Last Week Tonight with John Oliver (2014–…): Season 6, Episode 21 - Bias in Medicine - full transcript

LAST WEEK TONIGHT
WITH JOHN OLIVER

SEASON VI, EPISODE 21

Welcome to Last Week Tonight.

I'm John Oliver.
Thank you for joining us.

A quick recap of the week.
In which a lot happened,

Hickenlooper dropping out
of the presidential race,

he's one of these three men,
it's impossible to know which,

to a Russian airplane crashing
into a field with no one dying

or as it's more commonly
known, a "Dry Sully".

And then, of course,
there was this.

NBC News has confirmed



President Trump has talked to aides
and members of Congress

about possibly buying Greenland.

Yeah, of course he fucking did.
Of course he did.

Greenland is icy, distant and
semi-autonomous. It's Trump's type.

Speculation on Trump's comments
rose to such a point this week

that Greenland's premier
had to issue a statement:

"Greenland is not for sale."

If you had "Two and a half years"
in your office pool

of "When a leader would have to tell
Trump: 'You can't buy our country'"

congratulations,
you're a big winner.

But for now, let's turn to a different
diplomatic hot spot: Hong Kong.

It is the city equivalent of using
Hulu with your ex-boyfriend's account,

it's basically free, but that
could change at any minute.

For weeks now, Hong Kong
has been in a state of upheaval.



Hong Kong near the brink
after a day of violence

that shut one of the world's busiest
airports for a second day in a row.

International travelers caught
in the standoff

with hundreds of flights canceled
as luggage carts blocked passengers

pleading with protesters
to make their flights.

Come on !
You're being really selfish now !

I get that he's frustrated,
but he's in a tough spot there.

Come on, guys.
I need to catch my flight !

Can you tone down your fight
for democracy for a bit ?

Not saying don't try to maintain
your grasp on freedom,

but could you take it down
so I can get to my gate ?

Come on guys,
you're being selfish !

Protests began over a bill
that allowed China

to extradite Hong Kong
citizens to the mainland.

Opponents feared were part of a plan
to undermine Hong Kong's autonomy.

Protestors have
been very resourceful,

using umbrellas as shields and
lasers to disorient police

and circumventing a prohibition
against marches

by organizing them
on apps like Tinder.

Which is fantastic news
for anyone in Hong Kong

struggling to explain what they
were doing looking at Tinder.

I was recruiting protestors.
Female protestors age 24 to 29,

interested in public sex,
threesomes and assplay.

That's really what
this movement is all about, right ?

Chinese government
has been flexing its muscles,

moving armored carriers
to the border,

claiming protesters
"show signs of terrorism".

Within China, state media
has framed the protests

as the work of foreign forces,
one in particular.

There are indications
showing that there are

extraterritorial forces who've
played a horrible role in this chaos.

There are pictures of foreign agents
giving protesters money,

encouraging them
to mold public opinion.

Who are they ?

It's fair to say the CIA has spent over
70 years plotting in Hong Kong.

No one is saying the CIA does
not have a long, shitty history

of meddling
in other countries' politics.

It's helped re-installed the shah
in Iran,

it sponsored the Bay of Pigs Invasion
and it created "Paw Patrol",

to brainwash the planet's toddlers
with an authoritarian worldview.

All indications are that that's what
is happening in Hong Kong is local

and the result of long-simmering
internal tensions.

And if this is an American plot,
one thing is for sure:

nobody told the president.

Trump not only barely seems aware
of what's going on there,

he also gave China a green light
to do whatever they want,

like when he said this
at the start of the month.

Something's happening
with Hong Kong

because when you look at
what's going on,

they've had riots
for a long period of time.

I don't know
what China's attitude is.

Somebody said that at some
point they're gonna want to stop that.

That's between Hong Kong and China,
Hong Kong is a part of China.

They'll have to deal with that.
They don't need advice.

Nailed it.

Somehow there's both a lot
and nothing to unpack there,

but I will say this:

"They're gonna wanna stop that"
is the wrong message to send to China.

Anything would have been better.
If he'd said:

"What do I think of Hong Kong ?
It's strong, angry,"

"I don't like when it throws
barrels at Mario",

I'd think "You're thinking
of Donkey Kong, not Hong Kong,"

"you didn't wink at the possible
use of force, so no harm done."

Trump giving China a tacit endorsement
to use force against protesters

is not remotely surprising.

He sends the wrong signals
to other countries all the time.

Until his term ends, we'll live
with the fact that we have a president

who looks at America's allies
and says: "Go fuck yourselves",

looks at Russian interference
and says: "No big deal"

and looks at Greenland and says:
"200 bucks plus Don Jr., final offer."

