Transcript
Bell: The importance of receiving quality medical care cannot be overstated. It is often the difference between life and death for many people. A person should have the right to fair care when visiting the doctor regardless of that person's race, age, or gender. This is something that many of us agree on in theory, but in practice, things are far from ideal. Statistics show that different groups of people in this country have wildly different experiences when going to the doctor. There have been reports of patients that have not been believed when they told their doctor that they were feeling intense pain. In many of these cases, this misdiagnosis has led to death.
Gender and Racial Bias
Gender and racial bias in the medical field has been determined as the cause for a majority of these misdiagnoses. Having biases is human, but when those biases are the basis for making life and death decisions, people die unnecessarily. Not only that, but marginalized people will become skeptical that they will receive good care in the first place. As a result, they'll pass up on valuable opportunities for preventative treatments that can lead to further health complications.
Women are twice as likely to die as men in a year, following a heart attack, yet only 40% of women's health care routines include a heart risk check. Furthermore, a recent Wall Street Journal article stated that women who came to the hospital with heart attack symptoms are seven times as likely to be sent home than their male counterparts. Women are also twice as likely to suffer from chronic pain than men. Studies show that they are twice as likely to be dismissed from the hospital as men as well.
Things aren't much better if you're a minority. A New York Times article last year showed that black infants in America are more than twice as likely to die as white infants in childbirth. The gap is wider than it was in 1850 when slavery was still legal. Upward mobility is not a protector against these statistics either. A black woman with an advanced degree is more likely to lose her baby than a white woman with less than an eighth grade education. It can be hard to remove bias in a field that has textbooks, like the nursing textbook that was reported on in 2017, in which some of the following quotes were taken. "Hispanics may believe that pain is a form of punishment, and suffering must be endured if they are to enter heaven." "Native Americans may prefer to receive medications that have been blessed by a tribal shaman." "Blacks often report higher pain intensity than other cultures." These quotes were taken from the Focus on Diversity section of this nursing book.
This is crazy. These are some tough statistics to digest. It's hard enough to change the minds of people who hold these biases, front of mind. What's even harder is changing the behaviors of people who aren't even aware that they carry these biases in the first place. This systemic change can take generations, and even then it's not even guaranteed. That's a long time to wait. We don't have a lot of time. I sincerely believe that we don't have to wait that long to get equal access to quality medical care for everyone.
I believe that with today's technological advances in machine learning, big data, and anti-discriminatory algorithms, we can solve the problem of gender and racial bias in the medical field. What do we need to get this future of equality today? After talking to doctors and patients, we've identified two main groups to focus on. We've designated one group, at risk, and the other group, not at risk. After thinking about it, we decided to call the not at risk group, just normal. After analyzing our data points collected from many of our hypothetical users, you start to see that there are two main qualities that affect one's chances of being in the at-risk group. One is being a woman and the other is being a minority. We combine these two attributes to derive our core key metrics that we focus on since the start of our efforts. We ended up combining survivability, general satisfaction, and experience to compute our overall user satisfaction score. It turns out, to get the max satisfaction, a person's got to be not a woman and not a minority.
We're at the point now, where we're focusing on collaborating with the normal group, who are 99.9% made up of white guys. Furthermore, from the data that we've gathered, we've determined that white guys are in possession of a special privilege that everyone could benefit from. What if we could figure out how to democratize the privilege that these white guys have today? Sharing it with others could actually save lives. The data from our user interviews with white guys showed that white guys really want to share it, but they just have no idea how to. I've got news for you. Those white guys can drop that burden. We've figured out how to transcend the biological limitations of white male privilege today.
We are proud to present, I Need a White Guy, the first two-sided marketplace for white male privilege. Is your doctor not listening to you? No problem. Are you afraid that nurse handling your IV thinks that you have thicker skin because it's darker than hers? We've got you covered as well. With, I Need a White Guy, access to white male privilege is always just around the corner. That's not it. If you got white male privilege, and you're not sure what to do with it, we've got you covered as well. All you have to do is sign up and get certified, and helping people in need is just two taps away.
