00:00:00:14 - 00:00:06:16 Dr. Winn I'm Dr. Rob Winn and you're listening to Real Cancer Talk from VCU Massey Comprehensive Cancer Center. 00:00:07:12 - 00:00:20:03 Dr. Winn I was going to start with just opening up a couple of questions. The first question that I had was, as I was looking, I was trying to figure out what got you interested in surgery. 00:00:20:05 - 00:00:58:08 Dr. Freeman Well, when I was in medical school at Howard University, I finished medical school in 1958, a long time ago. So I was first interested in psychiatry, actually. And the theory of psychiatry really fascinated me in my freshman year of medical school. But, I became discouraged. But in the meantime, I shifted my thinking because when I rotated to surgery, 00:00:58:10 - 00:01:24:11 Dr. Freeman I liked the idea that you could make a diagnosis and operate. And the finding, like, take out an appendix and the patient would be okay, and I liked that idea. I liked the idea of being able to, to see what I was doing, to see the result of it. And that philosophy has kind of stayed with me, across other areas of my life. 00:01:24:13 - 00:01:53:03 Dr. Freeman I like to, to do things and see results, if that's possible. That's the kind of the answer to that. So I became a surgeon, and why did I go into cancer surgery is a question you might ask. And I think I'm not so sure you can really understand why you do things. But I do know that my father died of cancer, 00:01:53:05 - 00:02:22:12 Dr. Freeman testicular cancer, when I was 13 years old and had to serve my life a great deal. So I always didn't like cancer. So from childhood I didn't like it and I wanted to do something about it. I trained in general surgery and at Howard University under Burke Syphax, who was you know, you may know that name and LaSalle Leffall was really inspiring to me 00:02:22:14 - 00:02:58:14 Dr. Freeman at that time. And, you know, I found that, I wanted to see that that carried my skill level further, like LaSalle had done, and Jack White before him, both at Howard University. And then, and I got the opportunity to go to Memorial Sloan Kettering, where after general surgery, I, I did residency for three or more years to learn cancer surgery, radical cancer surgery. And because of my particular background, 00:02:58:16 - 00:03:34:04 Dr. Freeman in Washington D.C., I had a lifetime. But then that reflected what was happening to to people who were not treated fairly. And I lived that, I live that very much in Washington D.C., and so social, environment in which I grew up in, which was really separation of races, including all the way through Dunbar High School, where the high school was separated in Washington when I finished. 00:03:34:06 - 00:04:09:09 Dr. Freeman But, you know, it was an excellent school. Dunbar. And why? Somewhat why because it was segregated, and that school had started in 1870, just after the Civil War, as the first black high school in America. The teachers at Dunbar were people, some of whom were PhD people from Princeton and Harvard, you know. Now this is in that time when I went to high school for ‘47 and ’50, finished in ‘50. 00:04:09:11 - 00:04:53:13 Dr. Freeman The teachers were high level teachers who would, who had extraordinary education, you know, including the father of black history by the way. I’m trying to think of his name, he taught there. So, so well, you have to two different sets of prejudice. Having the students going, going to that high school because of prejudice and separation. And the best teachers that you could find at the same school, because they shouldn't have jobs anywhere else. They could, but they weren't allowed to have the best students and the best teachers in the same building at the same time. 00:04:53:15 - 00:05:31:24 Dr. Freeman And they created an extraordinary high school. Certainly would one of the best academic schools in the history of America. From, from from that school, high level people like Senator Brooke from Massachusetts came out of that school. You know, there are many famous scholars. Charles Drew came out of that school, Charles Drew came out of that school. And I can name many others. So I went to the I went into surgery because I wanted to see results. 00:05:32:01 - 00:05:56:20 Dr. Freeman So I went to Memorial. I wanted to get better technically than I had just with general surgery. Then then the next thing, why did I go to Harlem?. Well, I went to Harlem because of that particular background. So if I have all this skill that I built up over all these years, I want to apply it to help my people. 00:05:56:22 - 00:06:23:08 Dr. Freeman And that was 1968 when I went from Memorial Sloan Kettering to the community of Harlem to work as a surgeon. Now I'm ready to cut cancer out of Harlem. I'm ready to do it, I’m skilled. I know how to cut cancer out. I want to cut it out of Harlem. I can't do that. I can't cut it out. And so now I'm frustrated. 