Transcript:

DERAY MCKESSON: Hey, this is DeRay. And welcome to Pod Save The People. On this episode, it’s me, Kaya, Sam, and De’Ara, as usual, talking about the news that went underreported in the past week, the news you should know. Then I sat down with the one and only Dr. James Wood to discuss racial disparities in orthopedics. I learned so much.

My advice for this week is your calling will call, that like I didn’t understand what it meant to be called to a body of work until the protests began. And it just kept calling and calling that like, we can do this, DeRay. You can do something here. There’s something special that is possible. You can be a part of a team. You can do it. I’m like, you’re calling a call. And here’s the thing, is that only you can answer your calling.

I feel like so many people are listening to other people’s calls. They want people to listen in on that call and tell them what the call should be. Your calling is yours. Your calling is yours. Listen, be ready, be thoughtful, and walk into the call, but your calling is yours. Let’s go.

DE’ARA BALENGER: Welcome to another episode of Pod Save The People. I’m De’Ara Balenger. You can find me on Instagram and Twitter, @DeAraBalenger.

SAM SINYANGWE: I’m Sam Sinyangwe, @samswey on Twitter.

KAYA HENDERSON: I’m Kaya Henderson, @HendersonKaya on Twitter.

DERAY MCKESSON: And I’m DeRay, @D-E-R-A-Y on Twitter.

DE’ARA BALENGER: By the time this podcast airs, it will be the exact day of the one year anniversary since Mr. George Floyd was murdered by the Minneapolis Police Department, in particular, ex-officer Derek Chauvin who now has been convicted of murder and due in sentencing, I think, in a few weeks. The other officers are going to be on trial as accomplices to that murder.

And that is coming up soon. So you know, it’s definitely has been a year, the deaths of so many that have happened kind of both in the moment of this, George Floyd, Breonna Taylor, Ahmaud Arbery. I definitely think, in terms of my work with clients and through different partnerships with corporations and brands, there definitely has been a downturn in trend. I think, in terms of people still committing to anti-racist work, to seeing how they can show off differently.

I mean, I think, obviously, like we were at the height of it this time, early last summer. So I just think as we’re still in the midst of figuring out what all this is going to look like. We have a new administration that has been helpful, I would suppose. But a lot of police accountability or lack thereof is happening at a local level.

I don’t know, I’ve been thinking about what this looks like in terms of action but also just in terms of spirit, opportunities for Black folks, in particular, to find moments of peace and healing. I think we need more of that. I’m also really nervous about the summer as we’re coming out of COVID. But I think, people are still obviously living in trauma.

So just that, combined with kind of the increase in gun violence– I know, there were a few mass shootings just over the weekend, one in South Carolina, one in South Jersey. So what are y’all suppose like where are we going? How do we create opportunities just to be there for one another? I basically didn’t want to say it’s been one year, and ain’t nothing changed. But, you know–

DERAY MCKESSON: You know it’s hard because I feel like we’ve been through these situations so much where there’s like a national story, a national conversation. And then we get pulled into the like what has changed? One year– like it definitely happened for me around the killing of Mike Brown and then Freddie Gray and Sandra Bland and Tamir Rice.

You know, I’m hopeful that in this moment, there is a continued interest in dismantling policing. It feels like– I think about CNN’s policing team, like all these new reporters that focus on these issues and those things. So that’s one. I think that there could be some really good stuff to come out of the George Floyd Act if it passes. So I’m actually hopeful about what that might look like. So that’s interesting.

I also look up and I do realize that there are a lot more people who got into this work who understand themselves as activists, who believe in community– like all those things, I think, that happens every single time in the protests flare up again. I do and I’m always mindful of the numbers. Like the police have just been killing the same amount of people. That hasn’t changed. So as we go forth, this one conviction doesn’t change the demand. It doesn’t change the urgency.

And this year’s not over. So there are a lot of legislatures that haven’t voted yet. The legislation is still on the table. We don’t know what this year’s going to look like. So people are like, DeRay, what are you doing a year later? I’m like, this year is not over yet. So we still have a lot more to go in 2021. And I’m trying to see how the year ends so that we can get ready for the next legislative cycle and do big change.

SAM SINYANGWE: Yeah. I mean, I think, building off of this– again, as DeRay said, the numbers haven’t really changed or been– we tracked 408 people who have been killed by the police in just this year alone, which is very similar to previous years, almost identical to 2019 and other years that we track.

And so again, the outcomes in terms of police violence don’t appear to be changing nationwide, which is ultimately, the bottom line of whether progress is ultimately being made in ways that are felt, in ways that are material, in ways that can save lives. I do think that the conditions for changing those outcomes are slowly being created.

I think that we saw a number of cities begin to pilot new programs to transform the approach to a host of different situations for mental health, to traffic enforcement, to other low-level offenses. But again, those are very new and small scale pilots in most places. In other places, they’re being proposed but haven’t even been implemented yet.

So while these things can make a difference, it seems that it’s too early, or they’re not quite at the scale to make the impact that they might. And then also, thinking about police funding– in defunding the police, dismantling the system of policing, that there has been some progress in some cities as well on that. In looking at Austin made almost a third cut to their police budget.

Looking at LA, New York, with more modest cuts. Looking at Seattle about 18% cut. So I mean, there have been some shifts to a dynamic where year over year, in almost every city all across the country, police budgets were just expanding sort of inevitably. And now that seems to have– there have been– the brakes put on that over the past year in some of the larger cities in the country.

And things have started to move in a different direction. But again, these are oftentimes, single-digit changes to budgets. The numbers of officers on the force haven’t really changed too dramatically in most places. So it seems like this could be the beginning of moving in the right direction. And that if we can sort of build on that and scale that and sustain it, that it could actually impact those national numbers.

