So can you explain that study that was really interesting?

yeah so this was really a work of passion for me frankly i was i was a little bit dismayed at the literature that was out there and i found you know for one thing much like and i have to put myself in here much like the cross-sectional study that i just talked about that i did i found that a lot of people do studies like that on disparities because if you have any kind of database that has a outcome that you're interested in a palliative care outcome or any other outcome that you're interested in and has variables on race and ethnicity, it's really easy to produce a disparities paper and say, hey, look, it was different by these groups.

So literally, there's hundreds of studies that show that minoritized patients receive more intensive and potentially burdensome end-of-life care when compared to white patients.

And then there's a much smaller number of people that do more in-depth studies or really try to parse out causal mechanisms.

So it seems like there's a lot of people out there doing a one-off disparities paper and less sort of follow-up.

And so we aim to do a systematic review we wanted to look at the the literature for the prior 10 years and just as you're saying also look at where the attention is focused because my my hunch was that there was a lot of attention focused on those that are minoritized groups themselves, thinking about health literacy, thinking about cultural beliefs or quote-unquote barriers or religious beliefs, and less about, you know, how the healthcare system could be producing these disparities itself.

And that's what I really like in the mid-2010s, I think the National Institute of Minority Health and Health Disparities, NIMHD, they had created this framework that looked at multiple domains of causal mechanisms.

But yeah, in what ways do you think bias has shown up in the recent pandemic in the COVID-19 era?