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Joseph Kim:
Welcome to Clinical Research Confidential. On this show, we highlight and demystify the inner workings of this greatly misunderstood activity called clinical research. Now, why is clinical research important? Well, it’s the basis for nearly every modern remedy for sickness and a growing method to build trust and solutions meant to optimize health. But it’s not for the faint of heart. And so, on this show, you’ll hear what it really takes to succeed in the clinical research game. I’m your host, Joseph Kim, and I’ve spent over 23 years in the clinical research industry, now serving as the Chief Strategy Officer for ProofPilot. Get ready for some adventures as we look into the underbelly of clinical research.

Dezbee McDaniel:
And I’d love to welcome back today Dezbee McDaniel. This is a part two of our original podcast because we had so much to talk about and had a punch list of topics to go over, and we just never got to them. So, Dez, be great to have you back. Thank you for coming on again.

Dezbee McDaniel:
Of course. I’m glad to be back, and I’m excited to chat with you today.

Joseph Kim:
Yeah, for sure. There’s three other big topics I wanted to cover, especially when it comes to the underserved population or the notions around like access to technology when it comes to research participation, how this community likes to be paid because many of them are unbanked or underbanked, what it really means to do things decentralized or at home. And I’ll set each one up, of course, but let’s start with technology. Because I’m, listen, I’m confused here because sometimes people say people in certain underserved populations, black and brown folks, don’t have access to any computers or cell phones, and then I also hear many of them actually do, and this is their way they keep connected to the world. And then there’s a problem around not everyone has high-speed Wi-Fi.

Dezbee McDaniel:
Yes.

Joseph Kim:
Give me the truth. What is going on here?

Dezbee McDaniel:
Yeah, so I’ll give you the truth as far as I can see it and give it just to put that out there as I cannot define that because I have conversations about both. I’ve had conversations where the sentiment is that people don’t have access to that technology. I’ve also had conversations where the sentiment is, Oh, most people have an iPhone. So I think from my perspective there is more access, I feel like, than not, that most people do have some device, some access to Internet, Wi-Fi. I know a lot of people, I think, in these communities who have devices that aren’t actually activated, but they will put it on Wi-Fi when they go to a McDonald’s when they have free Wi-Fi. So I’ve seen experiences like that where people will, I think, leverage the technology that they do have and the access they do have to engage in things they really care about. And so that’s how I see it, as it’s not even necessarily just the lack of access to technology itself, but essentially, but do we make them care about it enough to actually access it with the technology that they already have?

Joseph Kim:
Got it.

Dezbee McDaniel:
I think that’s a question that I like to ask is, with the technology that is available, do they even care enough to seek out access to clinical research? That’s really been a question that I’m focused on. Again, my sentiment is that there is more technological access today than ever, and I think in a way that you can get more people involved than not. So that’s really my sentiment on where we stand with that. I think it’s about how you leverage the technology on the industry side, on the clinical research side. I think it’s about how you integrate with the different levels of technology that communities might have. So I think it’s about knowing that, okay, in this suburban community, that technology is maybe more accessible, that it’s a lot easier for people to access our platforms, but in a maybe more rural and lower on the socioeconomic-wrung type of community, that there may be nuanced ways and things that we need to do for their technology to add up with our technology and make it an easy process for them. So I think it’s really about tailored approach to communities and different levels of technology access in a kind of general way.

Joseph Kim:
Yeah, and trying to, and I guess what I’m hearing is like trying to not, try to get to the lowest common denominator in this, in a respectful way. As you alluded to, certain communities, when they don’t have access to all the bells and whistles get very creative with using a smart device and getting on the Internet. What it may not mean is that they have a credit card attached to the iTunes and they can download native apps. That becomes a higher hurdle versus just getting on a browser and being able to access the Internet in some way.

Dezbee McDaniel:
Yeah, that’s great point.

Joseph Kim:
Because you see a lot of companies in our industry where they always go to some like native app on the App Store, and I think that sounds like sexy to the sponsor, but that can be a barrier to someone who doesn’t have a credit card hooked up to an iTunes account and they don’t have a fancy phone to comply, because the app needs to be compliant with that too.