But we’re not there yet. And I also worry about sort of the backlash. I think there are these new policing teams and a lot of reporters who’ve been tracking this now. There are also a lot of reporters who have been using those platforms to sort of parrot narratives about crime increasing and that being somehow due to the protests or due to the police not being aggressive and not arresting people and not killing people.

And that narrative is so toxic. And you can see how that has already substantially shifted public opinion. That had already created space for these conversations to happen. And you see that some of that window is now closing. And the numbers are going in the wrong direction, particularly for white people who previously said that they support change and now are sort of backtracking on that.

So I worry that the window might be closing and that if the window closes, that all of these opportunities and the conditions that have started to be created to make real change might not ultimately bear fruit.

KAYA HENDERSON: I’m worried about the backlash as well, Sam. I think, we see these cycles over and over again where there’s the incident or the action, the fevered pitch, the response. What was different slightly about this one is that it inspired worldwide protest movements. And so there’s a part of me that hopes that other countries help to continue to try to hold us accountable.

My worry is over time, then you see things kind of fall off. And you see people go home and start living their regular lives again. You see the haters come up with a narrative to counteract what we thought we saw with our eyes or what we knew we saw with our eyes. I hope that we take this moment, this one year anniversary. And I think we have to re-galvanize momentum to try to keep this going.

I mean, y’all are experts at this kind of stuff. I am new to the party. But it just feels so easy to watch this all slip away and to be like, yeah, that was a year ago and dah dah dah. But I mean, Sam, the numbers that you recount are pretty astounding, right. We haven’t seen decreases. One of you guys tweeted like there’s only six days this year that police haven’t shot somebody. Like what?

I mean, when you look at other countries who have decided to deal with this, they deal with it. They changed policies. They changed laws and press Go. And we’re still protesting, talking about it, legislate and hope and dream and praying. I don’t know. I’m not particularly optimistic. I want to be optimistic. I don’t know how to be optimistic about this.

DERAY MCKESSON: The only thing I’m going to add is in terms of progress, we worked really hard on use of force. Over 350 cities maybe more restricted use of force policies. Over 15 states did. There’s still a set of states that have laws pending that have been recommended. There are three states that restricted no knock raids and total of five states that have restricted them. So progress is slow, but it is structurally changing, to add on what Sam said. So the look now is just to make sure that it actually changes the numbers. Like that’s the North Star.

DE’ARA BALENGER: I think the other thing that I’ll just add quickly is that next week is the 100 years since the Tulsa Race Massacre. So I think also, just putting into it like again, larger perspective to your point, Kaya, like I mean, y’all– I mean, please help, help us. Somebody. Actually I head to Minneapolis this weekend to just be with my family there. But Minnesota has never been an easy place to go to for me. It’s still not. So yeah, I don’t– I think, maybe I’m just having the feels around this upcoming trip. But I just think it is– I’m not trying to be in a place of hopelessness. But definitely, definitely searching for ways to process and remain active.

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DE’ARA BALENGER: So, y’all, my news today comes from The Daily Dot, which I hope is a reputable publication because I’ve never heard of it before, but I like how they situated this article. So here we go. Shout out to Daily Dot. But it really talks about the erasure of Black women in the 60 Minutes piece that talks about this research around AI. I wanted to bring this to the pod, one, because I feel like, in so many of my daily conversations, I hear, well, those Black people just don’t exist.

Black people that can do the tech and do the art and do the lawyering and do all the things, you know. They’re just not there to hire. Lies, lies, lies. You don’t know them. And because of your prejudice, you think that Black people don’t do the things that you do. But in fact, Black people have been doing things all along and have to reinvent how to do the things because you don’t let us do the things. So let me get off of my– off of my soapbox here.

But essentially, what I want y’all to take away from this is that kind of the pioneers around AI, particularly when it comes to prejudice and bias in AI are Black women, notably Joy Buolamwini, Timnit Gebru, and Inioluwa Deborah Raji, Black female scientists who have done groundbreaking research on racial bias and artificial intelligence.

And so what the 60 Minutes study was talking about was this like December 2019 study that they were calling a landmark study. But in fact, these women have been studying this and putting out reports on it prior to 2019. And imminently are behind a lot of the pressuring of Congress and the Senate for there to actually be federal regulation around a lot of these tech companies that are doing AI work.

Because right now, the United States government really doesn’t have a perspective on AI, right. And so, without a perspective, what’s happening is that folks of color, in particular, but everyone is being targeted by AI for commercial purposes. So just about everything that you do on the internet is being tracked. And you are being sold things because of this AI technology.

These women in particular, this is what they work on. So essentially, facial recognition software is more likely to falsely identify women and people of color with darker skin tones than it is to males and those with lighter skin tones. And so, several studies have confirmed this bias, and law enforcement agencies continue, though, to use these programs. So it leads to false arrests and potentially deadly police encounters for folks of color who are much more likely to be killed by the police.

KAYA HENDERSON: What was particularly egregious to me about this situation around 60 Minutes is they actually called the one lady and had hours and hours of interviews with her. She constructed a model for Anderson Cooper so that the TV viewers might understand exactly what facial recognition technology does. And at the last minute, they called her. And they were like, yeah, thanks.

No thanks, we’re canceling the interview. So it’s not like they didn’t know that these people existed. They knew that these women existed. They went out of their way to interview them and then decided at the last minute not to do this. So this wasn’t a matter of simple, oh, we didn’t know these people were there. This was actual intentional erasure.

SAM SINYANGWE: It’s sort of wild because it is like the compounding of the new racism and the old racism. It is– we are talking about these new technologies and how they’re being used to reinforce and amplify and weaponize in different ways existing biases, existing racist structures, and policies and institutions. And sort of giving them the impromptu tour of being data driven or being the result of these really complex algorithms. I think of this all the time in the context of predictive policing in the conversation around using technology to predict where crimes might happen, to send police to those areas.