00:06:23:10 - 00:06:57:00 Dr. Freeman I said, I got all this skill. I can cut this thing up. But then I get to the reality. I can't cut it out. Why? Because the people will come in too late with cancer for me for me to be able to cut it out. I can't cut it out. So now I'm faced with this and very sincere because I don't know very much at this point about life, except my own life. And I'm trying to find my way. 00:06:57:02 - 00:07:33:13 Dr. Freeman And I've had a certain kind of experience that that brought me to this point. I am the head of the breast clinic at Harlem. The people who come in with tumors that you can see with your eyes ulcerated come into my clinic for the first visit. And I said, well, how could this happen? So. So this was a turning point in my life, in my thinking, because now I see that what I'm doing is not the right pathway. 00:07:33:15 - 00:08:12:13 Dr. Freeman I mean, surely good to be able to be a surgeon and to operate, but if you can't operate because something in the community is overwhelming, this can. So you can't you can't. Something of that happened, it was a socioeconomic invasion that was different than the cancer invasion in the community. So I'm dealing with something that I've never really faced very much before. In my mind I said, well, these people are all black and they're all poor. 00:08:12:15 - 00:08:50:12 Dr. Freeman I'm asking them, in 1970, are they dying because they're black or are they dying because they're poor? Or are they dying because of some combination of being back and poor. And so that became the critical question. So I took time to call in maybe 20, 25 women who had come to my clinic too late. They were going to die, but they hadn’t died yet from advanced disease. I talked to them and said, well what really, what really happened to you? 00:08:50:14 - 00:09:15:20 Dr. Freeman Why did you come in so late with tumor? I could see the tumor. And she said well, the story was this. The person would say, well doctor, this was not the first time I tried to come in. I came in to the Harlem Hospital emergency room two years ago, and I had a lump in my breast. And I waited for six hours. 00:09:15:22 - 00:09:43:16 Dr. Freeman I finally got to see a doctor. He was polite to me, but he told me, you're in the wrong place. You have a lump in the breast, and that's not an emergency. And you're in the emergency room. And so you need to go to the medic first, or you don't have insurance. You need to go through the Medicaid office was 100 blocks south of Harlem Hospital at that time. 00:09:43:18 - 00:10:15:16 Dr. Freeman Get your Medicaid card, come back and then make an appointment to the to the proper clinic, not the emergency room. So, so in summary, to that woman, the process that was being recommended for her to solve her problems was more painful than the painless lump which she came in for. And so if that's the story, then the question is, well, what do you do about it? At Harlem 00:10:15:16 - 00:10:52:12 Dr. Freeman Hospital itself, I set up a free clinic on Saturdays. By this time I'm director of surgery by 1974. I set up a free clinic so the person who was coming in could just go right to my clinic without registering into the hospital. I set that up in 1979, and began to work until the hospital administrator told me, you can't do that. 00:10:52:14 - 00:11:16:06 Dr. Freeman You can't do that because it's illegal. You can't just set up a clinic at 9:00 on Saturday morning and tell people to come in. And, you know, that was correct. You can't do that. They were worried about malpractice and all that. And look, that was right. I called the Health and Hospitals Corporation downtown and said, look, I'm trying to help these people. 00:11:16:08 - 00:11:35:16 Dr. Freeman And they sent the vice president up to talk to me, and they said, well, you're trying to do the right thing, Doctor Freeman. And we're going to help you. And so that vice president, a black woman who came to visit with me, said look, we like what you're doing, but we gotta help you to do it, 00:11:35:16 - 00:12:02:14 Dr. Freeman so it's right. So she created a hospital number specifically only for my clinic, Saturday morning clinic, free clinic. And said, when the person comes in to your clinic, put this number on the chart, and the hospital will know that the patient is in the hospital. So now I converted a free clinic to one that was within the hospital system and went on from there. 00:12:02:16 - 00:12:31:01 Dr. Freeman So that was a big, big step forward. But still there were problems with getting the patient all the way through treatment. Now something else happened to me simultaneously. I had studied breast cancer in Harlem by that time, and published a paper on the death rate from breast cancer in Harlem. The governor's wife, Governor Hugh Carey. 