Dezbee McDaniel:
And to that point, our platform, CliniSpan Health is actually a web application. Yeah, because of that, we actually didn’t think that a mobile app would be the best route for us to start because of some of that access, but it’s easier to pull up a web application across any device, and it’s also mobile-friendly versus forcing people to have to download a mobile app. We actually felt like for our market that we end up being a more difficult experience for most people to actually engage with and encounter to your exact point.

Joseph Kim:
Yeah, I love it. I think the idea that, if you want to be inclusive, right, everyone talks about diversity and inclusion. Web apps are inclusive, native apps are exclusive.

Dezbee McDaniel:
Yes.

Joseph Kim:
That’s where I draw the line in the sand.

Dezbee McDaniel:
Yeah, I’ll agree with that statement, for sure.

Joseph Kim:
What about access to Wi-Fi, right? Not everyone has high speed in their phone. You mentioned, like there are public places like a McDonald’s or Starbucks. What are other creative ways that underserved populations can access Wi-Fi?

Dezbee McDaniel:
Yeah, I would say that’s been one of the biggest ways I have seen is accessing free Wi-Fi at places like that. That, I would say, is the number one way that I’ve seen, is that I’ve seen people sitting in a McDonald’s on a non-active device that when they connect it to that Wi-Fi. So that’s a huge way that I’ve seen. I don’t think, none really popped out to me as much. I’ve seen, I think, some rural town and city initiatives to get fiber optic cables, infrastructure into the city or town that wasn’t there. So I feel like from a public good standpoint that we’re starting to see more, not on an individual basis, but on a institutional basis that tells the cities are starting to put more infrastructure into their communities for affordable Wi-Fi and access. So that’s something that I feel like on an institutional basis that I’m really seeing to try to create more access in rural communities. But yeah, like I said, on an individual basis, that’s really one that I’ve seen. And I think hotspots, so I’ve seen people leveraging hotspots from a friend or a family member that might actually have Internet on their active device that they’ll leverage hotspots as well. So I feel like those are two ways I’ve really seen. It’s free, accessible Wi-Fi at local businesses and really bouncing off hotspots from family and friends.

Joseph Kim:
Yeah, and I want to dovetail this into this notion I’m going to skip over payments for now, but this notion of like at-home procedures being more convenient. And I think at face value, that makes sense, but from a technological perspective, if you’re going to give someone a connected scale that has to be on a phone, then go through Wi-Fi and you don’t have Wi-Fi at your house, all of a sudden, you’ve made it more problematic because they’re not going to take that scale to McDonald’s and do the thing there.

Dezbee McDaniel:
For sure, for sure. Nor can they get a package sent there, for example.

Joseph Kim:
Yeah.

Dezbee McDaniel:
Like the at-home packages they send, and they can’t necessarily seem to a McDonald’s address.

Joseph Kim:
Yeah, and I’ll tell you a little story about my first job out of college. I was a social worker, and I worked in disadvantaged communities like in the community multiple times. Yeah, I think we talked about this too. So multiple times a week, I would be going to public housing, Section 8 housing, to deal with the actual client that was there. And looking back on this idea of, Oh yeah, we’ll send a home nurse and or have an RV parked outside of that neighborhood. Tell me about like, how would that really play in a community like that?

