>> next is the tv monthly end up broke ram best-selling author harriet washington. she is the author of "medical apartheid", "deadly monopolies" and "carte blanche" about nonconsensual medical testing. host: harriet washington, you write that at age 10 albert schweitzer out of your life, out of my life changed her life. headed that happen? guest: i discovered that particular book and quickly began reading others and i was struck by his spirit of how he melded his christian beliefs, philosophical beliefs and most of all a life devoted to service i just found that incredibly compelling and this sort of like that would be very meaningful and so he is just totally

enchanting person and what's interesting is when i got older, my admiration of him continued unabated, but i became a bit more nuanced and people begin to point out things to me about his behavior and character, which basically added up to the fact thatng he was not perfect anymoe than the rest of us are perfect, but coming to that realization was quite a journey for me because at first i had an intolerance of any evidence of being less than perfectly actuated by his spirit of service and then i began to realize he's a human being as we all are and it's really important to not expect perfection because one will be disappointed, but rather to appreciate people who not only achieve great things like albert schweitzer date, but inspire others to also pursue a selfless agenda for their life, so let

him, still love him and think he embodies the spirit of medical science perfectly. host: professionally, where did that book in your own persona lead you? guest: well, even before i found that book, i think that was probably inspired by the film starring audrey hepburn, but very different brother rules. she was actually a non- who is deeply conflicted by her political beliefs and passions and torn between being good, i.e. subservient quiet and being a healer. ...

>> and of course that was a lie but i believed it because i had never seen one. was an instant derailing. but is used to being encouraged in the academic environment. so i exceeded to what they told me even though that was not true. of course i would never do that today. it was painful for me even more so because i realized it wasn't only my story that happened to a lot of people. host: your career as a medical researchers somebody said "girl, black people don't get

oregon's they give oregon's. >> yes. inin large part she was right. host: what is the back story to that? >> in my case i was managing a poison control center in new york. i love the job. it was wonderful. we were given old file cabinets by radiology. i saw there were some old patient files that had been forgotten in the cabinet so i read everyone. i wouldn't say i was nosy. i was curious i read every single file but was appalled to discover the file of the african-americans who need a kidney transplants seem to be treated differently. the social profile of the black patients had the word

negro prominently written onf every page of the social profile to make no mistake you need your reading the file of a black person. they seemed center. two files are pretty identical. the men were the same age. elderly gentleman, kidney failure, bothrl employed, both insured, but had families come all the things people look for with social support with physical and financial ability. but yet the white patient was that with his determination to live and everything needed to buttress his claim to an oregon. the file of the black person was dinner with one single line. the treatment goal was too help him to prepare for his imminent demise and signed by

a physician that i knew the erudite man the first qualities i admired inrs albert schweitzer and i was crushed. i was so disappointed. that was not proof it was a systemic factor of allocation of organs but it was evidence. i talk to someone who worked on the unit as a ward clerk and she told me where have you been? of course black people are not getting these organs. they are goingpl to white people. this summer i reviewedre a book called the oregon thief which an author talked about one of the first organ transplants from a black man into a white man. he detailed some ofan the history. some accurately, some not. andor illustrated how this

person in particular and other black people their bodies were used to procure organs to go to whites. the same thing was happening in south africa. as a high school student hearing about christian bernard and heart transplants but nobody talked about the fact that these organs were going into white people from black people where apartheid was the law. there was that disparity and it still is. host:ll your 2000 book, medical apartheid, you quote martin lutherot king put mac in justice health is the most shocking and inhumane civil rights abuse. what was he referring to? >> exactly that. doctor king had many concerns. typically we understandably hear about his political concerns. he was equally concerned about

economic disparities and healthcare allocation he was prescient enough to recognize a systemic problemon longg befoe many other people b dead. if you go back to accounts during that time. northern papers are denouncing the practices in the south that were overtly racist but turning a blind eye to their own racial disparities. doctor king had if you that was much broader. he somewhat was happening. the political and economic and health struggles of people were bound together in a strictly linked. he saw how profoundly cool that wasn't how that would dictate a person's life to be determined by their race or that they were poor.

host: medical apartheid is still a bestseller. you open the book with the story of doctor james marion sims. who was he? >> i talk about him early in the introduction. he is important to me because he a pit of my stay classic figure in american medicine. we have decided we designate certain people as medical heroes. the people we say o have achieved great things. but when we use the term hero, we are not concerned how they achieved these things only we think they have achieved them. sometimes we are wrong or ascribe it to the wrong person

but one - - he was the one way by whites a a one-way by blacks people to him as the father of gynecology someone who treated the slaves and with the ama and for a lot of white women he was viewed for a long time as a savior. he could cured a devastating complication of childbirth called the vaginally fistula. it is a horrible compilation a woman is incontinent of urine and feces. living life in perpetual pain and infection. doctor sims could close the fistula a surgically that based on african-american women. he only took black women and experimented on them for years trying different ways to close the fistula he did surgeries on them. they were painful and

intimate. black women lived in thef victorian era just as white women did. operating on genitalia frequently and in front of witnesses because he would invite friends and other doctors to watch him work. he was abusing the black women. not white women by subjecting them. it is horrible what happened but it's also horrible the way the ama treated this behavior. even today you will find people defending doctor sims. he claimed one - - he is no anesthesia because there wasn't any. but there was. the practices were different. today you have to test and write up in medical journals. the 19th century the practice was often to experiment. try things out. ask the patient yes or no if

they were right, but not asking if they were black. procuring a person then buying or selling or renting and doing what you wanted to do to theirir bodies. there are two different views of doctor sims. those black women that were enslaved and forced into intimate surgeries. and white women who could rejoice in medicare for a horrible consequence of childbirth. it is something one finds repeatedly if you look at the four centuries of history. repeatedly in american medicine the bodies a blackck people appropriated and used in service of other people without having any opportunity

to say yes or no. host: you write and medical apartheid the deeply held precepts of racism sound racist or absurd or both but in the 18th and 19th centuries, scientific racism was simply science. it was promulgated by the best minds of the most prestigious institutions of thesc nation. what was the role of the prestigious institutions? >> these institutions and men, the rule was among other things, not only solve medical problems, but tell the world who african-americans were - - swiss nationalist and harvard one of the best-known scientist in the world. the american school of economics the scientist who examined african-americans to make certain proclamations about them.

