- Good afternoon.
- [Woman] Good afternoon.
- This is a great turnout, wow, fantastic.
I'm George Daley, I'm the dean
of Harvard Medical School,
I apologize for being late.
This has unfortunately become
my MO, I had a late meeting,
but I'm here, and I'm
absolutely delighted.
I remember our meeting last
year, and this is always
a remarkable celebration of our community.
So we are here, because we
are gonna be celebrating
extraordinary recipients
of our diversity awards.
And, I am always inspired by the history
of Harvard Medical School,
and these three individuals,
whom we honor today.
To imagine that these doctors,
Doctors Howard and Dorsey
and Still, were graduates
of Harvard Medical School,
Class of 1869, and I think Class of 1871,
I think it's part of our proud past,
at Harvard Medical School,
and we're gonna be hearing
a bit more about their
careers, and their histories,
from Doctor Joan Reede.
I'm also very, very pleased to welcome
our distinguished lecturer,
Doctor Otis Brawley,
who was until recently the chief medical
and scientific officer, and
the executive vice president
of the American Cancer Society.
We have met previously, as I've pitched
the American Cancer
Society, I can't remember
if I got the money or not, but.
(group laughs)
I know there was a big ask,
at one point, in my past.
But anyway, Doctor Brawley is now
the Bloomberg Distinguished
Professor at Johns Hopkins,
where he's leading a
broad, interdisciplinary
research effort into
cancer health disparity,
so thank you, Doctor
Brawley, for being here
with us today.
And I think we are all
gonna be equally inspired
by the recipients of this
year's diversity awards,
their commitment, their work
on behalf of the community,
has brought meaningful
change, and they have clearly
shown us how diversity
enriches all of our lives,
and how diversity is
founded on the strongest
principles of excellence.
Right from the beginning,
when I first became dean,
one of my first phone
calls was to Joan Reede,
and in part because
diversity and inclusion
is a very, very high priority.
It's one of our most important goals,
and we are deeply committed,
as an institution,
as a university, to this work.
And it goes way beyond
the issues of fairness,
it really is about embracing
excellence, actually in
reviewing my comments
today, I actually got online
and did a little bit more
research, and there is
a significant amount of
social science research,
and a growing body of
literature, some of which my wife
who works in teams has directed me to,
and the idea that when you
bring multiple perspectives
to teams, the teams
function more effectively,
they make better discoveries,
and they contribute to
a greater sense of
meaning and satisfaction
for the participants of the team.
So, I'm incredibly moved, as
I look at this community here,
to realize how much
richer our environment is,
because we bring an eye towards diversity,
and celebrating that diversity.
Joan I think has been a
leader in creating a culture
that teaches us that
diversity and excellence
go hand in hand.
And because of the
dedication and hard work
of the folks today that we
are going to be honoring,
and I have to say it's not just
those we're honoring today,
but folks who continue to work tirelessly,
throughout our community,
we've made significant strides.
But, like so many areas,
at Harvard Medical School,
we can never be complacent,
we can never be satisfied
with where we are, we have to
keep striving to do better.
I'm so pleased that we
have such great leadership
behind Doctor Reede, but I
call everyone in this community
to work on behalf of the core mission
of improving our community, because truly
we are better together.
So thank you very much, it's
my pleasure to turn over
the podium to Doctor Reede.
(group applauds)
- Thank you very much, good afternoon.
- [Group] Good afternoon.
- I see some of you have
known me long enough
you know to respond, you know
we're just going over and over
we're gonna do the same thing.
Thank you Dean Daley, for
allowing me to be part
of this institution, to be
a part of an institution
that recognizes diversity and
inclusion and respect for all,
and valuing all is part
of its core values.
In 2004, Doctor Nora Nercessian,
who is a former associate
dean for alumni affairs here,
published a book called Against All Odds,
there's copies of the book in the back,
if anybody would like a copy of the book,
please pick it up.
It chronicles the history
of what we might call
civil rights, affirmative
action, diversity
at Harvard Medical School,
going back to 1850,
so please take one of the books with you.
She covered 150 years of
African American presence
at Harvard Medical School,
and really brought to life
the lives of Black men,
and women in medicine,
and their struggles, their determination,
their triumphs, and in this
were the stories of Howard,
Dorsey, and Still, the first
three Blacks to graduate
from Harvard Medical School,
and a little about them.
In 1869, after graduation,
Edwin Howard practiced medicine
in Charleston, South
Carolina, and then later moved
to Philadelphia, where was
essential in establishing
the Frederick Douglass Memorial Hospital,
and that was in 1895, and
at the time it was the only
hospital in Philadelphia
serving African Americans.