Dezbee McDaniel:
Yeah, so I think that difficult, just to start, I think it’s really difficult. There’s a lot of problems to manage, and you being a person who has been in a community like that, and just to be honest, I’ve lived in communities that had public housing, and my friends stayed in that public housing. That’s the community that I really come from myself. And so, speaking to you as someone who worked in that community, you really have seen that and understand some of the issues out there. Man, there’s a lot of hoops to jump through for everything, it seems like. It could be that there is an RV available that day, but it could be work schedules, it could be childcare issues. So it could be, the list is so ongoing that there’s not one thing you could solve to really make it easy. You have to, it really comes back to social determinants of health, I think always is. There are so many factors that affect us, one thing that we really have to look at, right? So I think that’s what makes it difficult, is that in communities like that, there are so many issues within that environment that people are dealing with that you can solve 1 or 2 of them, and it still can be super difficult for them to be involved and engaged and really trust it. I think it comes down to that too, that if communities have higher levels of trust, they’re willing to jump through more hoops to be involved. So if these companies that have RVs and are coming into these communities are able to build trust and be present in these communities beforehand, I really think that the people in those communities are willing to deal with more issues and go through more things to be involved because there’s higher trust there and they know that these companies have their best interest at heart. So I really think it comes down to a huge branding thing, is that people in those communities have to really trust that you’re there for their well-being. If they trust that you’re there for their well-being, I think that whole list of issues that they could encounter becomes that much smaller and more minuscule, where they’ll pretty much look past it and say, Hey, they really care about us. They really want to make our community better, and I want to engage with these people. So I really think that’s a huge part of it, and that’s what we’ve seen with CliniSpan Health, right? To your point, we’re in these communities, we’re in Martinsville, Virginia, is one of our communities that we have a heavy presence in. They are the number one poorest city in Virginia, the state of Virginia. And we did a turkey giveaway there, and we gave away over 100 turkeys, but it ended up on the local news; I think it was ABC 11 or something like that. And if I were to show you our signups in a database, we got lots of people in Martinsville signed up to learn more about clinical research because they trusted us. Never once did we mention a study at that point. We gave away turkeys, we let people know that we were in their community, and we care about them, and that they can trust us, and that we want to bring value to them, and that we operate in the area of clinical research, but we didn’t say anything about a study that they could access or anything of that sort. And so I think that short anecdote in itself really shows what we believe is the right approach to getting into communities that really have a huge lack of resources and lack of access.

Joseph Kim:
Yeah, you mentioned this in the first part, which was like, this investment is just exactly that. You got to be there before you need them. You have to be there after you’ve activated them too, this investment is long-term. It’s not transactional. And the story in Martinsville is a great example of like how to do this right. Because it’s easy to say, just invest, but like you’ve actually, here’s an example, go do this. There’s nothing stopping you from doing it.

Dezbee McDaniel:
Yep, it’s how, like how do you invest? Once you’ve decided you want to invest in the community, I think the question is how do we do that properly? And something that we always try to do is understand the community beforehand, right? That Turkey giveaway, we partnered with a local community partner that knew exactly what that community needed. We didn’t try to guess at investing in them how we saw fit because that maybe wasn’t fit for them, and so the investment that we made was really fit for us as well as a fit for the community. So I think it’s really about that as well, is how you invest in the community should really fit for them and excite them as well? If it only excites you and industry, then I think it’s being done incorrectly to start, but really should think excite the community that you’re investing in where they feel like, Wow, we wouldn’t have had this type of investment in our community and be excited about this without these organizations having a hand in our community.

Joseph Kim:
Yeah, let’s talk about the use of retail healthcare or pharmacies; basically, LabCorp or Quest. That’s not quite at-home procedures, but because it’s not at the clinic, I’m going to lump it in with that. How often is an underserved population utilizing those big box chains like a CVS or Walgreens or point solutions like Quest or LabCorp for Labs? Is there a different sort of level of retail health that they use? How advantageous is putting things there for this community?

