The Oncology Podcast

S3E2 The Oncology Journal Club Podcast: Is DEI Dead? The Future of Diversity, Equity and Inclusion in Healthcare

• The Oncology Network presents The Oncology Journal Club Podcast • Season 3 • Episode 2

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Welcome to The Oncology Journal Club Podcast Series 3
Hosted by Professor Craig Underhill, Dr Kate Clarke & Professor Christopher Jackson | Proudly produced by The Oncology Network

The Oncology Journal Club hosts break from their usual format to discuss the impact of political shifts on diversity, equity and inclusion in cancer research and treatment worldwide.

  • Recent political developments threaten progress in cancer research, particularly through attacks on the NIH, CDC and other scientific institutions
  • Evidence shows that diversity in healthcare leadership leads to better patient outcomes and financial performance
  • Censorship of scientific language related to gender and equity raises serious concerns about academic freedom
  • DEI initiatives aren't just political—they are clinical; with evidence that they save lives, with examples from bowel cancer treatment in New Zealand
  • Representation in medical fields matters for patient engagement, with data showing improved outcomes when clinicians reflect the communities they serve
  • Regional cancer centres can match metropolitan survival rates through targeted funding and research, saving approximately 90 lives annually in one Australian community
  • The hosts encourage colleagues to speak up where possible while supporting those who cannot due to political pressures

    Please share your thoughts with us via social media or email. We'd love to hear your feedback on this important discussion.

  • Subscribe to The Oncology Newsletter for regular updates on the latest cancer research and join our community at oncologynetwork.com.au.
    The Oncology Podcast - An Australian Oncology Perspective
Speaker 1:

Welcome to the Oncology Journal Club podcast, a dynamic and engaging learning resource for medical professionals. I'm your producer, rachel Babin from the Oncology podcast. Joining you today are your hosts Professor Craig Underhill, dr Kate Clark and Professor Christopher Jackson.

Speaker 2:

G'day g'day, g'day. Before we get into this episode, everybody, I just want to thank you all for listening. We're doing a special episode today on diversity, equity, inclusiveness. Since we recorded this episode, this has continued to be a hot issue. The New York Times published an article about words that have been flagged as needing to be limited or avoided on government documents and grant applications. These are words such as activism, belonging, bias, equity, minority, social justice, socioeconomic status. All sorts of seemingly innocuous words, male and female, should be avoided as well. So we're really in an era of censorship, and so I hope you enjoy the discussion, think about it, and we'd really love it if people could give us some feedback, either directly or via our social media. Thank you so much for listening.

Speaker 1:

For further information, head to the show notes at oncologynetworkcomau. The Oncology Journal Club is proudly produced by the Oncology Network podcast team. Thanks for tuning in. Let's get started.

Speaker 2:

Welcome to another episode of the OJC. Dr Clark, how are you?

Speaker 3:

Oh kia ora, kia ora, craig, you oh Craig. Always lovely to see you and Chris, but uh gutted at the uh uh dross coming out of Congress this afternoon yeah, yeah, chris are you depressed?

Speaker 4:

uh, look, I'm just burying my uh head in the sand at the moment. Actually, craig, I think it's a good time to be off social media. It's a good time to be off the news websites, I think. You know I like my life. I've got a lovely old life here in Dunedin, new Zealand. I've got great friends, great workplace, great patients, wonderful life. But as soon as I turn on the television or social media I get very, very, very sad. So I think I'll just go back to my nice little hippie life bubble.

Speaker 2:

Yeah, is that what we should do, though? Because I've been talking to my family about this and friends and family say oh, you know, I just can't stand watching news anymore. But my take is that it's probably even more important to try and keep up with the news and actually speak out about it. I don't know, because we won't have a happy life if we just retreat into our bubbles. I don't know. Discuss.