00:12:31:03 - 00:13:07:21 Dr. Freeman His wife died of breast cancer in 1974. The governor set up a high level committee to advise him about what you should do for breast cancer in New York State. I was called to testify before the committee because people knew that I had experience in Harlem. And it resulted in the governor deciding to put the money into Harlem. And from that experience, we developed the Breast Examination Center of Harlem, which was put under Memorial Sloan-Kettering. 00:13:07:23 - 00:13:39:18 Dr. Freeman Because of that work, I got put on the board of directors of the American Cancer Society, nationally, as a director at large, because there was no way that a doctor from Harlem could get on the national board. Somebody recognized what I'm doing. Ten years later, I became the national president of the American Cancer Society. LaSalle Leffall was the president of the American Cancer Society in 1978. 00:13:39:20 - 00:14:11:02 Dr. Freeman I came on to the board around that time, and LaSalle Leffall had started the committee called Cancer in Minorities after holding a meeting in Washington on cancer and black Americans. So LaSalle did a big step forward for cancer. I became the chairman of that committee after LaSalle was chairman, and he was going up to a higher level. 00:14:11:04 - 00:14:46:17 Dr. Freeman And I raised the question in that meeting of theAmerican Cancer Society, as chairman of the committee on Cancer Minorities, are these people dying because they're black or because they’re poor. The same question that had come to me earlier, but in this case, now a on committee reporting to a board. So the board unanimously said we have to study that, and you have to be the chairman of this committee to study it yourself. 00:14:46:19 - 00:15:27:17 Dr. Freeman So in 1984, that committee was selected. Scholars from around the country, epidemiologists and other kinds of people. And we did a two year study starting in 1984. The study was published in 1986, called Cancer in the Socio Economically Disadvantaged. And and the report concluded for the first time that I knew in the country that the principal reason that black people were dying from cancer was because they were poor. 00:15:27:19 - 00:15:53:15 Dr. Freeman That was the question that I wondered about. Now we have a two year scholarly study, and I and I had led a study. And so we were the cancer Society had reported with me as chairman, black people, the principal cause of death from cancer in black Americans is poverty. But now I have a real direction to go because that's it. 00:15:53:15 - 00:16:27:19 Dr. Freeman That's the answer to my question. Three years later and I became the president mysel in 1988. Ten years after LaSalle was the first president. I'm the second black president of the American Cancer Society. So the principal activity I carried out to during my year as president was hearings in America or cancer in the poor. Hearings. So there were national hearings on cancer and the poor, which I led in seven American cities. 00:16:27:21 - 00:16:58:14 Dr. Freeman Hearing the testimony of poor people of all races who had cancer. We're trying to get to what’s the bottom line. Poverty, universal, what's the what's it what's the bottom line? That committee concluded, and I wrote the paper from that, the principal reason that the experience of poor people with cancer is principal reason, 00:16:58:16 - 00:17:32:11 Dr. Freeman they meet barriers. Poor people meet barriers when they attempt to get into and through this very complex American health care system, they meet barriers. And from that idea, I thought of a concept. If people meet barriers in getting through the healthcare system with cancer and other chronic diseases, then maybe we should navigate. Maybe we shouldn't navigate them. 00:17:32:11 - 00:18:07:09 Dr. Freeman But so the concept of patient navigation came out of that experience. Now let’s talk about what does navigate mean? So birds navigate. They go from north thousand miles south. Butterflies navigate. Cars navigate. Airplanes navigate. So so people trying to get from one point to an endpoint. So that’s the concepts that we need to get from the point in the community to some point of resolution. 