Episode 153: Gender, Race, and Autoimmune Disease with Dr. Maggie Cadet

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How Do Gender and Race Impact Autoimmune Disease?

78% of autoimmune patients are women, and some diagnoses are 2-3 times more common among women of color. When it comes to healthcare, ideally we all get the same treatment, but many people have experienced some form of bias in the doctor’s office. Research shows this leads to serious health consequences. How can we address a problem this big – both as patients who want to get the best care, and as a community that cares about excellent healthcare for all? My guest is Dr. Maggie Cadet, a rheumatologist who is passionate about eliminating disparities in healthcare.

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Show Notes

  • Intro (0:00)
  • Thank You to Our Podcast Sponsor – Paleo on the Go (2:39)
    • A frozen meal delivery service, 100% of their menu is compliant with the elimination phase of the paleo autoimmune protocol (AIP). They have over 5o items, including entrees, side dishes, broth, AIP-friendly bacon, and desserts.
    • Use the code PHOENIX for 10% off your first order.
  • Meet Dr. Cadet (4:19)
    • Dr. Maggie Cadet is a rheumatologist practicing in New York City.
    • She was a competitive figure skater as a teenager and fell in love with the anatomy of the human body, especially the interplay of joints, muscles, tendons and ligaments.
    • In medical school, a close friend who was an African American woman, died from lupus complications. Dr. Cadet couldn’t understand how the disease could take someone so young, and she was inspired to learn more.
    • During her residency, she met so many women with autoimmune disease who didn’t understand their diagnosis and weren’t educated on how to manage their condition. Many had also gone years before receiving a diagnosis. She decided this was an area of medicine where she could make a difference.
    • She teaches her patients how to become their own best health advocates.
  • Why Is Autoimmune Disease More Common Among Women Than Men? (6:30)
    • The X chromosome contains genes that interact with the immune system and may leave women more predisposed to autoimmunity.
    • Testosterone may offer men protection by reducing the number of B cells in the body. B cells produce auto-antibodies that attack during the autoimmune process.
    • Estrogen also plays a role in inflammation and may predispose women to autoimmunity. Both high levels and low levels can be a trigger, depending on the type of autoimmune disease.
    • Lastly, stress plays a role in autoimmune disease – both as a root cause for developing autoimmunity, and as a flare trigger. While all human beings feel stress, women often carry a higher stress burden feeling the pressure to “do it all” as they strive to balance family, work, and self-care.
    • Research:
  • Gender Bias In Healthcare (9:42)
    • If a woman has a heart attack and goes to the emergency room, she’s more likely to die than a male patient having a heart attack, because they don’t always receive equal treatment. One reason is that women present differently than men when having a heart attack. Doctors (and patients) need to educate themselves on these differences.
    • Similarly, women who go to the doctor with chronic pain are much more likely to be dismissed than male patients.
    • Autoimmune disease itself takes an average of 4 years and 4 different doctors to diagnose. Most patients are women, many of whom are told that it’s all in their head.
    • Physicians need to be aware of this bias – which is often unconscious – and make sure they aren’t dismissing women’s symptoms as simply stress. It’s important to rule out (or discover) potentially serious illnesses that are being triggered by that stress.
    • Resource:
  • Patient Advocacy – Standing Up For Yourself (12:56 & 30:06)
  • How Does Race & Ethnicity Impact Autoimmune Disease? (14:17)
  • Racial Bias in Healthcare (19:20)
    • People of color receive lower-quality health care than people who are white—even when insurance, income, age, and diagnosis are the same.
    • When tested for bias, most healthcare practitioners have positive attitudes toward white people and negative attitudes toward people of color.
    • Software algorithms used by hospitals have been found to offer better healthcare options to white people than people of color. This affects both referrals and treatment.
    • In the US, African Americans have the highest death rate and lowest survival rate of any racial or ethnic group for most cancers.
    • African Americans and Native Americans are 2-3 times more likely to die from pregnancy-related causes than white women.