PaaS (Privilege as a Service)
I Need a White Guy, is a first-in-class PaaS, Privilege as a Service technology. We are ready to deploy white male privilege to our users so that they can get the care that they deserve. Here's how our privilege pipeline works. Jamila is a Mexican teenager who's been having a nagging ankle pain. She's gone to the doctor three times, and she's been told not to worry about it. After spending five minutes on WebMD, she's determined that she has tendinitis in her ankle. She returned to her doctor with the diagnosis and her doctor told her that she was wrong, and in fact, her ankle did not hurt. He suggested that the pain was all in Jamila's head. Since she's Mexican, she probably is thinking that the pain is an essential requirement of getting into heaven.
No service no problem, Jamila. Jamila pulls out, I Need a White Guy, and searches for a certified white guy in the area. She confirms her location. Stan arrives in three minutes and explains to Jamila's doctor that Jamila is in fact suffering from tendinitis and looks like she may need surgery. Jamila was rushed to the ER immediately. Problem solved. With, I Need a White Guy, spreading the benefits of white male privilege really is only a few taps away.
This is something completely fake that I created two months ago. I saw an episode of John Oliver. He did an episode on bias in the medical field. Towards the end, Wanda Sykes comes on, and she takes over and they do this skit with Larry David. Where she's like, "If you need help..." It was a website where Larry David has his canned answers to questions that doctors can answer. I was sitting on the couch with my fiancé and I was like, "I don't know if that's funny enough. I feel I can do better." Instantly, because all startups are about making Uber for something, I was like, "What if we had Uber for white privilege?" I took two days and put together, I Need a White Guy. I was really excited creating this because, if you couldn't tell, I might be in one of the at-risk groups. On the other side, the episode was really eye-opening for me. I didn't know about a lot of these statistics. I just hate the doctor.
When I took a step back and really thought about, I Need a White Guy, and when I started sharing with people and seeing how people were reacting, there were some lessons that stood out to me that I think we can take and apply to our mindsets when creating or attempting to create socially-conscious software. Some of that is going to take us taking a look at conceptual metaphor, and how it works, and how it affects people's behavior. From that, maybe we can take some things away that we can put into practice when we create.
Conceptual Metaphor
Let's dive right into conceptual metaphor. Metaphor is commonly thought of as a poetic device. At its core, it's understanding one thing in terms of another, where those two things have a shared characteristic. Let's look at an example. "You are my sunshine." In this sentence, it is implied that just like the sunshine brings life and warmth, you do the same by bringing happiness and warmth to my day. Said another way, I'm describing you in terms of something else, sunshine. You become associated with all the characteristics of sunshine by virtue of using the metaphor. If you look at the box here, you become enclosed in this encasement of metaphor that if somebody is seeking to understand you in terms of sunshine, there's no way you can actually get to understanding you without going through some of the characteristics of sunshine. I'm going to explain this a little bit more with some more examples.
This sentence is an example of linguistic metaphor. It also follows that our conceptual systems are metaphorical in nature as well. A concept is a general idea of something. Concepts determine what we perceive, how we get around in the world, and also how we relate to other people. Our conceptual systems define a large part of how we actually experience reality. The crazy thing about conceptual systems is that, though we use them, we're normally not aware that we're using them in the first place. It's like a fish swimming in the fish tank. The fish is moving through the water, but the water is invisible to the fish. It swims and moves without really knowing what's going on.
In a similar way, this is how we move through conceptual systems, otherwise known as cultures. We use them without necessarily being aware that they're there. Sometimes it's easy to confuse a conceptual notion with actual reality. Since these things are largely invisible, how can we get clues into our conceptual systems? How are they structured? Furthermore, how can we investigate how these structured, conceptual systems determine how we actually feel and act? When we were looking at the linguistic metaphor earlier, we took a look at how the sentence, "You are my sunshine" was structured. This gave us clues as to how metaphor was working to describe you in terms of sunshine. Maybe looking at a concept and trying to determine what it is defined in terms of, is a good place to start looking for clues about how a metaphor shapes those actual concepts.