Speaker 4:

Yeah, well, I think that's the big topic for today's podcast, isn't it? I mean, I think that the ability to retrench and avoid the news is probably the sign of ultimate privilege, whereby, if you can avoid the impact of the news that's not impacting on you day to day, that's because you are insulated from it and at some point, you do have to make a principled stand. I do think, however, the cost and onslaught of insanity can be overwhelming, and I'm a great believer in picking your battles, work out where you can best contribute and do so in that way, kate thoughts on avoiding the news or engaging.

Speaker 3:

I think it's very much like watching a car crash and I just can't look away. I don't have Christmas discipline. I turned it off multiple times this afternoon and then had to go back to it. It's like you know just what's he going to say next. But it's surreal. It feels like a dystopian novel. That's the bit that upsets me the most.

Speaker 2:

Yeah, that's right and it's happening right and it's all evolved in the last month. It's quite shocking. I kind of like look at the news before I go to sleep and go, oh my God, this just said what. And then you wake up, you know in the morning and have another look and you go, oh my God, he's just said a whole lot more, and sometimes it's actually about flipping on what he'd said the day before. So it is really shocking.

Speaker 2:

So we did want to talk about some of the recent issues in the US today. So it's a bit of a deviation from our normal format, because I think it is important we say something about diversity, equity and inclusivity, and some of the journals have published opinion pieces about this and will mention some of those and refer to some of those. But I think this is our little opportunity to protest and support our colleagues in the US. I came across a Nature paper and you can click on the link to that Trump 2.0, an assault on science anywhere is an assault on science everywhere because of the global interconnectedness. So we can't, I think, isolate ourselves in Australia and New Zealand and the rest of the world from what's going on in the US. I think our science and our research community will be the same because we're all involved in a global effort to improve cancer outcomes, and so there will be a ripple consequence to what's going on.

Speaker 2:

I think this article sort of summarized quite well what's gone on since Trump was sworn in and some of the attacks on science and some international organizations and initiatives. So that's summarized in there the attacks on the National Institute of Health, who, the CDC Center for Disease Control and Prevention, the Environmental Protection Agency, and so it goes on, with NIH grants suspended, they're unable to communicate, they can't attend meetings We'll touch on that in a minute. A freezing US aid, the US Agency for International Development, which is like their soft diplomacy counter against China, and vital funding for preventative and treatment programs in mostly lower-income countries, which will have massive ramifications in those countries and consequences for the global economy. But I love the summary which was written by the Nature editorial staff. Nature's mission is to serve scientists through prompt publication of significant advances in any branch of science and to provide a forum for the reporting and discussion of news and issues concerning science.

Speaker 2:

For much of our 155-year history, the US has been a global leader in research, including in its provision of funding for education and training in science to the great advantage of itself in the wider world. With the changes now underway, the new administration seems to be inclined to recklessly consign that to history. We in nature denounce this assault on science and we encourage the global research community, wherever they can, to voice their opposition. This is our little attempt, I guess, to voice our opposition, support our international colleagues, as I said, and we'll certainly hope that everyone will share this podcast where they can on social media, and we'll certainly push it with our US colleagues, many of whom have kindly appeared on the podcast over recent years. We really appreciate them doing that, and so, through this episode and that effort to push it out, we hope to support them and really not bury our heads in the sand about this.

Speaker 3:

Kia ora Craig. I feel very much like it's really important that we do say something because we can. Many of our colleagues in the states can't, for very good reason, and I genuinely think people don't understand what we are going to lose. So it is not just flash research organizations, it's libraries, it's archives, it's museums, it's the Environment Protection Agency, it's the ability to coordinate on climate change projects, on anti-poverty programs, it's contraceptive care for millions of women internationally which, as you know, affects health outcomes Terrifying.

Speaker 4:

Chris. Well, I feel like we can't just have a podcast where we'll just sit here and agree with each other, so maybe I have to play the devil's advocate here. You know, let me just start by saying I really love the USA. I mean, I think their contributions to science and medicine have been absolutely and utterly without comparison. The NIH has been the founder of first-in-class molecules which have taken our field forward. You know platinum drugs, testicular cancer, you know ASCO, obviously a major global organisation, nih. It's funded over the course of many years.

