Better Because You Were There

            This interview was different, as many aspects of all our lives currently are. As it could be safely assumed in the time of the COVID-19 pandemic, Dr. Jayne S. Reuben and I were not in the same room as we spoke. I was sitting in what I affectionately call the “jam room” of my apartment, with guitars and art depicting the likes of Jim Morrison and Tupac Shakur visible behind me. Dr. Reuben, on the other hand, was situated in front of the steep, snowcapped sills of Alaska’s coastline fjords. Well, in reality she was at her home in Texas, but her virtual background was taken from a summertime cruise she’d taken up North. These days, a little imagination will never hurt anyone. Dr. Reuben is a Pharmacologist, specifically being an Associate Professor in the department of Biomedical Sciences and Director of Instructional Effectiveness at the Texas A&M University College of Dentistry, and as such holds an important perspective regarding pharmaceuticals and the treatment of COVID-19. However, before we discussed her thoughts on the pandemic, including why people shouldn’t take hydroxychloroquine as a treatment for COVID-19 and how she views the meaning behind a multi-day social media argument she was presently involved in, she told me about the path that led her to where she is today. It began in South Carolina.

            Dr. Jayne S. Reuben was born and grew up in Sumter, South Carolina, a town east of the state capital that is now home to about 106,000 people. Her family is one of academics, so much so, in fact, that she was the fifth person in her immediate family to attain a doctoral degree. Her father was one of fourteen children, all of whom attained bachelor’s degrees in a time when African Americans had limited access to many major universities. Prior to his death, Dr. Odell R. Reuben, Sr. served as the President of Morris College, an HBCU located in Sumter, where the campus chapel is named after him. Further, Reuben Elementary in Newberry, SC got its name from him, as well. Regarding Dr. Reuben’s mother, another person very important to Morris College, a women’s dorm holds her name from her time spent there as a history professor and Academic Dean. With the academic accomplishments of her parents in mind, it is of little surprise that her eldest sister was an attorney and former associate dean of law and that her second eldest sister was one of the first African American women to attain a Ph.D. in Business Administration. Also perhaps of little surprise, Dr. Reuben emphasized that her parents made sure each of their kids got an education. “I fought it as a career for a while,” she told me about embracing her strong academic lineage. On the other hand, she also said, “teaching is in my blood.” Clearly, the latter sentiment won out.

Education

            Dr. Reuben embarked upon her own academic journey at Converse College, a small liberal arts institution located in Spartanburg, SC where she currently serves on the Board of Trustees. Despite eventually ending up in the world of Pharmacology, Dr. Reuben began her education completing her first semester as a music major. “My mother’s family was very musical, so I think that’s where we got it,” she started. “I was first-chair flute, all-state when I was a Senior in high school and was just really determined that was what I was going to do.” That first semester was quite easy for her, raising questions if there was something else that would call to her and push her boundaries. In fact there was, as she recalled an experiment she performed in high school, namely the chemical reaction of pure sodium with water. The result of this reaction can be easily seen with a search on any web browser, but could be succinctly described as a small explosion. “I remember telling my teacher, ‘wow, you’re crazy, but that was really cool!’” She laughed as she reminisced. So, in her second semester at Converse, she switched her major to Chemistry. She still played the flute, earning a related field distinction in Music on her degree, in addition to a minor in Biology. If she wanted more of a challenge out of her education, she certainly made the right move. “That didn’t make any sense, why did you leave the easy one for you and go into Chemistry?” she remembered asking herself, laughing with a sense of seeming incredulity as she told me. However, changing majors was just one of the challenges Dr. Reuben faced while pursuing her first higher-education degree.

            “[The students that I teach], their reality in the context of race, is so much different than mine.” In 1981, when Dr. Reuben was admitted to Converse, the number of African American women was greater in her Freshman class than was it in the entire rest of the school. Furthermore, though vestiges of segregation are certainly still contemporary, they were very difficult to miss in 1980’s South Carolina. For example, she explained that whereas Converse did indeed admit an increasing number of women of color, they were also consistently roomed with one another. This practice, while obviously incongruent with full integration of students who were not White and seeming to parallel a separate-but-equal viewpoint, at the absolute barest of minimums did not tout overtly racist verbiage in its explanation. This was not always the case. “In my Senior year, one of my best friends and I were invited to a white classmate’s wedding,” she told me. “When the student came into our room, she said ‘I want you all to come to the wedding, but you can’t come to the reception because it’s at a Whites-only country club.” My reaction to this statement was widened eyes and raised eyebrows. “Yeah…” she responded, nodding her head and laughing sardonically.

