A medical mythbuster's mission to improve health care | Joel Bervell (re-release)

[MUSIC] This is Ted Hell, a podcast from the Ted Audio Collective. I'm your host, Dr. Shoshana Unger-Liter. Social media often gets a bad rap, but what if it could actually make us healthier? Dr. Joelle Burvel is like a NAN American recent graduate of Washington State University School of Medicine. He's a science communicator and a 2024 Ted fellow. He's using platforms like TikTok and Instagram to tackle one of medicine's most urgent challenges, health inequities. Through creative storytelling and evidence-based insights, Joelle exposes racial biases in medicine and empowers patients and providers alike, with actionable knowledge. His work shows how a single voice can spark awareness and inspire change in a broken system. Then stick around after the talk for a deeper dive with Joelle, and how social media is reshaping health equity. We also talk about some practical steps we can all take to improve our health and strength in our communities. But before we dive in, a quick break to hear from our sponsors. [MUSIC] And now Joelle Burvel takes the Ted stage. I think in the face of any adversity, communities of color have always found solutions. I think for me, social media is one of those places in safe havens. Social media can be a positive change. It can inform masses about really crucial issues that are often overlooked in the media. My followers often are commenting on my videos saying, "I haven't seen this anywhere else." I think that social media can save lives when used in the right way. My name is Joelle Burvel. I'm a fourth year medical student, but I'm better known online as a medical mid-buster for creating content about health equity. They hit in history of medicine and the ways that healthcare needs to change for communities of color. [MUSIC] When I first started medical school, it was a really interesting time. I was thinking a lot about Amidabri and Brianna Taylor and George Floyd. All these moments were happening at the same time that I entered my first year medical school, where myself and one of the medical students were the only two black medical students in our school of 200 students. It made me think a lot about how we were talking about race in the United States and what race meant in the context of being a medical student. I kept hearing in my classes that black people were more likely to have asthma. Black people were more likely to get COVID. Black people were more likely to have diabetes. We never dived into the social or other political even ramifications of why that was. The history behind what led to those health disparities to exist. Seeing the lack of diverse medical education in my curriculum made me want to actually take to TikTok and Instagram to talk about the things that I wasn't seeing in school. My name is Dwell, the medical midbuster, and let's talk about racial bias with the alpha fetal protein test. Let's talk about racial biases in lung function tests. Let's talk about the racialization of extra radiation. The misguided racial correction built into this device, the sprometer, and it assumes that all black and Asian patients have a lower lung functioning compared to any other race. To 93% of cervical cancers are preventable. Yet in the United States, Latinos are more likely to be diagnosed with it, and black women are more likely to die from it. What looking back at this history teaches us is that racism becomes embedded and unnoticed until we raise the alarm to practices that make no sense. So many of my videos, a lot of the comments were from healthcare professionals, doctors, nurses, PAs, saying "I've never heard about this." A study in 2016 was done and actually showed that 50% of medical students or residents endorsed at least one false biological belief about differences between black and non-black patients. So it goes to show how the history of these biases and stereotypes continue till today and can impact the way that patients get care. Because everyone, especially most black people, have had an experience in the hospital where they felt like they weren't listened to, they were ignored, and they want to understand why. There's already legacies and histories of why, communities of color, don't trust the medical system, you can look at so many things that have been done. In 1961, Fannie Lou Hamer went to the hospital for the removal of a small uterine tumor, while under anesthesia she was given a hysterectomy without her knowledge or consent. This woman sells research on COVID, polio cancer, and so much more, but her sales were taken without her consent. Her doctor Sims practiced general surgeries on enslaved black women and children without an anesthesia. Our job as physicians needs to be to be able to figure out what should and what shouldn't stand from past beliefs to present beliefs. I think diversity equating inclusion is one way that we're able to critically evaluate the systems around us, especially in medicine. Diversity equating inclusion, one is really important because it goes beyond race, it goes to thinking about all aspects of our social identities and how that interacts with the healthcare field. And two, it's necessary just because the patient population we serve is diverse in itself. So often there are places in medicine where it doesn't make sense to use race, where that's through an equation that's about kidney functioning or about lung functioning. So being able to talk about DEI in that lens allows us to critically evaluate why we use race specific issues. If we're not able to accurately critique why race is included in systems and whether that's harming or helping patients, we're unable to do our job of do no harm. But there's a concerted effort to try and essentially root diversity equating inclusion out of medicine, people thinking that's negative in the medical field. If these anti-dehyde bills continue to get passed, I think we're going to see less diversity in medicine across the spectrum. I think we're going to see less access to research that's really critically thinking about why we're using race and being able to kind of re-correct that, which has