Dezbee McDaniel:
I actually think it could be, and I’ll speak specifically really right now to CVS and Walgreens. I would say those would be hugely impactful. Even people in the communities I’ve known, the family, in my own family, like CVS and Walgreens pharmacies are huge; that my grandmother right now, I feel like, goes there for most of her prescriptions to be filled. And I’ll say even Walmart as an example. So the pharmacy in Walmart, I think I would lump that into the CVS Walgreens. I think if we were doing procedures on clinical studies from there, we would see a lot more involvement. And I even think from a marketing standpoint, maybe foot traffic standpoint when I think of Walmart, there’s a lot of the same groups shopping in Walmart that are left out of clinical research that you could leverage the kind of place as a tool to speak to people, educate people about research. If you have a, some infrastructure in a Walmart to put on a study, you can go around Walmart and talk to people about the study and potentially educate them. Now, is that the best route to take? Maybe not, but it now has become an option that might not have been there before and you might, could have people with a more convenient screening visit because they were already on-site to shop. I think could see a lot of potential there just because again, the markets that CVS, Walgreens, Walmart is serving is the same group that is left out of clinical research. So I think there’s a lot of overlap of community there that you could leverage marketing infrastructure of a CVS, Walmart as far as their email list and all of that, because it’s a similar target group. And actually, to that point, I saw CVS recently send an email about clinical studies being a part of their infrastructure. So that exact type of marketing I could see making sense. As far as a LabCorp goes, I think, I don’t know, I guess that seems a little less retail than CVS, Walmart, for example. So I think that would make me feel less, I would believe less in that aspect of it because of the, that kind of foot traffic and that lesser retail aspect that I’ll talk about. So I think when I think of a CVS, Walmart, Walgreens, I think those have heavy potential.

Joseph Kim:
Yeah.

Dezbee McDaniel:
I think that goes back to potentially brand though, for example, right? I think CVS as a brand, out of the three, might be the strongest as far as pharmacy goes where there could be more trust for actually doing a study at CVS, because when I think about it, I can see people having questions about doing a clinical study in Walmart. So it becomes, again, back to branding. I think that Walmart, and maybe Walgreens and CVS will have to think about just how do they make that brand overlap but make people still feel comfortable and feel trust. And because I’m not thinking about it, I’m like, no, I feel excitement at people saying they’re going to do clinical studies at Walmart. I don’t know.

Joseph Kim:
Or Kroger. Kroger just came out, like the grocery store, and you’re like, Huh? Are you going to buy your chicken and eggs and then do clinical research? I don’t know. That seems a little.

Dezbee McDaniel:
Exactly. Yeah, it’s like a life experience thing. I don’t know if I should actually be buying my groceries and doing a clinical research study in the same place. I think that would be one of those hypotheses that the retail companies will have to understand more acutely before actually rolling it out.

Joseph Kim:
Yeah, to the extent that there is a pharmacy in a Kroger, and you can create a special place in there that seems more medical, I guess you could make that leap. Same with Walmart because it’s mostly retail and groceries, but there’s a pharmacy in a Walmart or a CVS, at least there’s always a pharmacist there, but they’re very different from doctors and nurses. We are, and then like we said in part one, it matters who’s on the other side of the glass or whatever, and it’s not going to be your people. It’s going to be some other kind of people. Maybe you’re not all that, in an advantage, advantageous position. I don’t know. What are your thoughts?

Dezbee McDaniel:
Yeah, so I think, on the ability to do it side, I think is very potentially doable. I think it would maybe take some restructuring, infrastructure in the pharmacy, maybe some additional space, maybe some additional, like you have to have someone, maybe they’re pharmacists, they’re, maybe being PIs before. So I think there’s a lot of nuances that you have to consider with changing the infrastructure for studies, but think it’s possible. And I say that because I’ve seen these mobile clinics and they’re so tight and small, but they can fit so many patients and so many studies. Like I’ve seen one that was relatively small in my mind that I think they can have six patients in there once and do three different study protocols at one time, and it was such a tight space, I would have never guessed that. And so I can imagine a similar type of structure in a Walmart, CVS, Walgreens, where they had this small area that can actually do a lot of research compared to what you really would think in the type of square footage and space that it would have. So that’s what makes me think that the space can be restructured for that. I think it’s a matter of probably economics and then also the kind of other structures as far as who is present in there, what is there maybe racial, ethnic background, what is their experience? Are they used to engaging with the demographic that they’re going to engage with in these retail pharmacy areas? So I think it comes down to a lot of the social science at the end of it, because I think that you could potentially see that as far as real estate, it’s potentially possible it might be some economic model that could work. But socially, will we actually be able to make people feel comfortable and feel like they’re being invited into something that they can be excited about and feel like improves their lives?

Joseph Kim:
Yeah, 100%. It always looks good on paper until you, like, walk into the room and that space just doesn’t. The energy is not the same.