In facial recognition, you also see some of the same impacts that you spoke to, De’Ara, where people are being falsely labeled, falsely profiled, falsely potentially arrested and killed on the basis of these biases in the algorithms that are confusing people on the basis of information that is incomplete, on the basis of an existing sort of framework, and mapping of people’s facial features that oftentimes is not inclusive of many Black faces.

So it just doesn’t have the same level of granularity or accuracy when it comes to Black people. And that is like something that could have been fixed from the start but is something that was a process where you have so many white people predominantly– who are involved in creating these platforms and these algorithms and technologies.

And you have whistleblowers. You have folks. Black women who have been saying that this is wrong– this is moving in the wrong direction, calling out these biases, and then being silence, being erased, and having their work appropriated in the 60 Minutes documentary. So this is the new racism and the old racism. But we have to be mindful of the way in which these technologies are going to continue to be proposed and evolved and strengthened and embedded within so many different aspects of our lives.

And that those algorithms can be a huge part of the problem if we’re not intentional about how they’re designed. And supporting the people who are calling those things out so that we can actually design technology that centers us that is inclusive, that actually is focused on uplift and not on strengthening the carceral system and resulting in people potentially being harmed.

DERAY MCKESSON: Everybody should check out Joy’s incredible organization, the Algorithmic Justice League. They do such good work. And I’ll just say, we often talk about facial recognition in the context of criminal justice that is where we all, I think, entered the conversation from. But we have to remember that this is also employment.

There are all these AI– like facial recognition and AI tools that are used for employment that review resumes, that like do a host of things in the employment process, and for housing. And one of the things that Joy’s work focuses on, too, is housing. So they highlight that there’s a building managing company in Brooklyn that wanted to use facial recognition for people to enter their homes and this host of things.

What her research does– and you should watch her Ted Talk. You should watch all the things– is they’re like– this AI can’t even forget– like you hear that the AI can’t recognize a Black woman. And you’re like, OK. It can’t recognize Michelle Obama, Serena Williams, or Oprah Winfrey. So like when we say the AI is screwed, I mean, it is literally– like some of the most famous Black women to live, the AI is not even capturing their face.

Now, the flip side of all this is that it was the AI that found all those people at the insurrection on January 6. It was you know– the AI does all this facial recognition stuff works well on white faces. And that’s what got all those people hemmed up who were there. But that’s another story. But go check out the Algorithmic Justice League, incredible organization.

KAYA HENDERSON: My news this week is from an article in The New York Times about the demographic winter that is approaching. In fact, we are set to see a population decline that is unprecedented. We’ve never had population decline on this planet Earth. In fact, in the 20th century, we saw the greatest population growth in the history of the world– I guess in the history of the time that people have been studying this, right?

But in 1900, there were 1.6 billion people in the world. In 2000, there were 6 billion people in the world. So we’ve seen unprecedented growth and is actually about to go backwards. Why is it going to go backwards? Because people are having less children. In fact, there is something called the replacement rate. And the replacement rate effectively says you need to have 2.1 children per family in order to replace your population.

And in many cases and in many places, families are just not having children. They’re not having children at the replacement rate. In fact, in some places as far below, in South Korea, the replacement rate is 0.9 to less than one child per woman. And even in countries like India and Mexico, where traditionally you’ve seen large families and multiple births, birth rates are falling below the replacement rate as well.

The only place that this is not actually happening is in sub-Saharan Africa. In fact, Nigeria is on pace to surpass the population of China by the end of this century, which is not something that people are thinking a lot about. In China, in fact, there’s been a sharp decline in population. And they’re projecting that it will go from 1.41 billion people, which is roughly what they have now, to about 730 million in 2100.

What does this look like? I mean, the practical matter is it means a total reorganization of how we live and how we do society. Much of our society is based on the idea that you have more young people than you have older people. And that young people will work to pay and take care of the older people. But in fact, in this situation, you’ll have lots of regions and countries and towns and places that are literally like old folks’ homes.

They talk about small towns in Italy where only six children have been born in the last year. And kindergartens are now used as nursing homes. They’ve shut down in places around the world maternity wards because there are not enough children being born. Women who are pregnant can’t find OB-GYNS because that’s just not a medical specialty that is in demand.

There are universities and schools that are closing and consolidating. You have universities that are offering bonuses to students, iPhones, and things like this because they can’t find enough students. In some places, pension systems run out of money. And in many places in Germany, for example, they just started tearing down homes that were empty because there were so many empty houses.

In some places in China, homes are so cheap, they are the same price as cabbage. And so this is very, very different than anything that we’ve experienced. You will see governments incentivizing people to have babies, bonuses for immigrants, immigration as a way to replace population pretty significantly. It works for places like the US and Australia where people are immigrating to.

But in places where people are immigrating from, it means that this population decline, actually, exacerbates much more quickly. But Germany, for example, invested in affordable child care. They expanded access to affordable childcare. They instituted a paid parental leave. And their fertility rate actually ticked up from 1.3 to 1.54. But when you look at the amount of money that countries are investing in trying to increase their birth rates, they are not seeing the payoffs.

In fact, Germany also had to raise their retirement age from 67 to 69. Let me tell you who’s not going to be working when she’s 67 or 69. But this is the case. This could be our future, friends, because there’s not enough young people being born to take care of us, old folks. I’m moving into the twilight of my life, y’all. I need y’all to get out and have some babies to replace this world population so that we don’t have a whole bunch of old folks sucking up all of the air in the system.

This is– it’s a fascinating article. And the thing is when you look at why people are not having babies, it really is just a cultural shift. It’s expensive to have babies. Many people don’t live near their extended families, so they don’t have the support that they need to take care of a family. And people are just choosing not to.

