Racial Disparities in Parkinson's DIsease

Webinar & Transcript

Dr. Jaime Hatcher Martin: [00:00:00] Okay.

So hi, everyone. Thank you for joining us today. My name is Dr. Jamie Martin. I am the Director of Movement Disorders here at Synaptic Care, and it is my pleasure today to welcome my colleague, Dr. Chantelle Branson. I'd like to give a quick introduction and then we'll jump right into it. So Dr. Branson is an assistant professor of neurology in the Department of Internal Medicine at Morehouse School of Medicine in Atlanta, Georgia, so we're neighbors.

She completed her residency training in neurology and subspecialty training in movement disorders and sleep medicine at Boston University Medical Center. And among other things, her research interests include understanding and improving health disparities among African Americans with Parkinson's disease.

And she's going to talk to us today about some of those disparities and. You know why they might be occurring and what we can do to to try to address a lot of those issues. So Dr Branson, it's a pleasure to [00:01:00] have you today. 

Dr. Chantale Branson: Thank you. Thank you so very much. I'm really excited. I love talking about this. We could talk all day.

I should find out how long we have before I start talking. I'm going to share my screen with you all. 

Dr. Jaime Hatcher Martin: Okay, can you see the screen. 

Dr. Chantale Branson: We sure can. Okay, great. So I wanted to just give you a little bit of history about this particular lecture, because I've only given it a couple of times I want to say about two or three times.

The first time that I put together this lecture. Was in 2016. I was a neurology resident at that time at Boston Medical Center. We have to give mini grand rounds. I think most residency programs require their residents to give some sort of a lecture or talk. And I wanted to talk about this because I was, I'd already started some of the research and racial disparities and looking at racial disparities specifically in Parkinson's disease, but I was just.

Fresh out of neurology [00:02:00] residencies. I wanted to talk about all of the disorders and go into great detail. And that was in 2016, sometime around 2017, 2018. I also gave this talk as a movement disorders fellow or sleep medicine fellow that kind of ran, ran together there at Boston Medical Center, again, to some of our students and, and people who are in, are medical students.

And the reason I wanted to give it today was I remember in 2019, shortly during one of the many uprisings that we may have had, racial reckonings people may have heard. We go through these ebbs and flows, right, of racial reckonings while there are always racial disparities and underlying health disparities.

Throughout the entire time, sometimes there's just a focal point or main focus that occurs and the previous. One of the [00:03:00] previous AAN presidents in 2019 gave a similar lecture. I mean, it was so uncanny. I was so surprised. I was like, oh my goodness, it, it sounded so similar, but that was just because unfortunately not much has changed.

You didn't, you know, hear 2015 with a neurology resident at Boston Medical Center. He, you know, this is just the data that he collected that I also collected, right? And I gave this talk and. I gave it a year after that, and maybe one or two years later, I hear that the one of the presidential we have the American Academy of Neurology meetings and so at this lecture and just hearing it, it, it was, it was interesting, shocking, a little sad that we have not gone very far.

So I wanted to look back. I wanted to give a history lesson, but also look back on what has [00:04:00] changed or what has not changed since that particular time. So again, I can talk all day about this, so please. I love it. I'll talk for like five minutes on the title slide. I also want to have a conversation. I don't want this just to be, you know, lecture, lecture, lecture.

I want, you know, Dr. Hatcher Martin, whatever, you know, whatever you want to just, if you have a question, if anyone out there, if you see anyone. Asking questions. Please feel free to ask. I don't want this to be just me talking, although I do like to talk about this topic. So now I'm finally moving on again.

I wanted to give you guys the historical perspective of kind of where. We have come from so that we can move to where, you know, hopefully we will be going in the [00:05:00] future. There were some things that I left out and I will probably mainly just talk about those things more recently and update, but I just wanted to go through this again because I just remember that talk.

And so this, of course, as many of you guys know, is What people titled it as the test TV experiment. I don't know if we call it that anymore. Can you see my slide? 

Dr. Jaime Hatcher Martin: Yeah, we sure can. 

Dr. Chantale Branson: Okay, great. I have a border interrupting. And so I was making sure it wasn't doing that on the screen, but we, you know, that's what it was called at that particular time.

And we know that that historical perspective, it started in. 1932, and it was one of the longest running quote, studies, end quote, again, you know, using these terminologies based on the historical perspective of what, of what it was called at that particular time. The US Public Health [00:06:00] Service began a study to review the natural history of syphilis.

This was before there was therapy or treatment for syphilis. Of course, as you know, in 1947, penicillin was approved for the treatment of syphilis. That was about 6 months. The study actually continued without providing the people who had the diagnosis of syphilis, the treatment. Without giving them the option of having the treatment.

Okay. And I think that's important to talk about that history because they're, you know, with our recent issues with the vaccine vaccine in 2020 and and how that historical perspective was a bit distorted. And not from the, not from, you know, any other point of context, just in general, that's just what happens in life.