            These sorts of experiences put the reality of racism in the unavoidable forefront for Dr. Reuben. As such, she highlights the importance of directly contradicting this ideology of ignorance by making cultural competency an important aspect of the way that she teaches her students. After attaining her Ph.D. in Pharmaceutical Sciences from the Florida A&M University College of Pharmacy and completing her post-doctoral fellowship in the Department of Pathology at the University of Michigan in Ann Arbor, Dr. Reuben began teaching pharmacology at the Baylor College of Dentistry/Texas A&M System in 2006. To explore and expand her students’ sense of multiculturalism, she would ask questions of them like, “what happens during Ramadan to a patient with diabetes?”

People

            Understanding and treating the person, not just the malady, is a key factor in working toward equity within healthcare. Indeed, racial health disparities in the United States have been and still are an immense issue. Afterall, it was said in 1966 by Dr. Martin Luther King, Jr. that, “of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death.” By training the next generation of practitioners with a focus in cultural competency, American practitioners of the future will have the knowledge and skills to create a bottom-up trend, consciously working to diminish these disparities. As a foundation, Dr. Reuben told me that good questions to keep in mind are, “what do you need to know about cultural influences, access to care, socioeconomic status and people’s different experiences,” to give your patient the best care possible.

            However, teaching cultural competency is only part of the solution. Dr. Reuben told me about how, when stratified into five socioeconomic tiers, students who were accepted into medical programs overwhelmingly came from the highest two tiers, which ended up including approximately 70% of these aforementioned students. Only about 5% came from the lowest. “So, what does that tell you about student experiences, if you come from the top tier as opposed to if you come from the bottom tier?” It turns out, it tells you a lot. Cultural differences abound between the highest and lowest socioeconomic levels, sometimes making it difficult for a patient and practitioner who reside on opposite ends on the socioeconomic spectrum to empathetically meet in the middle. If a practitioner comes from a background of never having gone without, it’s not always easy to truly understand someone’s situation when they can’t afford the co-pay for the visit, let alone the price of prescriptions, rehab services or transportation. A way to shrink this gulf between patient and practitioner is to look at who is being accepted into these programs in the first place.

            Fortunately, Dr. Reuben was in just the place to do that in 2011, as she was a founding faculty member of the University of South Carolina School of Medicine Greenville. “The first student I interviewed for admission at the medical school in South Carolina was a young African American man who, because of family circumstances, really just couldn’t shadow,” she began, before specifying, “probably less than 20 hours of shadowing.” In an ideal situation, many prospective med students shoot for the 100-hour mark, meaning this student’s 20 hours were probably not enough to get his foot in the door at many medical schools. “But, he gave a great interview.” So, he was accepted into the program, finished it, and went on to complete his residency in ENT. Many schools would not have given this student the opportunity to step up and be successful, but the University of South Carolina School of Medicine Greenville did. And he was. Admitting more individuals with diverse backgrounds, like this student, into medical programs is another way to improve patient/practitioner relationships. Having physicians who come from similar cultures as their patients, who look like them, who can connect with them, is meaningful for many of these patients. In sum, in addition to teaching through a multicultural lens, holistic admission criteria will improve the diversity of practitioners, thus leading to the improvement of equity in healthcare. To parallel a previous statement, doctors aren’t just standardized tests and memorized anatomy and physiology textbooks. They’re people too, just like their patients. They’re people who have lived experiences, strengths and weaknesses, passions and biases. The future of gatekeeping the admission of medical students is not in staunchly keeping tradition, perpetuating the prevalence of the most highly privileged people filling graduating classes of physicians. Rather, as Dr. Reuben put it, “it’s understanding circumstances can be different.”

