>> thank you for coming out to

this panel about a very important subject health inequality and health justice. we have here two fantastic authors with books i think every american needs to read. we have beth macy virginia based ournalist he's here with

his book raising lazarus hope justice and the future of american adults practice. next to her we have stephen w thrasher he holds the inaugural annual rent berkshire at northwestern middle school the first general is him pressures ship in the world the book is on dq arresearch. he's here with his book the barrel of the class the human toll when inequality and disease nkcollide.

i want to start this off by framing i think that's so important to keep in mind as we continue with his discussion. i can only imagine it was very difficult to report on i love you to share the story of the title. thanks everybody for coming.

why write a second book about the opioid crisis. i was sober harassed by the time i finished dope sick young woman who struggled with addiction for 5+ years, murdered after being abandoned by every system that was meant to help her mother saying goodbye to her battered body funeral home and rest because loss of also the rest because of the poor response of our nation to to the opioid crisis. i really wasn't ever going to write about it again. my husband said you should write a cookbook. [laughter] then i started going out and talking to people and learning

about really innovative things that surprised me particularly when you have people doing cutting edge harm reduction and low barrier care and rural states and communities that haven't even passed medicare expansion. why are they the model for our nation going forward. we still have an 87% treatment gap in america for ou d opioid use disorder that means only 13% of folks were able to access treatment. that's largely because of stigma and an action and so i thought, with the opioid money about to be coming down litigation settlement money why don't i write this book which is more helpful certainly the bits of hope aren't to the scale we wish it were but this will help teach communities how

to best spend the money.which is in the ways that the evidence supports and also just in the ways that humanity supports which leads to the title a lot of people think the title raising calazarus as a reference to mark yan an overdose of dorsal drug and that's part of it but i started reporting on these two women who were married they started whatever time they called the nation's only clear biracial faith-based harm reduction through they started passing out needles on the slide before it was legal in north carolina under the truck. then there were poised when neither exchange was legalized in north carolina to become full-fledged organization. people call upon michelle the

minister what she's trying to get christian groups to check the blind spots about harm reduction which is this idea of going to people where they are even in chaotic use treating them with nonjudgmental care and being okay if they are still using you are still a person if you're still using. we know people who go to needle exchanges are five times more likely to go hato treatment. i'm about to land this plan this is a long answer. the first time i meet michelle she's in this community meeting that gets hijacked by somebody who says, i think when they overdose we should let them die and take their organs. really? so she tells the story of lazarus. jesus was four days late getting to lazarus he was dead when he got there and jesus performs the miracle e of bringing lazarus back from the

dead but it's up to the rodisciples to roll the stone like remove the various you have a chapter called stone rollers. it's up to the disciples to do the dirty messy work of unbinding lazarus stop but only by getting close to these folks on the ground can you experience the miracle of raising lazarus. so that's where the title came from. >> i love that phrase the stinky messy work. let's talk about the viral underclass which is not a phrase that you coined yourself but you used to great effect within amabout. i love the framing you put on the book when we follow the virus any virus we follow the faultlines of our culture. really sort of the through line of what you're exploring the relationship between the spread of diseases and marginalize people. was the genesis of this book. >> thank you so much for having

me. i'm happy to be ere. [inaudible] when people ããany disease we want them to be able to come forward and get the care they need and know they are not going to be judged.

arrested for criminal exposure and transferring hiv to two people. facing life in prison actually got sentenced to 30 years in prison. because of our reporting and a lot of activist work we got about about 25 years early but he still spent most of his 20s in prison. was a real wake-up call to me to understand that even if people think doing things that might lead to exposure to somebody else nobody's trying to give anybody else covered nobody's trying to give anyone else hiv or aids but when you tell people that if you find out your positive and for the rest of your life you could be prosecuted. and you see somebody go to prison for the work of hiv prevention people that much harder after beginning. viral underclass i started seeing as a way sean uses to talk about people living with hiv under different set of laws i heard actavis using it in slightly different ways and this became base of the phed

