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I am from a small town
called Kyle, South Dakota,

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on the Pine Ridge Indian Reservation.

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Anyone ever been to Kyle, South Dakota?

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One? That's one more than usual,
actually, in a crowd this size.

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Very impressive.

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It is a very small town
on the reservation.

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And, the original name
of Kyle, South Dakota

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is Phezuta haka,
which means Medicine Root.

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In this region, there are actually
a lot of medicine men

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who come from there,
historically and in modern times.

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I was very fortunate
to grow up in a family

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with a lot of traditional healers
and medicine men.

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My Lakota name is Pejuta Wicasa,
which means Medicine Man.

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I always like to joke, when people say,
"What does Pejuta Wicasa mean?"

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I say, "It is Lakota for 'Steve'."

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(Laughter)

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I was named after my grandfather.

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I am very fortunate to come from a family
with a lot of traditional healers.

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As I was growing up,
I was able to learn a lot

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about our traditional ways of medicine,
our traditional ceremonies.

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I really was on that path of becoming
a traditional healer as I was growing up.

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When I was in college, I actually went

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to Arizona State University
for undergraduate,

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I was doing really well in school,
so I was encouraged to become a premed.

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I was really worried about what my uncles
would think about that.

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Does it mean I am going to the dark side
of medicine, going to medical school?

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Because I have heard all the stories
of how our traditional healers

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maybe have not been as respected
as they could be,

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in modern medical situations.

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But actually the opposite happened.

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They were not discouraging, if anything,
they were very encouraging.

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One of my uncles,
Ray Takes War Bonnet said,

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"I think this is a good idea.

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But if you do this,
go to their best schools,

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learn their way of medicine,

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and know it at least
as well as they know it,

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because that's the only way you will be
taken seriously as a medical doctor."

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I was very fortunate, I was able
to go to Stanford for medical school,

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and I have my MPH from Harvard.

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I have worked in a number
of different arenas of health.

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This is a picture of Little Wound School,
on the Pine Ridge Reservation in Kyle.

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On the left is where kindergarten is,
on the far-right is high school.

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One of our big challenges that we face

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is that less than half of the students
who start kindergarten,

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actually graduate high school.

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Less than half.

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So, we have a big challenge
in terms of leadership,

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in terms of educated people
going into health professions,

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education, law, etc.

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So it's a big challenge.

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We have a lot of rich history,
but our biggest issue

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is that we have now, a lot of poverty,
economically and educationally.

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We also have challenges
with access to healthy food

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in our impoverished communities.

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This is a picture of the Kyle Cafe.

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I think what they've learned here

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is that you can bread and deep fry
just about anything

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(Laughter)

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and serve it for lunch.

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The other reason I like this picture,

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you can see the rez dog chasing
the little girl down the street there.

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(Laughter)

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Well, right across from that,
is the gas station,

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which also doubles as the grocery
store, believe it or not.

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So, if one wanted to have
access to healthy food,

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they go to the gas station.

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It is all prepackaged food.

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Lots of sodas, lots of chips,

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lots of things that can be preserved
for a long time on a shelf.

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Is that healthy food?

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Is that good for us?

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Does it lead to things
like high rates of type 2 diabetes?

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Well, unfortunately it does.

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There is also a concept in public health
called the poverty tax.

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When you live in a food desert,

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or a population that does not
have easy access to healthy choices,

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they tend to pay more for healthier foods.

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So, trying to buy fresh fruits
and vegetables here

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is much more expensive
than it is in Fargo.

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Isn't that remarkable?

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So, less money, and they have to pay more
for healthier food choices.

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This is a picture of one of my relatives.

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You can see he has an amputation.

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The amputation is from poorly
controlled diabetes.

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There is a program
in many of our communities,

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in which if you need a wheelchair
and you have an amputation,

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they will build a ramp for you.

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That is wonderful, 
so you can have access to your home.

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But wouldn't it be better if we invested
in healthy food in the first place?

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So we wouldn't have to pay
for extra services after-the-fact,

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when things have
gone wrong, unfortunately.