Speaker 4:

America has more than pulled its weight in the international community in terms of contributions to WHO over many, many years.

Speaker 4:

And of course, more recently Biden with his cancer moonshot as well, again redoubling the efforts on cancer.

Speaker 4:

We would never have had the Pfizer COVID vaccine so quickly in the end of a global pandemic had it not been for changes in regulations in the US that actually led to the acceleration of vaccine development, for example.

Speaker 4:

So we have an awful lot to be thankful to the US for. I think also with that we have to note that the US is imperfect, as Obama was fond of saying, it was the imperfect union, and that America was a work in progress and that history was not linear and that there were ups and downs, and it feels to me at the moment, from my own personal perspective, divorced from the country, of course, that it feels, from a global perspective at least, that it is a global step backwards. But you know what? It's what they voted for. Trump is doing exactly what he said he would. He's prioritizing what he considers to be America's interests first and foremost, and he is bringing on his Secretary of Health, rfk Jr, who is well known for his views on vaccine and on health care, and he is doing exactly what he said he would. And he won the election.

Speaker 3:

That's the bit that offends me, though, chris. So that's the bit that I was struggling with. Watching the Congress today was that, as he said, egregious thing after egregious thing, elected representatives of their communities stood and cheered. Call me old fashioned, but I would have thought basic human decency would prevent perhaps some of the glowing, the crowing that was happening today in Parliament. It was just undignified, and that's the bit that I think is really getting up my nose is part of it is the delivery of some of this stuff, which I know is petty, I acknowledge that, but it is Sure.

Speaker 4:

And again, I don't want to just be the one who's defending the Trump administration, because that's not my position. I also think that in our own backyard, for example, we had six medical doctors in the political party who voted for the repeal of the smoke-free legislation and, as oncologists and as medical practitioners, that to me is almost an offence which you should be struck off, for you can't vote to liberalise smoking laws and yet that happened in our own country. In terms of national leaders. Disestablishing public health initiatives is happening in our own backyard as well as happening overseas, and it's happening amongst our own community, and it's happening amongst our own community leaders. In our own country, new Zealand, we had a disestablishment of the Māori Health Authority, which was the indigenous health authority looking to advance Māori health outcomes.

Speaker 4:

Māori have a seven-year shorter life expectancy than non-Maori and yet Maori initiatives were deemed to be only worthy of attention within a general structure which has actually perpetuated that life expectancy. And the government, who was fairly elected in a free and fair election, just established that and they did what they said they would. And so, again, I think this is one of the dilemmas you have. If you're a Democrat, which I am, I believe in democracy it's the worst of all the systems except the alternatives that the majority do have a right to rule, and when they say what they're going to do and they get voted in, it's pretty hard to then go and say that shouldn't happen. It is a time to stand up and say I don't think it should happen, but to make your case, to make your argument and to show why you believe what you think is right.

Speaker 2:

Yeah, thanks, chris. I just wanted, without dwelling on it, you talked about the mandate free and fair election but it was the smallest margin ever of a president in recent times, going back for 50 years, and this change of 300,000 votes in three spring states would have changed the result. So, yes, technically, absolutely, he has a mandate, and we're all in shock about some of the things that happened, but he was very upfront. He said he was going to do all this. So I just hope that there will be freeing for our elections in terms of two years' time, free of interference from Russia and Elon Musk, and that we're able to that people will then are able to cast their vote on whether the current program is a success or not so that's not how he sold his win in parliament today or, sorry, in congress today he had the biggest swing ever seen before.

Speaker 3:

So it's some of that stuff. I think also, you know he played the political game incredibly well. The college system allows tactics to be used, because that's the system that you people are working at. It's just like moving electron boundaries at the moment in New Zealand is going on. It's the same sort of game and it is politics, and I'm not a politician. So maybe we could talk more about what is genuinely at risk and the fact that there are some very brave people within America standing up and that we have a duty of care to continue to do some good work in this space, while there are other people who are unable to.