And again, in 1972, 1972, okay, so [00:07:00] this study started in 1932. In 1972, the New York Times published syphilis victims in U. S. study went untreated for 40 years. So I want to say it was the longest or one of the longest running studies that was conducted at that time that deepened the mistrust, right?

The, the issues, the, the The disparities the problems within the health care system. We did make changes, which I like to talk about as well. Again, the study was terminated shortly after that publishing of that article here is just some images at that time of how they did this final tap back in 1933.

We do not do that like that anymore. But just to Talk to you there were some changes that they made developed protect to help protect human subjects entering into research studies. The [00:08:00] Belmont report was created IRB institutional revenue review boards, which we all know now and people are aware or hopefully people know that this is not.

Something a research study or study is voluntary at any time they do not have to participate or they can it's a choice that they are making to help, not just the scientists who want to learn, but also society, it's a, it's a contribution to society volunteering to support. Science and research and we do that if we even talk about this in the context of giving blood or doing some voluntary service to support the community that we are in.

And I tell my patients all the time is you don't participate, you're going to get it the medication one way or another after the FDA is [00:09:00] approved it. So we did make changes, but that does not erase or change the history of what occurred. So I just. Again, can talk about it all the time. And then, of course, during that time in 2016, I wanted to get these little quotes.

I didn't want to leave them out. I think they still resonate today. I think it's important. Cameron Jones, Dr. Jones was at that time was the research director and social determinants of health and equity. I think she's moved on. She still is actually an adjunct professor at Morehouse School of Medicine where I'm at today, but she did a phenomenal TED talk, which I'm not going to go into detail about on the allegories on race and racism.

And really just to see how that history, again, the history has impacted what we do today. We know today that race is a social construct that it [00:10:00] does not define our genetics of yet, that we know of. We, we've done as mid much testing and studies as possible, but there's no race gene. There is none. It doesn't exist.

And so all of this information and data and studies and trials. You know, it's understanding the history behind it and why there may be some of the numbers that we'll talk about going forward, why they exist the way they do is based on society and the social construct that we've created. So we have to undo that and we have to work really, really hard as scientists.

Again, if I'm talking too much, just jump in anytime. You're doing great. So when we're looking at particularly health disparities in race, again, we, I just [00:11:00] talked a lot about the racial disparities and how race is built on social construct and idea of how society determines what race is. And that can therefore determine how we treat others.

And how we interact with others as professionals as providers as physicians, and this can cause what we, what we now call implicit bias, or the subconscious belief or idea these beliefs and ideas. Started from when we came out of the womb, quite frankly, it may be where we grew up in the household, the community, the society we were raised in and what those perceptions or ideas or beliefs of what black people can and cannot do, or how well they can and cannot score on an exam, or how much support they can or cannot find within their community.

Infects how we decide what to give what patient, what do [00:12:00] we give a patient with Parkinson's disease, and how do we eradicate those, those ideas I mean it's not, you know, these are ingrained in us as a part of our cultural being of who we are who we define ourselves as and so how is this reinforced again in 2016 so this is all back then so Just to tell you the context, a congresswoman, she was, she's the over the Congressional Black Caucus of Health Brain Trust created legislation to reduce health disparities, and she creates these annual health disparities report in America, Robin Kelly.

She still is. I checked the chair of this Congressional Black Caucus Health Brain Trust. And what they looked at were five key focus or areas in addressing health disparities. And one of them was access again, lack of [00:13:00] access. They define lack of access as contributes to gaps that we observe in national In national health outcomes. So not, not in the context of transportation, like going from one place to another, but again, workforce diversity. So it's important. Again, they use the term minority at that particular time in 2016. That minorities adhere to recommending giving recommendation. I'm so sorry you guys my computer is Adhere to recommendations given by someone who looks like them.

We've done several studies since that particular time, and probably before that time showing that that people of color irrespective of, you know, this can be. Whatever the race [00:14:00] is, people of color in general respond more to other people who are from their cultural background who looks like them who understand them who can have.

The exact same conversation. Nothing has changed, but we do note that that is a component of adherence and adhering to some of the recommendations that are given. Innovation and research, increasing minorities in clinical trials, and using the data to improve health, community engagement, eliminating health inequities

federal action such as funding, and they have done, they've, they've done some things we'll talk about as well. So overall, I wanted to talk a little bit about the neurological health care and the disparities within each, some of our, our four key. Neurological disorders, one of them, the most important being stroke.

This study again, looking at the data timeline, I'm going to give you something more recent, but I [00:15:00] wanted to just pay homage to this. This is between 2010 and 2013 from the CDC, looking at stroke mortality among adults age 45 and over, varied by race. And so they looked at non Hispanic black, Again, 54 to 68% were more likely of men and then 30 to 61% of women were noted to have the stroke or defined to have stroke.

