A Brief Discussion on Privilege

So, in the middle of our ongoing national nightmare of a police state, pandemic, and a chief executive experiencing obvious dementia (trust me, I’m a neurology patient, watch his gait, his repetition — these are all compensating mechanisms I’ve used after neurosurgery, and they’re also classic signs of neurological diseases), I had a conversation with a friend of mine who couldn’t comprehend the concept that government may not have her best interests at heart. Which wouldn’t normally be fodder for a column, but I have a neighbor who, during the year of chemo, asked about why his church would be formally against marijuana if it helped alleviate so many side effects of cancer treatment. I thought, as a disabled (sort of — I have a condition that counts, federally, as an automatic disability, and, although I have a slight limp — we’ll get into it — I’m not totally viable on stairs or arduous hikes, but I don’t need a cane for short walks) white man, I could bring a bit of light to the current crisis with my own checkered history with another set of trusted authorities: physicians, and how it might be somewhat similar to what racial minorities face in this country. AUTHOR’S NOTE: I can’t speak to racial, sexual, or even all ableist injustices and prejudices, and I’m not going to try — not because they’re not important or harmful, but because I can’t personally speak to them, and, in an era of tear-gassing churches for a campaign photo-op, we need authenticity and genuine empathy more than ever.

The first big thing every single person on the planet needs to understand — even if you’re reading this from a shack in Antarctica — is that every single human system in place is, by dint of being run by humans, innately open to corruption and abuse. Until we completely remove humans from the decision-making process, that’s going to be the horrible truth. The second major thing everyone needs to keep in mind is that the powers that be — the real owners of society (I don’t mean any shadowy cabal of billionaires, I mean them, the corporations they own, all the talking heads, on television, everyone in a position of real power) — did not get that way by being nice or fair. Kings strode to their bloodied thrones over corpses; in a neofeudal society, they just quietly let people die while they profited. And they will actually lie to you, if it means protecting their position, money, or power. We all might like to think that the Pope is a more moral, decent, and pleasant person than a used car salesman, but, looking back on history, we know the office has been abused, corrupt, violent, etc. and, in those situations, we need to ask how His Holiness now is any different from the power-brokers who endorsed the Frankish kings in exchange for a cut of the feudal pie? If Honest Ed’s Used Car Dealership would do it; why wouldn’t anyone else in society? I’m often asked by Europeans why Americans have such an odd acceptance — worship, even — of the status quo and those in power. I don’t know why, but the public’s tacit endorsement of power structures enables them, funds them, etc. from your local mayor all the way to the billionaire class. They will absolutely lie to you; they count on you not doing any investigative work to corroborate their stories, so, the minute you accept a statement from anyone in power, that actually does strengthen their position.

In my own case, coming from a biomedical background; I’m horribly aware that the process used to select and train physicians is biased, riddled with loopholes, and controlled — exclusively — by one group — the AMA. To be fair, in most cases, most of the time, most physicians are competent, empathetic, and knowledgeable. But, I knew, prior to getting my diagnosis, that there were plenty of bad apples that were protected either by other physicians, actively, or by the system that they had instituted to protect them (I’ve heard the line, “It takes a lot of time and money to train these folks, you don’t want to dismiss them at the first complaint.”). In American police; most complaints of excessive force or police brutality or corruption are investigated by… police. To be fair, it might be different groups of police or even different precincts, but go to a bar some night, find a group of work friends and ask them who isn’t doing their job, and you can get a sense of my unease about physician competence (or why racial minorities aren’t exactly keen to call the cops about a fender bender). Add to that the high death rate of brain cancer, the British Medical Journal’s finding that “medical misadventure” was the third-leading cause of death in America, and my own experiences with medical students and professors (who were mostly-fine people; but that’s the point; they are just people — they don’t put on a labcoat and all their imperfections or errors vanish), and you can start to understand why I’d be a little suspicious of a system that also keeps me alive.