Speaker 4:

I just want to be very clear. I do not doubt Trump's legitimacy as a president of the United States. I think he won the popular vote. He got more votes than he did last time and he got more votes than his opponent and he won more states than his opponent. In every way, shape and form he won that election and no matter what you think about the media coverage and the monopolisation and politicisation of the media in the US, he won and I think you have to accept that and I'm not saying you don't, but I think the alternative to when he lost the last election and his supporters did not accept that and they stormed the Capitol and tried to overthrow a democratically elected government the alternative to the smooth transition of power, the peaceful transition of power is far, far worse. So we must acknowledge that he won and he did, and the challenge for us is to make the case for the principles and the institutions that we believe in and hold dear and demonstrate why people should take a different course and show whatever your proposition is.

Speaker 2:

Let's do exactly that, chris. So I also found an interesting paper from the Journal of the National Cancer Institute, and so that's an important journal in the context of this discussion. The title is An Editorial and Essential Goal Within REACH Attaining Diversity, equity Inclusion for the Journal of the NCR, and so they really set out the case for why this effort, dei, is important, and one of the most important things is really that we've seen huge improvements in cancer outcomes in the last couple of decades through efforts in screening, diagnosis, treatment, survivorship, patient report outcomes, et cetera. But there are still population groups lagging behind, and in some instances those gaps have actually widened, and so you mentioned the Maori population in New Zealand and, in our case, in Australia, aboriginal and Torres Strait Islander populations and, to a much lesser extent, in regional populations. The gaps between metropolitan outcomes and regional outcomes, for example, have not been bridged, and the gaps between the First Nations populations and the rest of the country have actually got worse. It's actually a disaster.

Speaker 2:

So this effort to broaden the inclusiveness on editorial staff and boards, to encourage contributions from disadvantaged populations, to encourage papers focused on research, to overcoming the barriers, to bridging those gaps, has been an effort by the JNCI for several years and they, for example, you know if any of you have recently submitted a paper. You get asked some demographic questions about your gender, what your ethnic origins are, whether you identify in terms of race, and that data is collected. It's not linked to the submission, but they're collecting that data to try and track whether their efforts are actually leading to an improvement in the diversity over time. So, again, the paper is a bit of a call to action and a reaffirmation that the JNCI and the JNCI Cancer Spectrum will commit to diversity, equity and inclusion initiatives that were begun in 2022, striving to advance the diversity and inclusion of study participants, clinicians, research investigators, community engagement and investigator leadership in cancer research.

Speaker 2:

Encouraging innovative research aimed at addressing and improving cancer health equity, to ensure the advances in cancer biology and strategies for cancer prevention, screening and early detection, etc. Are accessible and affordable to all. So we really need to continue the efforts to try and improve the outcomes for those disadvantaged. That will have a bigger impact than it's just chipping away at the top. So, in an interesting article, I did notice, in fact, that one of the contributors was Martin Stockler from Sydney. So good on you, martin, for contributing to that editorial.

Speaker 4:

So, craig, just walk me through what the evidence is that improving diversity and inclusion has positive outcomes in terms of health. So when you focus on those targets that improve outcomes, they didn't address that in this paper.

Speaker 2:

They talked about the progress in the data they're collecting, but to demonstrate an impact of that program on cancer outcomes would be a multi-year effort and this program only started three years ago.

Speaker 3:

There is other people's work that they quote and that we're talking about later, that clinician diversity and clinician-patient concordance appears to improve outcomes for people in otherwise disadvantaged communities. It also increases the uptake of cancer screening, the receipt of recommended care as per guidelines. We've already got data to show that more women that you have working, the better your patients do. That's another thing altogether. That identifying as black Americans who are in a community with more black doctors have a longer life expectancy. Now, obviously there's a lot of stuff feeding into that, but that's consistent over time. So we know that people feel more comfortable if they see themselves reflected in the population.