already been difficult to get people to talk about in the first place. We're going to see scholarship programs, try out. We're going to see programs that are investing in the next generation, go away. We're going to see students less interested in going into medicine simply because there's not investments into communities that have been overlooked for so long. We're going to be set back to a time where we were not moving medicine forward and actually harming patients. I don't want to scare people away from the healthcare system, but I want them to know that they have the power and this information they can have when they get to the doctor so that they feel a little bit more confident. When there's awareness, providers, patients, researchers can actually start tackling a problem. I think when we don't know it's a problem, we don't do anything about it. I think there's just so many opportunities to use social media as this kind of ground for community to build and create advocacy and hopefully create change. I think especially when it comes to anti-dehyde bills, I think that's the space we're going into. It can be a space to continue to learn, educate and hopefully talk about how we can improve medicine overall. That was Joelle Bervelle, a 2024 Ted Fellow. This talk was adapted from the 2024 Ted Fellow's film series, which you can check out at Ted.com. Known as the Medical Myth Buster, Joelle has over 1.2 million followers on social media. And as we learn just now, his mission is to combat health disparities by exposing racial biases and sharing critical insights on medicine. A passionate advocate for equity and healthcare. Joelle is collaborated with the White House Office of Public Engagement and organizations like the WHO and the American Medical Association and has been recognized by Forbes 30 under 30 and TikTok as a voice for change. I'm so excited to speak with him today. So, Joelle, where does your passion for health equities start to develop? It really began when I was a young kid. For much of my childhood, my grandma was my American caretaker and both my parents are from Ghana, West Africa. But while they were at work, my grandma should make our lunches, our dinners, everything. But when I was in sixth grade, grandma ended up going back to Ghana. And unfortunately within a year, she passed away from malaria. And I remember hearing my mom crying and saying, "How could this happen?" And later finding out that they had expected my grandma to bring her own materials to the hospital. Things like I do tubing, which was insane. And where she was in rural Ghana, didn't have access to those types of equipment. And so for me, it was my first understanding that health inequities exist. I'll be at that point on a global scale. But then I also had a lot of family members that had chronic illnesses. And we'd be in and out of the hospital all the time. And thinking about things like insurance, literally hearing those conversations with doctors, for my parents saying, "Can we get this medication?" Or, "How are we going to pay for this for like long term?" Not just in the moment. Those were conversations that I was privy to really early on. And it made me better understand that health care isn't just about that health in the moment of the person, but all kind of the systems around it that impact our health. So you chose medicine rather than doing policy work or other forms of advocacy. Tell me a little bit about that. I call medicine the great equalizer. Everyone at some point is going to have a need for a doctor to go to the hospital. I think policy is amazing because you can truly create change. But to create policy, you need to understand people. In medicine is all about people. It's all about the stories and the conversations you have with individuals. What I got to college, I really got to see that up close. Obamacare, the ACA. Those were all conversations that were being had on being debated actively while I was a college student. During my sophomore year of college, I ended up working at the Urban Institute, which is a think tank and doing health policy research on the Affordable Care Act, specifically looking at what does it mean when Medicaid is expanded to 400% of the federal poverty level and how does that impact different communities. And I learned really quickly that it's great to have policy like I said, but if you don't understand the individual stories, you can't actually make policy that works for people effectively. I couldn't agree more. And so you decided to hit social media and your content has reached millions of people. What initially motivated you to start sharing on social? The COVID pandemic hit during my first year at medical school. And so I had a lot of time where I was scrolling through TikTok. And I started to think, what are the stories that I would want to share and put out there that could be effective for people and helpful? I had this moment where I asked myself, why am I consuming so much content instead of creating content? And I was home during winter break. And I remember I was scrolling through Instagram and I saw this article from the New England Journal of Medicine that talked about a device called a Pulsak Simulator. It's a device that goes in your finger and it matches your blood oxygen saturation level. The article showed that in patients with darker skin tones, Pulsak Simulators are three times as likely to lead to inaccurate, overestimated oxygen saturation levels when compared to patients with lighter skin tones. And I remember I just finished my pulmonology units. We never talked about this. And I was like, there has to be a mistake. There's no way we wouldn't talk about this because for those who don't know, Pulsak Simulators are used in every single hospital. It's the first thing you get for every single patient. And so I ended up going to TikTok at the time. But I posted this video and started off by saying, what does Rachel bias and medicine look like? This is a Pulsak Simulator and explaining the disparity and why that mattered particularly for the COVID pandemic. Within 24 hours, it grew up and most of the comments were from doctors and nurses and PA's saying, I