they had profoundly different bodies than white americans. in fact black people belong to a different species. naturally homo sapiens. it was the missing link between animals and human beings. black people did not feel pain the way the white people did because the nervous system was primitive. simply unable to register pain or anxiety or develop heart disease which was described as anxiety. they were profoundlynx different beings. not just different texture but those were not human and had diseases that white people never had. a deficiency disease was held to be infectious black people had because they were dirty. even the vaginally fistula the complication that doctor sims experimented on was held to affect more slave women than

white women because slave women were sexually profligate and dirty. the reason given for ailments like malaria or yellow fever, they proclaim black people did not die from yellow fever the way white people dead and suffer less from malaria. the theories were profound the idea they did not suffer from heatstroke, kugler one - - can work long hours without becoming tired, take the these police together with that profound apology for slavery if you are planter confront with vast fields in a subtropical environment wildly on - - widely held to be malaria environment. were very hot environment most white people native americans suffer heatstroke than what aca better boon to be given a

creature who did not feel pain, no heatstroke, didn't die from yellow fever come you were assured did not feel pain or have certain illnesses? it was a boon. is a wonderful thing. what doctors were doing was supporting enslavement. they continue to support it as enslavement changed suddenly with a lot of pressure to end the practices fromit other countries and so the medical theories became more and more hostile towards african-americans. but the real purpose is to support enslavement to lend moral and medical support for the practice. a horrible situation. and you can see aspects of that today. host: have you found proof of that mindset having effects

today? >> others have found t proof. sometimes it is well-documented. pain. the belief black people did not feel pain was used to justify forcing themtualal into enslavement and harsh work andnd into medical research. it's okaynl to cut the genitalia of african-american women ofee vaginally fistula regularly because the like the white women they would not feel the pain. he would think that belief would be long gone but studies have shown consistently that we still believe that. medical practice still incorporates that belief. the most recent was 2016 university of virginia did a study. 60 percent of medical students surveyed believed african-americans did not feel pain the wayrv whites did. they believe they required more radiation for treatment than whites.

these beliefs are out of the 19h century and affect howt people practice a good proportion of practicing doctors believe this now doctors are practicing and students graduating thinking that african-americans don't feel pain. that's a dangerous belief. again, straight out of a few centuries ago. i worry about what we are not tracking are looking at. and with the racially disparate diseases it sounds laughable that we have them today back in the 19th century they believed by

people it's not die from yellow fever or malaria, today they thought black people can only get certain diseases that only affected and killed black people according to them. it is a common belief even today sickle cell disease is a disease of black people. it is not. the people who are risk for sickle-cell are whose ancestors who currently grow up in an area where the mosquito is common. it carries malaria. being a heterozygote too have the traits for sickle-cell not the disease but the tray is protective against malaria. if you live in the a area with a lot of malaria and one sickle-cell disease you are more likely to survive than those without or don't have it. or don't have you. it gives you a fitness advantage.

it's a matter for you have grown up not your skin color. but we treat in this country sickle-cell as a black disease. even when coronavirus 19, when research began in france , french doctors quite promptly published an article they proposed their belief that africans and people of african descent reacted to infections of all kinds very differently than black people it is driving medical thought even now there is no evidence at all for it is very weak or poorly understood as his malaria. we have not totally shaken this off four centuries later. host: harriet washington your book, "carte blanche" erosion of medical consent opening with a doctor robin armstrong. who is he?

>> a doctor practicing in texas treating nursing home patients and employees and this medication promulgated by donald trump hydroxyzine had a profound conflict of interest he owns stock in a consortium that includes t14 stock. political importers one - w - supporters embraced it. and doctor armstrong was the first that proposes nomination for president in texas so he began giving it to his nursing home patients and the employees but many patients were too infirm or old or cognitively

deteriorated to offer informed consent. you cannot give informed consent if you have cognition problems and not c thinking very well or very ill. so those cases, it is typical to go to next of kin. you talk to your children. a lawyer. he did notaw do that when asked by reporters he said i didn't do that because if i talked with families about every treatment i wanted to give i would spend all my time talking to families. he is totally unrepentant of the fact he was not getting informed consent he also claimed people have been through it but with local health officials examine the records they found something very different. there was not a good curate in a good number of people had gone on to become ill and died despite getting this

medication. the larger issue is this penchant for not obtaining consent in situations where consent has either been mandated by law and practice or in cases where doctors or institutions decide the expediency of the organization is more important than observing people's right to say yes or no. as i discussed in the book, the larger question 1996 people are not aware of lack of transparency. we had two large changespe in the law to take away people's right to consentnt to medical research. people simply don'tw know this. we see more and more experiments conducted on people who never had the chance to say yes or no if

they want to be involved in medical research. the fateful step. frankly i'm still puzzled by the fact that so few people , there has been so little information seven aided. people have to know this. i have ad right to know it's a pattern in this country. afraid it will continue and then they will wake up to find out we don't have the right to consent to many things we would expect. host: harriet washington what is the legal and medical definition of informed consent? >> actually they are nearly identical. informed consent is just more than asking someone to do a procedure or conduct an experiment and have them say yes or no. everything a person needs to know to make a reasonable

decision. what is it you propose to do, how you propose to do in detail. the known risks you cannot address those obviously but the risks you do know. the benefits you hope will accrue and in research you cannot only give benefits theye could just as easily be harmful that tell them what you think itmi why it might be beneficial also anything how it might affect them tired, hungry, and able to eat or drive? they all have to be revealed to the person lifestyle changes that might result or what is the purpose of the research. that's very important. that has been violated in the past it's hard to see until you see a violation of that. you tell them all that but then you're not finished wednesday are in the research

as things change new information emerges, tell them that also. if you find this particular drug causes the hair of redheads to turn brown, you have to tell everybody that as well. so they are always in a state of knowing everything a person would have to know. you must also tell people the matter what they find one - - signed or paid daily to have the right to leave the research study. is alsoai very important it all has to be conveyed is in the code ofit regulations spelled out very clearly but in 1996, two exceptions were passed and that is where the problems began because now in certain types of research no one has to tell you any of these things they don't even tell you that you are in a research study.

host: from "carte blanche", since 1996 being forced to participate in medical research has been permitted under the federal code of regulations provided certain conditions are met. what are those conditions? >> various. one says if you are testing a neww treatment, you have to make a case it is better than the existing treatment. the problem with that is the vague language. that permeates the law. what is better? in my opinion that results when you want to test something new there is a full on press to disparage the existing treatment. the treatment that nobody questions and now to say the problem with giving celine on

—-dash sanofi people who are losing blood. sometimes you have to give permission those who are doing the study that they are losing this on - - in the study so for example. if they are shot in the chest, they could end up in a situation they have artificial blood pumped into their body. you tell them that so they know. used to be called community consent. there is no consent involved. it's called community notification so in some areas like in north carolina in the area of duke university there

were 5 million people in the region who could be affected but when they did community consent the only reached a tiny percentage of these people. aod few hundred. typically that what happens. in seattle at one point they told people the same thing testing artificial blood. you are in an accident or, the victim we can but this artificial blood into you without asking they had a daily of request of exemptions you were given a bracelet you have to or 24 hours a day to say i declined the study i declined up all the team studies are basically they ran out of bracelets for one year. during that one year nobody to get exemption from the study. it really was not observed even though they claimed that

it was. those are essentially the important conditions. but the conditions rely on vague language. the other standard of care. it has to be flawed in some way. will be hard-pressed to find any treatment that doesn't have some flaws but that is exploited to denigrate and push for the experimental administration without getting nd permission. those conditions are imposed. host: we have barely scratched the surface. our guest this month is medical ethicist and scientist harriet washington. the author of several books beginning in 2000 when living healthy withat hepatitis c. medical apartheid experimentation a black americans from colonial times to the present came out in 2007.

