The popular Dr. King quotes circulated over the days leading up to, during and proceeding the national holiday in his honor made their rounds. But as the culminating speaker for the Washington University School of Medicine’s full week of programming honoring King’s life and legacy on Friday, Dr. Kemi Doll dug deep to make it clear that he was aware – and fighting against – all forms of inequity.
“‘Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane,”’ Doll said, quoting King.
A professor in the Division of Gynecologic Oncology at the UW School of Medicine and an Adjunct Professor in the Department of Health Systems
and Population Health, Doll has made the battle for equity in healthcare her life’s work.
“Neither medicine nor science is exempt from white supremacy culture,” Doll said. “There is no reason to think that somehow when you get into the worlds of medicine or science, all of the biases in our society’s 400-plus years of white supremacy culture goes away. I am unapologetically focused on Black women and all Black folks with a uterus.”
Her research centers on examining Black-white racial inequity in endometrial cancer in the US and has been funded by the NIH, the Robert Wood Johnson Foundation, the Patient Centered Outcomes Research Institute (PCORI) and several foundations.
“We have not found ‘the Black gene’ for endometrial cancer,” said. Doll. “People have been looking for it and can’t find it. So, there has to be something else going on.”
She dove deep into that “something else” using her wealth of knowledge regarding Black women’s reproductive health. She pointed out that Black women have higher rates in reproductive years of fibroids, irregular cycles, worse outcomes with infertility and higher rates of premenopausal hysterectomy because of all of the things mentioned. They also have higher rates of preterm labor and low birth rates of infants, maternal morbidity and mortality. And over the entire gynecologic life course, Black women are doing worse at every single point.
“You can look at this and say, ‘What is wrong with Black women’s bodies,’ or you can look at this and say ‘what is wrong with the environment that Black women are in,’” Doll said. “‘What’s wrong with the way that we study these diseases? What’s wrong with how we research these diseases? What’s wrong with how we treat these diseases? Why do we not understand what’s happening in these women’s bodies?’”
Doll said that she doesn’t believe in the idea of objectivity when one is studying race and ethnicity differences because, “We live with these biases baked in.”
“My perspective doesn’t just come from being a Black woman in the United States – though it is informed by that,” said Doll. “It also comes from reading the very rich academic writing that is available in people who have been trying to understand how race, gender and health intersect to produce these outcomes that we see.”
Doll talked about the racial differences in stage of diagnosis that vary by healthcare setting.
“Unless we think that there’s innately inferior biological differences in these Black women at different healthcare settings, you have to acknowledge that something different is going on in these places,” said Doll. “Black women with Medicare – and with insurance – presenting with symptoms not getting ultrasounds, not getting biopsies, not getting DNCs. And these non-guideline pathways are associated with more stage 3 and stage 4 disease.”
Healthcare providers normalizing symptoms is also a factor.
“We have a group of people that have decades of higher rates of fibroids, irregular cycles, irregular bleeding, poor gynecological healthcare, poor experiences in reproductive healthcare and abnormal bleeding as a norm in younger women that can result in this normalcy of that very same symptom that now represents a cancer symptom in the menopausal years,” said Doll. “We found that 40 percent of the black white mortality gap is actually attributed to stage of diagnosis and surgery rate.”
Patients get to their provider, get an ultrasound to be told “everything’s fine.”
“How much longer does it take for you to come back,” Doll said.
She said there is not one magic solution, there are many needed solutions to this problem, which is common in health equity work.
“Our racial positioning – awareness or lack thereof – influences the design and interpretation of our studies,” said Doll. “Novelty and innovation in research are not just born out of new ideas, but new perspectives – which is why diversity in research and science is so critical and so important. It ensures that we live in a more equitable society – and attacking it ensures that we don’t.”