He then went on to establish
the Mercy Hospital in 1905,
and here's a quote of him
about he established it,
and as I read you some of these things,
my hope is that you think
about where we are today,
how far we've come, and how
much this still resonates.
The present hospital,
the Frederick Douglass,
having assumed the character
of a privately managed,
narrow, unprogressive institution,
fails to meet the objectives
for which it was organized,
an opportunity for Negro
physicians to get the incalculable
benefits of hospital practice,
which other hospitals
had denied them.
Also to train our girls in nursing,
as well as giving our people
additional hospital facilities.
So even then there was this
awareness of the need for access
and for training physicians
and nurses, of diverse groups.
Thomas Dorsey was the first
student of African descent
to actually earn his degree
from Harvard Medical School,
and we very little about
what happened with him,
we know he settled for a period in D.C.,
and during that time there would
have been the establishment
of Howard University and
its college of medicine.
But if we turn to Doctor
Still, James Still,
he graduated with honors at
Harvard Medical School in 1871,
and actually settled here in
Boston, where he practiced.
And part of the reason, the thinking
why he might have actually
come to Boston was he saw it
as an abolitionist city.
He was the first African American elected
to the Boston school board,
and was involved in opening
the first African American teachers
into Boston public schools.
He was a spokesman for civil rights,
and was actually his
nephew, William Still,
who is recognized as the father
of the underground railroad.
So in addition to paying
tribute to these three men,
there are many other amazing
individuals in our community,
and that's who we're here to honor today,
and those are for the Harold
Amos Faculty Diversity Award,
and the Sharon P. Clayborne
Staff Diversity Award.
Just a little bit about Harold Amos,
and we have a new video
that you have not seen.
He was the Maude and
Lillian Presley Professor of
Microbiology and Molecular Genetics.
He joined our faculty in
1954 as an instructor,
and became the first African American
department chair in 1968.
He was also the first
African American individual
to earn a doctoral degree
from the HMS Division
of Medical Sciences in
1952, a lot of firsts,
and now Harold Amos.
(whispers faintly)
- Sorry.
(guitar music)
- John Ingraham at Davis
knew Harold very well.
It was difficult not to know Harold
if you were a microbiologist,
and he was by that time,
very well established,
and very highly respected,
so he told me, "You're gonna
really enjoy meeting Harold."
So, of course, he was right.
Meeting Harold at this
interview was a delight.
He wanted to talk science,
he was really interested
in my science, but he also said,
he looked at me and says,
"You look sort of thin,
"you don't eat enough."
(laughs)
And he said, "Don't tell me
you're one of these people
"who does exercise."
(laughs)
- I ended up meeting and
playing Harold Amos in tennis,
and that's how I first met him.
He always won.
He was a very good
tennis player, actually,
and he always won, but it
was fun playing with him,
and it was enjoyable.
- As a young scientist just
coming out of postdoctoral work,
I was offered a job, here
at the medical school,
in the bacteriology department,
and he was a fellow faculty member.
And I arrived, and he
was just the friendliest
you could imagine.
Particularly in those
days, I think there was
much more stiffness at Harvard.
But Harold was not stiff at
all, he was incredibly warm,
and friendly, and helpful, and welcoming.
- Full scholarship to Springfield College
in the mid-1930s, unique in its own right.
In the service, return
here to get his Ph.D.
in the medical sciences,
and then establish his own
prominent track record in
research, but always cultivating
students, cultivating young
faculty behind himself.
So all of his extraordinary life,
he was called a jewel in this world.
- You know, he was such a humble man.
He never would talk about me
as a first African American
who did my Ph.D. here, who
served as faculty member,
who was chair of a department, never.
I mean, it was clear that he had done it,
and he was very much somebody
who wanted to be proactive
about the opportunity that
was offered to other people
and minorities, very much so.
- I arrived in '65, and
that was a new era, really.
I mean, I didn't bring the
new era with me, it was there.
He certainly became very
active, during that period,
as many of us did in
pushing the medical school
to bring in more minority students.
There were on average
one Black medical student
every two years, so it's half
a Black medical student per year.
- It was really the
medical people who were
very strongly opposed to
bringing in the African American
students to the medical
school, with the argument being
that we were gonna bring
people who are not qualified
to the medical school.
- So we had to make the argument that,
and this is what Harvard likes to hear,
is this is a new era
coming, if you bring in more
African Americans into the medical school,
they are gonna become
leaders in the country,
and Harvard always wants to be responsible
for determining who the
leaders of the Country
in various fields are going to be.