"deadly monopolies" the shocking corporate takeover of life itself and the f consequences for your health and medical future, 2011. infectious madness, the surprising science of how we catch mental illness, 2015. a terrible thing to waste, environmental racism in the assault on the american mind, 2019. the most recente,me book "carte blanche" the erosion of medical consent. we will continue talking. we want to hear your voices. this is a participation program.

host:oo what we have been talking about so far is washington, it leads to think about the henrietta lacks. [silence] harriet washington? >> i cannot hear you for a moment. host: everything we talk about leads me to talk about the

henrietta lacks stories. >> yes. first of all i am so happy that henrietta lacks is now a household name. it's a very important story and i am glad now so many americans know what happened to her. in 1994 i spoke with her husband who is still alive and her family about her. i was deeply concerned this woman in 1951 had been suffering from ovarian cancer, had her cells removed and cultured, kept alive without her permission. her husband was vehement, he told me in no uncertain terms he refused permission for her cells to be taken. the hospital did it anyway so this bodyy appropriation is something that has the fallen

people of color since they came to these american shores. it happens all the time. in her case her cells are very unusual. they turned out to be biologically very valuable to provide a good medium for culturing disease, testing medications including the polio vaccine. yet her family was lied to. first of all her husband who had noo idea the cells were taken over the stringent objections. i spoke with her sonal david many times and at length and visited him in baltimore. he told me they found out by accident from a family member who worked at the hospital the cells were kept alive. one researcher at r johns hopkins had been frank with them and told them everything and even included their

mothers story in his textbook but all others denied it in a trick the family by telling them at one point we are concerned you have the same cancer your mother had so we need to get blood samples. that's not the reason for laboratory techniques was call it one - - causing the samples to be misidentified. they needed to identify which samples and which were not actually it was an international problem because the cells were distributed so widely and were so valuable they had samples and cultured that were misidentified they that they were looking at prostate cells but turns out they were the healer cells but what is interesting reading the original medical journals the way that her cells were

racialized.di most cell cultures came from white people because researchers would tend to take their own families bodies cells and use them. but in this case i can only describe it is poorer laboratory technique. contamination. instead of blaming researchers it went on to the cells. language of them being rapacious and aggressive and actively taking over other cultures as if they are jumping around the laboratory. is ridiculous it is how they were racialized the idea that they were aggressive and not respecting boundaries. so with the cells a horrible example of how the family was lied to, the cells were taken

without anyone's permission they were very lucrative a great deal of money was involved. but yet researchers consistently said there is no monetary value. that's not true at all nothing they wanted to admit because they didn't want to compensate the family. fast-forward the positive aspect is belatedly johns hopkins tookte responsibility and the nih actually worked with the family to moderate distribution of the cells and include the family in their own fiduciary rights to the cells. it's a good thing. only applies to her cells unfortunately i would like to see it applied more widely but the other aspect there was also a white man who cells were treated in a similar manner. his name is john moore. people have no way of understanding or knowing that even with that dramatic

example of appropriation and lying and withholding income among other things and credit from the family, today we face a different type of appropriation it's a little longer unusual cells like henrietta lacks no cells have been found to have the qualities hers have. but now companies find large amount of normal cells very valuable profit-making companies have contractsld with hospitalss to take the surgically excised cells from patients after surgery and acquire them from the hospital for money and t then use them for medically valuable procedures. that means all of us are henrietta lacks we all have cells vulnerable to having

taken even without her knowledge or without understanding what it meant when we signedeth the consent form and taking these cells. not only profit there's a lot of focused onn the monetary. which are significant. the monetary value was but that is not the family's prime consideration. they were more concerned with the fact their mother was a global benefactor. she'd given something very important to medicine yet it had not been acknowledged. that is what consumed them. that's a they asked me about they didid talk about the many involved. i think a lot of journalist well-meaning first think of the monetary value and focus on that that that was not the families concern. the families concern was come as the sun said i don't think they wanted anyone to know it

was a black lady hoping the world. those were the exact words also poignant story of when i told him some of the things that had transpired in 1984, he wanted to see for himself so he went to johns hopkins medical library they would not let him in. he cannot read information about his own mother. yes he is very significant but because of the patent system we are now henrietta lacks sometimes it is their own tissues that frankly on the auction block. that means more than a

financial value maybe more importantly the lack of control the way our tissues are used. the lack of agency. it is true there are consent forms sometimes but if you've been a patient hospital you know what it's like to be given those forms before surgery they will sign it because they need the surgery and they will not notice has to do with distribution of their tissues in fact the language on the forms tend to have things in it like we want to take your discarded worthless tissue. if they were worthless theydi would not want them. because it is discarded doesn't mean you lose all interest in what happens. you can choose to discard tissue but yet you may be invested in what is done with it. for one example if you have a therapeutic abortion something mandated by her health status, but if you're antiabortion and they take the abortus and they do something

with it that has to do with supporting abortion, then you might not want have wanted your tissues use that way you can have an interest in discarded tissues and i think researchers would do wellar to incorporate in their decisions how you would distribute these tissues. host: you mention you talk to the lacks family in 1984 but not until 2010 that henrietta lacks became a common name in the american culture because of rebecca's book. >> that's right. host: did you think about writing the story earlier? >> i st did want to. in fact i wanted to. i had an interesting exchange. i wrote a brief article about it for a now defunct

newsmagazine, emerge magazine. i wanted to write more about it i was approached by the baltimore sun asking me to do a sunday magazine peace. is focused on what was most important to me and readers. the ethics and appropriating the tissues. the failure to acknowledge the important role of this african-american woman in american medicine. the ethics of distribution, things like that. weighty issues and the response from the baltimore sun was this is too heavy. humanize her a bit more. what do you mean cracks it seems so sad. it is sad. >> can't you write about her dancing? or wearing makeup or something to humanize her?