use this device every single day and I had no idea this is a disparity that existed with it. And at the same time, there were patients that were saying, is this what happened to me or is this why my loved one died? And I realized that there was an opportunity to talk about the systemic biases in medicine. Not necessarily all these implicit biases that we often focus on, but talking about how a device like a Pulsak Simulator, which wasn't tested on a diverse population, ended up leading to all these disparities that literally had an impact on patients. And some studies have shown that because of this disparity with the Pulsak Simulator, more black patients were turned away from the hospital and not given supplemental oxygen during the COVID pandemic when they should have been given it. I mean, that's incredible. So how do you approach creating content on complex medical topics, especially given how fast paste social media is? And how do you think about that? I love that question because it is hard. And I think a lot about misinformation and disinformation too and how to avoid making sure I'm falling into that trap, giving enough information to someone, but just enough words, not too complex. But I read a book a while ago. It's called Made To Stick by Chip and Dan Heath. Yeah, it's great book. Oh, you read it? Yes. I have this model called Success. And they basically say any idea that sticks has to use these six tenants has to be simple, unexpected, concrete, credible, emotional, and it should have a story. And I think if you can create any piece of content, whether it's five seconds or 30 seconds, that fulfills all of those things, you can have something that sticks with people and brings something down that's very complex. And so for the Pulsak Simulator, it's simple because we use it all the time. A very concrete idea of what it is. It's credible because we can point to the studies. It's emotional because we connect it to COVID and there's a story there in the sense that everyone can relate to themselves or they love the ones being able to experience that moment of getting this device and then realizing it doesn't work equally on that. And so I use that for every single video and I really try and make sure that I'm teaching it at a level that even a fifth grader could understand. Yeah, I love that approach. And so you talked about the story around Pulsak Simulators. What are some others that you found were particularly interesting to you that you've shared on social media? Absolutely. I kind of split my content up into three general buckets. The first is medical education, so how disparities exist there. The second is kind of race-based medicine or racial biases in medicine and then technology and how biases can exist there. And so Pulsak Simulators exists with technology. And when I say race-based medicine, what I mean is in healthcare, we use race often as a biological marker that actually stratifies care differently for people. So if you think about kidney functioning, for example, we have this equation called the GFR equation, which stands for glomeral filtration rate. And to test kidney functioning, we use estimated GFR. It's this equation that has been come up with that then can understand how well someone's kidneys are working, so if they're working well or not. If you have a high GFR number, your kidneys are working well. If a low GFR number, your kidneys aren't working well. Well, for decades, there have been a racial correction for black patients and only for black patients. That essentially said, if you are black, we're going to add a multiplier and your kidneys work better than any other race. Now, I always note that there's no other racial correction. It's not for if you're Asian or Latino. It's only black versus non-black. And many people would look at their own lab results and see the African American and non-African American GFR. The problem with this though is what it meant is that because a GFR qualifies you for kidney disease or getting a kidney specialist, black patients that were at the same kidney disease level as non-black patients were less likely to get diagnosed with chronic kidney disease, less likely to be sent to kidney specialist and less likely to get kidney transplants. And so it literally wasn't until 2021 in the wake of the George Floyd protests and this racial reckoning that was happening in medicine at the same time where researchers went back and said, "This doesn't make sense." And their new equation was created that no longer included race. One patient actually reached out to me and said that she sent every single one of my videos to her sister, her chronic kidney disease. Her sister took the video to her doctor, her doctor looked into it, and she was able to get moved up to four years on the kidney transplant list. And unfortunately, these kind of equations exist all over. There's so many other race-based medicine that exists with things like spirometry where if you're black or Asian, we automatically assume that you have lower lung functioning than any other race. With the UTI calculators, where it's harder for black females to be able to diagnose with UTIs because of this race-based equation, even in cardiology with heart failure functions, there's these point-metrics that exist that make it harder for a lot of patients to be diagnosed. And many of these equations and adjustments were done to actually be equitable ironically enough. The idea was that we don't want to over-diagnose specific populations. But when we use race as a broad biological factor, instead of understanding that's a social construct, and realizing that your ancestry is a much better indicator of your genetic profile than your race, we see how using race is inaccurate and how we don't have answers for things like what happens to someone that's mixed race. What happens to someone who doesn't self-categorize in these specific ways. And so it's a very inaccurate way of understanding how healthcare can function for people. So Joelle, what systemic changes do you think are the most urgently needed to address racial biases in medicine? I always like to say that we need to move from a race-based system