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But we face all kinds of challenges
trying to manage things like diabetes.

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Here in North Dakota,

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this is data from the North Dakota
Department of Health,

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if we look at the prevalence of diabetes,
we can see that American Indians

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have about twice as much diabetes
as the white population in North Dakota.

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About double among adults.

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So, if you have double the prevalence,

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you would expect to see
double the mortality rate.

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Right? Probably twice 
as many people dying from the disease.

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In truth, the mortality rate is about
six times higher for American Indians.

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So, think about that.

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There is a disparity
within the disparity, right?

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Higher prevalence, 
even worse in terms of rates of death.

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Now this is true in the Dakotas,

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it is true for American Indians
throughout the nation,

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but it's also true of indigenous 
populations everywhere in the world.

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Two of my colleagues,

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on the left is Alex Brown,
he is aboriginal Australian,

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and in the middle is Terry Ehau,
he is Maori from New Zealand.

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They are both medical and public health
faculty in their respective nations.

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They see the exact same pattern
of health disparities and poverty

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in indigenous populations
in Australia, New Zealand,

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and in other parts of the world
that we do here, in the US.

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Well, what can we do about this?

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Does it have to be this way?

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Are there things we can look at,

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in terms of our traditional ways,
and how we used to live,

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that we can recapture and move
forward in modern times?

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So, when I start this discussion,

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I always like to start
with a brief history of medicine.

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Very brief.

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2000 BC - Here, eat this root.

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(Laughter)

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1000 AD - That root is heathen,
here, say this prayer.

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(Laughter)

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1800 AD - That prayer is superstition,
here, drink this potion.

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1900 AD - That potion is snake oil,
here, swallow this pill.

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1950 AD - That pill is ineffective,
here, take this antibiotic.

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2000 AD - That antibiotic is artificial,
here, eat this root.

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(Laughter) (Applause)

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So, we have kind of come
full circle, haven't we,

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getting back to the roots of medicine.

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OK, that's a bad pun,
I recognize that now.

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What is really interesting when we look
at the history of modern medicine,

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all systems of healing used to have
spirituality incorporated,

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even modern medicine.

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But we saw a huge change
in the twentieth century

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because of advances in science.

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And probably the biggest scientific
advance that we found in modern science

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is the discovery of antibiotics.

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So, we could suddenly cure
infectious disease that used to be deadly.

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But if we look at antibiotics,
that is actually naturopathic medicine.

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The original antibiotics were actually
isolated from mold and fungus.

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The reason is that for millions of years,

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bacteria and mold have competed
with each other for space and food.

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So, they developed
chemicals to kill each other.

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So, penicillin comes
from Penicillium, which is a mold.

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Streptomycin comes
from Streptomyces, another mold.

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So in truth, the biggest scientific
advance in modern medicine,

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is that we finally harnessed
the healing power of mold.

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(Laughter)

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Makes me wonder what mildew
might have to offer us.

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(Laughter)

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Now what is interesting, when I talk
to my uncles who are traditional healers,

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they talk about how over the years,

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they would use different types
of mold for open wounds,

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to help clean an open wound,
and actually use mold.

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So historically our tribe
has been using antibiotics

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for thousands of years, potentially.

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And historically, we lived
in a much healthier way.

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We had hunting and gathering,

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so it was an all-organic diet
at one time, of course.

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Many of our tribes also were farmers.

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These are pictures,
on the left from Oklahoma,

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on the right from New Mexico.

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We had traditional farming
and very healthy food as a result.

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Traditional foods are whole foods,
they're not processed or refined.

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We also had a lot of variety of foods.

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Did you know there is
over a hundred varieties of corn?

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When we think of corn now, we just
think of yellow, sweet corn, right?

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That is pretty much all that we have
available to us, in terms of easy access.

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But there used to be
many varieties of corn.

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There are some varieties
that actually helped lower blood sugar,

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believe it or not.

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So, it was not all
just corn syrup, historically.

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(Laughter)

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So we have seen a dramatic change.

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Is it possible to get back to this?