And I remember there was
a very serious debate,
some people were very upset,
or tried to water it down,
but there was another
African American doctor
in the medical school, who got
up at this meeting and said,
I can't remember the exact
wording, but you know,
we don't want to be taken
care of by you, we want
to be able to take care of ourselves.
Which really, at that point,
we thought was going to
destroy the argument that this debate
among the faculty members,
and Harold stood up
and very gently responded
very differently,
and that sort of turned,
well, to some extent,
turned the tide in the discussions.
- He was the most wonderful, gentle man,
civilized human being
that had a great heart,
and his heart was in the right place,
and he promoted the educational
mission of this university,
or this medical school.
All the directors of all of the programs
that would get together and
then each program would present
its candidates, and then the
big group would then discuss,
and he personally took great
care in looking at each one
of those applications, and
making sure that nobody
was being left behind, that
might be very much worth
giving an opportunity.
Harold would make sure that
they would not be left behind,
and I think that was, so
rather than being very pushy
about it, he did a very
gentle way of making sure
that they would be considered.
- So you've got to remember
that our department
was pretty much a basic
science department,
he wasn't a medical doctor,
I'm not a medical doctor.
So the students we dealt
with most, or most closely,
were graduate students,
not the medical students.
But, in spite of that, he was,
he found students who
came into medical school
who were African American,
and worked with them,
and mentored them.
- He was, in so many ways,
another extraordinary person,
personages, within the
history of Harvard Medicine.
A professor's professor.
Somebody was also kind,
committed, a researcher,
an insightful individual,
forever looking out for students.
- One needs lots of
champions of diversity.
It's important to maintain that award,
and it's important to name the award
for the first African American professor
at Harvard Medical School, which had to be
an enormous breakthrough.
- Quite often these awards,
decades after somebody has died,
are given, and people
are happy with the award,
but they do not know anything about them,
I think Harold is so special,
that it's very important
that whoever gives the award,
makes sure that the recipient
knows who Harold was.
He was a great human,
and you can be absolutely
honored by the fact that this great human
is the name of the award that you receive.
And I would hope that you can,
regardless of who you are,
you can try to emulate that humanity.
(guitar music)
- So thank you very much,
I just want to also add
a few words about Sharon
Clayborne, the other award,
who was in medical school's
first financial aid office
in 1981, as a staff assistant,
that's when she first came.
She's received many awards, and
attention from our students,
and actually the Class of 1999
presented her with an award
in recognition of tireless
dedication to the students
of Harvard Medical School.
She also received 1998 Young
Black Achievers recognition
for her commitment to the service
on behalf of young people.
She received the first annual Deans' Award
for community service,
for working on good news,
and her gospel program at MIT.
Now I want to turn to
our guest speaker today.
When we established this lecture,
it was meant to honor these
three individuals, but others,
to also recognize others who had made
significant contributions to
enhancing this nation's health.
And our guest speaker today
is Doctor Otis Brawley,
who you've heard is the
Bloomberg Distinguished Professor
of Oncology and Epidemiology
at Johns Hopkins University.
We were talking a little
bit earlier, and I,
he's been on my list of
these honorable people
like you want to meet one
day, and I got to meet him
with this award, maybe that's
why we have these awards
and lectures, so I get to
meet my heroes and sheroes.
But he is definitely one of my heroes.
He's an authority on cancer
screening and prevention,
leads a broad interdisciplinary
research effort
at Johns Hopkins, a school of medicine,
Bloomberg School of Public Health,
and the Sidney Kimmel
Comprehensive Cancer Center.
He was a member of the
National Cancer Institute
board of scientific
advisors, and a member of
the National Academy of Medicine.
He's held numerous positions,
leadership positions
such as those in the
American Cancer Society,
but also as the director of
the Georgia Cancer Center
at Grady Hospital.
He was a professor at Emory University.
He was a Georgia Cancer Coalition Scholar.
As I said, many other awards.
One of the ones that I
think is most amazing,
special service for his
work in the aftermath
of Hurricane Katrina.
So in service in many, many ways.
He's a leader at the National
Institutes of Health.
He cares deeply about students,
he cares deeply about his research,
he cares deeply about
our patient populations.
And with that, Doctor Otis Brawley.
(group applauds)
- Hi.
- I will help you.
- Yeah, thank you.
- It's my pleasure.
- Ah, oh that's what it is.
- Yeah, they hide it.
Sorry about that.
And it's, here it is.