More recently, I looked again in 2023 2020, my apologies, 2020, so this is over 20 years of data and that line has not wavered. We have not closed that disparity gap. Bye. You know, maybe I mean even this drop whenever there's a decline there you can see there's a decline in white non Hispanic Asian or Pacific Islander [00:16:00] American Indian.

But, again, there's no closing of the disparity gap and that's from 2000 to 2020. So this is over 20 years. Again, looking at just looking at multiple sclerosis, another common problem within the black or African American community with regards to morbidity and mortality and outcomes. We talked about, at that time, African Americans having a greater disease burden on T2 and T1 imaging.

which increased tissue damage, higher lesion volume, having more aggressive disease. And we know this, we know all of this, right? And again, not much has changed since that particular time in 2016 or even before that. My research targets this disease, and I [00:17:00] talked, at that time I talked about Dr. Willis's Paper very cutting edge and the cross sectional study is the largest number of Parkinson's disease cases at that particular time in 2010 more than 65 years of age, there was a prevalence among African Americans again the terminology that was used at that time.

We're 50% lower than whites and the incidence ratio were compared to whites were higher. Meaning that African Americans may have a greater or do have a greater PD related morbidity

now more recently. I also published a paper shortly after that. In 2016 and I looked at, I, I did a racial disparities in Parkinson's disease, a systematic review of the literature, and we looked at all of the documentation and papers. Between 2004 and 2016, Dr. Deborah Hall did a similar patient paper.[00:18:00] 

Shortly after that, she again looked at all the papers from 2220 2004 to 2020. And the data that hasn't changed. It hasn't changed. We still have some of these papers showing, you know, and these, which was so interesting is. These are just throughout these studies occurred throughout the United States, right?

So the veterans hospital, the VA hospital is known for having their meticulous charting. And, and I, I did my, some of my, all of my training at the VA hospital in Boston, and you can pull up everything and anything. And they, they really pride themselves on making sure that all of the veterans receive the same care, the same type of care.

And looking just in 2008. 6% racial ethnic disparity of adherence to PD quality indicators. [00:19:00] And what they did, they did a deep dive into the charts, they did a chart review, basically, and pulled what we call what they call quality indicators. So, if a person had tremor, or stiffness, or all of these features that may suggest Parkinson's disease, they would look and they would say, What, what, what was offered to them where they offered physical therapy, where they offered medications for Parkinson's disease.

And as the data shows, whites were offered more or non Hispanic whites compared to non whites with PD were offered the standard of care, the treatment options that are available. that were available at that time in Parkinson's disease. So they also people looked at the treatment disparities in Parkinson's disease, their duality in 2009.

And none of this, none of this has changed. I also did a recent grand rounds, forgive grand rounds of [00:20:00] giving grand rounds at the BI and Michigan and in USC. And so I'm looking at this data all of the time, always reviewing it, making sure that there's nothing new and not, nothing has changed since that paper in 2016.

So we talked about stroke. We talked about multiple sclerosis. We're talking about Parkinson's disease, right? And yet we haven't really moved the needle when it comes to racial disparities. In these neurological disorders.

Dr. Jaime Hatcher Martin: So I think it's important. I don't want to, I don't want to interrupt, but you're probably going to get to this. I think it's. I think, you know, a lot of times people are afraid to talk about these things, right? But I think it's, it's so important that we, we have to define it so that we know, [00:21:00] you know, how do we address it?

Why does it happen? How do we address those issues? I think it's, you know, we've got to move the needle. 

Dr. Chantale Branson: Yeah. And doing this and we'll talk about that as well. What, what can we do, right? What do we do? And I'll tell you what I said in 2016 and we'll talk about some of that, the changes. When I was, you know, excited resident again, going back on the history just to give you guys some historical perspective, Dr.

Solomon Carter Fuller was the first identified as the first black neurologist. He was actually a psychiatrist and pathologist. Again, he was the first black African American psychiatrist. He worked with Dr Alzheimer's and it's so interesting. I love this picture, right? Because where is Fuller?

Fuller is not like standing in the back, right? He's not like, he's right [00:22:00] here sitting right next to Alzheimer's and he has been known to, some of the history can have given lectures at my alma mater, at Boston University they have You know, really looked in deep, did some deep diving into this that he might have, you know, provided a lot of support with regards to that diagnosis.

Definitely after his death, he translated a lot or during this time, he translated a lot of that. It was in German, I believe. Into English. But again, he was a path. He worked at the pathology laboratory at Westboro. His laboratory became the premier place for histopathology of the cortical cortex, cerebral cortex.

And, you know, he published one of the first cases. By Dr. Alzheimer's in English. Of course, [00:23:00] I'm talking about just the translation of it, but you know, his work, his, his life work as a neurologist, as a psychiatrist, as a pathologist, he worked at Boston University. He was an assistant professor there. They gave him the job title as chair, and he did not receive the pay.