the dissertation i really understood it as a way to understand systemic racism because overwhelmingly the people were prosecuted are block anywhere in s.the world i happened i started to use this as a way to think of it as a viral underclass as analytic to understand how and why similar groups of people become exposed to the different social conditions and where people get hiv and progressed to aids also finding people who tiare dying finding criminalized over policing your finding police killings you just see it on the maxima covid-19 that started happening in 2,020 i saw the same maps. my move in the book the underclass i still build off the work around race but one of the ways our book center sectors i have chapters that in west virginia this is not only a matter of race this is raises a big part of it but this is for white people this is

affecting people who are lgbtq people who are disabled and people who have been incarcerated. i wanted to add quickly one point of hope is that activists the time i started working on this have done really good work raising awareness about the criminalization of hiv only two states have gotten rid of the laws entirely and when people are cynical tabout the two par system i tell them the two states that have gotten rid of hiv laws are illinois where toi live, blue talks about him and texas. thank you for all of you is happened under your government with lots of bipartisan support. i think for the first area i would like to drill into a little bit more you both alluded to in your discussions of your books it's a stigma. it such a big part of you both are reporting about in this book. to me stigma is about creating a sense of other these issues are for other people.

other groups we can shunt away. most of us have a pretty good awareness of how we treat people as others when it comes like racial divisions or sexual orientation or gender identity. what you all both explore is this treatment of coother when comes to drug use or homelessness or incarceration or sex work having some of the diseases that come with stigma hepatitis hiv. it's put so well treating human beings as objects instead marginalize people's. i would love both of you to drill in a little bit more about how stigma prevents us from reaching solutions in these public health crises.

>> so much of the stigmatization comes from this place people fall through the gaps and die. this tension between treating people like a criminal and moral failure like the human beings they are for the treatable medical condition. if you look at the radicals back to the harrison narcotics act of 1,914, it goes back to the nixon's war on drugs. i think a brief digression to talk about nixon in his early years when he actually has treatments funded as well as he had incarceration for drug use funded. he appointed the first the nations first'drives the super

trustee psychiatrist reported directly to him. designed a program of on-demand methadone clinics. then you see at startup, a way to please people in order to get vote and southern strategies that he employs which is well documented. think of stigma i think of the story in the book that got me the most i was following around and landon wright with hiv worker whose job was to test and treat people for hiv in charleston west virginia. state that has the most concerning hiv outbreak in the nation. and the state that just criminalized needs based syringes exchange one thing that we know works to prevent the spread of these infectious

diseases. she's looking for three people but mostly on house she can't find them then the needs are just screaming at her like coming out her right hand left. at one point we are looking for a person we are at a homeless encampment we run into this man in a wheelchair he's dos equis crying he's picking maggots out of abscesses and his feet early in the day. he walked out of the hospital even though he's going to die of this bacterial infection because he went there last week and treated like crap for 18 hours. so she sits at his feet it was like watching jesus she sits on the dirty ground she opens her first aid kit she put the gloves on and puts packet after packet of ointment on him and he's crying he's upset he needs to get drugs to get well.

at that moment a police officer comes up and puts an eviction notice up on the homeless encampment. i thought all the stories just came together in that moment in the sex worker who also lives in the homeless encampment comes out and says to brooke, honey, that antibiotic ointment ain't gonna cut it. was a nurse for 17 years. and lpn and then i got married. bennett was like but on bottom. she went like this like a ãã it was incredible she walked away and brooke said she should be the person treating him. if something hadn't gone wrong for her, this is what we have to remember this is at the base of stigma. if we have to remember that this guy in a wheelchair had a family he had kids he could be just like us i think stigma is

really at the base of all those many things all the layers discrimination and that one moment and just how poorly people in our own health care system, which by the way participated in starting the opioid crisis they need to participate in putting an end to it. >> the statistics i think about the most read about in the book is that one in every two black gay men are projected to become hiv positive in their lifetime and there's no reason for that to happen and certainly there's no reason for anyone to die of aids, hiv is an extremely slow acting virus can take 5 to 7 to 10 years for people to start having bad health effects 10 to 15 years until they die yet 10,000 people still die of it in the united states every year the better part of the billing diet around the globe. a big part of it is academics but a lot of the stigma people are made to feel so bad this