That is some of my background and experience; we’ll get into further details as they become pertinent. In the area of racial relations and privelige, I’d recommend Obama’s “A More Perfect Union,” or Trevor Noah’s discusssion. But, in America, as Obama noted, most people see the word, “privilege” and think, “Where’s my stuff?” The fact that you’re looking at the system and already thinking you’ll get some benefit is the first sign of privilege. Minorities are usually thinking how we don’t lose any ground. In America, privilege isn’t so much about the shit you get for showing up white; it’s about the shit you never have to deal with as a result of your body or gender (and, let’s be clear, if you are white, you enjoy some kind of privilege, if you’re male, you enjoy some kind of privilege, if you’re able-bodied, you enjoy some kind of privilege, if you’re heteronormative, you enjoy some kind of privilege). Let’s take just a few theoretical examples. Say a friend asks you if you want to go hiking, or go to a party. If you’re not me, you’ll probably say, “Yes.” I have to do some quick calculations, “Is it going to be a long or strenuous hike? Will the party be in a five-story walk-up? Is there parking nearby? Am I going to have to do anything that’ll stop me from getting to my anti-seizure meds tonight?” Your female friends have to ask, “Am I likely to be assaulted? Do I feel safe with that group?” Your black friends have to ask “Is it safe? Will there be drugs in the zip code? Are cops going to stop me going in or out?” If you’re white and male, you can say yes, right there and then, and, then, this is the magical part you never even think of; you just go. This is the part you have to understand freaks all of us minorities out. You can just go do something, somewhere, anywhere, at any time you like, without major consequences, without thinking about it. Once some of those liberties get stripped away, the world is a far more perilous place to navigate.

I’m using my particular example in this case, because an easy one for most white people to empathize with — it’s not too far from Type 1 diabetes or a chronic knee injury. Except I might die if I’m wrong. That’s the critical aspect of privilege in this country that white men are shielded from; if your mental calculations are wrong, you go to the wrong party at the wrong time, you might end up in prison or lose your job. Those are the default worst-case scenario options on the table. The default, average-case scenario hovering over all your minority friends’ shoulders, at all times, is, “I might die.” If you can’t appreciate that the severity of those two outcomes are not equal, at all, I’d advise you to go back to kindergarten or something.

Let’s take another quick example. Let’s say you get a job offer across the country. It’s a great job, pay bump; your partner is fine with it. I get the same opportunity, I have to start asking a whole lot of new questions. “Will I still have access to my current medical team under their insurance? Can I afford to pay those premiums? Can I take time off in the event of a recurrence?” To be fair, these are not dissimilar questions to the ones couples with children have to ask, but, again, the critical difference in outcomes is, if you’re wrong, you don’t die. I do. I can’t speak on behalf of my black or Asian friends; but I’d imagine a similar risk-benefit-cost analysis is played at every major decision. And, again, the worst-case scenario isn’t a lousy education or a lackluster career; it’s that we die. The privilege stakes minorities play for isn’t that we get stuff, it’s that we don’t die.

To start tying these things together; I was enormously lucky in who was on my medical team. However, at the same time, whenever I meet someone new in a labcoat, I do have to approach them cautiously and double-check everything they do. If they screw up my prescription list, I suffer a seizure and die. If they miss something on my scans, the cancer comes back, I die. If I move someplace I can’t get medical coverage, I miss appointments and I die. I have to approach every physician as if they can — through both action or inaction — kill me. They might lose their job; they might even go bankrupt in a massive lawsuit, I’ll still be dead. This is what black people face: those few bad apples might lose their job, those black kids can not be brought back. The fundamental, social problem we need to address in America right now is; if you are a minority in this country, you don’t play for the same stakes as everyone else. Some people are aiming for a beach house in Malibu; some of us are just trying to live past 40. And, increasingly, there isn’t a middle-ground between the two, which is a massive problem.