He left Boston University because I'm going a little bit too quickly here, but in 1928, he was appointed head, quote, unquote, of the neurology department. He was never given a title, remained an associate professor, my apologies, not assistant, but associate. In 1933, after 34 years of teaching, he resigned after a white assistant professor was promoted to full professor and head of the neurology department.[00:24:00] 

He has a building named after him. Psychiatry did name a building after him at Boston University. I've had the pleasure of speaking with his living relative, his grandson. They have nothing about, you know, but some things to say about him, but it was a challenging time. And even that hasn't changed, right?

We talk about the pay gap and talk about changes within it's just so uncanny. We're talking about 1933. It's 2023.

Again, I can talk about it

again, looking at that diversity. This is in 2016. I'll show you some more recent data at that time. The more recent data. It's a bit more detailed. Oh, I see something in the chat[00:25:00] 

because we'll sit. But at that time in 2008, black or African American we're, we're 1. 8%. Those are people who are, it is a little bias, it's self identified. So maybe someone didn't could have picked the other button, not have wanted to share their demographics, but. This is, this is the data we had for all members, 1.8% and in 2015, 2.4,

so 2.2%, and I looked at various different 7.9% faculty. And I just wanted to note as well, you know, at that time in 2016, we made up [00:26:00] about black or African American made up about 13% of the U. S. population.

So, I think the most important thing is to recognize that. We're not trying to say, you know, I'm not trying to say that we need to have 100% or the numbers, but we, it should represent or reflect the population that you're in. Basically and again, 25 years. That was 25 years. Despite rapid growth of minority groups, only a modest increase over the past 25 years.

We looked at I looked at some a and leadership diversity program that they have and that they are continuing to do. I also looked at my institution that I was at in Boston Medical Center more recently. Now, this is much more detailed data. They did not have that in 2016. So there was nothing to really compare that [00:27:00] previous data that I provided to you too.

They looked at the number of neurology residency program directors who self identify again. So if I identify as a specific race and then I don't know if you guys can really see the colors based on this, but

black is here before. So this is the number of neurology residency program directors by race. And then there's the, the the, the female versus male, the gender.

So again, how much has changed? This one below, so that was program directors, this was fellowship, neurology fellowship program [00:28:00] directors. By race. 

Dr. Jaime Hatcher Martin: And just for since a lot of people that are watching our patients, can you just tell a little bit about the difference? What is residency? Yeah, 

Dr. Chantale Branson: so when we're talking about increasing diversity so that people can see or have a representation of the people that are in the community and their providers, such as their physicians, their

APPs and things of that nature. These are some of the training programs that we go through. So we go through a residency program to help in specializing in the treatment of neurology and neurological problems, such as I talked about stroke, multiple sclerosis, and Parkinson's disease. And each of those fields like stroke and MS and Parkinson's disease, you can do an additional training such as fellowship training, and that will help us [00:29:00] with being represented within the community within the society that we're in today.

So what I wanted to talk about again, some of the people that I highlighted. Physicians that I knew back in 2016. And then this is US today. This is a, a picture of neurologists, neurosurgeons, pm and r attendings throughout Georgia. I know Dr. Hatcher Martin know a couple of them. Yep. And. Yeah.

So I, you know we have come a long way, but I think I just wanted to provide more of a historical context of some of the health disparities, why that has happened from a patient perspective, also to help understand where we are going and how do we get there [00:30:00] particularly for our patients who are out there listening.

Being a part of the research and participating is, is, it's important, it's imperative. That's how we learned about Parkinson's disease in the first place. The person who is named after, Dr. Parkinson, he found three people on the street. And that was a part of his, you know research. And so we, you know, talked about Dr.

Solomon Koehler and providing a path for future neurologists and just introducing other millionaires, contemporary neurologists in the field, but just working on expanding the context of those neurologists and understanding that a little bit better. That's all I have. I didn't want to be too, didn't want to talk for too long.

Dr. Jaime Hatcher Martin: Fantastic. This is, no, I think it's a great [00:31:00] way to Sort of set the path of why you know why we're having this discussion why I mean why this is so important and you know, we have to understand where we've come from, in order to understand where we go forward from here. So maybe you can tell us a little bit about kind of what you're doing now right you're the first if I remember correctly, or the first movement disorders docket at.

Morehouse, is that correct? 

Dr. Chantale Branson: Correct. So, yes. So, after I completed my training at Boston Medical Center in Boston, Massachusetts, I joined faculty at Morehouse School of Medicine. I was the first movement specialist at Morehouse School of Medicine, which is correct. It is a minority serving as junt or historically black college or university, HBCU.

I developed the first movement disorders clinic in at a Grady Hospital. Grady Hospital is a safety net hospital in Atlanta, Georgia. We provide care to people within certain counties, which is free of [00:32:00] charge if they are uninsured and insured. We provide care to ensure patients as well. And what I've been doing with regards to research is developing a.