disease is made to feel so shameful through hiv criminal law through jokes, through the ways people are treated in healthcare settings that they don't get the help they need. i was thinking while you were talking if people don't have a safe place to sleep it doesn't matter whether or not you get them these drugs? it's relatively easy to deal with that he captured in early stages. but stigma is a huge barrier and they all get the secure that they need. i was saying something nice about your state earlier what abba is doing with trans children the way the trans children and lgbtq people are being criminalized in the state florida and arkansas is creating these pathways of the state to select viruses antibodies. if trans people cannot get the medically supervised care they need for hormones and safe setting people who are dealing with addiction as a health matter cannot get sterile

syringes. the state is opening up their veins and their bodies to hiv and hepatitis and other pathogens because they are going to get the care they need somewhere stigma not only is it a physical matter but stigma becomes his barrier that makes people feel ashamed to get the help they need. one of the stories that touched me the most the first person in my outer social circle that i have covered was really amazing activist name for half who known in the trans latin x mother she herself had been living with hiv for decades she had been a sex worker and really amazing volunteer work she would go out in the street and get people sterile syringes she would give them food and condoms and anything they needed and really met people where they were. she was the first person contracted covid and died. when she had covid in the very

early days in march 2,020 she did not want to go to the hospital because of all llthe b experiences she had had thin th hospital herself. i won't go into any depth i wrote about an experience i had when i needed a testicular sonogram and i was doing my phd work i was a little older student that allows me to feel very welcomed because my age the receptionist about not thinking i could be a referral health center. that made me understand the ways that as a trans person is going for healthcare particularly if they are met with that kind of response you don't look like i was expecting, that's a big reason why they might not want to go in and get care that's one of the reasons they are so much more likely to get sick unnecessarily. >> i want to ask about

intention. we have this healthcare system in our country that is capitalistic profit driven so what interests me to explore a little bit is to what extent do you think people making the decisions in our public health system and healthcare companies and hospitals have some sense of malignant intention to intentionally marginalize these groups and to what extent is this just a byproduct of the structure of our system because it's profit driven? >> before dope sick came out and was asked to talk to the nonprofit hospitals in my region called currently in. i watched her struggle not to be cared for at their own hospital i said all of you took

a free trip curcio purdue pharma to arizona and florida to become paid speakers from the country but y'all participated in the system you should participate in correcting it i think a lot of it at that point that was 2,017 two years later they totally change the way they do medicine they started doing medication assisted treatment offering it whereas before they thought that was his treating a drug addition was drug it was not god they can change the world and and and when they changed one guy with a lot of power decided he could change the rules. that's what i see over and over in this book. somebody has died of overdose somebody sometimes is just somebody like dr. birx whose i

asked him what happen he said we better but. [laughter] how could we not be doing this and now he tells me he's kind of an evangelist for other hospitals wanting to do this evidence-based practice. it's not that heavy lift. i don't know if it's because of capitalistic system as much as the creation of the overdose crisis to begin with which begins with purdue pharma introducing a very addictive drug in 1,986 and basically buying off all the politicians and lobbyists and fda the guy who stamps approval goes to purdue tripling his government salary. years later. nobody is regulating these systems. so we have to get rid of the revolving door is one thing.

you see that happen again later when the dea lybasically gets kneecap from going after suspicious pell-mell doctors ...... ...... sed to work for t. i mean you almost couldn't make this up but i think it's both. i think the health care providers want to get back to to doing harm. i quote a guy this medicine doctor met i'm doing this because he wears this big cross and he's very religious and he runs a homeless out of the basement of his office. but he says the answer comes back he said the answer goes back to 1926, francis peabody said for the secret of caring for the patient is to care for the patient. i think when we let capitalism rule, we have to get back to carry.