Argument is War
In the opening of his book, "Metaphors We Live By," by George Lakoff, he uses the example that argument is war. The implication here is that we treat argument conceptually, like we treat war. Looking at a few sentences can help to clarify this fact. "Your claims are indefensible." "He attacked every weak point in my argument." "Her criticisms were right on target." "I demolished his argument." "You shot down all of my arguments." The way that we shape the language about argument shows that we do treat argument as war. War here being a two-sided battle with a determined winner and loser. The conceptual metaphor not only shapes the way that we speak about argument, but it also shapes the way that we prepare, how we act, and attitudes that we carry while arguing. We're not usually aware that we're referring to argument in this way because of the invisible nature of conceptual metaphor. We think that the war is the stuff that argument is made of. Normally when we're thinking about it, this distinction is not really aware. It's not front of mind. This is the conceptual water that we swim in. We move through it, but we're not necessarily aware that it's actually there. What happens when we begin to poke a hole in our conceptual fish tank?
Imagine for a moment that we are transported to another culture, where instead of argument being war, argument is seen as dance. Let's imagine that we attend a debate in this culture where a group of people, they're arguing. Our attempt to understand what's happening might look a little something like this. Instead of one side trying to defeat the other, we would bear witness to a group of people seeking to create an aesthetic performance pleasing to us, the audience. It's doubtful that we would even recognize it as an argument at all. The different metaphor, the different conceptual system breaks the line of sight of understanding. We would probably look at this argument and it wouldn't even click that it's argument at all. How does this affect how we behave and how we feel? We talk about argument as war, because we conceive of argument as war. It follows that we act in accordance with how we conceive of things. This is another connection that can be easy to miss at times. Said another way, it's a cup half-empty, half-full. If you view situations as a cup half-full, then your behaviors and your associated feelings will most likely be positive. It would be really weird if you saw the cup half-full but you were still feeling crappy and down.
How can we take this understanding and apply it to the major conceptual metaphor that's working in, I Need a White Guy? How can we use that to expose some of the things that make it really seductive? "Maybe this could work, but then, why does it feel icky at the same time?" What behaviors does this conceptual metaphor promote? How do these behaviors relate to the stated goal of, I Need a White Guy? There's this relationship between the metaphor and the behaviors it promotes. How does that relate to the goal that, I Need a White Guy, says that it's trying to accomplish?
Let's start with some of the sentences from the website, instead of with the metaphor, and see if we can infer some of the characteristics about the conceptual metaphor at play. "Share some of your privilege, white bro." "We delivered privilege to 3 million customers this quarter." "I got fair treatment at a great price." "Get access to our cohort of over 300,000 vetted white guys." "Subscribe here".
Privilege is Commodity
I Need a White Guy, treats privilege as a commodity. What types of behaviors are associated with commodity? You have a buyer. You have a seller. You have a marketplace. You have a transaction. The values that are associated with commodity that get applied or projected onto privilege is that a commodity, it can fluctuate over time. On the other hand, we have privilege, which at its core is something that we claim that should be static and fixed. If you are human and you're born, you should just be treated fair. We have a conflict of something that's dynamic, and something that's static and fixed.
This is at the core of what makes, I Need a White Guy, ultimately a self-defeating effort. It's claiming to reinforce the static nature of a human right using a metaphor that promotes its variability. The more effort you pour into the transactional metaphor, the greater the distance you'll create between your goal of inclusion. In other words, people feel like shit.
Seeing here, what's happening is that, I Need a White Guy, is trying to take something that's static, from the static conceptual metaphor and pull that over into this dynamic space. There's a conflict. There's tension going on there. That tension actually reflects to what we do with humans in real life. That's what, I Need a White Guy, is seeking to expose. Seen another way, we're taking a human right and trying to pull it into the space of commodity.