A research core team. We have a research core team here. We were the first minority serving institution to join the Parkinson's study group or PSG. It is a consortium of. Studies that people from all around the US Emory is a part of the consortium, Columbia, Boston University you know, many of the large and small academic institutions throughout the United States and Canada, they love to say Canada as well.

And we have. Since joining Morehouse School of Medicine, we have four clinical research trials that are going on [00:33:00] actively. This doesn't mean, you know, I want anyone and everyone to join and to participate in research. I just think it's important for us to continue to have that representation. And Morehouse School of Medicine has always had a premier research center.

They have their own standalone clinical research center. It was just having that movement disorder specialist there. 

Dr. Jaime Hatcher Martin: Absolutely. So maybe you can talk a little bit about maybe some more specifics about Parkinson's disease and, you know, What do you think are some of the issues that result in, you know, what are the disparities that we see in Parkinson's disease specifically as far as patients go, you know, why do you think some of those disparities are there and how do we, how do we address those?

Dr. Chantale Branson: Yeah, great question. So, the Parkinson's disease, just to give some information for your audience, which I know you guys are aware of. It's a [00:34:00] clinical diagnosis. We basically look at tremor, rigidity, and postural instability. We look at these clinical findings, but it does not mean that you have to have all of them to have a diagnosis of Parkinson's disease.

So there are some people, 25% specifically, who may not have tremor. And we already have some challenges with Diagnosis, diagnosing people with early onset Parkinson's disease because of the clinical findings that can vary based on each individual. Therefore, when you take away something as simple as arresting tremor, and you may or may not have a movement disorder specialist in your community, and then you have what we talked about some of those underlying biases.

There can be a delay or a decrease in receiving the [00:35:00] medication or the diagnosis and or the diagnosis, we already know that black or African American people are under diagnosed with Parkinson's disease in general, and therefore they also have a delay in their treatment options. And while, you know, many of our treatments are what we call for symptomatic management, some of the medications.

We also know that exercise can help decrease the progression of the disease. So if I'm delayed to the point where I'm having trouble with walking, and I don't know that I should have been up doing some of these activities and exercise and things of that nature. Then that can affect or interfere and impact the what we call morbidity, meaning going to a nursing home or or being dependent upon others family members.

We also know that many [00:36:00] family members within black or African American communities have to work or have to do other things. In addition to that. So they may not receive the same type of care that might. That is needed. So those are some of the, that's a little bit about some of the disparities within Parkinson's disease.

Also, just to know, in general, Parkinson's disease, as you probably know, it's on a spectrum, right? We know that many of the non motor symptoms start 10 to 20 years before. So these non motor symptoms can be early. As a sleep specialist, REM behavior disorder. So people can have vivid dreams, kicking, fighting at night in their sleep.

Some people can have constipation and that trio, meaning triad, meaning constipation, REM behavior disorder, a decrease in your ability to smell, that has been known to have a higher risk of Parkinson's [00:37:00] disease in the future. So we're already behind the eight ball, right? They're, when they come in and they're shaking, they may have had problems 10, 15 years before.

And then you add on all of this other stuff, all the socials, you know, constraints and biases and all of these underlying issues, you know, That is where we're at. And that's why it can be also very hard to kind of move the needle to try to eradicate or decrease or change these disparities because of all of that additional problems.

I also saw in the chat I just wanted to comment about that. Someone asked about the incidence of prevalence of PD in countries in Africa and how does that. Comparative data in the U. S. So there was a study done in 1972, a very long time ago, and they looked at this, they [00:38:00] McKinney, I'm blanking on the name, I should have had it up but they looked at, they compared it A city in Alabama, and they looked at the same number of people.

It's like 40, 000 people or something. My apologies in advance. I'll give you that paper to reference, but they compared that to a country in Africa. So the country in Alabama, what they did was they did a longitudinal study. They went to each door of people who were over a certain age, they were adults, they were elderly and they took those numbers and they looked at how many people were diagnosed or had a clinical symptoms of, again, tremor, rigidity, postural instability, bradykinesia, meaning their face isn't able to move or isn't moving as, Similarly to people without [00:39:00] Parkinson's and they saw that blacks are African Americans had a higher number of new diagnosis of Parkinson's disease compared to white and that they're prevalent.

The incidents meaning when the prevalence meaning. When they were diagnosed at that particular time was the exact same as white. So this was a longitudinal study back in 1970 something and they did a comparison to a similar city in Africa, but their numbers were much lower and they weren't sure if it was related to morbidity, a higher mortality or death rate at that particular time.

So, I don't know what the numbers are now. I will tell you that no one, as of yet, has done a longitudinal study looking at the numbers either. 

Dr. Jaime Hatcher Martin: And, and speaking of, you know, difficulty getting movement disorder specialists, you know, we certainly have difficulty in [00:40:00] the U. S., but there's an even bigger shortage in a lot of the African countries as well.