There were a couple of examples in the article where young women were just like, oh, my god. The thought of having a baby right now. The cost, the care, the whatever, I just can’t do it. And as somebody who has not had a baby, not a biological baby, I feel that. But if I had it to do all over again, I would go back and have me some babies so that the world would be a safer place to be for us all. That’s my news.

SAM SINYANGWE: This is pretty wild. And one of the things– after reading this article, doing some digging into some of these population demographic trends, I came across a study from the United Nations called “World Population Prospects.” That was published in 2019. And the UN projected population growth, for almost every country, going all the way through 2100.

So between 2020 and 2100, they projected a number of huge shifts. And one of the biggest things that stands out in terms of which countries are rapidly gaining in population, where more babies are being born, and in which countries are sort of shrinking, one of the things that you see is how many African countries in particular are among the most rapidly growing nations and will soon be among the largest nations, by population, in the world by 2100.

So of the 10 largest nations in the world today, only one is in Africa, Nigeria. By 2100, there are projected 5 of the 10 largest countries in the world will be in Africa. So in addition to Nigeria, it would be the Democratic Republic of Congo, Ethiopia, Tanzania, and Egypt will all be among the largest 10 nations in the world.

What’s also interesting is that some of the largest countries now will either see their populations shrink, according to these projections, or stay relatively the same. So China, for example, currently has about 1.4 billion people. They’re projected to actually shrink down to about 1 billion people by 2100. India is projected to stay relatively the same around 1.4 billion.

And the US is projected to increase slightly from about 330 million to 430 million. But again, if some of these dynamics that we’re seeing that you talked about, Kaya, continue, some of that growth might not actually come to pass. The other thing that’s interesting about this is just thinking about what does it mean where by 2100, a projected half of all the world’s babies will be born in Africa?

So again, this is a major, major shift just in terms of the concentration of people and in particular, young people, who will be the innovators, who will be the job creators, who will be the people who are creating culture, who are creating the new world, right, in 2100. So many of those people will be Africans.

And I think, that is something that– like I haven’t heard that conversation outside of– comes around maybe Nigeria and a few countries. But the broader constant, I think, is moving in a direction that is promising and is different than some of what we see in Europe and in the United States where we see some more stagnation.

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SAM SINYANGWE: So my news is about an app called Citizen. Now, I didn’t know about Citizen until reading this, but it is scary. And it’s getting scarier. So this is an article in Vice News. And they just got leaked documents from this company. Now this is a company that bills itself as a private security type of company, a company where you can report if you see something that might be a crime.

You can report it to this app. It notifies other people on the app. And then people can be more aware of potential safety threats in their area, could potentially come and intervene or help out somebody, and just be notified in order to keep them potentially safe.

Now, as you can imagine, an app like this could be incredibly problematic in terms of people potentially reporting all kinds of things that they think might be crimes, they think might be suspicious, or clearly just figments of their imagination based on their own biases and racism.

But it’s getting even scarier because according to these leaked documents, this company is actually in the process of developing a new service that they bill as a subscription law enforcement service that essentially would allow people to call a private security force to come in and intervene whenever they feel unsafe.

There are photos that were taken of this– it looked like a police car, but it was labeled Citizen. It had the name of the app on it. And literally, it looks like a police car. It has the sirens and everything. It is supposed to be a car that has a private security company that is staffing it. I don’t know whether the people are armed. They haven’t said anything about that.

But ultimately, what they are trying to build, according to these documents, is a service whereby in addition to all of the problems with the existing system of policing, now they’re going to overlay an app that allows people to call a new private security force, essentially private police force, to intervene whenever they want, in any situation they want, as long as they’re a subscriber to this service.

And you can imagine that all of the issues with police violence and discrimination and profiling and a lack of accountability that we see in the existing system would only be worse in the context of this approach because it’s not even a public institution. It’s a private company. It’s not governed by any set of public policies around use of force or restrictions. Any of the things that we see in sort of the public system, it would be even worse in the context of this private security force.

So I wanted to bring this to the pod because as we talk, again, around technologies, new technologies and how they could potentially make existing problems even worse, this one struck me as something that could dramatically exacerbate the lack of safety and the risk to Black people, in particular, from essentially a group of potentially armed vigilantes, who could be called in at any moment to respond to anything that a subscriber to one of these apps deems a reason to call the police.

So I hope this doesn’t actually get– this is still in the process of being implemented. These leaked documents have shed a light on what they’re trying to do at this app. But it hasn’t yet been implemented. And I hope that it doesn’t because ultimately, this is something that could endanger people’s lives.

DERAY MCKESSON: Sam, I can’t believe you have not seen the Citizen app. I know so many people to have it. And what it does is the moment that there’s a crime or a suspected crime– because it’s actually citizen reported– it gives you a ding. So it’ll be like robbery two blocks away from you, and your phone dings. It’s like a whole ding. It like feeds this sense of just like there is terror always around.

And because it’s just citizen reports, there’s no confirmation. It’s just like, I saw a blah blah blah blah blah. But there’s like a heat map, essentially, and like a little ping that comes. And it was– I remember when it launched and being like, this can’t be a good thing. I think about it like the next door of crime. Like it’s a place where people can just– and it’s not in all cities.

I know– I think, it’s in New York. I even think it’s in Baltimore. I don’t know why I feel like it’s in Baltimore. But it definitely is in a lot of places. And a lot of people use it. And seeing this was so scary because you’re like, I knew it was bad when it first came out just because like we don’t need to freak people out anymore about this idea that crime is ever present in their neighborhood.

But the idea that you can– and this is when people talk about alternatives to the police. This is not one of them. If the alternative to the actual police department is not your on higher police. Like that is– that’s not it either. But this was scary. And shout out to whoever leaked it so that they could help us get in front of this to make these things illegal so that people can’t do this.