i said i don't want to do that. this is an important ethical issue i don't want to dilute that. then they asked me some pointed questions that to me they were with the cultural divide for example there is a mall in baltimore that had gone to several name changes african-americans referred to it as monument mall i guess the official name was monda men so i referred to it by the african-american name they were adamant i should change it i said yes but i talked to the family they did not even know that was the official name of them all. most people knew d it as monument mall. so then i realize there was a cultural friction and disconnect it would not be bridged i would not write about her dancing and wearing

makeup because i thought that way dilute the import of what happened. i would not impose i would use both names but not the wrong name. it just seemed like there was a cultural problem i said forget it. don't run it i don't want you to run the piece. they ran a piece afterwards and in that piece began talking about henrietta lacks her nails were painted red and focused on her dancing. that was a piece they wanted to run i wanted to write the story the focus with the editors that i spoke with were looking for seem to me to be the wrong focus a focus that would undercut the severity of what had happened and it's import also seemed intent on

having family members saying certain things they were not saying that i realized it would not happen and not climate or with those editors. the interesting thing is that although the important thing about rebecca's book is now everybody knows who she is. that is wonderful. very grateful for that but i would ever in a very different book one of the things i know as a medical ethicist with my training with the lack of ethical regulations during this time with henrietta lacks

that there were no medical ethics back then i would we grieve of the oregon piece this summer that made the same error and a pointed out in detail there is a number of laws passed and established the right to informed consent that only in law the hospital practiced and then to acknowledge abuse of african-americans because the reality was sometimes observed when it came to whites but not black people such as they did not exist was to exonerate those who chose not to observe them when it comes to african-americans. i would ever in a very different book and i may yet. host: harriet washington a lecture in bioethics at columbia university. former page one editor "usa

today". research fellow medical ethics at harvard. first call from bayside new york. you are on with author. washington. >>caller. thank you i just got my c-span reinstated i didn't know a anything about your book i cannot wait to get my hands on it. because of my own experience and how elderly people are treated in the hospitals so does it contain advice not to go on and on but somebody who had recently come back to colorado talking about

advanced directives if you're not informed how bad the patient is an i was saying to her should i carry them with me? if you're in a car accident and you are unconscious and go to the hospital had you get that protection? she said people in colorado are getting tattoos with proof there is some type of protection. >> this is an excellent question. i talk about advanced directives and limitations and the elderly are particularly valuable but it is very hard

in my opinion, what can one person do? you are confronted not only with the laws during the high end of necessity and then to actually see the loved one in the hospital or talk face to face with doctors and caregivers it's even more difficult. this is a problem that needs to be solved in the law. you can't ask individuals to negotiate and navigate because they don't have the leverage or the information they need as they pointed out.

they need to change the laws to prohibit making draconian decisions and without the input of family members for the consent for those to give consent. it will affect even more now with the pandemic. host: the most recent book "carte blanche" the erosion of medical consent. next call from gary atlanta georgia. >>caller: how you doing miss washington. >> please call me harriet. >>caller: i knew ron. >> you did? that is my late husband. we must talk. >>caller: what a great guy. >> yes he was. >>caller: the reason i'm calling i am on prep as a black gay man. i don't see a lot of black gay men and trying to get the word

out so what is the medical opinion of that black gay man distrust the medical system cracks because being on prep, you don't have to deal with aids and hiv. and compared to the white counterparts they are 80 percent on prep it is a disparity and nobody can answer the question as a young black gay man living in atlanta and new york city there is a high prevalence of hiv why wouldn't you be on prep? host: have you got in the covid vaccine or are you planning? >> yes. i am vaccinated. thank you for asking. host: harriet washington you write in medical apartheid,

the fear of medicine with black people. >> yes. the fear is often justified. and so the fear of african-americans without also talking about the untrustworthiness of the us health care system. these go hand-in-hand. you cannot talk about african-american behavior about the healthcare system which is routinely abuse them. the african-american behavior is a problem so we have a system that creates disparities that abuses people

and in particular african-americans and punishes them for seeking medical care. i talked earlier about the belief african-americans don't feel pain the way whites do. and black people in pain come to hospitals in fact they are routinely turned away as drug-seeking. in that case is at a black person afraid of care or the healthcare system? having said all that, there is also the fact sometimes african-americans as gary points out do avoid healthcare and don't get healthcare often but again we don't know in cases like that i how often they are avoiding the care african-american gay men are they avoiding proper not trustingng it or is it less likely held out as an option? it's important to find out what is going on.

unless we do studies designed to find out, then we cannot know what is happening. i'm glad peterat you brought up thet vaccine because we had been reading all last summer and daily headlines to say african-americans didn't want to sign up for clinical trials with covid-19 they were afraid to sign up for clinical trials i got the original data from a researcher at johns hopkins. 10 percent of people in the modern a trial and in the pfizer trial were african-american they are 12.3 percent of the population. that means african-americans were signing up. there was no full-scale abandonment or refusal. we were right there. my question is who is tracking

white americans? where they signing up at the same rate as the population with only 50 percent? the question is why are we scrutinizing african-american behavior in so often calling it avoidant or aversive behavior when in reality it could just as easily be lack of access or the vaccine trials are right there are not acknowledged? that gary you seem to be following this well let's assume it is exactly as you feared in african-americans are avoiding it. the question becomes after you without access problems are they offered athe the same rate of whites and to make sure african-americans understand the advantage and find out if

there are any fears, find out what they are, you cannot ally without knowing the fears and then addressing them. it's a matter of doing a little research to find out what's going on maybe that's not offered as a often and if they are avoiding it, why. then weekendsnd e-mail in. that's an excellent question. thank you for asking. host: if you are intrigued with our conversation today go to the c-span shop.org you can purchase one of her books part of thatt purchase price supports the c-span mission. ron from san diego go ahead with your question or comment. >>caller. >> my name is ron brown.

i was calling about the racial bias. i recently found out that when i had a blood test they had a blood test for blacks and others. why is that? and also with harriet a lax - - harriet the lax, why don't they had any how many diseases has this lady cured? she gave more to medicine than anybody that ever lived qassem soleimani - . >> you might be right about the latter point. that is what her family was concerned about as i talk to them in 1994. talking about what i knew about, that's what they

said. she was a benefactor to the entire a world. why don't they admit this or talk about this? is a very good question. i have been asking repeatedly about many people including medical researchers who tend not to get their do if they are african-americans. they, are ignored. excellent question. but with the blood test what exist? this is news to me. i had no idea there were tests that were administered on a racial basis. can you tell mee more about that? host: i apologize. he is gone. >> i wish i knew what test. text us and let us know i don't know anything aboutut it. as a lot of people know, early in the design of blood storage, blood in this country

was categorized by race with blood from african-americans being cap separate from white americans. and charles was working on blood storage in the uk but initially did not want to work in the us for that reason. based only on racial superstition absolutely no medical basis at all. it is shocking to think back is still be happening today. host: ron if you want to text and include your name and your city.