Dezbee McDaniel:
Yeah, you’re like, Yeah, it. Just gives you a vibe, that’s all, I’m walking right back out.

Joseph Kim:
And the economics are important too, especially for companies like Walgreens and Walgreens, CVS, and Walmart because they think a lot about, they measure a lot of things on dollar-per-square-footage. So if you’re going to carve some space out, like you said, like that’s going to go into the average of square footage of retail space and it’s all going to go to that formula, and if it doesn’t, if it looks upside down, it may not last. But speaking about economics, let’s talk about payments. There’s a couple things I want to really understand better. One is, hey, how do people? Let’s talk about the unbanked people, right? These people who don’t have a bank account, let’s say, or they don’t have high limitations or limitations to their banks, or have, is it better to give them paper checks? Like, how do people process their own cash flow? And I know that’s a generalization, but one of the varieties of ways that people in underserved communities deal with their own cash flow.

Dezbee McDaniel:
Yes, so I would say that, I feel like, I don’t know the percentages, but a higher percentage of people I think have bank accounts just in general these days. So that’s one thing. Again, like earlier, right? Some people are like, oh, they don’t have, some people are like, oh yeah, they do. From my standpoint, I feel like there’s a higher percentage of people that have access to an account these days than not, and more than even a bank account, for example, Cash App, Venmo, those are platforms that are acting as banks. So I know a lot of people in communities like this, underserved communities that actually have a Cash App account, a Cash App card, and they use that as their way to manage cash flow. And so I think if clinical research companies can really integrate into, that would be hugely impactful. What I have seen that I think is a step in the right direction for sure with volunteers and studies is there’s, they receive cards just basically like debit cards that has cash uploaded that they can use in whatever way. I think that’s a huge step in the right direction because you don’t need a bank for that and you can just leverage that card and you might keep that card if you come back into multiple studies at this site or with this company. So I think that’s a huge step in the right direction again, for the former industry that works for people in underserved communities. But I think if the industry can integrate with Cash App, Venmo, and all of the kind of new platforms that are digital banking, like alternative digital banking solutions is how think of them.

Joseph Kim:
Yeah.

Dezbee McDaniel:
I think the more we can integrate with those, the more we can serve underserved people. Cash App I know is a huge tool for people in underserved communities. They are doing business with Cash App. I know a lot of, for example, even I think hairstylists in communities like that that are Cash App. They take all of their deposits via Cash App. They manage all of their cash flow via Cash App. So that’s a heavy tool I’ve seen that I think even if industry started there with just Cash App where, you could potentially Cash App volunteers for being involved in the study and they could have that extended to that Cash App card. That’s one area as far as payments and technology that I think would be a huge integration point for underserved communities.

Joseph Kim:
Yeah, this idea that a bank doesn’t have to be a building on the corner or like own a stadium and it can just be this virtual ecosystem of sending and receiving money like Cash App, with sometimes a physical manifestation like a card when you need it. Because you don’t, I guess, you don’t, you never really need to be holding the money physically, it just has to be accounted for somewhere. But yeah, mobile payments is certainly the future for all sorts of financial transactions no matter what, for sure. What about this idea of a paper check? Should that like just disappear, check cashing storefronts in certain neighborhoods? But so it still happens, but is that just because people won’t give it up or would a community be fine just to never see a paper check again?

Dezbee McDaniel:
I think so. I think so. I think that even in these underserved communities, I think that, again, the technology, the technological infrastructure has caught up to a point where paper checks, I think could be obsolete. I think that what I’ve noticed with paper checks, it seems like an infrastructure issue that even when companies are providing it, maybe that, it’s easier on their infrastructure to just write a paper check than to do something digital. So I’ve seen it on the business side and consumer side where it’s a difference, but more of the business side, more of the businesses, it’s easier for them to write these paper checks than it is for someone to actually conveniently go cash it. You have to go stand in line. You have to go to a physical bank and you have to go stand in line. So again, it goes back to if I don’t have a physical bank, what do I do? If I do have Cash App as a primary banking tool, to my knowledge, there’s no way to upload a paper check to that right now. And so with that said, I really think paper checks can go obsolete from today on in that I don’t think we really seeing an issue with people receiving their cash. I think it would be actually a lot easier for people across the board to be able to manage their funds that way and keep their time. It’ll be a much more convenient process as well.

