Addressing inequities in health care treatment

ANGIE MILES: The Centers for Disease Control reports that racial and ethnic minority groups in the United States experience higher rates of illness and death when compared with White counterparts.

Dr. Robert Winn is Director of VCU Massey Cancer Center and is spearheading efforts to close that gap and build trust among populations previously disenfranchised from health care and medical research.

We want to welcome to our program, Dr. Winn.

Thanks for being with us.

ROBERT WINN: Well, thank you for having me.

ANGIE MILES: We definitely want to delve into this very important topic, but first I was hoping we get a chance to get to know you a little bit better.

I would say, you might agree, your roots are somewhat humble.

How did you get from your early days to where you are now?

ROBERT WINN: I am the quintessential example of people seeing something in me before I saw it in myself.

I did not grow up thinking that I was going to be a scientist, nor a doctor.

But I would have to say what I did know is that I had people around me who, when opportunities knocked, could help me actually open the doors.

And so, for me, this is quintessential of being able to have the opportunity to fall in love with science and then be able to have the opportunity of having folks at Notre Dame, where I went to undergraduate, having folks like Father Walters and Father Austgen at the time tell me that my path would be medicine.

And essentially I said, "sure."

ANGIE MILES: You certainly bring with you a lot of passions.

One of those is for helping underserved communities.

We know that there are health disparities between Black people, White people, but also rural communities, or ultra urban communities.

Where is it that you see Massey being able to make a difference, you being able to make a difference with regard to this problem?

ROBERT WINN: Yeah, thank you for that question.

The way I see this is that many of those communities, unfortunately, are invisible, and yet are contributing to the greatest number of poor outcomes from cancer and cost.

And so for me, the goal right from day one when I took over as cancer center director, was to not only be excited about creating the next molecule at the laboratory, wet laboratory, that would become a medicine, but to actually figure out how do we get medicines to not some of the people, but to all of the folk.

And so for me, the bridging of the discovery sciences and the implementation of that science of getting it to our communities mattered.

And one of the tools that we're using is to make sure that we are developing not only high tech ways of reaching communities, but reminding that the most effective way is high touch.

And so, boots on the grounds, making sure that our navigators and community activators are absolutely involved and at the center of what we do.

ANGIE MILES: That's really interesting the way you described the innovation of blending the discovery sciences and the implementation sciences, not keeping those living in separate spheres.

You've also talked about a symbiotic relationship between people in communities and the providers, the researchers, the people with the knowledge, that they're actually able to learn from each other and improve outcomes.

Can you talk about that a little bit?

ROBERT WINN: What I really love about what we've created for the last 50 plus years since the discovery of DNA by Watson, Crick, and Franklin, it really has been, which, by the way, was seminal.

It was the first time human beings, by the way, were able to understand the nature of human cells.

And since 1950 we've been very focused at the laboratory.

Well, it was called the bench to bedside model.

If a scientist was bright enough to come up with an ideal at the laboratory bench, they would then potentially bring that to the bedside.

For us, that was a shortcoming.

It meant that if you couldn't get to the bedside, you wouldn't get the help at all.

What we've done here at Massey, which I think is now getting national attention, is we said, "What if we flipped the script?

What if we went from a bench to bedside to a people to pipette model?

In other words, what if we actually found out more about the communities we were serving, got more data about what we were doing, and then refined our scientific questions to ultimately have more impact.

What would that do?"

And so we have launched the great experiment here, in the 21st century here at Massey, of being able to say that if we collect community data first, it helps our basic scientists, our clinicians, and everyone else be better at asking what are the questions that not only advance science, but will be beneficial to our communities.

And that we're really proud about.

ANGIE MILES: Petersburg, you are the lead on a lot of important work happening there.

Can you describe how your vision and your approach is playing out in the work that's happening in Petersburg right now?

ROBERT WINN: Absolutely.

So, there are areas, communities like Petersburg where we have done what are called community engagements, or community walks and outreach.

Interestingly enough, there were groups of, in this case, African American women, who bought to my attention that, "Why wasn't I doing something about those women cancers?"

And I scratched my head, "You mean breasts?"

They were like, "No."

I was like, "Well, what other?

Ovarian?"

"No."

And then we stumbled upon endometrial cancer.

It turns out that in African American populations we are seeing an increase of endometrial cancers that are actually, unfortunately, incredibly devastating, and that there is no cure.

This is the people to pipette.

I then subsequently took that information and was curious enough to ask my clinicians, "Are you seeing increased rates of endometrial cancer?

I didn't think that was a thing."

The clinicians here said, "Absolutely.

And by the way, Dr. Winn, we're looking at more aggressive forms."

I then took that information and said to my team, "Are there medicines and drug trials that are actually addressing this issue?"

There were none.

We got together our basic scientists, our clinical trialists, and the long of this story is from community to me, to my people, we now have launched a clinical trial, first ever, addressing the issue of potential impact, favorable impact, in treating endometrial cancer.

That's how this works.

We could have done it the traditional way where a smart person says, "Hey, I want to do something in endometrial cancer."

And it turns out that the community, when you go there, endometrial cancer's not a problem.

In this case, it's going directly to the community and helping them help us set the table that really mattered in this case.

ANGIE MILES: We addressed this a little bit, we want to hear a little bit more about how pronounced the health disparities are in Virginia, both health conditions and access to treatment.

Can you just elaborate a little more on that?

ROBERT WINN: Yeah.

The health disparities here, in the commonwealth, are amazingly frustrating.

It turns out that if you look at some of our underrepresented groups, for example, prostate cancer, African-American men are two times more likely to get prostate cancer in this state, and to die from it.

The interesting question that comes to mind is that if you look at our rural groups, whether you're talking about breast or colorectal, or you're talking about GI cancers, all of those are disproportionately negatively affecting, in the commonwealth, rural communities and communities of color.

The truth of the matter is, and a surprising finding, was that we also, in the commonwealth, have some of the lowest life expectancy for White men.

Interesting enough, outside of our Petersburg area, we have a locality in which the average age for White men in that locality is 61.

That's unacceptable.

The truth of the matter is if you look at that and now you look at groups of rural and underrepresented, and by the way, turns out in Virginia and the commonwealth we have a substantial number of underrepresented minorities that are in rural communities.

What are we doing about those communities?

How are we getting to them?

The science is always going to be there.

In fact, we're going to create new cures, we're going to have new medicines, that's not the issue.

The issue is how do we get those new medicines to our most at risk so we can improve the health of the commonwealth as a whole, and how do we build trust doing it?

And, in fact, I think by addressing the health disparities issue, it will actually put us down a path that in addition to the creating new drugs we have to do these other things like care, and actually making sure that our communities aren't invisible to be able to make this effective.

And I'm excited that we're going to be able to do that, and we're walking down that course right now.

ANGIE MILES: We look forward to seeing what other things you will be doing through Massey Cancer.

So, thank you so much for joining us for the interview, and we appreciate the time, Dr. Robert Winn.

ROBERT WINN: Thank you.