barbara from new york city, good afternoon. >>caller: good afternoon. to questions. regarding "carte blanche". a local newspaper hear a woman wrote an article about vacillating vaccine she's refusing to get the vaccine shot and at the end of her article she made a statement implyingng it is the duty of people to get the shot you talk about how individuals are told it is a moral responsibility to participate in research. can yououu speak about if we hae a duty or a moral responsibility to take the covid vaccine?

you also talk about murder to sell theer body to the anatomist. one documented incidents ofha that.wh can you explain when and where that happens? host: why did you pick up "carte blanche"? >> i saw she was going to be on your show i rushed out to get it. i have her other book medical apartheid. i think she is wonderful. . . . .

by accepting the vaccination against the coronavirus you are protecting other people whether that means the person is and i see that even though they are well-designed and they may not work for certain c people.

and so the more people who are vaccinated, the better the chance we have at the community and as a country and the argumentnt issues should be vaccinated to help's other peop. and it's hard to argue with that because that argument has moral authority. but going from that, saying that it is imperative, that we should force people to get the vaccine, that is quite a step. it sometimes they should be saying hey, i am not equipped to say whether it's something we should mandate by lawul or not. i think that mandating a by lars thing that weby should better. so i am not sure that we should do it. so it is kind of a tricky thing. the problem is that, americans, we love ourdo freedom.

so how many things that we invoked in the name of freedom of speech? that people in other countries would not necessarily see us freedom of speech? so we love our freedom. and we do note take kindly to being told that we have to do something. yet at schools and in public health -- i sometimes think that we don't use it often enough. so i am not prepared to say that vaccines should be mandated by law but i am prepared to sayti that it is protective, we know it can be protective and right now at this time we so often rely upon authorizations or institutions to enforce it that we are unable to. how many videos can you see offo people in whole foods refusing to wear a mask and exposing leother people? before you realized finally that those people are not necessarily

equipped to enforce this., if it has to be enforced, it should be enforced by the government. this is something that is sha al even more often in the case of vaccinations, i am not quite sure. a lot of claims about people on refusing vaccines, i find to be very serious. african-americans in particular, being accused of refusing vaccines, just like those that are accused of not trying to be in clinical trials but they did, the african-americans not getting vaccines come a lot of it is due to a lack of access. we actually have had policies that separate african-americans from vaccines and separate them from the vaccinations. so mandating it by law would be problematic, as in punishing people for things that are not at all their fault. we have a policy that dictates that people who are 85 years old and older get priority and then

we have to faceac the fact thatn this country african-americans, hispanic americans, native americans, the young population, they are much less likely to reachh that age of 85 years old. those that are 90-year-olds that sare white are twice the rate as those that are black in this country. so when you have a policy that criticizes those 85 and older you're actually acting against people of color. we should certainly be prioritizing people. older people. but we often prioritize people of color that are also at a higher risk of infection. so we need better policies of not punishing people for things that are not their doing. >> host: have you gotten your vaccine, and what kind of research did you do? >> guest: i am the first one to

admit that i got the vaccine and i was very happy, but it worked out well it's very quick and effective and seemed to be very safe, but how much research can one really do. of necessity they had the vaccines that were indeed generated more quickly and without the same meticulous data that we require for other vaccines and we didn't have the luxury to dot the i's and cross the t's. but we also relied upon the vaccination rate, not quite the same thing, but the thing was that in my opinion it was the only logical step.

i was very happy that we vaccine and i embrace the vaccine because look at the alternative. the longer people take to embrace the vaccine -- i tried to make it very clear that it's not 100% guaranteed that there would be no problems that could help us reach that goal and you have a much higher rate of infecting someone else and falling victim to a variant that could be much worse than what we are seeing right now this current time. i worry about the peoplee who sy that they are going to wait and see. i spoke to a doctor who has written about this and one of the things of saying i'm going to waitt and see if the longer you wait the more chance that you're going to be exposed to a variant that will be worse than what experiences are now.

and then spread that variant. so it is a dangerous thing to waitit and see and it's very clr that the best possible course of action is to take the vaccine. >> and the massachusetts general? >> guest: yes, the massachusetts general hospital in boston. correct. so taking the vaccine, in my opinion, is the only logical route, the thing to do, i'm grateful that we have and i'm glad we have that g option and making it abundantly clear by now it is important too realize that african-americans like other americans understand that and that is why we were in thehe clinical trials despite the headlines to the contrary and that is why i'm convinced that it is a lack of access, and tempering them from getting them in greater numbers. there's a lot of headlines and

anecdotal focus on those that don't want to take the vaccine, but i am convinced that those numbers are dwarfed by the many people who are having a hard time getting the vaccine. >> from portland, messaging you from washington, i had heard that there are different test standards for things like diabetes for black people than there are like others in determining whether someone has diabetes orr not. >> guest: i do not know about diabetes. iab do know that there are algorithms that are basically formalized, used to determine whether or not someone is in a diseased state or not. also what treatment should be given to people and unfortunately you are right that race is factored in and it should not be factored in and i think that that is changing slowly but we are beginning to

see changes -- excuse me. if you read the medical journals you'll see that racism is immediately won the first things that are said and my question is why. shouldn't you be describing the patient, what they are experiencing, their own history, why do we need to know this, this is a deep flaw in a logical flaw in these algorithms contained a slot, deciding that a diagnosis would be different for black or white, i spoke with patricia williams and i was on a panel with her and she described eloquently exactly what you are paying. she had a osteoporosis tests test and the doctor was trying to run t the results and it was not working. they could not get any response from the testing mechanism and kept saying hey, no response

possible until her doctor decided that he was going to take the fact he was african-american out of the equation andon immediately had a valuation for her. yes, something is being done in american medicine, it incorporatesat that that persons african-americans from the beginning and the assessment and that is wrong. it should not be there. all that does is skew the results and that is veryer problematic. so i wish that i could say that i see evidence this is changing quickly, i see evidence that it's changing glacially slowly. >> host: this individual says i am a dmt behavioral psychiatric nurse. one of the things i've noticed and in working in units of the patients of color, especially black patients, are given higher doses of psychoactive medication compared to the white patients

who exhibited similar symptoms from the same diagnosis. >> guest: yes, you are absolutely right. for a long time i worked in a psychiatric unit in the emergency department and i saw the same thing. african american patients are more than likely to be diagnosed with psychosis or a serious mental illness, the same symptoms would give a white person in a process dullness. so the symptoms tend to be interpreted much more dramatically, with much more severere illness and they tend o bebe given more higher doses of medication than white people. when i asked a nurse why it was that black people were receiving higher doses, she looked at me

