these interventions and scale them back citing budgetary concerns or hiring limitations. </p><p>It gives the impression that they view racism as an easy issue to fix, that can be slotted in under an existing line item, rather than the severe problem requiring radical reform that it actually is. The first step to moving forward in an anti-racist framework is to compensate the students for their labor in making the institution more inclusive. Inclusion and equity improve the educational environment for all students, so in the same way one would pay a consultant for an audit that identifies weaknesses in your institution, you should pay your students who are investing countless hours in strategic planning. While financial compensation is usually preferable, institutions can endow specific equity-related student awards, fellowships, and research programs that allow the work that students are already doing to help further their careers. Next, it is important to invest. Add anti-racism and equity interventions as specific items in departmental and institutional budgets so that there is annual reserved capital dedicated to these improvements, part of which can include the aforementioned student compensation. </p>
<p><em>To BIPOC and LGBTQ+ Trainees: </em><em><strong>Seek and be mentors.</strong> </em>Early in my training, I often lamented the lack of mentors who shared important identities with myself. I initially sought a Black, queer mentor in medicine who could open doors and guide me from undergrad pre-med to university professor. Unfortunately, given the composition of the U.S. academy, this was not a realistic goal. While our white, cisgender, heterosexual colleagues can identify mentors they reflect, we have to operate on a different mentorship model. In my experience, it is more effective to assemble a mentorship network: a group of allies who facilitate your professional and personal development across one or more arenas. For me, as a physician-scholar-advocate, I need professional mentors who support my specific research interests, help me develop as a policy innovator and advocate, and who can guide my overall career trajectory on the short- and long- term time scales. </p><p>Rather than expecting one mentor to fulfill all those roles, as well as be Black and queer, I instead seek a set of mentors that can share in these roles, all of whom are informed or educable on the unique needs of Black and queer trainees. When assembling your own mentorship network, remember personal mentors who can help you develop self-care strategies and achieve work-life balance. Also, there is much value in peer mentorship. Some of my best mentors are my contemporaries. Your experiences have allowed you to accumulate knowledge—share that knowledge with each other.</p>
<p><em>To Educators and Institutions: </em><em><strong>Hire better mentors</strong></em><em>.</em><em> Be better mentors. </em>Poor mentorship is a challenge throughout academia that is amplified for BIPOC and LGBTQ+ trainees. Part of this challenge is due to priorities established in the hiring process. Institutions need to update hiring practices to explicitly evaluate faculty and staff candidates for their ability to be good mentors, particularly to students from marginalized communities. This can be achieved by including diverse groups of students on hiring committees and allowing them to interview candidates and assess how the candidate will support student needs. Also, continually evaluate current faculty and staff based on standardized feedback from students that will allow you to identify and intervene on deficits and continually improve the quality of mentorship at your institution. </p>
<p>The suggestions I provided are about navigating medical education, as it exists now. I hope that incorporating these practices will allow institutions to better serve the BIPOC and LGBTQ+ trainees that help make their communities vibrant. I also hope that my fellow BIPOC and LGBTQ+ trainees can see themselves in this conversation and feel affirmed and equipped in navigating medicine based on the tools I provide here. However, my words are only a tempering measure. True justice in medical education and health will only happen when we overhaul our institutions and dismantle systems of oppression in our society. </p>
<p>[<strong>Editor's Note: To read other articles in this special magazine issue, visit the beautifully designed </strong><a href="https://online.flippingbook.com/view/604426/" target="_blank" rel="noopener noreferrer"><u>e-reader version</u></a>.]</p>
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Elle Lett is an M.D.-Ph.D. Candidate in Epidemiology at the University of Pennsylvania. Their work focuses on intersectionality, specifically engaging transgender/gender minority and racial/ethnic minority communities. They hold a bachelor’s degree in Molecular and Cellular Biology from Harvard College and a master’s degree in Biostatistics from Duke University. They plan to pursue residency training in Emergency Medicine and use health services research and social epidemiology to motivate policy changes that help achieve health equity for marginalized populations in the United States.
Twitter: @madblqscientist
April 12 | 2021
New Podcast: Why Dr. Ashish Jha Expects a Good Summer
Dr. Jha discusses Covid vaccine passports, how supply and demand of the vaccines is about to shift, the AstraZeneca situation, what's new with kids, herd immunity, and more.
Photo of sticker by Marisol Benitez on Unsplash; Jha photo by Brown University.