>> capitalism is to extract, the healthcare system is not about healthcare the reason is their primary motivation. many of the sicknesses are opportunities to do so. because of phrase remains at the organization that is successful in government and business reaction the 1980s and 90s perhaps the most important contribution is the force the fda and government change how trials were done and that's why billions have been able to get vaccines for covid and it could take a total of one year end a phrase they use when medication came out, the figure out how to do it and save lives and

capitalism won the war, the reason more people have died of aids after medication. capitalism is the reason there's a higher rate of aids among african-americans in 2015 than there ever was among white americans before medication 20 years earlier so these are the results the system creates. the people you are writing about and those doing the work out of the truck, they are interested in care and between our books i noticed we are writing about people who have different ethics of care and the covid pandemic would inform us, many more people have different sense of ethics of care. i know so many people who work in offices prior to the covid pandemic but once home truly enjoyed doing things like mutual

aids and things of that. those of the models we need to look at. a person has an people in the basement, they are doing that work. the people i've interviewed aboutt monkeypox, gay sonos who work all summer inform people about monkeypox and try to get vaccines disturbing vaccines and activities and turning them to get vaccinated, they are doing a new work. and something else i thought about how covid-19 put in a different response for monkeypox and work around genders in

society and we could have ethics of care much less judgment about the activities that would not only benefit people on the individuals later but of public healthll outcome overall. >> i'd like to invite a anyone from the audience would like to ask a question of panelists to come to the mic. while we are doingt that, i want to talk a little bit about hope here toward solutions because one thing, this idea that people who need the most care are the one with the actors to care. you show individuals who i want to say are fighting back but finding ways to help in the ways they can, ofy the solutions available? is there a way to take the models and make them work on a

large scale? >> i think they have to be. we can't lose hope. i write about a bureaucrat who comes in the same community they said let them die and take their organs, figure out a way to offer post overdose response teams and. recovery specialists, every person who now overdoses a recovery to come help them make those steps. he had to battle -- it is a little problem more than anything else. he has to battle judges who don't want to allow the court even though he has money for it so i call the peers my angels. recovery work, they reach out in our community, find one good

cop, something that gives me hope, if you could turn one good cop into doing things different to bring people from jail and into care, you can show how that works so that is something that is scalable. >> what i think has been scalable are things that people who do work around drug use and rsclear house for decades is understood by millions and i think we are going to see ripples for decades and it's a huge unionization effort. the covid pandemic and people feel in their workplaces coming together i think young people, teams and people in their 20s will take lessonsat learned and understanding the much more collective response everyone

feeling they are an individual failure. >> let's go to the audience. >> is it on? >> do you want to come up here? >> you can just say it and we will repeat it. >> say it, i'll repeat it.

[inaudible] [inaudible] h >> it's okay, we can hear you. will repeat it. [inaudible] >> older adults they are

stigmatized and treated -- when it comes to covid how these living situations created traps for overp adults. >> elderly are a huge part of my book but i have an entire chapter about the closest person to me who died of covid, my former editor, it was a completely stupid reason. he had a tooth infection and ended up in the icu in new york where i lived at the time, the opening people with covid in nursing homes and recovering from his tooth infection, he got covid and died. one in ten nursing homes die of covid and one in every 12 and congregate settings including younger people who are disabled, one in 12 died as well. i got many letters from people were utterly about their spirits with covid and one thing in my

book was to give people a chance not only to mourn people they lost but older people or people who had covid feel like they've been forgotten very much in the elderly and my critique on capitalism, mostly because about your health, didn't care about the elderly andom very crude terms, talking about the utterly as a drain because they are costing money from the economy rather than contribute to it. i wrote in other research, the elderly are affected by hiv and aids, one of the few demographics that increase because elderly people don't have snacks so no consideration ergiven to healthcare, pleasure and things like that so very much the elderly are the underclass and enormously for the brunt with attorney general whoo talked about grandparents

giving up their lives for the good of the economy and it is turning and that's why a disability framework is helpfula because elderly and the way our disabled and disability is usually thought of as how productive you are to the economy so you're not able to do certain things and it is disheartening to see across the political spectrum and mainstream media aversion talking about covid as only harming people who have problems and we don't need to be so concerned when we still have more than 10000 people dyinge. overwhelmingly elderly people.