and she was perfectly serious and said you have to understand that african-americans have more muscle mass and it's harder for them too metabolize it. i knew that that was sheer bs, but that the same kind of thinking that i talked about and we saw in the 19th century with the doctors deciding that african-americans had different diseases, that they had these as they were immune to and also they believe that the medicationsd given to white people and black people should differ, that some of them work on black people at all and others needed a higher dose and more radiation for cancers. it is complete fiction and it has no basis in fact and yet it's being done and it is something that needs to be

challenged. maybe it's someone working within the profession that can get some kindred spirits to interrogate their own institution on why they want to continue doing this. >> have you considered going back to medical school or going to start back in medical school when i. >> guest: i am a bit old now, i probably would if i were younger >> host: mama is in eugene oregon. her name is. >> guest: i was diagnosed with polio at the age of 22 months old. it does not affect the phase, but that was most of my body that b was paralyzed, and i feel like i was experimental and experimented on quite a bit when

i had polio. >> host: why do you say that, norma? >> i've had seven of these procedures, prior to that when i was younger, i went to y the hospital from 22 months of age pretty much continuously to nine years old. >> guest: oh, my goodness. >> caller: most of his care was paid for by the march of dimes. there was whatever they wanted to do with me and i was in isolation. >> host: norma, do you think that maybe experiments were done on you, or is this something that you have proof of? >> no, that is most of my question, because i was in

isolation. >> host: thank you, man. that's a good question and. >> host: it's difficult to prove that it has been used in research, it's very difficult to prove. but you can, as you look at the old record, it is a problem that old records may not be available and all too often what i found this over and over again in researching events is that recordsos are lost and when i hr that the records are lost i almost always have a negative reaction thinking okay, maybe they were lost, that maybe they were lost on purpose. the reality is you have to go into it with your eyes open and realized they may not have access to these things but one

that approach might be finding a sympathetic ear and a journalist, perhaps someone in a local publication because they are very practiced and very skilled at getting information. it's something that anybody can file in the freedom of information act, but as many know there can be small changes in the way that youou file it ad it increases chances for success. so whether than going into this on your own, you may want to try to find a journalist that is interested in this. and if you can't, it's a matter ofof educating yourself, you knw thee institution where you were treated and where surgeryas was done, the freedom of information about your own case and so some regulations might prevent but

they should be able to find out about their own. and also it's a matter of dining out when you can what kind of procedures were done, and that can also be very difficult. if you live in l california it s a bit easier because california has the sunshine laws that make it easier to find out about government activities and what other states it is a fishing expedition that can take a long time. you mention mentioned the procedures i think in 2019, with those i think the chances could be a bit better to find out what is happening. and again, it might start with contacting the institution and ask them, some people find it easier to try to get information in a nonconfrontational way and say that i'm interested in knowing this and if that gets me

nowhere, filing be freedom of information act and i wish you all the luck in the world, and it can be done. but again, i would urge you to try to get somebody who could maybe doo these things a little bit more skilled in a manner than the rest of us can. >> host: it looks like we have ron from san diego. let's chatbl with him. >> i was talking about blood test. they have an algorithm where when you takeen the test to use the algorithm to determine -- if you're black they have an algorithm of it. and for me that is racial bias. and so the way that i also look

at those internal medicine and also the va is part of that and i guess others as well about this situation, investigating it, the racial bias of medicine, the new england journal of medicine, and there's a lot of those you can go and t see. >> host: okay, ron, we are going to leave it there. >> guest: yes, the algorithms are in play. there are many types of test. this is one that is in particular part of it. >> i apologize, i let him go and i wanted to give him more time, so i apologize to both of you for that. susan is in massachusetts. hello, susan. >> thank you for taking myy cal.

at the beginning we mentioned doctors and one that i would really hope that you would look into is harold, who is listed as a father and a pioneer of psychosomatic illness. well, he worked through the cia, there are a number of books that i know of that explain his involvement in developing techniques, which he then used on his patients and my brother was a patient of his and he was told he had a psychosomatic illness that had ath brain tumo. so his research on psychosomatic illness, what he did was he took

the techniques through deprivation and etc., and he useded them on migraine patients through the records said came out terrified and said that they had headaches that were gone but they did not know if that was because -- >> host: canan you put a periodn this? >> caller: they put a profile of him in 2016. >> host: there's a lot of information there, is there anything you would like to respond to susan about the mac's. >> i am very sorry. >> guest: i'm very sorry about your brother, susan. it sounds terrific. party sounds like this has been the subject of three books and publications and i'm glad that this has been exposed and i'm

very sorry about what happened with your brother. >> host: gladys from baltimore, thank you for joining us, you: are on t booktv on c-span2 with author harriet washington. >> caller: good afternoon. this is my first time to ever call and i am curious about the president of nigeria. i do not know him. but i am curious about the doctors in england that they have been a part of a couple of times and i'm wondering why for his medical problems -- i don't want to know what his problems are as well. so could you tell me why he is going over to england all the time? >> host: what is the crux of your question? a distrust of u.s. medicine?

>> caller: yes, i would say that. that would be an answer, yes. >> i have no idea what he suffering from or why he is preferring doctors in the uk to the u.s. >> we have not talked yet about a terrible thing, environmental racism and the assault on the american mind. what is the definition of environmental racism? >> guest: well, if you ask 10 people you get different definitions, but essentially the exposure to toxic substances, whether they're industrial chemicals or packaging, this exposure is racially mediated in this country, people are -- people of color are exposed to it at much m higher rates than people who are white. even profoundly poor white

people are less exposed to hazards than middle-class black people. it is racially mediated although it's not recognized ass such. so a lot of arms are also racially mediated and so we find that lead poisoning is a success story among white children in this country, but among black children it is a scourge not only of their healthh but also f their cognition over time. so we have these sources of profoundob illness and cognitive brain problems and brain damage inam this country due to the failurelu to regulate hazardous materials effectively. >> would lead paint be part of this problem? >> lead is a heavy metal that we

know causes a variety of physical ailments and hard to locate anything that is not harmed, but also the brain and so lead in terms of paint, lead and gas, even lead lined water that causes all the destruction in places like, you know, flint, michigan, pittsburgh, the u.s., most major american cities probably be iconic environmental toxicity. washington, your book came out in 2011, we referenced it a little bit, but in this book is he writes that in 1980 the university secured 260 patents per year and in 2000, that