00:18:07:11 - 00:18:52:11 Dr. Freeman So why not apply navigation to medicine. So let's navigate people across the health care continuum. Now these were poor people. They were in my case, were black people. So now so what is the journey? The journey has to do with reaching them in the community, educating them in a community, finding ways to navigate them from the community to get a test in the hospital or elsewhere, like a mammogram or colonoscopy. And don’t stop there, they get the test. 00:18:52:16 - 00:19:20:00 Dr. Freeman You make sure they get the test even if they can't pay for it, get them the test. That's part of the journey that you have to eliminate any barriers they would have as a community person in getting the test. Eliminate the barriers and navigate. If they have an abnormal finding from the test, they need to have a biopsy to prove what it is. 00:19:20:02 - 00:19:50:02 Dr. Freeman That's a journey that hadn’t been payed much attention to. You have a lump in the breast, but it needs, it's got to be biopsied rapidly. So the journey goes from biopsy to pathological findings. Now you have cancer of the breast and then you’ve gone that far. And now you have to navigate them into treatment. Surgery, radiation, chemotherapy and through that in a timely way. 00:19:50:04 - 00:20:20:08 Dr. Freeman And so we came up with this, this, this, this journey shifting from what I do as a surgeon on one patient, which I still continue to do, to the journey of the patient across the continuum that they had to go from the point of the community they live in, to testing, to treatment, to resolution, to support after care. 00:20:20:10 - 00:20:58:19 Dr. Freeman And that became patient navigation. I got to testify before the Congress on patient navigation. I had studied it. What happened was the Patient Navigation Act was passed by the Congress in 1995 based on Harlem experience, and the information came out that. It came to law, signed by George Bush, the son, you know. And by this time, I was the chairman of the president's cancer panel. 00:20:59:00 - 00:21:37:06 Dr. Freeman That helped a lot too. I was in that position for 12 years. So I had communication contact with three different presidents during that time as chairman of the president's cancer. I'm getting promoted. So this is another stream of life into the river in my life and the river of my experience that I refer to. So now, now you got something coming out of Harlem where, you've asked some questions and you've begun to try to answer them, and, and you get to an answer and then you get promoted. 00:21:37:08 - 00:22:00:13 Dr. Freeman So you have a platform to say what you believe to the whole country, because now you're president of the Cancer Society and they get behind you and they help to drive this thing. I get a lot of credit. Give to the Cancer Society for allowing this to happen and allowing me to take this thing along that way. 00:22:00:15 - 00:22:51:14 Dr. Freeman And so now from Harlem, we get a change in the laws of America, where millions of dollars are put into patient navigation. So at this point, I think patient navigation has become one of the most critical activities to help disadvantaged cancer patients, I think, the American College of Surgeons, several years ago determined that to have approval as a cancer center in America, you must have a patient navigation program. The Obamacare has within it patient navigation. 00:22:51:16 - 00:23:34:02 Dr. Freeman Obamacare came in in 2012 and had requirements for patient navigation. So that I had the opportunity to become a trained surgeon, that I came from a particular background that caused me to be concerned about injustice, particularly racial injustice. And I applied it to my work. And, and, and I really, was the principal driver of the point number one, that race, that racial issues in cancer are driven mainly by poverty. 00:23:34:04 - 00:23:57:19 Dr. Freeman That's a different question to how did you get poor, is a different question. And why are you poor, and surely the 400 years since 1619 had something to do with that. That's it. But that's a different question, you know. But and you say, well, what's causing you to die is because you are poor. And that's a different question. 00:23:57:21 - 00:24:53:11 Dr. Freeman Why are you poor? You do need to act on things related to prejudice and social injustice, but you have to act on what does poverty cause. It causes you to have less knowledge, it causes you to have less access to care. It causes you to be fearful of the environment and all those things. We need to shift it back to a human concern, to concern that an individual patient, irrespective of their ability to pay and the educational level, can, in a rapid way, get into and through the healthcare system, particularly when they have a lethal disease. 00:24:53:13 - 00:25:31:04 Dr. Freeman And the other side of it is if you don't pay for it in the beginning, you will pay for it in the end. There is no doubt about it. When people died from cancer, it costs them and society. So when a take a change and shift over to a system where you're directing your thoughts toward the movement of everybody in a timely way to an end point within the healthcare system. 