And, I mean, worldwide, there's a lot of, there's a shortage. So, that can certainly make it more difficult as well. So, How do we, how do we change this? How do we improve access? You know, it's, it's, you know, obviously there's a shortage of movement disorders, doc. So we, we try to do as, as best we can, but you know, what can somebody like me do where, you know, you know, I want to, I want to reach people.

I want to be able to educate people on these, these are the symptoms you need to look for. And if you have these symptoms, you know, you should come in sooner rather than later because of all of these things, you know, being able to educate about exercise. How do we, how do we reach people that. You know, for for all of these variety of reasons are not making it into clinics or not making it into research trials.

Dr. Chantale Branson: Yeah, that's a great question. It starts with this. What you're doing right now, having these conversations via Facebook, [00:41:00] Twitter, if the whatever your choice, sharing it with your family members and loved ones, working on wherever you are, you're at, if you are a provider or physician and academia, increasing the number of black or African American applicants, they're there.

They actually someone already talked about this before they do have those numbers they are applying. They are not being accepted, and they have a higher what we call recidivism meaning they're being forced out more frequently than others out of their training programs. So, doing this, having this conversation, thinking about it, it's active, right?

The AAN, I forgot to mention that, and I didn't, I'm going to add that to my slide. I did, I did the other slide, but I didn't do this one. The AAN, the American Academy of Neurology, has a anti racism curriculum. And [00:42:00] every time I do the mic, I'm like, has anyone heard of it? Being active and intentional about What we are doing day to day, even as a patient, even as a, you know, a person with Parkinson's disease, we can all be a part of that process.

Does Morehouse do any outreach? At large community events like essence festival in New Orleans to help screen for PD patients. So we are the, I don't know if anyone has heard of the National Medical Association, the NMA, they have an annual meeting. It is actually in New Orleans this year. And all of the people who identify as black or African American are just underrepresented people of color.

I don't even know what to say anymore. I'm trying to be polite. [00:43:00] 

Dr. Jaime Hatcher Martin: That makes me feel better because a lot of times, you know, we're, you know, you, I worry about, I want to make sure I'm saying the right thing and I don't want to offend anybody and I want to make sure I'm, you know, so that actually makes. That makes me feel better.

Dr. Chantale Branson: I mean, I just, and then it flips because I've been doing this research for so long. So I've, I've seen it all. Yeah, you know, I've heard that, you know, minorities is now yeah. So basically, yes, we are working. There is another study called all of us. I don't know if anyone has heard of that. That has been actually one of the studies congressionally from the former President Barack Obama to the NIH that has They gave a lot of money.

They've given a lot of support and money through the government to help evaluate and just look at more longitudinal data with data collection, history taking blood draws and things of that nature. Morehouse has [00:44:00] again it's a site for that. All of us study. I've seen them like in the grocery store.

I mean, they're like everywhere they were like before COVID. And so that is also another one that, Okay. You can kind of find everywhere, but that's a great idea about the festival. I am currently we are a part of the Parkinson's disease foundation, and they are doing a genetic study looking at what we call PD generation.

They look at about seven genes, and really, the goal of having us. Having this Morehouse as a site is to increase the number of minorities a part of this particular study and looking at Parkinson's disease or the cause, etiology of Parkinson's disease among patients in general, everywhere, all, all patients, but particularly at Morehouse School of Medicine, looking at underrepresented communities.[00:45:00] 

So that is a great idea. I can take that back to the PD foundation and make that suggestion. I get to go to the festival. 

Dr. Jaime Hatcher Martin: And also throw into I know Michael J Fox foundation's doing a study with aligning science across PD the black PD study so it's blacks and blacks and African American connections to PD so black PD they're also doing a study looking at.

You know, black and African American patients as well. And it's not just patients. It's not just people with Parkinson's disease, but also people without to be able to look at the differences as well. 

Let's see, there's another question. So somebody was saying, can you elaborate more on the PD gene or PD generation generation study?

Dr. Chantale Branson: Yes. So PD generation is a study. What we're doing is collecting genetic data. And there are two ways to collect that data. There are sites all over the United States, and you don't [00:46:00] have to do it, you don't have to go in physically, it can be done electronically, virtually as well. So what most people do is collect the genetic testing via a swab, a cheap swab, but they can also offer blood draw.

Of the site have taken the route of the cheap slot because it's a little kit and they just mail it to your home. Once you consent, you have to consent, you have to read, watch a video, talk about genetic testing, and what the purpose of the study is, and then they can mail a kit to your home. Again, it's only seven genes.

We know that there are more than seven genes. Seven genes and Parkinson's disease. And I think they also look at different variations of those particular genes. So it, it's not all encompassing of all of the studies, but it is free and they provide genetic counseling. So that is what we really like.

The, you receive the, the patients receive [00:47:00] the results of their genetic test and they receive genetic counseling. And that can be found. I can provide a link for you to reach out to Morehouse directly. We are a site but also if there's other, there are other places that, that did the same study as well.