Speaker 3:

Providing the health care and collecting that data is going to be difficult. Providing the healthcare and collecting that data is going to be difficult, but there is at least some work in in Naisance that suggests that you get real concrete benefits from diversifying your population. I think the other bit that's important is that, within research, the more diverse a community that you have thinking about research, the more interesting research questions you get, because we're getting research coming from different angles and you know, Chris and I have the privilege to work with some mātaranga practitioners, so people who are using traditional knowledge and new ways to solve new problems, and that adds depth.

Speaker 4:

So, Kate, you know, clearly I don't disagree with you on all of those points, kate, but I'll just put to you a perspective that you know I've heard voiced by others. So, ok, we think that diversity, equity, inclusion does promote better outcomes, etc. Etc. But hang on a second. What are the intakes to med school these days in terms of gender balance? I mean, it's excessively women, isn't it? At what point do we have to say that actually men are an underrepresented demographic of the intake? We have to correct that. What's your answer to that?

Speaker 3:

So when 50% of department heads, 50% of professors and 50% of those publications have vaginas, then we've won. And we are a long way away from that. And that cross just pushed a button there, but we are a long way away from that. So there, you go.

Speaker 2:

Well said Kate, but this paper doesn't particularly address how their diversity program has made a difference. But, as you say, they summarise some of the literature about how it may improve outcomes. I like that word you used about the concordancy between the populations.

Speaker 4:

I'm not going to let you away with that, kate. And again, because the distinction between it's important not just to have an echo chamber of a podcast, it's important to explore these ideas, so I'm going to push you on that. So let's just take that perspective. So the time lag between intake into med school and achieving faculty head and professorship, et cetera, et cetera, is what? 20 years, 25 years? So to what extent do you let the gender imbalance at medical school run with that lead time to then actually have it go too far the other way? So how do you actually balance that?

Speaker 3:

I don't have any data in front of me, but I'm pretty sure the gender balance was hit in the 80s without assistance, and yet we are still seeing the same proportion of things. So I think there are a significant number of barriers.

Speaker 2:

Kate, I'm going to agree with you. I started medical school in the 80s and I think the intake was about 50-50 and there's certainly not a 50-50 balance in leadership positions in the medical industry.

Speaker 3:

So this is a paper called the Face and Political Attacks on Medical Education the Future of Diversity, equity and Inclusion in Medicine, and it is written by three United States academics Yara, demaya and Streve, and their focus is actually on sexual and gender minority groups. So, although women have been and probably white women have probably benefited the most from traditional DEI diversity and equity inclusive programs, it's been a long time since there has been an active push for women. So this, this paper, the goal of dei and health care and public health does ensure that leaders of health care systems value all people equally and that all people can obtain the power, knowledge, resources, conditions and opportunities that enable them to achieve optimal health. And this requires health workers to reflect the population who they serve, is the argument of these three authors. It feels to me like this is the pursuit of happiness, right? So what we want is we want a community where people can safely pursue whatever happiness means to them, and we do not provide that for many of our many people at the moment. Sexual and gender minority groups are at significant risk of avoiding health care due to feelings and differences from their clinicians and many states and actually countries. You know we are bagging the US at the moment, but a lot of countries have similar issues and restrict the ability of educational institutions to have DEI efforts, and I won't list those states, you can guess them. Also, legislation is restricting health care for people of sexual and gender minority people, including legal action against clinicians providing gender-affirming care, including in Aotearoa, new Zealand, as of last week.

Speaker 3:

It's very, very easy to turn the public against gender-affirming care and other DEI goals by using language, and that's what Chris was trying to do.

Speaker 3:

He was using his very careful debating skills to point out how easy it is to draw out. So if you call gender-affirming care child abuse, nobody wants child abuse and mutilation. If you say that providing a space where it is safe for people to be black or to be Maori and that's somehow racist against your white colleagues, nobody likes racism. If you say that women have been 80% of graduates for decades and yet we aren't saying there's something wrong with women. There's something wrong with the way that men are being treated, people are going to you know something wrong with the way that men are being treated. People are going to agree with that. I think the language that we use has to be so very, very careful, because people only have time for a soundbite and the soundbite that, particularly as of the news in New Zealand last week that gender affirming care is dangerous and child abuse, got quite a lot of airtime and that is a concern for people who are already struggling with accessing appropriate health care.