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Well, we do have to recognize
we have a big challenge,

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because modern-day hunting
and gathering is quite different.

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(Laughter)

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And unfortunately, we have the issue
with access to healthy food.

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There is also what is called
the commodity food program;

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- Some of you may have heard of that -

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It is with the United States
Department of Agriculture,

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and it consists of things
like sugar, flour,

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it used to be lard,
now it is vegetable shortening,

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white bread, some sort
of Spam-like meat product,

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I'm not exactly sure what that was,
powdered milk, grape juice,

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which I think was just sugar water
with purple food coloring.

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And they used to actually
distribute pure corn syrup.

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On the label it said,
"Use on your pancakes."

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Now, is it any wonder we have
such high rates of diabetes,

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and high rates of death due to diabetes?

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We will not invest in healthy food,

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but when you have an amputation,
we will build you a ramp.

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Is that logical?

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Is that intelligent?

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Is it ethical?

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Well, from my perspective, no, it's not.

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There is much that we need to do,
much that we need to reconsider

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in terms of how we address
health in the United States.

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So one of my favorite old photographs,

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this is actually one of my
ancestors from Pine Ridge,

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and he is a medicine man.

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You can see what he is doing here

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is very different than what we see
in the modern clinic, isn't it?

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He is touching the patient.

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He is praying with the patient.

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They are with the earth.

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The family and the community
are participating in that healing process.

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And for those of us who participate
in traditional ceremonies,

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the power that you feel,

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when you know your whole community
wants you to be better, is indescribable.

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We do not tap into that healing power
very well in modern medicine.

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We have a lot of laws around privacy
and health information protection.

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There is a law called HIPAA that deals
with medical information privacy.

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So when I am talking
to a group of physicians,

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I always acknowledge,
this might not be HIPAA-compliant.

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(Laughter)

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But it is meaningful and powerful healing.

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Do we have the opportunity
to embrace this?

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Do multiple cultures have the opportunity
to embrace what they once had,

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in terms of a healthier lifestyle?

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Symbolism is very important to us

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in many traditional 
American Indian cultures.

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I am sure many of you
are familiar with this symbol.

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That is a single serpent
wrapped around a staff.

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This is the Staff of Asclepius.

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That is the ancient
Greek symbol for medicine.

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Single serpent wrapped around a staff.

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And I am sure you have seen this one.

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Two serpents wrapped around
the staff with the wings at the top.

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That is a Caduceus.

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That is the ancient Greek symbol
for traders and thieves.

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So somewhere along the line,
someone really screwed up, didn't they?

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I think they thought,
"It is prettier, it has wings,

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so we'll call this one medicine."

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If you are watching the news,
and see this symbol,

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and they say "Health Alert,"

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you know the traders
and thieves must be sick.

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(Laughter)

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Well, this is a Medicine Wheel.

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This is our symbol for many things,
including medicine and healing.

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It is a beautiful symbol.

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There is a lot of complexity built
into the simple circle and cross.

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The cross demonstrates things
that are opposite to each other,

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like east and west, or north and south.

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The circle, connecting
the ends of the cross

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shows that all things
are connected on this earth.

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In a very real and basic way,
from the perspective of this room,

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we could say east is opposite from west.

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Right, we can agree, those are opposite?

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But in truth, on this Earth,

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if I go east, and I go east,
and I keep going east,

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eventually where am I going to wind up?

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Yes, right here.

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So in truth, I am over there,
I am over there, I am over there,

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I am over there, and I am right here.

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It is all truly connected in a circle.

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The way we look at health
and an individual,

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whether it is the health
of the individual,

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or the health of the family and community,

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we look at four main components:

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spiritual, mental,
physical, and emotional.

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In order to be healthy,
one is in balance, in all four directions.

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Now, another word for a modern
doctor is 'physician', right?

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So, we are saying as physicians,
we deal in the physical arena.

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'Physical' and 'physician' have
the same Latin root, 'physic',

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which means the natural sciences.

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So, it is very narrow focused
in modern medicine,

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just focusing on 
the physical aspect of health.