KAYA HENDERSON: This is terrifying. This is terrifying, right? All of the accounts of being well, Black that happened without an app, now technologically enabled so that everybody who remotely suspects anything gets to not just say it but call out a private security force. Like this was astounding to me having had no prior knowledge of Citizen. It was also pretty astounding that–

I mean, the opening of this article, they’re like, yeah, this news comes after Citizen offered a $30,000 bounty against a person that falsely accused of starting a wildfire. So wait, you got everybody in town looking for me with a $30,000-bounty on my head, thinking that I did something that I didn’t do. Like the potential for this to go wrong is staggering. And so yes, shout out to the employees who leaked this.

One employee who says, there’s no need for the Citizen app and that the leadership is, and I quote, just a bunch of scum, says this former employee. I mean, I cannot understand, in anybody’s world, how this is a potential alternative right now. And the fact that they’re talking to police departments about being kind of first line of defense is even scarier.

The article sites that they’ve been in conversations with LAPD because LAPD just doesn’t have enough people to deal with property crimes. And so they could potentially deal with the property crimes. Oh, my– like Ahmaud Arbery, anybody? This whole thing, I don’t know. This has my blood pressure high, y’all. Thanks for bringing it to our attention, Sam.

DERAY MCKESSON: So my news is about the propaganda that was in the AP about corrections officers. And we probably should stop calling these people corrections officers because like what are you correcting? I’m not sure. It’s like we should probably call them like the police in prison. But with the AP reports, is that nearly 1/3 of federal officers in prison, the jobs are vacant.

And that what prisons are doing is that they’re repurposing cooks, teachers, nurses, and other workers as guard inmates. Now the hocus-pocus and why I call this propaganda is the hocus-pocus of the article is that the government is like, you know what? The cook is actually also trained as an officer. You’re like, well, how does that work? Is the cook and the nurse, are they also– is everybody– you’re telling me everybody in the building is on a parallel track to be trained as a corrections officer?

You’re like, well, that’s not– there’s not a world where I think that’s true. And I will just say as an aside, this is not one of my main points, but Jeffrey Epstein, you probably saw that Jeffrey Epstein allegedly die by suicide. And everybody’s like, how he was on suicide? Why? It’s like how could that happen? And the officers who were supposedly watching him have recently come out and said they lied about watching him.

We don’t know what the lies are, but they say they lied. And what this article says is that one of those officers was actually repurposed from the warehouse. He wasn’t a real prison officer. He was this guy in the warehouse who came up. And now, you’re like, again, this is why this is hocus-pocus. There’s not a world where I believe that Jeffrey Epstein, one of the most media-storied inmates that we had of the year, of that year, that they had somebody from the warehouse.

You’re like, OK, this is– the math is not mathing on this one at all. But it was just so interesting because the article just goes on and on and be like, we don’t have enough officers. And because we don’t have officers, we are scrambling. It’s a shortage. And it’s like, A, you could just let people out. Like clearly, you don’t have– you’re putting everybody in harm’s way. You could actually just let people out.

We know that violent crime is not what people believe it to be. Like you could just let people out. That’s really like all I think about. Is you can just let people out. It’s nobody work there, let them out. Parole and probation is also awful in a lot of ways. So we don’t even have to do that. We could just tap people, check in once a year. There’s so many options. But the article’s slant is sort of like, we need more officers. Hey, like I don’t know if that’s the only option here.

I think that there are a host of options. And you think about like what an indictment of an institution that nobody wants to work in? And the answer is not make it an institution that people want to work in. It is actually like this is on its last leg, right. People don’t want to do this. And they don’t want to do it because this actually isn’t the best solution to the problem anyway.

That if we need to think about consequences for people, the cage is not it. And people don’t want to work there. If there are other places where like people just refuse to work, we would be like, wow, something is probably wrong with the place. And that is actually what I think is happening here.

SAM SINYANGWE: So it’s sort of interesting to read this and then track that against the numbers because the federal prison population has been undergoing a historic reduction. So this often doesn’t get– it’s not that widely known. But we’re at it like a 20-year low in terms of the number of people incarcerated at the federal level. It’s the lowest it’s been since 2001.

So you have this reduction in the federal prison population. So you should have a reduction in staffing, right? Like that should be, you have fewer people, you should have fewer staff, fewer correctional guards, fewer all of that. We should reduce this entire structure and system and continue to diminish it down to zero. And yet, this article is making it seem like there– we need to just keep hiring more people, more correctional guards, more police, et cetera, et cetera.

And that is just not consistent with where the direction of what the actual quote, unquote, need is to actually fill positions to actually be in those facilities that are now essentially beginning to empty out. We should be reducing the number of correctional guards, not increasing them. If there is attrition and many of them are sort of not filling the jobs that have been offered, that’s a critique on the institution as DeRay said.

But also, I mean, they should step back and say, do we actually need to fill these jobs just because they were budgeted for, just because the budget for federal prisons continues to remain massive year over year over year? It doesn’t mean that actually the federal prison population is the same every single year or that the need is the same. And I think that they should be diminishing those positions, rather than complaining about the fact that they’re not able to fill them.

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DERAY MCKESSON: Dr. James Wood is an orthopedic surgeon who trained in both sports medicine and trauma. Dr. Wood, thanks so much for joining us now in Pod Save The People.

JAMES WOOD: Well, thank you, DeRay. Thank you for having me.

DERAY MCKESSON: So I’m excited to talk to you because obviously, you know, we’ve known each other for a while. But there’s so much about your field of medicine that I have questions about, especially with regard to race. But before we jump into that, can you tell us a little bit about your story? How did you– why a doctor? Why ortho? What was your journey to medicine?

JAMES WOOD: As a kid growing up in Baltimore, I had the good fortune to meet a lot of physicians. Baltimore had a large number of African-American physicians. And I needed them because I was a kid with asthma. I was a kid that didn’t know flying was wonderful, but landing was a problem. So I broke a lot of bones.