Speaker 2:

So, chris, you're causing some chaos in the podcast now. No, I'm good.

Speaker 4:

No, no, no no.

Speaker 2:

So I'm just mindful of the time. So how about you tell us about the paper that you're going to cover and we can come back to this as a discussion?

Speaker 4:

Yeah, no, the one I wanted to mention, which was policy related to what Kate had just brought up, was the University of Otago Mirror on Society Policy, so I'm just going to bookmark that and come back to it. I wanted to reflect on the McKinsey Report on Corporate Diversity. So there's been three different McKinsey Reports 2015, 2018, and 2020. And it looked at the relationship between diversity in the executive teams and financial performance and they actually found that the relationship between diversity on executive teams and financial performance actually strengthened over time. And that was found to be true over 15 countries and 1,000 large corporations. So those were the top quartile. Legitimate and ethnic diversity in their corporate leadership teams had the best financial performance.

Speaker 4:

Now it's quite hard to know which way that causal arrow goes. Is it the most open-minded and adaptable companies which have the greatest inclusive policies, or is it the greater inclusion that leads to better financial performance? It's not clear to say what the causality is, but the association's pretty clear there that those with the best diversity and equity and inclusion have the best financial performance. So if you want to make money, include people I think that's the bottom line really and ensure that your leadership is representative.

Speaker 4:

I think the other thing is, anyone who's ever been in a leadership role or chair the committee or whatever will know the perils of groupthink and it's important to have a diversity around the table, otherwise you get lulled into that and you'll miss stuff. And certainly I've learned the most in committees that I've been on from the people who are least like me, as they've challenged my assumptions and thinking all along. So I've always really valued that diversity in committees and the like that I've been on. And can I just give a quick shout out to Eva Sigalov, founder of the OJZ podcast, who of course was a vociferous, vocal and frequent critique of the mental and oncology conferences around the world. Good on you, Eva, for always calling that out and for being true to those principles.

Speaker 2:

You're lucky she's not here today, Chris. I think she probably would have been reaching through that camera.

Speaker 4:

Oh look, craig. I think it's important for us to be able to hold our arguments and articulate them clearly. The Otago Mirror on Society policy is a really good example. It was formulated by the previous dean of the School of Medical Sciences, a beautiful, wonderful man called Peter Crampton, whose overarching view was that the medical school intake should represent the community from which it was drawn, and that meant ethnic representation, socioeconomic representation, morality, etc. And to say that the med school graduate should be simply a mirror on society. And the beauty of the policy was you could understand it just by its name. Now, that was in place until last year. It's just been replaced and updated by Te Kauai Paraora as well, but effectively it's an affirmative action style programme.

Speaker 4:

The thing is, without the affirmative action programme, it would take another 30 to 40 years for the medical workforce to look like what our community does. So there are, of course, entrenched privilege in terms of access to education, in terms of access to wealth, in terms of the advantages that gives you and how that translates to your medical intake. And Kate's completely right Having a doctor in a community of health professionals that looks like you increases your likelihood to engage with that, and we already know that Māori and Pasifika in particular have more difficulties navigating the system and even accessing healthcare in the first place. Having a workforce that looks like you is appropriate to overcome those barriers. So I do completely agree with you that the purpose of trying to be the devil's advocate is simply to tease out the truth as best we can here.

Speaker 3:

I love my job, I have very much enjoyed being a doctor and it comes with some cachet and some privilege that I know at least some of the young people going into medical school. That's what they're after. But there are always going to be more young people that want to be doctors than we can ever educate and or give jobs. In my day there was a little bit of a DEI, but it was very small and they pretty much just drew a line and everybody above the line got in and I'm not sure all of those people were the best people to be turning into doctors. And so you know, I think we have to acknowledge that you don't actually have to be that clever to be a doctor. There's a lot more to it than just being book smart, and so let's give these relatively new programs a go.