And now this.

It's That Time Of Year Again...
Again.

Starbucks offers Pumpkin Spice Latte
starting this month on the 27th.

That's two weeks from today,
the earliest it has ever started.

Behold ! Pumpkin Spice Latte
has returned earlier than ever before !

Not that I'm complaining,
because I am a PSL lover,

but that's not even fall yet.

- August 27th, right ?
- 21st is next Wednesday.

On Wednesday we ride through
the nutmeg gates

to rain frothy steamed milk
upon your souls !

That is the earliest launch ever
for the so-called PSL's.

You know summer's over when they
whip out the pumpkin latte.

Give up ! You can't escape
the sweet oblivion of the spice !

I don't know what its called
"pumpkin spice",

there's no pumpkin in it.

You fool !

The glory of the spice is beyond
your feeble human comprehension !

Starbucks saying they'll be
introducing that treat,

which for some reason, like McRibs,
has a cult-like following.

Indeed !
It is... kind of like the McRib !

Pumpkin Spice Latte, pumpkin spice
coffee usually coming out in the fall,

but now,
SPAM wants to jump in this.

Yeah !

Let the feast
of the pumpkin meat begin !

Moving on. Our main story
tonight concerns doctors:

rated number one by "Reasons There's
a Finger in Your Ass" magazine.

Doctors held a position of high
esteem in society for generations,

as you can see in the 1930s
film, "Men of Medicine".

In every U.S. city and town,

there is one house that everybody
knows, the doctor's.

Available here are the services
of the man who by law is privileged

to practice the most respected
of all professions.

Only doctors have the privilege of
shoving a stick into a child's mouth

and diagnosing the condition that we
in the 1930s know as "gross throat".

The cure for it is drowning !

While medicine may be "the most
respected of all professions",

not everyone has the same experience
when they visit a doctor.

I would have been treated
differently if I had been male.

You'll hear doctors and nurses
like: "They're just exaggerating."

Not really listening to them
because it's a black person.

If it's like a white person, it's like:
"My god, like, this is serious."

If you are a woman, and/or
a person of color in the U.S.,

you may have a different relationship
to our health care system

than a white man.

Who better to talk at you
for 20 minutes about this

than me,
the whitest of white men ?

I get a sunburn watching
the Travel Channel.

I'm a walking cider doughnut,
pale, filled with cake

and found at every farmer's
market in the northeast.

This is a discussion
we need to have.

While the vast majority of doctors
are doing hard work

with sometimes-limited resources,
bias in medicine is an issue.

It's not the only factor
in determining health outcomes,

it can have a massive effect.

So tonight, let's talk about bias
in medicine, in two specific areas,

first sex and then race.

In the words of every therapist
I've had, let's start with sex.

Women's bodies have been fraught
with judgment and misconceptions.

Mom, can I go swimming
with Peggy tomorrow after school ?

No, it's not a good idea the first
two or three days of your period.

You might get chills
and catch cold.

That's right. Peggy, of course I can't
go swimming. I've got the curse.

Yeah, Peggy ! What are you, an idiot ?
She's got the curse !

She can't swim.
She'll fucking sink.

In the fifties, women referred
to their period as "The Curse".

Breasts were "The Haunted Mountains",
butts were "The Valley of Doom",

pregnancy was "The Happening",
giving birth was called "The Babadook".

It was a very scary time
to be a woman.

Things have improved since then,

but women can still face an uphill
battle to get quality healthcare.

There are many studies showing this.
They found that women were less likely

to be referred for knee replacements
than men.

If over 50 and ill, less likely
to receive lifesaving interventions.

When going to the ER
with urgent abdominal pain,

women were less likely
to receive any pain medicine.

Listen to one doctor sum up

how too many in her profession
treat female patients.

A lot of times, women's
symptoms, especially pain,

are attributed
to emotional imbalance

or women being hysterical
or crying wolf about their pain.

That's wrong.

Of course it is. The only time
it's understandable for a doctor

not to hear a woman's
complaints about pain

is if she's calling into the office
and she's got AT&T.

Because the calls
keeps dropping out !

Boom, business daddy,
I got you again !

Business baby woke up all cranky.

I'm airing my dirty diapers
in public again !

I'm high-maintenance.

While some of this may have to do
with implicit bias on doctors' parts,

there is also a systemic problem,

where doctors may literally
know less about women's bodies.

Historically, medicine
has studied men's bodies,

which here means
those assigned male at birth,

as a proxy for all bodies.

As one researcher will tell you,
the reason was incredibly dumb.

There's this assumption that you
are me with pesky hormones.