So I had the opportunity to meet a lot of physicians in different personal experiences that really led me to wanting to be a care giver, to be a helper. And I saw that as crossing old lines of interactions with all types of folks– I can give you examples of being in camp when the bullies would come to camp. And I’d go with all my little medicines because of my asthma.

Somebody would get sick. And we’d be in the camp, and then they have trouble breathing. Well, I get an little inhaler you could try to use. And all of a sudden, the bully became my friend. And it was just an interesting interaction. An airplay of being able to be a healer and a helper was something that totally just hit me in my core. I had good examples of people who live the kind of life that I thought I’d want to live as an adult.

DERAY MCKESSON: And why orthopedics? And is orthopedics and sports medicine– is that one thing together, or are they two separate things? I’m asking because I just don’t know.

JAMES WOOD: Well, orthopedics just spoke to me because orthopedic, sports medicine– I was a quasi athlete. But again, as I said, I had a fair amount of injuries. The beauty of orthopedics is that most people’s orthopedic problems are dealing with function. And so, it’s not a life or death situation in most times. And so you can actually help people get back to their level of activity and health.

And so that you can come all the way back and find ways of interacting, interfacing with your patients, and then finding ways to get them back to their high levels of function. So there’s a real gratification in being able to work with people in that area. So as a medical student, I worked in different rotations in orthopedics because of the anatomy and the practicality and certainty that goes with it.

All of those things sort of spoke to me. And you’ll find in medicine there’s so many different specialties. And everyone needs to find something that really excites them so that they will do this for a lifetime. There was not a day that I got up to go to work that I wasn’t happy to go.

DERAY MCKESSON: Now, let’s zoom out a little bit. And can you explain to us of what is orthopedics and what is sports medicine?

JAMES WOOD: Orthopedic surgeons take care of the musculoskeletal system using both non-operative and operative means. So the musculoskeletal system is your support system of your bones, your joints, your ligaments, your muscles. And so we’re dealing with this skeletal system. And in orthopedics, we deal with it in children in how they grow. Of course, the trauma when you break things, the developmental abnormalities when they don’t form properly and therefore impede your function.

Of course, there’s cancer that affects the musculoskeletal system. So in sports medicine, you take about the different stresses, the extreme stress into that and put on the musculoskeletal system, including the body. And so in sports medicine, we’re looking at these athletes– athletic injuries that occur and trying to find a way, not only to get the injury to heal but to get the patient back up to the level of proficiency to allow them to return to their sport of choice.

That’s why early on, you had a lot of doctors who just would be associated with high-injury sports. And then through them and through their leadership, they developed techniques and technology to help us understand what caused the injury and ways to care for them. And you think about understanding the pitching motion and how shoulders and elbows are destroyed by the mechanics of that motion and how to affect the mechanics of it–

As many people don’t go down because of injury, all the Little Leauge coaches now limit their numbers of throw was because of the studies of sports medicine doctors did, talking about when kids should throw, what type of pitches as you throw, how often they should do it. All of that came from sports medicine study, to try to keep the athletes’ help.

DERAY MCKESSON: And just for those of us who don’t know anything on medicine, when we say orthopedics, that seems like that’s foot, that’s hip replacement, that’s– what are the other things that I would know without knowing the language?

JAMES WOOD: Things that you hear all the time. You hear anterior cruciate ligament reconstructions. You know, so many football players and very famous people have had ACL reconstruction. And so that’s one of the ligaments that’s in the knee that subject to tearing because of a certain way you land or twist or push off. That ligament is such to tear. And, when it tears the knee is unstable. And you can’t plant your foot and cut in different directions.

I always tell folks, when you get your cut on a dime, after you’ve had an ACL tear, you cut on $0.13. Once you’ve had a reconstruction, ultimately, you really cut on 10 and 1/2 cents. Really, those are common problems. People talk about unstable shoulders, dislocations, and lesions of the shoulder that cause rotator cuff problems that you hear about all the time in athletes.

And so you hear about all those types of things. Fractured necks in auto accidents and stingers in football players. I mean, there’s just so many of the hip problems in gymnasts and foot problems. And all of those things are all orthopedics.

DERAY MCKESSON: Got it. So let’s talk about ortho. One of the things I was interested in is there was a study that came out that showed that Black and Hispanic patients were more likely to be readmitted after total joint replacement compared to white patients. And I wanted to– A, I was like, what is total joint replacement? Is that a knee– is that like the formal name for a knee replacement or is something else total joints?

JAMES WOOD: Total joint replacement is replacement of the articular cartilage. That is the cartilage covering over the ends of the bone that allows the smooth movement of two bones against each other. So when you open your chicken bone and you open between your thigh and your drumstick, if you get the knife right in the right place and open it, you see there’s a ball on one end and a socket on the other.

That’s a joint. And what happens in arthritis is that white gristle, that cartilage is destroyed by wear and tear in age. And so what a total joint does is replace that surface with a plastic and a metal or a ceramic and a metal to allow for a smooth articulation again. So we replace knee joints, hip joints, shoulder joints, ankle joints. We’re doing some disc replacements in the neck.

And so where there’s a joint, a moving joint and articulation, and when they’re worn out, we’re able to put materials in there to allow them to move smoothly frictionlessly, and painlessly again. So that’s what a total joint replacement is.

DERAY MCKESSON: One of the reasons I want to talk to you is because you have spent so much of your career working in Black communities, specifically on these issues. How have you seen race be a factor? Or like why studies like this abound where Black patients are more likely to be readmitted after a total joint replacement. Do you have any idea about why these things might be true? What is it about the care in our communities that we either are receiving or not receiving and what might we do about it?

JAMES WOOD: Well, DeRay, when we talk about disparities in health care– and so the difference in outcome among different populations is a health disparity. And then also the difference in delivery of health care and for the quality of different care to patients. So some people tend to live sicker and die sooner because of the lack of quality care provided to patients. And African-Americans and race in America does play a significant role in care in places where there are concentrations of African-Americans.