Just do this, and that's the cover.
- Perfect, thank you.
- And your thing is on?
- Yes.
- Your microphone.
- Yes, yes.
Thank you, it is truly, truly
a pleasure to be here today,
thank you Dean Reede,
thank you Dean Daley.
A little about Joan Reede, got to meet her
fellows last night, and
spend some time with them.
I've actually known of Joan
Reede, I'll actually say,
I'll probably get in trouble for this,
known of Joan Reede for
30 years, and never really
got to meet her, I've heard her talk,
as I travel around the
country, she has a national,
a really international reputation
for her work in diversity,
and her work in creating
leaders, and guiding people,
and it's just wonderful
to finally get to sit down
and have a conversation with you.
In many respects, I sort of
feel like the Forrest Gump
of medicine in that I get
to meet people like you,
and get to have, I, by the
way, got to meet Harold Amos,
about 30 years ago, it
was in the early 1990s.
Also, today is a very
special day for me, because
as we talk about diversity,
opportunity, mentorship,
and encouragement are all
incredibly important, and it was
39 years ago that Doctor
Elliot Keith and his wife,
Jacqueline, met this 19-year-old,
wet-behind-the-ears kid
from Detroit, who was at
the University of Chicago.
They spent a lot of time
counseling him against going into
graduate school in
chemistry, and toward going
to medical school, and
Elliot and Jacqueline,
thank you very much, and I
hope I'm paying it forward.
(group applauds)
Now, Michael Bloomberg has given
me a tremendous opportunity
at the Johns Hopkins Medical Institution
to sit back and sort of
look at what's going on
in oncology, look at what's
going on in medicine,
and for the next half hour or
so, let's talk a little bit
about cancer control in the 21st century,
and the emergence of the field
of cancer health disparities,
and what's really going on.
First, my disclosures, I
work for Johns Hopkins,
I do some consulting for the government.
I do a little bit with
Turner Broadcasting,
those of you who have
seen me on CNN know that
some producer at CNN
decided that one way to make
Sanjay Gupta look really
pretty is to put him on TV
with me and then the contrast
between the two of us.
I published a bestselling
book a few years ago,
reflecting on what's going
on in medicine, as well.
So let's talk about cancer
control in the 21st century,
and let's reflect a little
on the evolution of the field
of health disparities,
cancer mortality trends,
we'll go through, look a
little at the economics
of health care, both in
cancer and in general,
and then end up talking about
the future of health care.
Now, a brief history of the discipline of
health disparities, coming out
of the civil rights movement
in the 1950s and 60s, was the realization
that there were Black-White
differences in the cancer death
rate, as well as in cancer survival,
and then there was increasing awareness
of sickle cell disease as well.
And those things actually
led to an interest in
what was called minority
health throughout the 1970's,
and it evolved, and
people started calling it
special populations health, and then
I was actually an
admiral's aide working for
Surgeon General Satcher,
in the room when I think
he actually first came up with the idea
of calling it health
disparities, he literally said,
we were talking about how
to get special populations
research and minority
health research accepted
in the political community,
and he said it's call it
health disparities, and I
want to see a politician
stand up and say, "I am
against programs to reduce
"disparities in health."
That's literally how it started.
Now we're starting to
talk about health equity.
Now a little about cancer,
my old group at the
American Cancer Society estimates that
about 1.8 million will be
diagnosed with the disease
this year, and about 607,000 will die
of the disease this year.
I'm gonna show some age-adjusted
cancer mortality rates
in a little bit.
But, since 1991, going to 2016,
the last year we have data,
there's been a 26% decline
in cancer mortality.
Here you can see, in 1900,
for every 100,000 Americans,
64 died from cancer.
In 1991, it peaked at 215, and
now it's at 159 as of 2016,
that 26% decline over 25 years.
Now, when we talk about
cancer disparities,
we can actually talk about
them by race, by location,
by socioeconomic status.
A little bit about race.
The demographic data that we
have falls into these five
racial categories, and
one ethnic category,
Hispanic or non-Hispanic.
The federal government only
recognizes two ethnicities,
Hispanic, and non-Hispanic.
These categories change every
two years before the census,
indeed, when we talk about changes,
it means that they are
sociopolitical categorizations
and not biologic.
They've been rejected by
the anthropologic community
as being non-scientific.
When I say it changes over
time, if you talk about
native Hawaiians, when
the Republicans control
the White House, native Hawaiians
are considered Pacific Islanders.
When the Democrats
control the White House,
native Hawaiians are
considered Native American.