Dr. Jaime Hatcher Martin: So what, and this is, this is maybe not specific for race, but what about people who don't live in, you know, the Atlanta metro area? What about people who live in areas where they're not anywhere near you know, movement disorders, doc? You know, and obviously. I'm very biased. I've been doing telemedicine since 2016 and I work for a telemedicine company now.

And do you think that telemedicine is, is a way that we could address some of these issues? And if so, you know, I guess the question is, again, how do we get the word out? How do we encourage people to, to sign up? 

Dr. Chantale Branson: Yeah, so I have to, we have to have this conversation before COVID and after because 2020 changed some of those rules.[00:48:00] 

Yeah, same here when I joined Morehouse and they they are doing, we do telehealth, we to, Expose or to provide support to those rural areas, particularly south of our state, which is really a desert, right? There's not much there and more houses aware of that. And so we do do that. We provide telehealth support for that location.

And so before. COVID, it was because of the state you lived in, your licensing, and all these types of things. There's, there's a website that you can find the movement disorder specialist in your area. Again, it's usually really, really far away or in the big cities, we're all concentrated in one certain area.

And it's just hard to get an appointment. Scheduling can be challenging and things of that nature. So we did, we do, we did do that before and it was on a limited basis because people weren't very familiar with how to use telehealth [00:49:00] and some of the platforms vary and change and are different and can be a bit challenging and also internet connectivity and things of that nature in some of the rural areas with the weather.

As we had just this past weekend can be all very challenging. But I think now, I want to say that that really moved most people to feel at least comfortable, somewhat comfortable with utilizing telehealth. And I agree. I think that this is the way to go. With regards to Parkinson's disease or all disease, quite frankly, and I know there's a lot of concern from providers and I like to note that because I did it before COVID that, oh, well, you can't diagnose.

Someone with Parkinson's disease. So you can't do this. Remember, there's a certain number of features and you don't have to have all of them. So we, you know, miss that. You know, if they're gonna kill us, you know, right. [00:50:00] Some before and before COVID what we used to do. would meet or have them go to their local center, their local doctor's office.

And we would do the telehealth visit there. So we would have an AVP maybe move their arm for us and check for rigidity and do some of that support after COVID. We kind of understand that we can look for other features and, and really. Have a very good diagnosis. Irrespective of that. So, 

Dr. Jaime Hatcher Martin: yeah, it's one of the things when I started my my telemedicine clinic for movement disorders in 2016.

It was at the Georgia Alabama border for a lot of patients that were coming in from Alabama and Mississippi and You know, my, my argument was so much of what we do, you know, when I did all my training for how, you know, you, we do these scales where we write that we measure you know, you get scores for how do you do your fingertops and your opening and closing.

And I'm like, all of our, my training was all on [00:51:00] video to be able to learn, you know, to be able to, to be certified, to do this testing. And I'm like, we're doing this on these, you know, older videos that are kind of shaky anyways. You're not sure if it's the video or the patient. But, you know, you don't have the ability to ask somebody, Hey, could you change your position?

Could you do that again? You know, when, when we do what are called blinded Raiders on trials, right, where I review videos of patients that are, you know, getting a treatment in a clinical trial, and I don't know if they have. you know, Parkinson's or not. I don't know if they're getting the treatment or they're not.

I'm doing all videos based on scoring. And when patients say, Hey, I'm having this funny movement, you know, when we change my medication, the first thing I tell people to send me a video, you know, if you can't come in and send me a video and we'll take a look at it. So, so much of what we do is, is based on the visual aspect of it, right?

I mean, like you said, James Parkinson picked people up off the street. So it was all visual. And you know, it doesn't mean that we can't get the ball rolling. There are certainly things that we can't do via [00:52:00] telemedicine, but there's a lot of things that we can do to get the ball rolling and to start the process of evaluating for other things.

And, you know, a lot of times it may be, we start medication and if the medication works and that really helps confirm that diagnosis, but you know, there are tests that we can order now, right? That scans and skin biopsies and things like that, that can really help. You know, confirm or, you know, make us more confident in that diagnosis as well.

So I think it's, you know, and, and, you know, as a company for synaptic care, we're, we're licensed in all 50 states, but we're happy to work with, you know, other physicians, other health communities, centers, you know, anything. You know, support groups, whatever it is to help get access to patients any way that we can.

So there's a question in the chat. So there was a study, I can't remember, it's been quite a while now that looked, you know, and this is actually, it's funny because I reference this study all the time when I'm, when I'm talking to patients about the risk of dyskinesias. Right. So dyskinesia are [00:53:00] those big extra movements are not necessarily big, but the extra movements that people sometimes get when they take levodopa or Sinemet.