You have some states where there aren’t too many African-Americans, so the disparities don’t stand out. But in places where there are large numbers, we know the socioeconomic, social determinants of health show less support and less opportunity for African-Americans to either obtain care or get good quality care or be able to be treated the same way as their white counterparts.

And we see that not only for African-Americans, but we see it also fall out in Native American population and the Hispanic population as well. So when you called one study about readmissions, the question I always raise is what were the comorbidity? In other words, what other diseases that the African-Americans have when they came in?

Were they operated by a high-volume or low-volume surgeon? Do they have adequate follow up in a situation where they’re going home to a population where they don’t have really a good home situation that they can stay and recover? Or do they have to come back into the hospital system in order to get what they need? So there are all those factors that come into play that would make for that statistic to stand out.

DERAY MCKESSON: Got it. Was there a most common surgery you would do when you were in low-income communities? You think about– we know that there is an overrepresentation of arthritis, for instance, in black communities. Did that lead to more surgeries or a hip replacements the most common things that you saw, or was it– I don’t know. Like do we know what comes up often? And is there a way to get in front of a hip replacement? Like is there a way to do something, so you’re hip doesn’t need to be replaced?

JAMES WOOD: Well, first of all, to answer your first question, arthritis tends to occur more commonly, it seems, in the African-American population. Or maybe it occurs the same, and we’re going to assume that the standard is going to be the white population, the white counterpart will be our population that we will take our standard from. And then we’ll talk about our numbers based upon our white counterparts, who we assume are getting the best care that is offered in general.

And so we look at our African-American population, they may have arthritis at the same incident. But they will tend to be more severe. They tend to come to the doctor later. And they tend to have less opportunity or to take advantage of the opportunity of total joint replacement as compared to the white counterparts. So there is disparity there.

And you look at across the board for joint replacement, or of the hip replacement, or knee replacement, we’re looking at the incidence of African-Americans taking advantage of this only about 50% of their white counterparts.

So when you look at the percentages, you know the arthritis is more severe. It manifests itself much more in the African-American population in terms of days off work and effects in terms of needing to use a cane or crutch. But they don’t take advantage of total joint replacement nearly as much as their white counterparts do.

DERAY MCKESSON: Do you think that’s an access issue, like a money issue? I imagine hip replacements are like expensive.

JAMES WOOD: You know, when a hip joint is very severely involved, there is not much we can do from a medical point of view other than give people pain medicines and put them on crutches and tell them that every day of their life, they’re going to have a fairly significant amount of pain and limitation of their walking activities, unless we do something to replace it.

There just aren’t any other treatment options for us, really, involved hip. And the same thing is true for the knee, but you see a lot of people walking. I mean, you go to a Black church and you watch folks coming in on their wheelchairs. You come to see them walking on their walkers. You see them sort of say, honey, I’m going to live with this. I’m not having any– I’m not– they’re not taking me in cutting on my body.

And then they’re going to experiment on me. I mean, the whole issue of God confidence and trust in the medical system is a big part of why African-Americans do not want to come into the medical system, unless they absolutely have to. There is some justification for that based upon some of the historical studies that have been done on African-American patients that were shown to be not in their best interest or their care and treatment.

And then, of course, the concordance of numbers of African-American providers. So you don’t have to raise concordance when you walk into a clinic or a place. You don’t necessarily see people that look like you. And so your level of confidence is not easily encouraged as you first come in. But as you know, I’ve worked in this– I’ve worked in the medical system for 40 plus years.

And I’ve met very excellent, compassionate surgeons from all races and backgrounds. And I would say the vast majority of surgeons and everyone that is there to take care of the patient than who the patient is. But getting people, that his patients, to feel comfortable inside the system is one of the challenges that I found in terms of working in a place like Baltimore, within the high African-American population.

But, DeRay, I was able to see a patient talk with a patient, call a colleague who specializes in the same area that this patient may need, make the introduction. And that introduction alone, the hand off, that pass off, I think, really places a lot of the patients at ease. It gives them the opportunity to really trust in the care that they’re going to receive from that person. So somehow, improving that relationship is going to be an important piece of taking more advantage of what the medical care that we have to offer at this time.

DERAY MCKESSON: You know, so there can be a lot of people who will hear this. And I think about people in my own family who have needed to go to an orthopedic surgeon or a doctor, who I have to believe that this is normally their first encounter. Like their hip hurts, and then they go see a specialist, you are the specialist. What should people– what are the questions people should be bringing into the room.

Like if somebody’s grandmother is about to go in because her hip hurts, what should they be asking so that they do navigate it well? Or should they read something before– I don’t know. Like how can we make sure people walk into the room prepared? Especially given what you just said is that people are like, they don’t trust the medical system. They haven’t seen it work for them. Like how can we set people up for success?

JAMES WOOD: They hear a lot of places where it didn’t work for people. You could do 20 hip replacements, and everybody does fine. And Ms. Jones shows up at the church, and she’s walking beautifully. There’s one hip replacement that doesn’t go well for whatever reason, infection occurs. The patient may dislocate. There may be a fracture or something. And so it’s not a good result.

But I promise you, everyone in the church knows that. So understanding that everything is not 100%, that medicine is as an art as well as a science, and so be respectful of that. Two, understanding clearly what the doctor says to you. I don’t remember what he said. So try to get as you can a basic understanding. And doctors are now being trained to better communicate with the patient and make sure that the patient understands.

So motivational interviewing is being taught to the doctors to teach them how to communicate with patients so that things are on a level that patients should understand because you should never hesitate to say, I don’t understand what you said to me. And the doctor should have that methodology in place to give them pictures, to give them pieces of information to take home, to allow them to pull their cell phones out or take pictures of their X-rays.