00:25:31:06 - 00:25:37:16 Dr. John Stewart Doctor Freeman, it warms my heart to hear that you won the psychiatry award. I won the Psychiatry Award upon graduation from Harvard Medical School. 00:25:37:16 - 00:25:39:02 Dr. Freeman And is that right? 00:25:39:04 - 00:25:47:05 Dr. John Stewart Yes. And I also won the Jack White Award. Yes, with Mickey Syphax.. So yes, that story was amazing. 00:25:47:07 - 00:25:47:13 Dr. Freeman Yeah. 00:25:47:13 - 00:26:04:15 Dr. John Stewart So, you know, we know that life is all about relationships and and, you know, it's chronicles about your relationships with LaSalle D. Lefall. You know, Doctor Rob Winn is in Richmond, so we've got to give a shout out to your relationship with Arthur Ashe. Can you talk to me about how your relationships with those two individuals have shaped you? 00:26:04:17 - 00:26:38:05 Dr. Freeman Well, LaSalle was just a little ahead of me in training for a few years. LaSalle was one of the most brilliant people that I've ever met. So when I, when I went into surgery at that time, I did not know LaSalle in the very beginning. I was relaying to Burke Syphax. Burke Syphax, who was the head of surgery at that time? 00:26:38:07 - 00:27:11:12 Dr. Freeman Burke Syphax was a great teacher to me because he dealt directly with the patient. He would he would put his hand on the abdomen to examine the patient. He wouldn't just talk from the side. So he taught me that. Now when LaSalle came on, I kind of a I felt like he was, he personified as a young man 00:27:11:18 - 00:27:53:01 Dr. Freeman what Syphax was teaching more than anyone else. And then. So those two people had a very deep effect. In fact, I went into surgery because of Syphax. And after seeing LaSalle he showed me the ways that a young person like me might have a guide on how to go forward. So those were two heroes for me, in directing my life along the line of surgery. LaSalle and I stayed in touch until he died, I was with him. 00:27:53:03 - 00:28:20:01 Dr. Freeman I think he was one of the most brilliant people that I have ever met who stayed on point all the time. There's something about life that's important that is, you have to stay on course. And he stayed, he never went off course. He kept getting better and better. He would you get to be president of the American College of Surgeons. 00:28:20:03 - 00:28:34:24 Dr. Freeman He was well loved by everyone who said a wonderful example for, not only for me, but for many, many, many people. So so those are my heroes. 00:28:35:01 - 00:28:39:22 Dr. Winn Now, you know, I'm down here in Richmond and Massey, so, you know, Walter Lawrence was the other guy who played tennis. 00:28:39:22 - 00:28:42:20 Dr. Winn Did you guys ever get a chance to play? 00:28:42:22 - 00:28:52:09 Dr. Freeman I never played him, and I knew about him. Yeah, no, but, I know Arthur Ashe, you know, I actually played Arthur. 00:28:52:10 - 00:28:55:18 Dr. John Stewart Yes, yes, that is that is well chronicled. 00:28:55:20 - 00:29:28:23 Dr. Freeman The Arthur, Arthur was 16 years old, and, I was ten years old. I played him in a tournament. He whipped pretty bad, you know. But I felt so bad about it, the guy was a 16 year old, it wasn't that great. But, it was contested. I felt bad that a 16 year old would beat me. But then soon after that, he had been Chris Crawford 00:29:29:00 - 00:29:52:08 Dr. Freeman at Forest Hills after that. So I didn’t feel so bad because it became the world champion. So but but he he was a really fine young man and saw him develop with Rowan Johnson in Lynchburg, I saw I, I met Arthur when he was eight years old, and I saw him develop to be the world champion. 00:29:52:10 - 00:30:20:19 Dr. Freeman I, I was selected when I was 15 before Arthur to play tennis by Whirlwind Johnson. They wanted, they were pushing me as the black champion to get into, you know, USTA. But my mother made me withdraw because John want me to live with him, and she wanted me to go to school. So. So that's what happened. 00:30:20:21 - 00:30:40:19 Dr. Winn You know what? Thank you for sharing with us. And, for me, you were one of the shining lights, you know? I mean, you you. It's interesting how humble you are for what you did. Because your thing of navigation has actually lighted a new fire in many of us, again, I'm cancer center director, but it's based on community first, second, third and fourth. 00:30:40:21 - 00:30:51:16 Dr. Winn And I actually give credit to you and people like Dr. Lafalle, and doctor Walter Lawrence. So I just want to say thank you for spending some moments with us. 00:30:51:18 - 00:30:52:23 Dr. Freeman Thank you so much, I appreciate it. 00:30:52:23 - 00:30:56:00 Dr. Winn Thank you so much. Good to see Doctor Freeman.