number was 3000 per year and hundreds of millionsed of dollas on colleges and universities. so what happened? >> guest: well, some make $6 billion per year and basically what happened in 1980 was that this was a convinced group of people and embraced that they needed to be able to exploit the patent development and universities and the federal government was supporting theal university research and coming up with patents and molecules and discoveries that were potentially important but universities are not in the business of producing products. so they said let us rent these

patterns and it will create more medicines that are needed and we will generate a lot of industry and we will make m them into medications. the government said goodd idea, and as a result of that law there are some similar laws and by the 1980s we now have corporations who are basically controlling medical research based upon what drugs are developed and how much they are going to cost and they have determined will be scourged and ignored in the things that they once did, corporations are focused on the bottom line. they are not going to garner it necessarily is the best drugs. and so that's why we have 20 drugs for this particular function in almost no new drugs

for malaria. the latter is a killer, but erectile dysfunction is something that people are willing to pay a lot of money forot, it. so basically in 1980 we turn this from universities over to corporations and it was not a good deal. >> why do they seem to cost more in the u.s. than and other countries? is it because they are not subsidized? >> guest: they cost more than many other countries because they will charge what people are willing and able to pay to stay alive and it's no accident the most expensive drugs are for the most dangerous diseases and so if you have a drug that might save you from dying of cancer, the companies know that you are willing to pay almost a million a year and that is what they charge. however, you don't have people that can necessarily pay that kind of money or the people

developing can't afford it and so in this case people go bankrupt paying for medication and in the developing world just died. >> what about generic? >> well, what are generics are made by the same companies that make the patented for profit brand, it was approximately 20% lower -- and the problem is they are not the answer because what will happen is that -- they are not that much cheaper, the companies will come through and same thing asthe better than the old drugs that might work perfectly well or

even better for some people, but the new ones are being pushed, the ones that doctors are under pressure to promulgate and describe. so thinking about g generic drus is that in some countries for a very long time you had drugs that had, for example and this country what is patented and is the actual combination of the drug. and it might be the manufacturing process. and that includes much more cheaply in places like nigeria, thailand, other places where they could notca afford the dru. unfortunately they forced poor

countries to respect pat western patents. so then they had to buy the really expensive drugs. and basically an escape clause.r perfectly legal for the u.s. or any other country to say we are going to take the patent away from the company that is selling the drugs for a lot of money for something less than peopleor can actually talk about. but the u.s. is quick to castigate them of doingng something criminal and it is really frowned upon. our government and our companies don't want to do this. and they won't do this and they do castigate people that do this. so it's basically an escape clause not been made available tova us. so the drug prices have been

maintained and the prices, let's be really clear, have nothing to do with the cost of the drug. they claim that the rationales are very expensive to produce and market when it comes to thee drugs, but they are not nearlye as expensive enough to merit the prices that are being asked for them. so the reality is that the cost is one thing, but the price is based on what people are willing to pay and able to pay to stay alive. >> host: herriot washington is a lecturer at columbia university. she is the daughter of two soldiers and she is the author of six books, one of the things we like to do with our author is ask him or her what they are reading and if this is something that interests you, we are going to show you the book that herriot washington, some of her favorite books and some of the

books that she is reading -- here are some of her favorite, rudolf fischer, "up above the world" and the beggar's opera and the word for world by ursula mcguinn and other stories by samuel delany. she is currently reading books by thomas mann as well. there's a lot of books there, but then you added this note to the producer and said that i just finished reading 30 books in my role as a national book critics circle board member, so i am taking a break. >> that is a logbook. but i am lucky enough to be in this group and we reinforce each

other in every way. there you haved it. >> host: when wee were reading the list of books and when you heard about this, what is one that struck you that you would like to talk about. >> guest: arrowsmith. i cannot completely explain the fascination for me, but it's a fascinating book that i read at least once a year. and i find it's weird because the book was published in the 1920s. sinclair lewis was given a nobel prize based upon it. but it's embraced more by scientists than literature and on the face of it it is kind of straightforward in talks about a man who becomes a medicaldi researcher and before he engages rin pure research he has a lotf

space towards public health and private practice and a lotot of assets of medicine was kind of reveals something about his personality and also described by sinclair lewis in this lovely but deep perception of them that seems to be a little bit mocking but also very true that it's hard to describe except that sinclair lewis invented part of theid american continent and it did not exactly exist, but when you read it in this recognizable , he did that for american medicine in the 1920s in a way that resonates today. they talk about things like one of the signall events is when there is a epidemic breakout in

a tropical island and they have to decide whether or not he is going to give half the people on the island what he hopes is the cure, a vaccine, and the other half goes unvaccinated, and he does this and he justifies it. but the limit that we face today, today we are faced with the dilemma of a reborn to view some is basically test subjects to improve the health of other people, this perennial dilemma. and he captured it perfectly and it's a wonderful book and i can't recommend it more, you'll recognize a lot of things and it is probably one of the best

books i've met on the american medical landscapes ever. >> george bernard shaw seems to make an appearance every now and then. >> jessica my doctor friend said that he was a great doctor haider, but i don't think h he s and he had a sardonic sense of humor and one of the things he talked about that i applied to african-americans is that the year he talkedta about that, medicines of tragedy -- you have to trust medical people and doctors and research and yet you don't trust them, yet it was a horrible dilemma. it's anmm american dilemma witha lot of people facing it every day.e so i think they were right on the money there.

and i think he had a clear idea that doctors were highly skilled and idealistic and again human beings. a flawed like the rest of us. >> host: we have herriot washington, about 15 minutes left. steve, you are on booktv. >> caller: thank you for letting me speak. and congratulations to you for a fabulous book, it is amazing. harold freeman was a cancer surgeon and came up with a procedure called navigation where he helped people get to and from cancer care and get turned upside down the whole issue of mortality. he became the first

african-american president of the americann cancer society, also a member of the columbia medical university faculty as well, but it never really spread across the country and sometimes we have to figure out thei procedures to know they are effective. and also reluctant to use the navigation approach. >> i just camell across it, incredibly impressed with his research showing that in five years he had transformed a 70% mortality rate to the success rate. >> host: are you in the medicall field? >> caller: yes, trying to help people get other health treatments and also help others well.ximized as >> guest: thank you for bringing up doctor friedman.