Joseph Kim:
And paper checks don’t, because they’re so hard to actually dispense and like cash, it’s very hard to do like micropayments. Patients, if you’re going to ask them to do more, like on their own, you want to be able to compensate them too. And why make them wait till next month? You can get $5 a pop for doing X, Y, and Z, maybe that ends up being $120 for that month, but like you’ve given it to them all along the way versus issuing them a paper check each time. That’s crazy, right?

Dezbee McDaniel:
Yes, and to that point, what we’ve seen around payments, the speed and efficiency at which you pay incentivizes or does not, the continuous participation and retention of patients.

Joseph Kim:
Wow.

Dezbee McDaniel:
So if you’re able to do incremental payments where they are receiving that value and feeling good from that in a lesser time span, the excitement levels and participation levels are going to stay much higher throughout that time than, let’s say it’s a two-month span and they got paid twice with a paper check at the end of the month. I think throughout the month, their excitement levels and then wondering about participation is going to wane a lot more than if each week; you’re giving them some uploaded payment to their debit card that they can go use. We’ve found that actually doing that more frequent incremental payments will actually help with patient participation and retention.

Joseph Kim:
I love it. Yeah, it’s great that you’ve seen that in actuality because it seems right, but, and I’ve experienced it like once or twice, but it’s great to have it validated.

Dezbee McDaniel:
Yep, yeah, that’s something I think that we want to try to figure out, sharing that more the industry to think about as a infrastructure thing for your payments, think about more frequent incremental payments and really pay attention to how that leads to patient participation, and I would guess even lower attrition rates and all of that. So I think we want to start to try to formalize some of these data points that we have and really share them with the industry so that we can hopefully ideally make some change around payment structures that are more volunteer and patient-friendly.

Joseph Kim:
For sure. Yeah, maybe we can help you do it.

Dezbee McDaniel:
Yes.

Joseph Kim:
So with the last ten minutes, I really want to focus on this big topic now and I’ll tell you a story to help get the juices flowing. So I suspect that there are dynamics that cause health disparities in healthcare, and they’re almost the same that cause them in research. So this was years ago, but a company called Clarinex, you might know them, they’re like a patient recruitment firm, they brought in a panel of African-American folks in New Jersey. Just tell their story around, like, how do they find research? What was it like for them? Blah, blah, blah. So this one young woman, I believe she was from the Bronx, she told this story of how she was looking, she, all she was doing is looking for birth control. And so she would be going to her normal healthcare system and they would reject the need for her having it, which to me seemed really systemic racism at play, as well as personal racism at play. Oh, you don’t need birth control. And so she got kicked around the system and only happened upon this clinic who was doing some sort of trial with fertility health and then was offered the trial because, so I’m getting the story kind of wrong. But what troubled me was that why wasn’t this woman being treated as like a normal patient and why was she being kicked around anyway? So I offer that up. And if we’re going to try and fix the disparity in clinical research, don’t we also have to, or how related is that disparities in healthcare itself?