With pesky hormones.

The idea is that the fundamental things
are similar between you and me.

So, that ironically the best way
to study you is to study me.

Because you don't have
pesky hormones.

We study the fundamental
things without this nuisance stuff.

Women are full
of "nuisance stuff".

It's why medicine
has long chosen to believe

that women
are just hormonal men.

Also, children are tiny men,
dogs are furry men,

trees are big hard still men,
birds are men who can fly,

fish are men who can glub
and volcanoes are men

who, for some reason,
ejaculate lava.

And this idea that women
are just men with pesky hormones

has led to some woman-shaped
blind spots in medicine.

For decades, women were excluded
from medical research trials,

in part because their menstrual
cycles would complicate the results,

which you would think
would be all the more reason

to include them in tests, because
women are half the population

and can respond to treatment
or drugs differently.

In some cases their exclusion
was ridiculous,

as this news report
from the nineties shows.

In 1990, the Journal of the National
Cancer Institute published this report

which looked at the impact
of diet on estrogen, metabolism,

and its links to cancer
of the breast and uterus.

All of the subjects were men.

They studied a way to prevent
cancer of the uterus

on people who did not have one,
that's ridiculously unhelpful.

It's like studying
healthy conflict resolution

surveying
the Real Housewives of New York.

They've resolved no conflicts !

Luann's pissed
about Dorinda's fish room,

Ramona's uninvited
at the clambake,

Tinsley's furious because they laughed
'cause she froze her dead dog.

The group's dynamic is still a mess !
The show's all the better for it.

When you have the male body
as the default reference

and doctors who might not take
women's pain seriously,

the consequences can be deadly.

Take heart attacks.
You think of them

looking like they do
on TV all the time.

People grabbing their chest
and then falling over.

But for many women,
that is not what they look like.

Their heart attacks present
subtler symptoms

like pain in the back or jaw,
nausea and unusual fatigue.

Lots of doctors miss that.
Look what happened to Katherine Leon,

who went to the ER
with serious heart problems...

The young doctor came in,
very condescending,

thought I was just
a drama queen, and he said:

"It's not my job to tell you
what's wrong with you,"

"it's my job to tell you what it's not
and it's not your heart."

And that was it. I was like:
"Well what do I do next ?"

and he's like: "You go home."

That doctor managed to find
literally the only time

that telling someone
to go home is bad advice.

Having a bad day at work ?
Just go home !

At a party stuck next to a guy who
wants to talk about Bitcoin ?

Go home !

You're on second and your buddy
grounds a single into left field,

the outfielder picks it up,
but you realize he's overthrown ?

Go home !
Go home, now !

Katherine Leon
was having a heart attack.

She should not have been sent home !
She's by no means alone.

Women
who came to the hospital

with heart-attack symptoms
were seven times more likely than men

to be misdiagnosed
and sent home.

Terrible. The only thing a woman should
be seven times more likely to do

is recognize those Real Housewives
references from earlier !

Even that is not remotely okay !
That show is both a nuanced

and searing portrayal of wealth,
power and loneliness in Manhattan,

themes that can transcend superficial
boxes in which it's confined.

It's our
"Much Ado About Nothing"

and Andy Cohen
is our Shakespeare.

But that's not the point.
It's a very good point.

It's an excellent point. But it's not
the point we're making here.

Which is, sex and gender bias
can clearly distort medical outcomes.

But they are not the only forms
of bias that can do that.

If I may quote the inside of Trump's
head when energy at one of his rallies

seems to be flagging:
"Let's get to the racism stuff."

There's a disparity in life expectancy
between black and white Americans,

particularly for black men.

When one study tried to quantify
the "mortality gap",

they found shocking numbers,

which this documentary illustrated
in the most jarring possible way.

We found over 83 000 excess
deaths per year

in the African-American
community alone.

83 000 excess deaths each year.

That's the equivalent of a major
airliner filled with black passengers

falling out of the sky
every single day, every year.

Okay, but that's such a weirdly
specific way to put that.

You don't need to take a number
that's already a disaster

and put it in terms
of another disaster.

Is like four double-decker buses
driving into each other every 6 hours.

It's 32 hot-air-balloons
exploding every minute for a week.

It's the death of Princess Diana,
83 000 times. I get it.

It's pretty bad, I get it.

Clearly, there are systemic factors
contributing to that number.

Even when it comes to contact
with the health care system,

there can be appalling disparities.

Many studies show African-Americans
have a lower likelihood

of receiving recommended care
for everything

from pneumonia, to hip fractures,
to multiple cancers.