If you know someone who's from India,
who came to the United
States prior to 1950,
they've been three different
races in their lifetime.
They were actually
considered Caucasian in 1960.
If you know where the
Caucasus Mountains are,
that actually makes a little bit of sense.
And my favorite of all time
is, Barack Obama was White
in 1970, and became Black
for the 1980 census.
(group laughs)
The 1970 census had a very
Judaic definition of race.
It said you should declare
yourself to be the race
that your mother considers herself to be.
So, it's sociopolitical,
it is not based in biology.
I have disparities by location,
we're gonna talk about
some disparities by region
in the United States.
State, north, south,
east, west, rural-urban,
we're gonna talk about neighborhood.
One of my friends likes
to say your ZIP Code
is more important than your
genetic code, which is true.
Socioeconomic status is also
a way that we can look at
disparities, and we'll
talk about personal income,
family income, education, and so forth.
I'm sorry, I trained in
both medical and college
in epidemiology, I have to
keep showing you these graphs.
If the lines go down and
to the right, that's good,
if the lines go up and to
the right, that's bad, okay.
This is 1990 to 2015, looking
at mortality from cancer
by those five racial categories,
you can see Blacks on top,
we have the largest decline.
Whites in orange, and then
Native Americans who have had
essentially no decline from 1990 onward.
The noise is because the
population is very small.
Then you can see Hispanics, as well as
Asian-Pacific Islanders.
Everybody's in decline,
except Native Americans.
Blacks have the greatest
decline, but they started
at the highest level.
Now, the American Cancer Society estimates
that of the 1.8 million who are diagnosed,
this year, 202,000 will be
Black or African American.
Of the 607,000 who will die,
about 72,000 will be Black
or African American.
While we've had a 26% decline in 25 years
for the population as a
whole, we've had a 35% decline
for Blacks, that's just
saying that that blue line
is going down faster
than all the other lines.
This is looking at our
history from 1975 onward, for
breast, colorectal cancer
and prostate cancer,
colorectal cancer divided
up between male and female.
I want you to see a pattern in
breast and colorectal cancer,
there were no disparities
by mortality in the 1970s,
and the disparities only
started around 1980,
and you can see, they get wider and wider,
and indeed in breast cancer,
the death rate disparity
in breast cancer is greater
in 2015 than it has ever been.
Again, it did not exist in 1980.
Same in colorectal cancer,
you can see the scissoring,
for men and women, here.
This is what the disparities
have been about for Blacks
and Whites, and quite honestly,
we should be talking about
the White disparity versus the
other races and ethnicities,
there's a lot that can be learned there,
and then prostate cancer's
a special problem,
but you can see we've now
got declines in mortality
in prostate cancer.
Now population disparities
have always increased
when you have scientific
progress in medicine.
In the 1970s, we learned
how to screen and treat
for breast and prostate
cancer, and then we created
those disparities,
between Blacks and Whites,
because of progress.
And this has been seen
whenever there's improvements
in screening, and treatment of disease,
and it's going to occur even
more as we move into the era
of precision medicine and immunotherapy,
where some of the drugs
actually are starting
to work very well.
And new, preventive
interventions, by the way,
are less likely to cause
disparate outcomes.
There are no disparities in smallpox.
We can prevent that disease.
Looking at breast cancer,
in 2019, it's estimated,
269,000 will be diagnosed, slightly more
than 42,000 will die.
There has been a 40%
decline is age-adjusted
female mortality for breast
cancer, from 1990 to 2016.
A 40% decline in mortality.
This is really that same
graph I showed you earlier,
and for women, this is Blacks
in red, Whites in blue,
and these are the other three
races and ethnicities here.
And you can see again, there
was no disparity in the 70s,
the beginning of the
disparity in the 1980s,
we really started learning
how to screen and treat
for breast cancer, in the early 70s,
and people started not
dying around 1980 or so.
Now, showed you Black-White disparities
over a period of time, let
me show you the disparities
over a period of time by state.
This is not by race, but this is by state.
The dark blue states, you can see,
primarily in the northeast
and in the very north,
are the places where there's
been a 50, up to a 51% decline
in breast cancer
mortality, over the period
1988 to 90, through 2015.
The purple states are
the states that have had
a 20 to 29% decrease in mortality.
Literally, a women who
lives in Massachusetts,
who is 60 years old
today, her risk of dying
from breast cancer is half
what a woman of the same age,
her risk of dying from
breast cancer in 1990.
Her risk of death has
halved over 25 years,
for a 60-year-old woman
of any race, any age.