to race-conscious system. What that means is we don't say because you are black, that's the reason why you have asthma or you're more likely to have chronic kidney disease. It's saying that because you are black, you have had policies like redlining that have put you in areas where you're more likely to be exposed to pollution and therefore get asthma. As you are black, you're more likely to be in an area that has food deserts and because of that, you don't have access to healthy food and so you're more likely to get diabetes or other long-term conditions that can negatively impact your health. I think once we're able to make that change, we're able to better focus in where policy should go. I also think it's really important to realize the importance of something that's a big topic right now, diversity, equity, and inclusion in medicine and why that matters. There's a large effort to try and remove DEI from medicine and beyond and my argument for it is, but all the things I've talked about already today are examples of diversity, equity, inclusion, understanding how clinical trials and have diversity, clinical trials make sure that we have better devices like postdoc seminars that work well on us. It allows us to look at AI and understand how does artificial intelligence treat people differently based on race potentially if we don't know how AI is working and discrimination productions, right? Patients from communities that are underprivileged are more likely to go back to communities that are also underprivileged and served there as well. I think all these things go hand in hand, but it's moving from a race-based systems to a race-conscious system and understanding the importance of diversity, equity, inclusion. So what responsibility do you think that those of us in medicine have to advocate for more systemic change beyond just the individual patient care that we're engaged in? Absolutely. I like to say mentorship is a huge way of putting it forward and this might be unpopular, and so this isn't for everyone, but I think unfortunately there is a lot of misinformation disinformation on them. And so I think our responsibility is really as communicators to sift through information and use our knowledge that we have to say this is accurate, this is inaccurate. And so doctors, in whatever way it is, whether that's you want to be doing policy, whether it's just talking to your patients and informing and communicating to them to let them know about what their diagnosis means, whether it's having a larger platform and using social media to start talking about issues. I think those are all things that we can be doing and we all have a responsibility with the knowledge that we have and that we've gained to share it and make sure that we're using it and passing it on in a way that allows for patients to control their own health. I think now more than ever, right? That's critically important. So you touched a little bit on technology and AI, for example, but what role do you think that tech and artificial intelligence will play in addressing or maybe perpetuating health inequities in the future? I think AI is going to be used a lot more. I mean, it already has been used a lot more. in medicine, both on the consumer side and also even in hospitals. So one way that consumers are using it that could be helpful is looking at things like skin conditions, being able to take a picture of skin condition by with AI and recognizing whether it's something that you need to go to the doctor to actually look at or not. It can help really risk stratify it and help people understand that they need to go to the hospital or not on the flip side of that though. It's understanding that in medicine, we haven't had diverse images often. And so AI doesn't have an input that's diverse. It may not read accurately on darker skin tones. It could be inaccurate. There's another thing I talk about when it comes to artificial intelligence about ways that can perpetuate biases. And there's basically an algorithm that's used by millions of hospitals across the United States to risk stratify patients when they come to the emergency department. Essentially, it looks at whether you are sick or non sick and this AI algorithm will say, "Does this person need to go see a doctor first or can they wait?" Researchers looked at this AI algorithm and found that for the same sickness of care, black patients, for some reason, were less likely to be recommended to go to the doctor than other patients. What we know is because of the history of redlining, lack of access to hospitals, gene crawl, all these sorts of things, black patients and patients of color are less likely to use the healthcare system. And so that means this AI algorithm was automatically assuming that these individuals that were front underrepresented backgrounds were less sick than others. And so I think it's a huge example of showing how AI, while there's many ways it can be used well, can do more harm if we're not understanding the ways it works or understand the way the actual algorithm is created. How do you see motivated when tackling issues that I would imagine feel so deeply ingrained in society and in medicine? I've been doing this now for about four or five years making content. And one of my favorite messages I've gotten has been your content made me apply to medical school, now in medical school. Or teachers literally telling me that they put my TikTok on their syllabus as required watching, which is crazy to me, because a lot of the information I'm sharing, whether it's about what do skin conditions look like in darker skin tones versus lighter skin tones, or changes to the GFR equation, or pulse oxenitors, or AI, a lot of these conversations aren't being had in the classroom and so they're having to outsource it to resources like mine. And so I think I keep myself motivated by actually looking at those messages. I have a little folder on my phone when I actually screenshot those messages and look back at them to remember my why. And then I focus on my grandma as well. The whole reason I got into medicine, the whole reason I've been so laser focused on equity was her. And I think