While there's no one cause
for these disparities,

it doesn't help that, as a study
of med students and doctors found,

three years ago, misinformation about
African-American patients is rampant.

The study found some doctors believed
there are biological differences

between the two races.

25 percent of doctor residents
thought blacks have thicker skin.

Holy shit. You do not expect
to hear that at a medical school.

You barely expect to hear it
yelled across a table

by a racist grandfather
at Thanksgiving.

What are you talking about,
Grandpa ?

His skin isn't thicker than yours.
Even if it were,

that is not why
you didn't vote for him.

That is not the only insane
belief that that study found.

14 percent of second year
med students agreed

black people's nerve endings
are less sensitive than whites',

which they aren't.

17 percent believed that black
people's blood coagulates

more quickly than whites',
which it obviously doesn't.

I wouldn't be surprised to learn
86 percent of them believe

that Irish jizz
is green on holidays.

Not even just St. Patrick's Day.
All holidays. Even Yom Kippur.

That's the worst
time to ejaculate.

It is impossible to say exactly
where they came by those beliefs,

but medical textbooks
are not immune from bias.

This nursing textbook was available
until just two years ago,

when it was pulled after it emerged
that it featured statements like:

"Hispanics may believe that pain
is a form of punishment"

"and suffering must be
endured to enter heaven."

African-Americans "believe
suffer and pain are inevitable"

and Native Americans
"pick a sacred number"

"when asked to rate pain
on a numerical scale."

You expect that a textbook might have
typos or outdated information.

You do not expect it to basically
say: "Hispanics think God is kinky"

and "Native Americans
will tell you wizard numbers !"

Misconceptions like those can have
tangible effects on treatment.

If a quarter of all medical residents
think black people have thicker skin

and nurses have been told that
they think suffering is inevitable,

that might lead to black patients'
pain being treated differently.

Which happens.
Wanda Sykes summed this up best.

Because of racism, black people,
we don't even get our hands on opioids.

They don't even give them to us.

White people get opioids
like they Tic Tac's.

It amazes me how many opioids
you mother fuckers have.

I had a double mastectomy,

you know what they sent
my black ass home with ?

Ibu-fuckingprofin.

From now on, Advil should absolutely
call itself "Ibu-fucking-prophen".

That is non-negotiable.
That has to happen.

That's by no means unusual.

One recent analysis found that black
patients were 34 percent less likely

to be prescribed opioids for pain
than white patients.

While there are a lot of good
reasons to prescribe fewer opioids,

"my patients are black"
is just not one of them.

If you consistently have bad
experiences with health care,

you might be less inclined
to seek help in the future.

Listen to this woman,
diagnosed with lupus,

describe how she was impacted
by the response from doctors.

It was just this belief
that I was making things up,

what I was saying wasn't real,

that I must be seeking drugs
or selling the drugs.

That's what you were getting
in the doctor's office ?

Absolutely.

What happens is you start to develop
fear around going to the doctor.

Yeah, of course you'd be
frightened to go to the doctor,

if you thought they'd treat you
like a drug dealer.

I'm terrified and the worst
thing doctors said to me was:

"You're 42 and you
should no longer need to be bribed"

"with a lollipop to get a flu shot."

But I want one. I want a wowwipop.
I've been very brave !

Give me a wowwipop.

I'm not saying all doctors are racist,
or sexist, they obviously aren't.

But people have biases
and doctors are people.

They may've come up in a system
that, intentionally or not,

has discounted the experiences
of a major portion of the population.

And their biases
have life or death consequences.

There's no starker expression of where
sex and race can negatively impact

health care outcomes
than maternal mortality.

The US has the highest rate of maternal
mortality in the developed world.

Which is already terrible, but it gets
even worse for black women.

If you're a woman of color,
especially if you're black,

your odds of dying in childbirth
are four times higher in our country.

Why ? 'Cause you're not talking
about access to health care,

about money or education.

No. And this is gonna be
hard to hear:

we believe black women less
when they express concerns

about the symptoms they're having.

Yeah. And that is hard to hear.
It is worth really underscoring

what he just said:
these racial discrepancies exist,

even when you control
for socioeconomic factors

like education
or insurance status.

We are literally disbelieving
black women to death.

And that is appalling
enough in theory,

but it's heartbreaking in practice.

Take Kira Johnson,
who gave birth to a son,

only for things to go horribly wrong.

Her husband said
she waited hours for a CT scan.

When doctors took the situation
seriously, it was late.

She died in surgery.

Her husband still wonders what
he could have done differently.

I sit awake at nights thinking:

Maybe I should have grabbed
somebody by their collar, right ?

I should have turned the table over !
I thought about the whole issue...