However, for a woman
who lives in Louisiana,
her risk of death has gone down by 20%.
Not 50%, but 20%, that's
a disparity by race.
I'm sorry, disparity by state.
This is not a race thing,
this is a state thing.
There are seven states, by
the way, in the United States,
where there is no longer a
Black-White mortality difference.
Now let's look at colon and rectal cancer,
colorectal cancer.
101,000 will be diagnosed
with colonic cancer this year,
about 44,000 with rectal cancer.
51,000 Americans are gonna die
from colon and rectal cancer.
There has been a 50% decrease
in colorectal cancer death
in the United States since 1980.
That is to say, a man or a
woman who is 60 years old today,
their risk of dying from
colorectal cancer is half
what it would have been
for a 60-year-old in 1980.
That's real progress.
True, true progress.
This is looking at it in race for women.
Again, you can see,
Black women, White women,
and the other races and ethnicities here,
by the way, we only
started counting deaths
for the other races and
ethnicities in 1990.
This is men, again,
you see the scissoring.
This is looking state by state.
These are the, in blue,
up here in the northeast,
you can see 63% decrease in risk of death
from colorectal cancer
for men in Massachusetts.
In Mississippi, 12%.
Again, we're starting
to define disparities
not by Black-White, but by
Massachusetts and Mississippi,
by state.
Region of the country,
as a matter of fact,
if you were to, it's a 50% decline overall
in the United States, if we were to remove
the old Confederacy, the
decline would be almost 60%
in the United States as a whole.
Now, insurance matters.
Sorry this is a little
bit more complicated
than I would like, but
this is five year survival,
you can see 60 months on the x-axis,
and this is percent, 0.9 is
90%, 0.8 is 80%, and so forth.
Stage one is in red, stage two is in blue,
the insured are solid
lines, and the uninsured
are dotted lines.
These are really people who are uninsured,
or have Medicaid that
they get when diagnosed
with colorectal cancer.
And the purpose of this
slide is just to show you
that in the United States of America,
you are better off having
Stage 2 colorectal cancer
with insurance, than Stage 1
colorectal cancer without insurance.
Your chances of surviving five
years of colorectal cancer
with the more advanced disease is better
than your chances of surviving five years
with the less advanced disease.
This is simply to tell
you, insurance matters.
Now, causes of colorectal
cancer disparities are
differences in the
prevalence of screening,
the quality of screening,
we don't talk enough about
quality of screening and
treatment, the proportion treated,
quality of treatment I've already noted.
There are differences by race
and socioeconomic status,
but there are also differences
by region of residence.
I'm a cancer doc, I
can't give a cancer talk
without talking about lung cancer,
the leading cause of cancer
death in the United States.
The dark states here,
are the states that have
the highest death rates from lung cancer,
and the light states have
the lowest death rates
from lung cancer, you can see in Kentucky,
the death rate is 67.7 deaths per 100,000,
whereas in California and
Utah, the death rates are about
19 per 100,000, a
difference, 19 versus 67.
Now, smoking rates are very
high, still in these red states.
Remember, this actually
reflects what smoking was like
30 to 40 years ago, it takes
30 or 40 years of smoking
in order for somebody
to die from lung cancer.
So these death rates reflect
what smoking was like
30 or 40 years ago, but quite
honestly, if you looked at
smoking rates, they'd
be very similar today.
The heaviest states in the
United States for smoking
are Kentucky and West
Virginia, where almost 30%
of adults smoke, and the
lowest states are Utah
and California, at about 10%.
I guess when I talk about
smoking in California,
I have to stress, it's
10% smoke tobacco, right.
(group laughs)
And by the way, when we look at states,
the death rate from Utah
is 125 per 100,000 in 2015,
the death rate in Kentucky
is 195 per 100,000,
huge disparity, not by race, but by state.
So a lot of this has to do with smoking,
a lot of this has to do with
other preventive activities.
Indeed, I think the
most important question
we can give in cancer
control, is how can we provide
adequate, high-quality care, to include
preventative services to
populations that so often
don't receive them.
This is a very busy slide, but
just for a second, focus on
this column, and this column.
Smoking, 33% of all
cancers are due to smoking.
The combination of overweight,
diet, and lack of exercise
account for 25 and five, 30% of cancer.
Second leading cause of
cancer in the United States,
think of it as a three-legged
stool, energy balance,
it's too many calories, not
enough exercise, and obesity.
Second leading cause of
cancer in the United States.
And then, of course we
have occupational factors,
viruses, alcohol, UV radiation.
I spend a lot of time
in the screening space.