about her story a lot. I'm a picture in my room that I always am looking up at even as a recording content. And I think it reminds me that in tragedy, there can be beautiful things that happen. And I know that if she was here, she'd be proud of me knowing that I'm taking her story, carrying it forward and making changes in the world on behalf of her and that passion that she had. Oh, she absolutely would be so proud of you. I mean, I wish when I was in med school that I could have had access to your content, I feel like it would have helped me a lot. So well, how do you envision the healthcare system evolving in the next 10 to 15 years? And what role do you hope to play in that evolution? I think the next 10 to 15 years, my hope is that we continue to diversify medicine. Unfortunately, we're kind of going the opposite direction right now. The WAMC released a report looking at new and release and the racial breakdowns. And there were double digit drops in each of the categories, the most significant being with people that are indigenous with a 20% drop in medical students that were enrolled. And this is in the post affirmative action case that was removed. The reasons why isn't necessary to do with the affirmative action case, but the fears of institutions of being penalized for looking at these things. There's so many things I want to see in the future. I want to see the entire model of health insurance change. I want to make sure that we have clinical trials that include diverse backgrounds, that hiring increases, that residency spots open up, that more medical schools are out there, that we go back with the WHO and work with them again to make sure that we're getting all this information out there. And I think for me, my role in the next few years is really going to be putting a megaphone on those parts of medicine that need to be spotlighted a little bit more. And I think in this current climate that we have right now, there's a lot of conversations that are being overlooked or you can't go online and find out about reproductive health anymore in an easy way, at least from the federal government level. And so making sure that I'm creating content and creating basically curriculum that people can access whether they're patients, whether physicians, whether they're medical trainees and being able to have access to it. If you had a magic wand and could rewrite the medical education curriculum, what changes would you prioritize to better prepare future doctors? In the past few years, it's been a better focus on social determinants of health. And I want to continue that trend of making sure that every single course that we have, there, it's our nephrology course, our cardiology course, has a portion in there where we focus on the SDOH, but also focus on the little bit of the history of it too. And they go all too often, these changes happen like with things with the GFR equation, but then we don't realize they happen. And we can fall back into the same trap, unfortunately, of going back to using race-based as opposed to race-conscious medicine or not understanding the ways that people that are houseless or people that have LGBTQ backgrounds or all these sorts of things play in our narratives. So for me, it's really wanting to make sure that individual identities are better put into healthcare curriculum, that patient voices are put at the forefront, what that means literally bringing in a patient to talk about their experiences, both good and bad that they've had with physicians, and really being able to better serve our communities, creating a curriculum that makes sure that we understand that our purposes doctors is to serve people and that while the medicine aspect of it is crucially important, we can only do our job for listening to our patients, understanding their lives backgrounds, and connect with them on a human-to-human level. Joelle, beyond your social media presence, are there any other projects that are coming up that you're working on that listeners can keep an eye out for? Yeah, one of these projects that I'm really excited about right now is called The Doctor Is In. It's a mixed reality animated TV show that's going to be housed on YouTube that I'm super excited about. And essentially, we have Leeland, who's a five-year-old black boy who dreams of becoming a doctor. And we talk about medical concepts, along with our three medical supplies, standing the set the scope, auto the handbag, and say to the X-ray. And my whole goal is really to inspire the next generation of kids to go into medicine. I've always believed you can't be what you can't see. And I hope that people look at Leeland as a five-year-old and say, "I can see myself in him." And I learned at five years old about medical concepts like, "What is asthma? Why are stomach growls? How to step the scope does and how to use it." And I think it's going to be a show that hopefully, guess people are really excited, but can be killed with parents, too, to learn a little bit something new. And where can people find this show and when is it coming out? It will be coming out in May, but we'll have content leading up to it. You can check out our YouTube channel at The Doctor Is In Show. And what about people who aren't already following you on social media? Where can they find you? All over every platform at Joelle J-O-E-L Bravelle. Joelle Bravelle, thank you for talking with me today and for all the incredible work that you've done and that you'll continue to do in the world. I mean, it is just absolutely remarkable. So thank you. Thank you so much, Ashana. And that's it for today's episode. Thank you so much for listening. Our head health is part of the Ted Audio Collective. This episode was produced by me, Dr. Shoshana Ungerliter and Jess Shane, edited by Alejandro Salazar and fact checked by Vanessa Garcia Woodworth. Special thanks to Maria Lagas, Faraday Grange, Daniella Balareso, Konstanzagayardo, Tansika Sangmar Nivong and Roxanne Highlash. If you enjoyed today's episode, rate and review the show on your favorite platform. It helps other people to find us and I'd really love to hear your feedback. Send me a message on Instagram @ShoshanaMD.