I didn't want to be seen not only as
angry, but angry black man right ?

I'm not the smallest guy
in the world.

And what that would mean
and how we would be perceived

and how we would be treated
as a result of that perception.

When this first happened,
I would get the question a lot:

"You think would be different if Kira
was white or was a different color ?"

And the way I answer is:

the simple fact that you have
to ask that question is a problem.

Yeah, it is.
It's a huge fucking problem.

That's devastating.
A woman no one would listen to.

And a man who feared he'd be judged
for the color of his skin.

I don't think anyone in their right
mind would be comfortable

with the idea of someone getting worse
medical care because race or sex.

Given that we all agree on that,
what can be done here ?

Ideally, we'd simply figure out a way
for no one to ever get sick again,

thus making trips to the doctor
an embarrassment of the past,

like VCR's, or MTV giving out
something called

the "Michael Jackson Video
Vanguard Award."

2019 ?
They're still doing that ?

Is that a different Michael Jackson ?
It must be, right ?

Why drag Missy Elliot
into this shit ?

There are also concrete measures
the medical community can take.

Standardizing care
is a good first step.

Since 2006, California has cut its rate
of women dying in childbirth

by more than half, instituting
protocols for maternal care.

Some hospitals there now do
things like quantifying blood loss

by gathering the sponges and pads
and weighing them on a scale.

The doctor's potential
biases are removed from the equation,

'cause if a patient is bleeding too
much, the scale will say so.

That is just one example
to address one very specific problem.

We need to think much bigger.

I am just not the best vehicle
for this message.

We need someone who can speak
with authority from real experience

and luckily I know just the person...

Please welcome Wanda Sykes.

Wanda, I've got to say...

Exactly, Wanda...

- I'm so, so glad that you're here.
- I bet you are.

I was worried I might be a bit too
white to give advice on this subject.

That's because you are.
You're real white.

I bet you clap on the one
and the three, don't you ?

I wouldn't know how else to do it.
Yeah.

So, you're just
gonna have me stand here ?

- Would you rather...
- Yeah, I would.

- Okay ! Sure. Please.
- You get to sit. Let me sit.

Should I just crouch then ?

- You can go.
- I could go. Okay, all right. Sure.

Thank you.

Hello and welcome to "Last Sad
Tonight With Spectacles McDorky."

If you're a woman or a person of color,
going to the doctor can be rough.

Been there, done that,
got the ibu-fucking-profen !

But there's some things
we can do.

First, doctors and med students
should get bias training.

I know that doesn't sound like fun.
But it's one of those things

that's not fun,
but you should do it anyway,

like reading with your kids.

Trust me, you don't want to hear
your child has a reading problem

and it's you.

Second, we need more diversity
in the medical field.

We need more non-white doctors
in actual hospitals,

not just the ones
made up by Shonda Rhimes.

And finally, until we do
those first two things,

you've got to advocate for yourself.

And if that doesn't work, don't worry.
I've got a backup plan:

it's called "bring a white man".

If your doctor's ignoring you,

just bring a white man
to repeat everything you said.

If you're thinking: "Where the fuck
am I gonna find one of those ?"

Don't worry ! I've got a white friend
who loves complaining to doctors

and he's recorded some messages
you can use.

So, let's say you're having a heart
attack and they're not listening.

Just take out your phone
and show your doctor this.

You know what ? I'm having
a heart attack, but it's not like...

It's a lady heart attack.
I'm having a lady heart attack !

They're not sending
that man home !

They're giving him an EKG,
an MRI, and a BLT if he asks for it !

It's not just heart attacks.

I got Larry to record messages
for every occasion.

My elbow hurts when I do this !
Like a whipping motion.

My knee ! I can't bend it.
I can not squat.

My uterus is killing me.
I've got some pesky hormones today.

Shouldn't have to say this but,

my skin thickness is pretty much
the same as everybody else's.

It's hard for me to explain
what's going on with my ass,

but I'm gonna tell you
something: it hurts.

Side to side and the crack.

I don't know if it's coming from
the crack and that's why the sides hurt

or if it's coming from the sides
and that's why the crack hurts.

I can't go swimming.
I've got the curse.

That is so great, Wanda.

Let me just ask quickly:
what if a doctor still ignores you ?

Don't worry ! I got Larry to record
the white-person sevenword mating call.

Check it out.

I'd like to speak
to your supervisor.

- Conversation over.
- It's done. It's all over.

That's great, Wanda.
And thank you so much.

That's our show. Our thanks
to Larry David and Wanda Sykes !

We're off until September 8th.
Good night ! It's over.

END OF EPISODE 21,
SEASON VI