Speaker 3:

And Chris and I both teach in New Zealand and the new batches of medical students are good people and they are a diverse group of very tall people. I'm getting short with my old age, but very tall young people, they're lovely. Kate, I feel like when you're talking about the people who shouldn't have ever gotten. I'm getting short with my old age, but very tall young people, they're lovely.

Speaker 4:

Kate, I feel like when you're talking about the people who shouldn't have ever gotten to mid-school, I feel like you're talking about me not at all all right.

Speaker 2:

So a couple of other papers we'll just link to. The Lancet wrote a paper called American Chaos Standing Up for Health and Medicine, and JAMA, which is one of our favourite journals on the podcast, reaffirming their commitment to health patients in the public and really highlighted some concerns about how American predominance in health sciences research may be at risk and the global consequences of that, interesting some of the other responses. So there was a lot of journals reaffirming that they would stand tall. I was interested and, kate, you might want to talk to this. I would say appeasement from industry. So GSK have overturned their policies.

Speaker 3:

GSK removed their DEI policies from their internet and from their programs, despite the fact they are, at least nominally, owned and based out of the UK, and we all know how well appeasements worked for us before. I find I find they're absolutely fascinating, the amount of rollover and you know, I think we've talked about this before, but those two are very wealthy people at the inauguration, many of whom one would have assumed had other political views now telling us that their boards need to go back to being more masculine and anti-woke policies and that they've been too soft and that's cost them money. So I find the whole thing fascinating, but terrifying in the same respect.

Speaker 2:

Yeah, and Chris, did you want to talk about? We actually reached out to a couple of colleagues. You probably don't want to name them, but we actually reached out to a couple of colleagues that are potentially appearing on this episode.

Speaker 4:

Yeah, so we spoke to a couple of colleagues who worked at the NCI in the US and my colleagues felt that even their email communications were being potentially monitored and they didn't want to have conversations, even over media channels like WhatsApp, and so would prefer voice calls and the like, which were more difficult, and they didn't want to go on because actually, when it came to the chop which is inevitably coming, they would be more vulnerable for not aligning with the values of the administration. So, again, it is that self-censorship that goes on with that which is a real worry. And one of the things I thought, craig, that was really fascinating about that Lancet editorial was it referred to the government executive order had said that any federal funded research which uses the words gender, transgender, non-binary, lgbt are banned from being used in any federally funded research.

Speaker 4:

And this is America, the land of the First Amendment the land of free speech, the land of academic freedom, and you are banned from using certain words in your academic publications and that is beyond Orwellian. That is a step towards the Handmaid's Tale.

Speaker 2:

Yeah, that's right. It really feels like it's crossed the line, hasn't it?

Speaker 3:

And just running with that Handmaid's Tale theme. As a woman, I don't need the Trump administration to protect me from queer or transgender people. They are no threat to me. However, the HHS website, which was taken offline by the government and then was made to turn themselves back on again, says the Trump administration rejects gender ideology and condemns the harm it causes to women by depriving them of their dignity, safety, well-being and opportunities. Being a woman rocks Anybody who also would like to become or has always been a woman and would like to affirm that you are more than welcome. So just while I'm ranting, I just I found this quote the other day on the internet. I thought it was wonderful because it is pride month over here in the deep south. Pride Week does not turn straight kids into queer kids. It stops queer kids being turned into dead kids, and so, yeah, that hits really hard, really really hard 100%.

Speaker 4:

And in New Zealand just last week, kate, you'll be aware of it for our audience there was a drag king in a library in our capital city who was reading stories to kids that got raided by a church protest who then physically intimidated and roughed up a couple of people there, kids being read stories in a library. Now I don't know what the consequences of Dame Edna Everidge has had on the Australian population, but you know, guys dressing up as girls.

Speaker 2:

Darling, you'll never know, darling.