Dezbee McDaniel:
Yeah, very related. I think very related, can easily make a connection. When you told me that story, I’ll throw off 2 or 3 more stories in different areas when it comes to pregnancy. My sister recently had a, my nephew, and a big concern for us was how they would treat her as an African-American woman that is pregnant and dealing with all these issues. Because a lot of what I talk about with the African American women in my family is they feel not heard. They feel like they give insights to how they’re feeling, what’s happening with them, and doctors dismiss it or say that it isn’t as serious as they might think. So that’s an area of pregnancy. Cancer, my aunt, she had breast cancer. Thankfully, she beat it, but when she was going through her chemo and everything, she was applying for disability, and she got denied 2 or 3 times before they approved it because they said that she wasn’t basically struggling enough, she wasn’t having enough issues with her cancer experience for them to give her disability, but she literally couldn’t walk, couldn’t get up. So there was no way she could physically work, and you could see her, you could look at her for 20 minutes and see that she was struggling. She was having issues with the bottom of her feet, hurting legs, all of this, but they said that she wasn’t strong enough to be on disability. So that’s two stories of my own that you sparked just from telling me that, and those are different areas of healthcare. So I think you can look at any area of healthcare and see that for some reason certain groups, I think, are treated differently, looked at differently, and have different overall healthcare experiences. I think we could find that in any area of healthcare, whether it’s primary, secondary or, and so I think as far as solutions for that, one big solution that I think is maybe the, not difficult, but the most difficult to achieve is just having more people that that are of different communities that are in healthcare, that are present in healthcare. I think that’s a huge systemic approach, but I think as time goes on, ideally the system does have more African Americans, Asian, Native American, Hispanic, and just more equitable, I think physicians and people in healthcare in general. I think that’ll be a huge thing that helps just because I’ve also had the conversations with the black women in my family that when they’re working with a black woman doctor or a black doctor in general, that they have better experiences from their standpoint and that they feel more heard. I think it comes back to a cultural, maybe competence thing that because they are of the same racial background, they have similar cultural competencies in that the doctor can, I think, hear them differently, maybe, and arguably better because of that cultural competence piece. So I think that’s one huge thing that can be done. And then up until that point, I think that continuing to try to download the current healthcare system with more cultural competence and more understanding, right? So if there is a, let’s say you are going to a white physician, and I would say let’s try to figure out how to get a white physician to be more culturally competent to, for an African American or a Hispanic patient, where they can actually help them feel more comfortable even though they don’t look like him. So I think that’s something that you can try to do up until the point that there are more people that are of different communities. I think that you just continue to try to have the healthcare industry care and really put themselves into, I think, understanding cultural competence in diverse communities as best as they can. I really think that’s what right now what it’s about is, are you trying as best as you can to understand these communities? I really think what I see is that there isn’t even proper effort, that once we get proper effort, okay, we’re trying now, do the outcomes match our effort? So I think we have to focus on effort, and then once we see more effort across the industry, then we become more outcome-focused. And I think the FDA is looking at it in a kind of similar manner where they’ve done the diversity guidelines and they aren’t necessarily requirements for a certain community to be involved in your trial at a certain rate. And I think it’s because they recognize that if they enforce that, probably a very small percentage of the industry is going to meet that because we don’t have as many efforts that can lead to those type of outcomes. So they put out guidelines that I think you will see more efforts in the market, that then they’ll 5 to 10 years down the road, maybe 15, 20, they have requirements because they actually see industry-wide that the efforts have led to more mappable outcomes; that you can say, okay, we know most of the industry can meet 10% African American, 10% Hispanic, so let’s make that a requirement now. So that’s really how I see it, is we have to focus right now on efforts. And I think you and I both have probably seen more efforts over the past couple of years for sure with it being a hot topic. I think past those efforts, we need to make a 5, 10-year, 15, 20, time span, starting to actually see more outcomes. And as we are able to track and measure and share those outcomes that we can actually then start to see maybe requirements on that, and then companies really are again forced, I would say, to some degree to care about that.

Joseph Kim:
I love how you put this. This is what makes it so simple, like it’s effort first, look at the outcomes, and if those outcomes are good, then you make requirements, right? Because we always get overwhelmed by the hill, but you really just have to take the first step and that’s the effort. And if it seems like you’re moving in the right direction, then the requirement will be like take three steps an hour and you will get there. It’s been fantastic having you back on. I think we might have do it on number three, but.

Dezbee McDaniel:
I’m down. I enjoy this so much, Joe. So sign me up.

Joseph Kim:
Listen, this has been so great. Thank you for staying with us and coming back a second time. We look forward to seeing CliniSpan continue to grow. Love your efforts. And yeah, let’s stay in touch.

Dezbee McDaniel:
Let’s do it. Thank you so much, Joe.

Joseph Kim:
Thanks.

Joseph Kim:
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