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I have done a lot of work also
in alternative medicine.

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In addition to being a family doctor,
I have training in medical acupuncture,

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homeopathy, 
and botanical medicine as well.

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In my circles with traditional healers,

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but primarily with alternative
medicine providers,

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it is really interesting,
I have heard them say things like,

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"We have found that when we incorporate
spirituality into the healing system,

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it is much more fulfilling."

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From a Lakota perspective,
that is kind of like saying,

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"We have found that apple pie tastes
better if it has apple filling in it."

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(Laughter)

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So I tell them, "That is very wise."

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(Laughter)

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Another one of my favorite photographs
is actually Chief Red Cloud,

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when he was meeting with one
of the federal government agents.

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They were doing 
the land settlements for the reservations.

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The reason I like the photograph,

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is there is a lot of symbolism
built into this.

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In the traditional Lakota way,
you are supposed to be quiet and humble.

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You can see he is in a seated position.

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Also, a way to show respect
is to look down.

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Actually, if you look someone in the eye,

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that can be considered
a confrontational behavior

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so he is looking down.

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And then look at the federal agent
and the symbolism there.

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Standing over him
from a superior position,

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talking down to him,
and looking him right in the eye.

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Now from each person's
cultural perspective,

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they are behaving appropriately.

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But my question is, at that handshake,
how well do they understand each other?

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How well does Red Cloud
understand the agent?

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How well does the agent
understand Red Cloud?

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Well, if we look at the land settlements, 
obviously not very well. (Laughter)

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Let us look at this
from another perspective.

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This is a traditional American Indian
person being diagnosed with diabetes.

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He is working with a well-trained,
non-Indian scientific physician.

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Is it possible that they could have
challenges in communication?

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Well, when I think about diabetes,

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and when I think about my modern training
in medical school and residency,

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we focus on insulin-resistance
and high blood sugar.

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But when a patient
is diagnosed with diabetes,

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do they go to the doctor and say,

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"Gee, Doc, my blood sugar
feels like its 362?"

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No, they don't.

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But are there emotional concerns?
Is there depression?

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Is there anger? Is there denial?

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In the spiritual realm,
I have heard patients say,

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"Why would the Creator do this to me?"

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"Why would the Creator
do this to my family?"

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"What did I do wrong to deserve this?"

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In the mental realm, 
is there anxiety? Is there stress?

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Are they worried about the future?
Well, absolutely.

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And if all we are is physicians,

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and all we can tell our patients
is that your blood sugar is too high,

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we are not addressing the issue
from the patient's perspective.

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We are just addressing
the scientific perspective.

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I would put forth that all of us
can learn from this.

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All of us can be more holistic
in the way we deal with each other.

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I would like to close
with a picture of Black Elk.

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He was a Lakota spiritual leader
and medicine man from the late-1800s.

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We did not have
a written language in Lakota.

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We had an oral history.

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But he met with a writer
in the early-1900s,

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and they wrote the book 
"Black Elk Speaks".

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This is my favorite quote from him,
"Of course it was not I who cured.

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It was the power from the outer world,

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and the visions and ceremonies
had only made me like a hole

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through which the power
could come to the two-leggeds.

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If I thought that I was doing it myself,

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the hole would close up,
and no power could come through."

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What he is talking about is humility,

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recognizing that he does not
own the healing power.

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The best we can do is try to access it,
and channel it in the right direction,

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but as soon as we believe we own it,
we no longer have access to it.

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Now, that is the core value in Lakota.

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It probably doesn't surprise you

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that was not the core value I learned
in medical school, humility.

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But I think we all can be 
more humble in our approach.

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I think that we all could approach
each other with more respect,

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even if we have different backgrounds,

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we have different histories,
and we have different cultures.

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And let us remember that we all drink
from the same stream of consciousness.

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We are all connected 
by that same stream of consciousness.

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We are all related.

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What we do to each other,
we do to ourselves.

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Act kindly toward my people,
for indeed my people are your people.

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(Lakota) Thank you, 
everything is connected.

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Thank you all very much.

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(Applause)