One thing that we don't
admit to ourselves a lot is
right now, nearly 2% of all
cancers in the United States
are actually due to medical radiation.
When we talk about questions of screening,
for mammography, or for lung
cancer screening, so forth,
we need to think about that.
2% or so of all cancers
in the United States
are now due to medical radiation.
Tobacco is still the
leading cause of cancer
and cancer deaths in the United States.
Cancers due to tobacco use, however,
other than bladder cancer,
actually declining,
more so in men than in
women, but they're declining
in both men and women.
Cancers caused by infection
are a significant problem,
and we can do a great deal
to prevent those cancers.
Liver cancer deaths are
expected to go up 50%
due to HCV, and HBV.
Now hepatitis C is one of
the few viral illnesses
that we can cure.
And unfortunately, the
cure costs a mere $50,000,
that's cheap in my world.
I routinely give drugs that
cost 150 to $200,000 a year.
But the cure for hepatitis
C is $50,000, unfortunately,
the people who get hepatitis
C are the very people
who cannot afford the $50,000 cure,
and they very frequently live in states
that are not willing to
pay for that $50,000 cure.
Hepatitis B is preventable with a vaccine.
Head and neck cancer deaths
are increasing by 30%
in the near future, due primarily
to human papillomavirus,
and HPV in the long term,
is also preventable,
with a vaccine.
Prevention of cancer is
clearly a need in the future,
and something that needs
to be on the agenda
for the 21st century,
as does energy balance.
Overweight, obesity,
and too many calories,
lack of exercise.
2/3 of of adults in the United States,
and a third of children are
overweight at this time,
and weight-related cancers
are expected to increase
30 to 40%, within the
next decade to 12 years.
We've gone from 5% of
kids being obese in 1970
to 20% of kids being obese today.
Weight-related cancers are
something we really need
to look at, especially
in the United States.
This is the United States in
1970, with the less than 15%
of adults being obese,
now we're well over 30%.
These are some of the favorite countries
I like to compare the U.S. to, you can see
the obesity problem is a
uniquely American problem,
although it is starting to catch up
in other countries as well.
This is the problem in
non-Hispanic Black women,
today nearly 60% of
non-Hispanic Black women
are in the category we would call obese.
That is not obesity plus
overweight, that is obese.
It's a problem for all
Americans in general,
and it's a lifestyle issue,
there are a number of things
that are going on in American culture,
that encourage us to be
overweight and obese,
and that's a social science,
social medicine issue,
but it is something for the
agenda for cancer control
in the 21st century.
And this is oh so
important as we talk about
the cost of health care
in the United States.
I'm gonna show the last few slides
talking about what this is costing us.
This is what the U.S.
spends on health care
on a per-person basis from
1980 through about 2010,
and you can see the rise
in the United States,
versus other countries that we
like to compare ourselves to.
Our health care costs
on a per-person basis,
per capita basis, is
going up dramatically.
In 2016, we spent 3.3 trillion
dollars on health care,
that's not 3.3 billion,
that's 3.3 trillion.
A trillion is a big number.
(group laughs)
A million seconds ago is
11 and a half days ago,
a billion seconds ago was 31 years ago,
Ronald Reagan was president
a billion seconds ago,
and a trillion seconds
ago was 32,000 years ago,
30,000 years before Jesus Christ,
was a trillion seconds ago.
A trillion is a big number.
We've spent 3.3 trillion
dollars on health care.
Another way of looking at it,
these are the largest
economies in the world.
If American health care
were its own country,
it would be the fifth
largest economy in the world.
We've spent more on health care
than was spent on everything
in the United Kingdom, and
damn near spent as much
on health care as was spent
on everything in Germany,
the fourth largest economy in the world.
We spend a lot of money on health care.
3.3 trillion dollars
translates into almost $10,000
per man, woman, and child
in the United States.
3.3 trillion dollars
translates into almost 18 cents
out of every dollar spent
in the United States,
was spent on health care in 2016.
How does that compare to other countries?
This is cost per person
versus life expectancy,
and you see the United States up here
is the most expensive cost per person,
this is 2013 data, and you can
see all of these countries,
people live longer, and
health care costs less.
Switzerland is the second
most expensive country
in the world, but people in
Switzerland live much longer.
And I was actually at the
University of Nebraska last week,
at the Buffet cancer center,
so I had to pull this
quote into the top.
"Cost is what you pay,
value is what you get."
We pay a lot in the United States,
and we get a lot less that
what other people spent.
We can become much more
efficient than we are,
in terms of health care.