[inaudible] >> how the hospitals seem to be owned by religious organizations and it affects people's care and the limits of the care and i think means they are tax exempt as well. did you cover that in your books along with capitalism and religious aspect and ownership? >> i didn't really get into that as much from the structural level but i explained the title raising lazarus and most individuals, individual people with personal ethics, many of them based on religious beliefs

are the ones leading us out of this and doing mutual aid. i tell the story in the end where this catholic nun is in her 80s and she reaches out to me to start a gofundme she can't pay the light bill for her education center and the sackler still paid for 200 years and here's an 88-year-old counselor working 12 hours a day asking for money. most of these nonprofit hospitals are not paying taxes and they did participate in the system that ultimately led to 7 million americans addicted and i think they should step up. >> ideal briefly, there are ways religion contributes at an

individual level, many people are involved that i've seen. every about this, i turned in right before the decision that came out were after the dobbs decision but there is real length in the ways that we conceive of religion and tax status and speech so it is dangerous the way corporations have been able to say we don't want to pay for abortion, it violates our religion and similar things that are filed and it is dangerous. i think it was a massive investigative story a month or two ago how hospitals and nonprofits using aggressive still collecting techniques. people who are supposed to get care' three and they are not evn

aware because they are theho lectures for for-profit. >> thank you. >> one thing on the panel the other night the height, basically made abortion illegal for poor people and really only full access for a few years, similarly what's happening with this care but in florida they have made it so you can get trans care and things like that and it puts us on a similar path to have his amendment led to this over time abortion not being legal. >> i look forward to reading this. youed talked about one bureaucrt you talked with who's doing work

trying to address these issues. did either of you talk to other people trying to make change and do things different to solve these issues? >> i was just at the white house a few weeks ago and i met with the drugs are and i know he knows the research because he's author of all of it. again we come back to politics and i am hopeful this administration has ways to get evidence-based care but still i kept asking everybody, what is the magic one? there's no federal fix because healthcare is run by states and communities. you might have one community who doesn't want exchange at all and another might have 17. a lot of states made it illegal,

we have 13 states that haven't passed the medicaid expansion so where you live in the country who determines your ability to get healthcare and that is concerning. i think the administration is aware but is just how to bring it in. >> i don't interview many government officials, i more interview people in the underclass and more critiquing how things play out across party lines. the biggest one being 400,000 people died of covid under trump, 660,0005 hunter biden and trump didn't have the vaccine, here's a cartoon dealing with the pandemic. a lot of good people i know in the administration but when

people don't have homes,, theres only so much we can do and when the u.s. has more incarcerated people than anywhere else in the world, thatvi is the major drivg tension of disease particularly respiratory. i'm writing more on this but i've known really good people go into the administration and then i feel i don't hear from them again. >> why don't we hear from good people? they will be very loud and public do activism and work that is cutting edge andad critiquing the administration and government response and they are brought in to doing that work and then they stop tweeting or

publishing. >> so scared of getting fired. >> doctor dimitri who is out cake leather sex positive work in new york city, they've maintained for the world but a lot of people, i hope that is what drives the administration much for the go to die. >> in my mail was a political add from the republican party all these pieces of misinformation about puberty blockers and transfuse so i'm

curious what can i do, what can people do to combat or reverse and coming, they mightpa have caught this. my neighbors and friends are believing that. >> is aces gender person it is on us to explain to anyone who will listen, people take puberty blockers for all m kinds of medication that affirml gender for all kinds ofac reasons of al gender spectrums and many haveim been used by cisa people for a long time. it's important to share that as a gay person i find it important to explain to other gay people

are community the ways talk about as gay people in the 80s and 90s you should go through conversion but never accept any more. particularly in rural areas, jobs went away and government did nothing and people left behind capitalism rules that one things like the opioid crisis come into being and ill-equipped to deal with it. in the media's role not covering

we won numerous national awards, 105 employees in the newsroom and now eight reporters so it is really important we talk about revolutionizing nonprofit journalism and supporting journalism left out there. o this is what you're doing in your mailbox. we've got this information. >> one quick back people will say, we don't know what's going to happen with trans people but this is not true. there's four years of research, decades of research and jon stewart at any national level journalist attorney general of arkansas, no, no, no. this is how it works, decades of research so research is widely available. >> i want to echo, support local

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watch online anytime that booktv.org. >> a healthy democracy doesn't just look like this, it looks like this. americans can see democracy at work are public drives. get informed straight from the source on c-span. unfiltered, unbiased word for word from nation's capital to wherever you are, the opinion that matters the most and this is what democracy looks like. >> courtesy of diane and robert over there hiding in the second row. sixteen previous books and this does not