i'm aware of his works, extremely important, groundbreaking work. and he saw things during the 80s and 90s that a lot of people only realize just now. he's also the one that famously said, it is you cannot compare the health of black people in new york is it's all are being treated well because reality is different. and navigating rty the system is something he saw as very important. what was interesting about that is a reversal is that he was taking the point of view of the patient and up until that time the focus had always been system

centered and are they doing this or that, he took the point of view of the patients. how can the patient get their medications. and once he gets there, how did the patients find out or navigate, how did they find out how to get to the right clinic for the right caregiver. he recognized the hospitals werl largely opaque and that a lot of the focus on patients not following through or those not doing what they are expected to have more to do with system failures than patient failures and that is a very hard thing to take historically when there are certain perspectives from the point of view of the doctor of

high social status and what was being done from their point of view. was the patient doing xyz. whether or not they needed to be navigated or improved. it is a huge change and it's it. hard for people to make i have noticed anecdotally that it seems to be more the norm in parts of the uk in a place like london, and you know, just like his success in getting people into the system successfully in getting them seen and treated appropriately has been mirrored

by other people as well, i'm thinking of one everyone was wringing his hands and saying that african americans won't sign up or follow through or they can be complicit with it. but they got many people in this areaar and beyond, they were vey invested inin it. signing up to be donors, giving their friends to sign up and even otis, another american cancer society president who also has that same inverted perspective from the point of view of the patient on the subject, how can we better serve them. that seems to be the big change on taking that approach rather than how do we get through the health care system and so that

is anv hard thing for people who make culturally and also just so you know the habit of practice. i'm not through the convenience of theon researcher, the high status practitioner in getting people to invert that is a big thing to ask. but it can be done, it's very successful and i hope that success that these people have had is going to facilitate for others paying attention and doing things differently. we can c only hope that was a great thing to bring up,p, he. >> are we looking at your office at home and that is this where you do your writing 2. >> this is what passes for it in office. the huge bookcase to the left

and the smaller one over here and all of my equipment and stuff it is my little space capsule here. >> host: all right, "carte blanche" came out this year, how muchch was research and writing? >> guest: i don't know about the research and writing. it's a hard thing to tease out for me because thech research is continual and so i really don't know when i worked on it for about two years, but the pandemic intervened and made a lot of changes in publishing and so the book ended up being published about a year later, which is fine, really happy with it, i'm happy with the columbia global reports and it was actually a bit of a relief to write a smaller book and this

one was more focused on smaller and i really enjoyed that. >> are you ever surprised at where your research takeses you? 2 yes, constantly, i would worry if that was not the case, one of the larger and more broad things that i had to say is that 2002 or so, i used to look on conspiracy theories very differently and i would sometimes hear from people who would tell me something and they sounded utterly fantastic and although i've prided myself on keeping an open mind i sometimes had to say okay, this can't possibly be right. but the more i have learned, the more i revise my thinking and now when i hear the more fantastic thing, my reaction is

not this tends not to be so there are things that i honestly didn't believe that could have happened and that they had happened in so i really expanded my idea of what people are capable of and my appreciation of how often when we hear stories we hear claims of how often we and i include myself in that -- the tendency is to judge the likely veracity and i think to myselff okay, i'm hearing frm a person and they may not have that much education, they may not be that sophisticated, more likely to think conspiracy theory or something that maybe isn't veryt' true. but then you also hear from

people who are vastly credentialed as well and so the bottom line is that i have a better appreciation for how often been dismissed as a conspiracy theorist is a factor of a person's income, social status, you know, rather than how true what they are w sayings that i guess the important thing to understand is we would know more about history and events if we judge them based upon the history based upon who they are. >> host: let's talk to michael from florida before we end the conversation . >> caller: hello, thank you for having me. what you are really talking about is a blindness to a huge

moral inconsistency. another question for you and hopefully aefo discussion that follows to compose, wider than just textbook dictionarye definition. just pure meaning of words and that includes trump covid genocide. specifically eugenic. >> host: okay, herd immunity, genocide, president trump. >> guest: one of the problems about theories that are illogical and nonsensical is they sometimes talk about something that is actually real and then infuse so much fiction intomu them and so much illogicl

assumption and it has a lingering amount of credibility. that's what happened with herd immunity. it does exist and more to the point. and yet it is suicidal. and when you allow it to be unchecked for example that disease, we have hardly lost so

how many more will die and it remains more variant for example if we have variants are even more dangerous than you could tescalate. and it is suicidal as supposition and especially when it comes to a person that finds this kind of completely illogical situation, yet it's something that is being proposed.

and we have to understand the things that can occur. so when we asked someone like doctor anthony fauci, or any other doctor, they will explain why it is a concept. and i'm glad that you brought it up. we have to be careful not to ignore the experts. >> host: she is the author of its books, the most recent being "carte blanche", harriet washington, thank you so much for the time today. >> guest: oh, thank you so much. i'm very grateful to be here. >> be sure to visit c-span.org

to get your copy of. washington's new book, "carte blanche." >> supporting c-span2 is a public service provided by public funding. >> on our author interview program "afterwords", the deputy chief of staff talked about modernizing the u.s. senate that would include changes to the filibuster. >> i think that you have to make it equate for bills that are urgently needed to pass again. there are many different ways to do this, but you have to get to a place where it only takes the

majority to pass the bill. and providing use of talking filibusters. and that includes having senators go to the floor and explain their filibuster bill, that is the other thing about the filibuster is that whether or not it meets the phone call, they never have to explain themselves if they don't want to, so i think that the fundamental thing is that we must focus in what is the purpose of the senate. the rules exist to serve some purpose and it is a chamber that is supposed to be the place that generates thoughtful policy solutions to the challenges that we face as a country and it is not designed as a filibuster, it

is designed to produce thoughtful policy outcomes. and one of the dynamics that is underappreciated is once they demonstrate, a lot of people come off the sidelines and start negotiating. and what happened was that in oregon and that includes the democrats that filibuster this and so once it was clear that they had the majority, a bunch of them spoke about it. you have the potential by bipartisan action and you have

to take that option off the table for them to sit on their hands to make them look bad. getting back to the framers, they would explain in explicit terms the this is why they wanted the senate to be the majority rule body. they feared a minority and that includes that includes how we live in a polarized environment and how it is dominated by negative partisanship. and they drive senators to want to oppose anything the majority does and we have to remove that

blockage. and i don't think we should do this to empower leadership and that includes rank-and-file senators to the floor and there is an open free-flowing debate and we don't know who is going to get a vote on what, but that is a good thing, so let's restore debate and let's also make it a place that is capable of passing bills in responding to the policy challenges that we face today that are so substantial. >> to watch the rest of this program, visit our website and click on the "afterwords" tab and click on all the past episodes. tonight on booktv in prime time, john archibald is looking at the role of those in the

south and also reflecting upon the 36 year career, and discussing her career and life lessons is dana perino. and also harriet washington talking about the history and the misuse of medicine in the united states. visit booktv.org for more work and saw your program guide. semantic you for joining us for this event. i amft the director for american studies at the heritage foundation and it is my pleasure to be here for conservatism and america's future and i am also delighted to welcome everybody here as part of this lecture series. including what they call the permanent things, the mal