Speaker 4:

Yeah, or girls dressing up as guys. That's why you've got such bad glasses, isn't it? So you know, I really can't see the harm of that. Kids just think it's fun and an exposure to fun stories read by someone in costume isn't going to upset things. We've had Christmas pantos like that for years and to me it's a way of group identification and group membership and strengthening the group membership of a failing and small community and stopping them from grooming even more by targeting a vulnerable group. But that stuff is really sad and it's happening in our own backyard too.

Speaker 3:

The rescue. The wonderful thing in that video, which is available on the internet should you wish to put yourself through it, is at the tag end. The two librarians who came to the defence and kicked these very big, large people kicked them out of the library and one auntie actually said I hope you're happy with yourself and the best Kiwi accent. So you know, always look after the aunties, always look out for the helpers.

Speaker 2:

So I think, in conclusion, my take-home would be that we're in the privileged position where we can at the moment speak up, so we'll keep speaking up about diversity. Equity and inclusion Papers focused on addressing equity has always been something that we've done on the podcast and will continue to do. We'll continue to offer support to our international colleagues. We'll call out overreach. It feels like some of these initiatives in the US are definitely overreach. We hope that the democratic process will decide in a couple of years on the merits of the current programs of the administration.

Speaker 4:

Yeah. So, craig, I'd just like to share a story of success. Just like to share a story of success. So this talk of DEI and focus on equity-based research and focus on equity, et cetera, they're not just buzzwords, they're not just a political position, it's not just wokeism, it is actually about people's lives.

Speaker 4:

So when I started researching bowel cancer in New Zealand 20 years ago, there was a massive equity gap between Māori and non-Māori New Zealanders in terms of bowel cancer outcomes.

Speaker 4:

Māori waited longer, less likely to get referred for adjuvant therapy, less likely to receive adjuvant therapy, less likely to get intervened for metastatic disease and shorter overall survival. And over the course of the last 20 years, I've seen that gap shrink and shrink and shrink and shrink and shrink. And that has been through the systematic focus through Cancer Navigators, it's been through equity statements, it's been through systematic reporting of equity outcomes, it's by diversification of the workforce, it's by about cultural safety and cultural competence training as well, and it's by a relentless highlighting of that equity gap and how it is unfair and how people die prematurely as a result of that. And I've seen that gap shrinking over the course of my career. So these aren't just buzzwords. The problem is fixable. It is not persistent or permanent and it is not inevitable, and we are in a position to do something about it and, as leaders in our field, when we shine light on the facts and we show a path, we can save lives.

Speaker 2:

Yeah, I agree, and so, Little Vignette, in our own city. We're one of the few, maybe the only region in Australia where we've actually matched metropolitan five-year survival outcomes through some funding and building a cancer centre through research programs. And so we worked out, we calculated, just in our city that equates to about 90 lives per year saved. So you know, in a small community that's not a mid-substantial amount. So, yes, these aren't just buzzwords, these are human lives 90 people, 90 families, hundreds of friends. So thank you all and a big shout out to Rachel for giving us permission to do this episode as the producer of the show. So thank you, Rachel, for enabling us to have this GADfest and let's hope that people had enjoyed it, get something out of it. Please share it and give us some feedback on your thoughts. Thank you, everybody and we'll see you again soon for hopefully a funnier episode.

Speaker 4:

And if you really just want to send really mean comments, craig will leave his Twitter handle in the comment section at the bottom of the podcast episode and just direct all of them to him, not to me.

Speaker 3:

Thanks, and I managed to get the word vagina into this podcast too, so yeah, that was great.

Speaker 2:

See you later.

Speaker 1:

Thank you for tuning in to the Oncology Journal Club podcast, proudly brought to you by the Oncology Podcast. Part of the Oncology Network For healthcare professionals. Seeking regular news, updates and insightful discussions, we invite you to join our community at oncologynetworkcomau. Your free registration includes a complimentary subscription to our weekly publication, the Oncology Newsletter, a valuable resource to stay updated on the latest advancements in the field. We value your input and welcome your feedback and paper recommendations via our social media channels, email and website. Your insights help shape the conversation and drive the direction of future episodes. This is Rachel Babbin signing off for the Oncology Journal Club podcast.