Dr. Jayne S. Reuben

            As the time on our interview began to draw short, I wanted to speak to Dr. Reuben about one of the most important contemporary issues of the day: COVID-19. We spoke about many things regarding the novel coronavirus, but there were some highlights that emerged as especially pertinent as we talked. First, and importantly, Dr. Reuben told me that a person should not take hydroxychloroquine to either prevent or treat COVID-19. That’s it. Don’t do it. It has not been scientifically shown to be effective at treating or preventing COVID-19. In addition to the fact that it will not help you, one should not take hydroxychloroquine for COVID-19 because it has an extremely narrow therapeutic window in conjunction with having the possibility of irreversible side effects. To those of us who are not pharmacologists, me included, this essentially means that the difference between a safe dose that still has enough of the drug to make a helpful difference in the body and an unsafe, potentially harmful dose is small. Indeed, it’s not difficult at all to accidentally have too much of this drug in your system and when too much of this drug is in your system, you could have cardiotoxicity and damage done to the retinas of your eyes that will never heal. “You cannot double the dose with this drug, that is beyond the dose that we want to give to a particular patient in a day,” she specified. This narrow therapeutic window and the possibility of harmful side effects show why scientists need to conduct robust clinical trials with this, but in effect any, drug that could be disseminated to our population. This takes time, but it is important to garner evidence of safety and effectiveness when developing pharmaceuticals. In a slightly different vein, people who need this drug, for example, individuals with malaria or lupus, had trouble attaining it when it was first mentioned in the news as a possible treatment for COVID-19. Leave the supply for those we know it will help.

             Another aspect of the pandemic that we spoke about was the public discourse that has been brought up around COVID-19. In today’s times, people should try their hardest to stay informed, respect expert opinions when they provide information on the topics in which they hold expertise, and reject anti-intellectualism. However, that’s not always how people behave. Indeed, for some folks it can be tough to stay collected when interacting with people who call this pandemic fake or assert that their 15 minutes of internet searching makes them as knowledgeable as someone with a Ph.D. and 20 years of experience. For others though, they see it as an opportunity to reach out to someone, connect with them and educate. Dr. Reuben falls into the latter category. “We’ve been having this exchange for four days,” she started, to my shock. A four-day argument on social media! That’s too draining for me, but Dr. Reuben continued that dialogue for such a long time because she really lives her role as an educator, in this case taking it even beyond the classroom. One could usually assume that just as she would trust someone with a background in engineering to have some expertise in engineering, others would trust her to have some expertise in pharmacology. Unfortunately though, that’s not always the case when science or medicine is involved. So, perhaps unsurprisingly, Dr. Reuben got some pushback from this person, but she didn’t give up. Rather, she continued, committed to her simple end goal: “I really want to convince you why this drug should not be put in the general population.”

Impact

            Dr. Reuben and I spoke about many things when we virtually sat down together. She told me about where she grew up, her family, her career. However, I think the way she handled that guy on social media told me the most about who she is as a person. When we talked about it, her tone was that of a joke, pleasant and light-hearted. She didn’t focus on the fact that this man felt highly qualified to try to educate (incorrectly) a pharmacologist on the pros and cons of the large-scale distribution of hydroxychloroquine. She didn’t focus on the 96-hour stand he was taking, nor that he eventually resorted to personal insults. She did, however, focus on how important it was for people to know the facts and how she was determined to not just tell, but show this guy that what he was saying was not correct. Why? Why spend so much time on someone who is clearly not open to listening to you?

            Dr. Reuben told me about a saying that her mother had: “Make every place you go better because you were there.” She specified that within this quote, better can mean a lot of things, and it still affects her to this day. “Better sometimes means you help someone else to be better,” she started. “My role as an educator is not just to educate you about drugs. It’s educating you about character, about being a citizen, being a part of a community that is local, national and international.” The way she describes the philosophy behind her teaching parallels the way she handled that argument. They talked about the drug, so that first obligation of an educator she talked about was fulfilled. However, she also taught about those other topics she said fall under her umbrella, albeit in a different way. Solely by engaging with him in the way she did, she taught character, being a citizen and being a part of a community. She treated him with respect, gave the facts and didn’t just block him after such a long battle, which is probably more than most of us can say we would have done in her position.

            Altogether, a few words from Dr. Reuben do a pretty good job at summarizing what’s important to remember: “What we do impacts people.”

By Matt Gonzales

I'd like to thank Dr. Jayne S. Reuben for sitting for an interview with me and offering edits on an earlier version of this piece.