The way that I approach every single physician — “Is it really worth the risk? Are they going to hospitalize me and screw around with my meds and kill me?” (Before anyone asks, yes, I’ve been hospitalized multiple times, yes, nurses have missed meds)(thankfully, it hasn’t yet been fatal) — is the way black people have to approach every single police officer or white person in the country. That officer might be able to help that poor black kid; it might be an off-day and it’s Trayvon Martin. No, white people don’t get stuff just for showing up, but they can — and do — kill people and get away with it. The good news is, that’s usually not enough motive for most people, but there are always a few bad apples; and you’ve abdicated policing yourselves, so minorities are not getting much help.

To get a taste of the exquisite horror I get to deal with, let me take you back to the halcyon days of 2017, when the Administration, after a brutal loss of repealing parts of the ACA, decided to simply repeal the whole thing. Again, if that happens, I lose my health insurance, I die (people in civilized countries are always befuddled at this concept that the American government simply lets people die; white, able-bodied people seem violently opposed to it, even though Vietnam was a thing that happened, HIV killed hundreds of thousands, and Covid has racked up over 100000 deaths — if your government doesn’t think you’re worth it, they will absolutely let you die, then lie about it to the citizenry). I watched the season finale of 24 with less anxiety and tension than I did the senate debates. Thank gods for McCain. A single vote, and I get to live. Again, for those of you sitting in the majority section; that is the razor-thin margin of life and death for some of us: a single senate vote.

And somehow, with that very palpable threat hanging over our heads at all times, minorities in this country are expected to be model citizens and contributing members of society. A society that is, let’s remember, pretty actively invested in letting a fair number of its citizens die, if that protects the profit margins of a few insurance companies. Why would I expect them to treat black people — who have 400 years of extreme racism working against them — any differently? And, in a society that so flagrantly values money and stuff over human life; why wouldn’t property destruction be a valid form of social change? Feudalism didn’t end because the barons decided they’d had enough raping, looting, pillaging, and crushing taxation of the marginalized; it was because the marginalized realized they outnumbered the barons’ knights, burned the fields, got out the guillotine, and demanded the right to leave their land in times of starvation. We’ve had over 1000 years to prove that eating your vegetables, saying “please” and “thank you,” and asking nicely gets you ahead. Not only has it not worked, it’s gotten a lot of people killed, reaching for a carrot that isn’t there while some faceless devil brings the stick in from the other side. So, when it’s a choice of a brutal death at the hands of the devil you know, or burning it all down and taking your chances; well, that is exactly the same gamble I made going into a clinical trial. And, hey, it worked for me. And, like most black people, I’m well-aware that society is only too happy to let me die. I know this because society has already attempted that once, had live hearings on C-SPAN about it a second time. Do I really feel comfortable waiting around to see how this plays out another time?

The thing that gives me a tiny bit of hope about this whole, gruesome, “Maybe we should let black people live without fear of psychotic, rogue cops” debate (make no mistake, that is exactly what will frame the entire election cycle, “Do we sacrifice our citizenry for the pensions of a few, or do we all pull together, rewrite the domestic agenda, and change society from a grotesque celebration of despicable wealth and power, or make it a just, verdant land for all?”) is, oddly, COVID. See, if we, as a society, can grasp that a few really good weeks in the stock market is not an appropriate price to pay for 2–10% of the population, we might start valuing human life. We might even start listening to one another, and empathizing. That simple action of understanding and believing one another is not enough to save everyone, but it scares the hell out of the folks at the top of society. Tonight, when you hear about rioting or looting, instead of casually condemning the rioters or looters, ask, “What desperate straits would drive me to that?” I guarantee you, there is something — maybe a few million dollars, maybe that house in Malibu, maybe a gun at your child’s head — that would coerce you to burn a Camaro. Once you have that hypothetical, the next, critical question to ask is, “Who tangibly — in US dollars or votes — benefits by my mis-directed anger?” Because, I guarantee you; that is who deserves your fear and disgust, not some poor black kid being tear-gassed by riot police.

Written by

Science journalist, cancer survivor, biomedical consultant, the “Wednesday Addams of travel writers.”

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