If we were Switzerland, health
care in the United States
would be far less expensive.
One of the things a chief
medical officer has to do
is help negotiate insurance
for your employees.
When I was at the American Cancer Society,
we had 5,000 employees.
Every year or two you had to negotiate
what health insurance costs.
The average cost of a health
insurance policy for a family
in the United States
right now, is $18,500.
If we were Switzerland,
it would be $11,600.
We would have higher
productivity, and employees
would be able to employ more employees.
And costs are actually going up.
Actually one of the
most frightening graphs
I've seen recently, and I
will, I should incorporate it
into the talk, it actually
looks at median family income,
starting at 1960, going through
2015 and projecting onward,
and it looks at average cost
of a health care policy,
starting at 1960, going through
2015, and projecting onward,
and the two lines cross in 2040.
That's not possible.
Median family income and average
cost of a health insurance
policy, the same in 2040.
It actually means we are going
to have health care reform,
whether the politicians want it or not,
we're going to have health care reform.
See one of the problems that
we have in American medicine
now is that some people
over-consume resources,
and this can be harmful
to the over-consumer.
People actually die because
of medical interventions
that they didn't need.
Some people under-consume,
and this is cause of many
of the disparities, we
need to get good medicine
in the Louisiana and
Mississippi, for example,
both preventative and therapeutic.
Meaning health care
outcomes could be better,
and actually at a cheaper price.
This is a plea for
evidence-based medicine,
and it's huge inefficiencies right now
in the overuse of medical technologies,
and it's perhaps best
seen in what's happening
in screening for cancer.
There is good evidence-based
screening to do
all of these things, but,
very frequently these things
are being done in an
inappropriate fashion,
either too often, or in
the wrong populations,
or the wrong types of tests, and so forth.
Now the true cost of American health care
to a cancer doc like me.
I told you earlier that my group
at the American Cancer Society estimates
that 600,000 Americans will
die from cancer this year.
It's also a fact that
college-educated Americans,
the 32% of us who have college educations,
have a much lower risk of cancer death
than the other 68% of
the American population.
We simply calculated how many
people would die this year
if all Americans had
the risk of cancer death
of a college-educated American.
This is not new science, this
is not a new screening test,
not a new treatment, this
is simply if all Americans
got what we already
have, and we already know
a human being ought to be getting,
from the prevention
standpoint, the screening
and treatment standpoint.
The answer is, instead of 607,000 deaths,
there'd be 455,000 deaths.
Literally, a quarter of all cancer deaths
would be preventable,
if we just distributed
what we already have to
everybody in the United States.
152,000 deaths a year, a quarter
of all the cancer deaths.
Actually, the number would be even higher,
if we started talking about diabetes
and cardiovascular disease.
The 152,000 deaths per
year that are preventable,
by the way, the majority
of those 152,000 people
call themselves White.
Health disparities just
became an issue that is
beneficial to all Americans,
regardless of race,
more beneficial to the White population
than the Black population,
and Native American
population, or others.
The issue of disparities in health
is no longer just a racial minority issue.
I'm hoping that I've convinced you
we need to start talking
about health equity,
not just equality, how
do we get the services
that people need, to the
people who need them.
And this slide is just
making the argument.
Some populations are going to need
a little bit more than others.
I would argue that we need
to be doing a lot more
in Louisiana and Mississippi right now,
than perhaps in Massachusetts.
And so, I'm actually gonna
stop at that point, it has been
a true pleasure to be here,
and I'm really thrilled
to meet you guys, and I
don't know if we have time
for questions or not.
- [Woman] Just one or two.
- Yeah, we have time for a
couple questions, thank you.
(group applauds)
- Question or comment?
- Questions.
(person speaks faintly)
- I think think this is
being recorded, yeah.
- [Man] I didn't know, now I'm shy.
(group laughs)
But, one comment is in
the states that they have
the increased rate of cancer,
in the southern states,
it seems that economically,
probably they are poorer states,
in comparison to the other
states, so I would suspect
it's not just location, and culture,
but it's also socioeconomic.
- It is socioeconomic
that the states that have
the worst outcomes, it's
really a socioeconomic thing.
Using socioeconomic in its
broadest sense of the word,
those are the states that have
the lowest family incomes,
they have the greatest
distances to health care,
they have the lowest levels of high school
and college graduation, and
another socioeconomic issue,
those are the states that
have not expanded Medicaid
and the Affordable Care Act.
So there are a number of
issues that make those states
being in the back of the
pack in terms of outcomes.
Anybody else?
Well, thank you very much.