Making Sense of Science features interviews with leading medical and scientific experts about the latest developments and the big ethical and societal questions they raise. This monthly podcast is hosted by journalist Kira Peikoff, founding editor of the award-winning science outlet Leaps.org.
Hear the 30-second trailer:
Listen to the whole episode: "Why Dr. Ashish Jha Expects a Good Summer"
Dr. Ashish Jha, dean of public health at Brown University, discusses the latest developments around the Covid-19 vaccines, including supply and demand, herd immunity, kids, vaccine passports, and why he expects the summer to look very good.
Kira Peikoff is a journalist whose work has appeared in The New York Times, Newsweek, Nautilus, Popular Mechanics, The New York Academy of Sciences, and other outlets. She is also the author of four suspense novels that explore controversial issues arising from scientific innovation: Living Proof, No Time to Die, Die Again Tomorrow, and Mother Knows Best. Peikoff holds a B.A. in Journalism from New York University and an M.S. in Bioethics from Columbia University. She lives in New Jersey with her husband and son.
April 09 | 2021
How a Deadly Fire Gave Birth to Modern Medicine
The Cocoanut Grove fire in Boston in 1942 tragically claimed 490 lives, but was the catalyst for several important medical advances.
Boston Public Library
On the evening of November 28, 1942, more than 1,000 revelers from the Boston College-Holy Cross football game jammed into the Cocoanut Grove, Boston's oldest nightclub. When a spark from faulty wiring accidently ignited an artificial palm tree, the packed nightspot, which was only designed to accommodate about 500 people, was quickly engulfed in flames. In the ensuing panic, hundreds of people were trapped inside, with most exit doors locked. Bodies piled up by the only open entrance, jamming the exits, and 490 people ultimately died in the worst fire in the country in forty years.
"People couldn't get out," says Dr. Kenneth Marshall, a retired plastic surgeon in Boston and president of the Cocoanut Grove Memorial Committee. "It was a tragedy of mammoth proportions."
Within a half an hour of the start of the blaze, the Red Cross mobilized more than five hundred volunteers in what one newspaper called a "Rehearsal for Possible Blitz." The mayor of Boston imposed martial law. More than 300 victims—many of whom subsequently died--were taken to Boston City Hospital in one hour, averaging one victim every eleven seconds, while Massachusetts General Hospital admitted 114 victims in two hours. In the hospitals, 220 victims clung precariously to life, in agonizing pain from massive burns, their bodies ravaged by infection.
<img
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data-runner-src="https://leaps.org/media-library/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNjAzNjQ3Ni9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY2NTIwMTAyNX0.77dvty3a7SPumoa3cOwDKSQ8atKwu_HytV-yztByWOc/image.jpg?width=980"
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The scene of the fire.
Boston Public Library
Tragic Losses Prompted Revolutionary Leaps
<p>But there is a silver lining: this horrific disaster prompted dramatic changes in safety regulations to prevent another catastrophe of this magnitude and led to the development of medical techniques that eventually saved millions of lives. It transformed burn care treatment and the use of plasma on burn victims, but most importantly, it introduced to the public a new wonder drug that revolutionized medicine, midwifed the birth of the modern pharmaceutical industry, and nearly doubled life expectancy, from 48 years at the turn of the 20<sup>th</sup> century to 78 years in the post-World War II years.</p><p>The devastating grief of the survivors also led to the first published study of post-traumatic stress disorder by pioneering psychiatrist Alexandra Adler, daughter of famed Viennese psychoanalyst Alfred Adler, who was a student of Freud. Dr. Adler studied the anxiety and depression that followed this catastrophe, according to the <em>New York Times</em>, and "later applied her findings to the treatment World War II veterans."</p><p>Dr. Ken Marshall is intimately familiar with the lingering psychological trauma of enduring such a disaster. His mother, an Irish immigrant and a nurse in the surgical wards at Boston City Hospital, was on duty that cold Thanksgiving weekend night, and didn't come home for four days. "For years afterward, she'd wake up screaming in the middle of the night," recalls Dr. Marshall, who was four years old at the time. "Seeing all those bodies lined up in neat rows across the City Hospital's parking lot, still in their evening clothes. It was always on her mind and memories of the horrors plagued her for the rest of her life."</p><p>The sheer magnitude of casualties prompted overwhelmed physicians to try experimental new procedures that were later successfully used to treat thousands of battlefield casualties. Instead of cutting off blisters and using dyes and tannic acid to treat burned tissues, which can harden the skin, they applied gauze coated with petroleum jelly. Doctors also refined the formula for using plasma--the fluid portion of blood and a medical technology that was just four years old--to replenish bodily liquids that evaporated because of the loss of the protective covering of skin.</p><blockquote>"Every war has given us a new medical advance. And penicillin was <em>the</em> great scientific advance of World War II."</blockquote>