    • If a white patient and a Black patient are both hospitalized for vascular disease that affects their limbs – the Black patient is more likely to have their limb amputated instead of being offered a salvage procedure.
    • Black people are more likely to experience serious mental health problems.
    • Right now, with COVID-19, people of color are more likely to be hospitalized and die than white people who contract the virus.
    • For good reason, people of color often mistrust the healthcare system and are less likely to follow recommendations or keep appointments, which also worsens health outcomes.
    • How do we address and correct this bias?
      • Healthcare practitioners need to become aware of their own unconscious bias.
      • Doctors need to re-establish trust with marginalized patients.
      • Medical schools need to recruit more BIPOC students. Only 4% of doctors in the US are Black and only 2% are Black women. There are even fewer Native American Physicians: .3%.
      • Healthcare systems and medical schools need to promote people of color into leadership positions.
      • There needs to be cultural competency training in training programs and the workplace.
      • Barriers to healthcare need to be identified and addressed, including lack of insurance and lack of transportation.
      • There needs to be patient education programs, so patients become knowledgeable about their disease and whether their race or ethnicity leaves them more vulnerable to disease complications.
  • White Coats for Black Lives (24:35)
    • This is a coalition of doctors of all races. Their mission is to dismantle racism in medicine and promote the health, well-being, and self-determination of Black and indigenous people, and other people of color.
  • Thank You to Our Podcast Sponsor: ShopAIP (27:28)
    • Today I want to highlight some of the special AIP reintro products they sell: (1) Artisanal Chocolate (2) A wide variety of ghee, including goat ghee (3) Sprouted nuts which make them easier to digest (4) Epic Beef Liver Bites (the only required reintro is black pepper). If you haven’t yet done reintroductions and want to learn how, check out my Paleo AIP Reintroduction Guide.
    • ShopAIP is an online store dedicated to the Paleo Autoimmune Protocol. With hundreds of items for the elimination phase of the AIP, and new products labeled by reintroduction category as well. You can find protein bars, sauces and condiments, AIP-friendly spices, cooking and baking ingredients, delicious snacks, non-toxic skincare, and more.
    • If you’re a first-time customer, use the code PHOENIX for 10% off your order. Purchase here.
  • What Can Individuals Do To Help? (28:48)
    • The first step is recognizing that bias and disparity in healthcare exists. Keep the conversation alive and educate others.
    • Support healthcare and disease organizations who are allocating resources to help marginalized groups. The American College of Rheumatology is one such organization. They created the Lupus Initiative to reduce healthcare disparities with Lupus.
    • The NAACP seeks equality in all areas, including healthcare.
    • See if you can volunteer at a local health fair to raise awareness.
    • Become aware of your own implicit bias and work to overcome it.
  • What’s the Difference Between Implicit Bias & Overt Racism? (35:12)
    • Overt racism is intentional and obvious. Implicit bias is often unintentional and subtle, but can have a strong impact. Also called micro-aggressions, these are the small, repetitive behaviors that show a person’s bias toward marginalized groups.
    • We discussed earlier how implicit bias leads to lower quality care for people of color. It’s also an independent risk factor for disease, because it puts marginalized groups in a state of chronic stress. We all know that stress is inflammatory, and it’s a root cause of many health conditions, including heart disease, diabetes, and autoimmune disease.
    • Resources:
  • Educating Our Children (42:32)
    • One of the most effective ways to support long-term positive change is to educate the next generation. Biases are often formed at a very young age.
    • Ask your school what type of programming they’re doing surrounding racism and implicit bias.
    • Read to your children. There’s an Instagram account Dr. Cadet loves, called Here Wee Read. They share diverse books for children of all ages. If you’re not on Instagram, they also have a website. One of Dr. Cadet’s favorites is You Matter by Christian Robinson.
  • Implicit Bias Education Resources (45:16)
  • Outro (46:07)

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