I Need a White Guy, is a commentary on the trend of commodity fetishism, not only in tech, but in society today. What are the costs of commodification? How does that affect society? We have kids right now who are really suffering from self-esteem issues because their self-esteem and their self-worth is measured from this arbitrary determiner of likes. We have relationships that are just passed through these algorithms on apps like Tinder. Elections, you just need to turn on the news to see how trying to commodify our democratic system is going for us.
Let's zoom in on human rights. No matter how hard you attempt to be inclusive using transactional metaphors, you won't get to inclusion. In fact, the harder you try the worse things will get. It'll be better if you didn't try in the first place.
3 Takeaways for Creators
What are three takeaways that we can walk away with for us as creators? Because we're all susceptible to this, all of us are immersed in culture. One, metaphor of compatibility, you really want to make sure that the idea or the change that you're effecting is rooted in an idea or a concept that will promote the behavior that you're looking to change. Does my conceptual metaphor encourage the behaviors that I'm looking to promote? For example, if we were trying to start a business that promoted the general well-being of mental health of dogs, you probably don't want to push a cup half-empty conceptual metaphor, because you're going to get some unhappy dogs. Where are some places that we can look to get a better sense of how metaphors work, because this stuff can really be hard to keep front of mind?
Comedians, they're really good at this, at focusing in on metaphors and playing with them and inverting them. When we see them out of place, all of a sudden we gain this awareness and we get to laugh. Another benefit of satire in comedy is that it can remove the inherent guilt or the inherent defensiveness that often happens when we start to bring up some of these more sensitive issues. That can facilitate greater conversation and collaboration. Poets are really good at this. Musicians, linguists, psychoanalysts, they're all really good at this, of making you aware of the metaphors that are in play in your life and how they're affecting your behaviors.
Second, using personal experience. When you make something personal, you get a free pass into this metaphoric conceptual space, because it's core and essential to you. That's why when we try to abstract the pain of another, oftentimes, we stumble and drop it. It's because it's our actual experience in reality. It roots us in the conceptual metaphor, and it makes it easier to keep those things in mind.
For example, when I did, I Need a White Guy, that was rooted in personal experience. When I started the talk, I said I didn't really know much about the bias in medical field, all the statistics behind it. I am a black dude in America, and I did grow up really scared of the police. There was one day at work, where I had a nervous breakdown. It was one of those summers where every news report was some unarmed black dude getting killed on tape, and I just snapped. That resonated with that part of me. I was like, "I can create something." It was immediately cathartic. When we create in these ways, it can be really powerful because what it does is it'll draw other people to it.
These are some ways that you can become aware of what's going on with you without having a nervous breakdown. Some reflective journaling, therapy, intense physical training, or meditation can offer you an outlet to create some distance between your perception of metaphor and your actual experience of it. Non-violent communication is a great way to get an insight into some of these things, and also, systems thinking.
Collaborate
Last, rubbing your mental models and conceptual metaphors up against other people's, is a great way to make you aware of inconsistencies. This is one of the very pragmatic and practical benefits of diversity or having different ideas and different points of view. Those different ideas and those different points of view, they're contingent upon having psychological safety, because if people don't feel safe, they're not going to be open about what they really think. If they aren't open about what they really think, we don't really collaborate well. This is one of the downsides of using the metaphor of competition, when we apply to our teams and our groups. Because when you have a competitive environment, the behaviors that subsequently come from that, work in direct opposition of collaboration.
In terms of how to collaborate, active listening. I was reading a book about organizational theory. There was one guy who put some of these ideas into play. The guy who wrote the book interviewed him and said, "How did you know that this stuff was actually working?" He said, "I was in a meeting one day and people were having an argument," or some conflict. He noticed that there was a shift from before they put these things into play, people would really say, "I know the truth." When afterwards, once you start to understand how these concepts work, you might say, "I have a truth." Then you make space for other truths. There isn't this need to fight for this either/or, which is often coupled with competitive spaces, and by extension, argument is war. Meditation, non-competitive creation, and systems thinking.
I would urge you, if you want to hear more about this or you're interested, I'm going to be sharing some information. If you go to ineedawhiteguy.com and sign up for early access, you can get access to that.
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