And say, listen, call me back or speak to my physician assistant or my nurse. And they’ll come in and spend more time with you to really make sure you understand when you walk away. As a physician, my whole thing is always, repeat to me what I said to you. What did you hear me say? Because I want to make sure that when you walk away or your son who lives in Texas calls and says, mom, what the doctors say?

And you just say, I don’t know. He said something. I want to make sure that you can sort of repeat what the highlights are of what we talk about. So being inquisitive about your body, taking responsibility for your care and your body. Some people feel like that because they are on Medicaid or they don’t have much insurance and they find it is more difficult to access a system, that when they get into the system, they don’t have much agency when they’re in there.

The other thing is, of course, when they’re in some of these high-volume practices in other places, they only get two minutes. And that’s it. And you can believe it. There is bias in place. And there’s bias against obese patients because patients who are very obese– everybody wants to blame whatever disease that is on the body habitus. But there’s new study and new research now on obesity that’s talking about people in their best body. I see people who are obese by any standard.

They walk in, their BMI, 38-40. But then their best body, these are the same people that can run five miles. They can hike. They can ride bikes at 20-30 miles, in great shape. It just big people, doing their best body. So being able to really have people understand this and respect this is something else that’s coming on new in the future.

So people who’ve been fat shamed and other things like that– and this is happening. It has happened to doctor’s office where they walk in and say, well, you’re too fat. I can’t take care of you. Or you’re too fat, you’ve got to do that, so you could take care of your diabetes or your hypertension or your arthritis in the joints. Being more cognizant of what the conversation is now about obesity would be very helpful as well, just as an example.

DERAY MCKESSON: I’m curious. You’re a doctor, you’ve been a doctor for a long time. Have you experienced racism in the medical community even as a doctor? Have you walked into a doctor’s office and they just didn’t know you were a doctor and the care you got was not the care you deserved or the treatment you deserved? Or do people just treat you differently because they know you’re a doctor?

JAMES WOOD: Well, I try to go into the medical offices and don’t tell them I’m a doctor. I’m a consumer. And I try to understand what my patients experience. But you know, it’s funny because it’s many times, I’ve had to pull the doctor teeth. And it may not be I’m a doctor, I may say something that shows that I understand much more than they thought I understood in terms of what they said and what they did.

So I may say, for example, you didn’t wash your hands. Maybe you need to push that black pressure cuff up a little bit more. And just some things that I’m just critiquing what I saw, all what I’m doing. And so it is difficult to be in a system when you turn your well-being over to the system. But you do have to be vigilant. And of course, I’m a physician. I’ve been in it for a long, long period of time.

So I recognize it. But it’s hard to keep that level of proficiency at the highest levels. So when I go in, I don’t announce to them that I’m a physician because I try to experience it the way my patients would experience it. And have– you asked me the question, have I experienced overt racism? I don’t think that I have personally experienced it. But I have witnessed it. So I’ve witnessed it.

So I think that that is– and I’ve witnessed it in trauma centers. I’ve went– this is in emergency situations. I’ve seen people evaluated just by how clean or dirty they were, what the color of their skin was, how they came and presented. Let’s say they were on a substance or something that was modifying their behavior. That I could see the bias and the racism coming out of that.

And so, yes, that may be how they presented, but that’s not who they are. You’ve got the job or the obligation as the caregiver to work through that. And so many people do. But it’s not easy. And you can imagine, someone who’s not listening and out of control. They’re going to present with the worst and bring out the worst in people. It’s a human interaction.

DERAY MCKESSON: And what about– one of the things we covered on the pod– I don’t know– a couple of weeks ago was a race correction. And the formula is that doctors– or that are used in the medical profession that push out a score based on race. Over race correction, is that used in orthopedics or not? Do you have a take on whether it’s good or bad?

JAMES WOOD: I mean, with race correction in orthopedics, we don’t see that much. We don’t have that much in the way of something that’s going to inform our decisions. We’ve got certain diseases that tend to affect African-Americans more often, as we talked about, arthritis. But that’s in the health disparities piece. I think about sickle cell anemia where we see that more in the African-American population.

And therefore, we see people with sickle cell involvement of bones. Sickle cell will clot the vessels that run to the end of bone, especially growing bones. And in that way, they will cause death of the bone. And so that death of the bone will cause premature arthritis in very young people. So very young people may end up having to have joint replacements. So these folks who are in pain with sickle cell anemia, this is severe pain.

So the question is, do they get the pain medicines that they need to manage their pain. These studies have shown that they tend not to, from the general population of medical practitioners. But those who specialize in the area of sickle cell symptomology and those who have broad experience in this disease recognize the level of pain and treat the patients much more appropriately. Because there’s been that push back in opioid epidemic that has come to the attention of the medical professionals.

And as some other professionals have actually been dinged because of their use of pain medicine. So it’s a fine line of sight defining who does and does not give pain, and bias comes into play. So I think, with African-Americans presenting with pain must go south, once they are clearly understood of who they are, they get their adequate pain medicines. But early on, that might be a problem.

DERAY MCKESSON: Cool. We consider you a Friend of the Pod and can’t wait to have you back.

JAMES WOOD: I would love to. Thank you, DeRay. It’s always a pleasure to talk with you.

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DERAY MCKESSON: Well, that’s it. Thanks so much for tuning in to Pod Save The People this week. Tell your friends to check it out. Make sure that you raid it wherever you get your podcasts, whether it’s Apple podcast or somewhere else. And we’ll see you next week. Pod Save The People was production of Crooked Media. It’s produced by Brock Wilbur and mixed by Bill Lancz. Our Executive Producer is Jessica Cordova Kramer and myself. Special thanks to our weekly contributors, Kaya Henderson, De’Ara Balenger, and Sam Sinyangwe.

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