And I always reference a study when people say, well, you know, I heard that, you know, if I take Sinemet for a certain amount of time, it only works for a certain amount of time, or, you know, it's, it's, you know, the longer I take it, the higher the risk of dyskinesia. And so I know there was a study where they looked at, you know, people who had never been exposed to people with Parkinson's who had never been exposed to.

Carbidopa levodopa. I don't know if you've read the study before or not. But basically they looked at people and it was people in Africa who I, we say have never been exposed to levodopa. They didn't have access to levodopa at the time. And so this was sort of a, what we call a natural history of Parkinson's disease, people who didn't have access to treatment.

And they were able to show that You know, looking at it, if you took a group of people who had access to medication for 5 10 years versus people who didn't have access to medication, [00:54:00] if you gave those people who didn't have access to medication, if you gave them levodopa, depending upon how far into their disease they were, and this is as a group, not necessarily each individual, but as a group, they require the same amount of levodopa to get, you know, the similar control of their symptoms, and they had the same risk of dyskinesias.

Right. So it was more related to the duration of disease rather than, you know, how long they had been exposed to the medication and the, the, the, the, the converse of that was true as well. If you took people off medication that had been, you know, had been taking it for five or 10 years, then they looked the same as people who had never been exposed.

So, right. The thought was that. levodopa didn't, did not accelerate things, but it also didn't, you know, improve things either, right? It didn't, it didn't change the course of the underlying disease. So the question from Thomas was, how much do you believe this data comparing the African PD patients versus, you know, the EU or [00:55:00] US in terms of no difference in dyskinesias?

Is there any data? I mean, it's, I feel like there's such a dearth of data. period. But is there any data looking at the risk of dyskinesias in, you know, African American patients versus, versus, you know, white or others? And, you know, earlier or late, you know, later on in the disease when they started.

There's not 

Dr. Chantale Branson: any that I know when you're comparing race. But I also know that there's not much difference again, when you look at the studies that we do have on the treatment of these carbidopa levodopa or dopamine agonists and some of these other medications, the. There's not a difference, but a lot of the studies have a lower number of African Americans within them to, to, to actually, you know, scientifically or definitively say that this is, there's no [00:56:00] change or no difference.

Again, I don't think there would be a change or a difference outside of what we would call environmental factors. Again, we talked about access, not being able to. Keep having it right now, being able to get to it and not being able to get prescribed the medication. Those would be again societal problems or issues that would preclude the person from having the same amount of outcome with response with respect to maybe responding to the medication and.

I want to share one more thing. I'm good. I'm going to try to share my screen again. Because this is also again from another from that study, I was trying to reference and I was just having a terrible time remembering. This is just another, another talk that I gave, and [00:57:00] I think this is important what to answer the question as well.

This was the study I was mentioning that talked about the other study, but Dr. McInerney, McInerney, McInerney, Leo talked about recommendation for future studies, and she mentioned that without a community based study, There's the possibility that the prevailing, prevailing idea that PD is less common among Africans or African Americans might, they called it bias, this is how old it is, 2004, bias ascertainment, and serve as a self fulfilling prophecy, a cross sectional study of a population, which is what was done back in 72, 73, such as this would only ascertain the prevalence of PD.

So we all, in science, For our patients out there. We mainly do cross [00:58:00] sectional studies. They're easier, they're cheaper, it's just easy. While a long term survey of the population needed to determine the incidence and phenotypic picture of PD in the different ethnic groups. So to answer your question, you know, I don't think there will be a difference, but again, I don't think we have enough data or studies, particularly longitudinal studies and data to really determine that.

Dr. Jaime Hatcher Martin: And I think we're, we're right at time, but I think it's, I think one thing. You know, we talk about there's maybe no inherent differences, but you alluded to this. And again, this is probably an entirely and then a whole nother hour of discussion is, you know, we know that there's environmental exposures that can increase the risk.

And we know that environmental exposures are different in different areas. And, you know, if people don't have, you know, or live in areas where there is, you know, more environmental [00:59:00] toxicants and waste, or, you know, maybe they don't have access to, you know, you know, Certain types of foods that may have less pesticides or less toxicants in them, or they're living in areas with more pollution or things like that, or, you know, maybe because of rural areas, maybe they're growing up in areas with more farming, as opposed to having, you know, sort of the city job or whatever.

I think it's, I think there's so many other things that play into the risk of developing Parkinson's disease that are beyond, like you said, I mean, our genetics are the same. So that's, that's clearly not the issue. So, but that's, that's for a whole conversation for another day. 

Dr. Chantale Branson: So you guys heard it here.

She's going to have me back for another conversation and another day. 

Dr. Jaime Hatcher Martin: Absolutely. It's official. It's been recorded. So we want to be respectful of everybody's time. If there are other questions this will be posted to Facebook. So please, you know, ask your questions you know, in the Facebook comments, we'll try to [01:00:00] address all of these.

Dr. Branson, thank you so much for joining us today. We really appreciate it. And I hope you have a great day. Thanks everyone. Bye bye.