<p>"The initial insult with burns is a loss of fluids and patients can die of shock," says Dr. Ken Marshall. "The scientific progress that was made by the two institutions revolutionized fluid management and topical management of burn care forever."</p><p>Still, they could not halt the staph infections that kill most burn victims—which prompted the first civilian use of a miracle elixir that was being secretly developed in government-sponsored labs and that ultimately ushered in a new age in therapeutics. Military officials quickly realized this disaster could provide an excellent natural laboratory to test the effectiveness of this drug and see if it could be used to treat the acute traumas of combat in this unfortunate civilian approximation of battlefield conditions. At the time, the very existence of this wondrous medicine—penicillin—was a closely guarded military secret.</p>
From Forgotten Lab Experiment to Wonder Drug
<p>In 1928, Alexander Fleming discovered the curative powers of penicillin, which promised to eradicate infectious pathogens that killed millions every year. But the road to mass producing enough of the highly unstable mold was littered with seemingly unsurmountable obstacles and it remained a forgotten laboratory curiosity for over a decade. But Fleming never gave up and penicillin's eventual rescue from obscurity was a landmark in scientific history. </p><p>In 1940, a group at Oxford University, funded in part by the Rockefeller Foundation, isolated enough penicillin to test it on twenty-five mice, which had been infected with lethal doses of streptococci. Its therapeutic effects were miraculous—the untreated mice died within hours, while the treated ones played merrily in their cages, undisturbed. Subsequent tests on a handful of patients, who were brought back from the brink of death, confirmed that penicillin was indeed a wonder drug. But Britain was then being ravaged by the German Luftwaffe during the Blitz, and there were simply no resources to devote to penicillin during the Nazi onslaught.</p><p>In June of 1941, two of the Oxford researchers, Howard Florey and Ernst Chain, embarked on a clandestine mission to enlist American aid. Samples of the temperamental mold were stored in their coats. By October, the Roosevelt Administration had recruited four companies—Merck, Squibb, Pfizer and Lederle—to team up in a massive, top-secret development program. Merck, which had more experience with fermentation procedures, swiftly pulled away from the pack and every milligram they produced was zealously hoarded.</p><p>After the nightclub fire, the government ordered Merck to dispatch to Boston whatever supplies of penicillin that they could spare and to refine any crude penicillin broth brewing in Merck's fermentation vats. After working in round-the-clock relays over the course of three days, on the evening of December 1<sup>st</sup>, 1942, a refrigerated truck containing thirty-two liters of injectable penicillin left Merck's Rahway, New Jersey plant. It was accompanied by a convoy of police escorts through four states before arriving in the pre-dawn hours at Massachusetts General Hospital. Dozens of people were rescued from near-certain death in the first public demonstration of the powers of the antibiotic, and the existence of penicillin could no longer be kept secret from inquisitive reporters and an exultant public. The next day, the <em>Boston Globe</em> called it "priceless" and <em>Time</em> magazine dubbed it a "wonder drug."</p><p>Within fourteen months, penicillin production escalated exponentially, churning out enough to save the lives of thousands of soldiers, including many from the Normandy invasion. And in October 1945, just weeks after the Japanese surrender ended World War II, Alexander Fleming, Howard Florey and Ernst Chain were awarded the Nobel Prize in medicine. But penicillin didn't just save lives—it helped build some of the most innovative medical and scientific companies in history, including Merck, Pfizer, Glaxo and Sandoz. </p><p>"Every war has given us a new medical advance," concludes Marshall. "And penicillin was <em>the</em> great scientific advance of World War II."</p>
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Linda Marsa is a contributing editor at Discover, a former Los Angeles Times reporter and author of Fevered: Why a Hotter Planet Will Harm Our Health and How We Can Save Ourselves (Rodale, 2013), which the New York Times called “gripping to read.” Her work has been anthologized in The Best American Science Writing, and she has written for numerous publications, including Newsweek, U.S. News & World Report, Nautilus, Men’s Journal, Playboy, Pacific Standard and Aeon.