Thank you to German Orrego and the Harvard School of Public Health student government for inviting me to present this afternoon’s Global Chat, "Mixing Up The Medicine: Hip Hop and Health Care at RapGenius.com." I sent out a quick invite on Twitter to attendees of this week's Association of Writers and Writing Programs national conference at the Hynes Convention Center. On the off-chance anybody affiliated with AWP decided to stop by this afternoon, welcome to the nation's home to the fuel for your life's work. The House of God is a few doors down.

What makes Rap Genius great is that if you didn't "get" that joke, you can click on the link and an annotation will open up to remind you or to help you out. And if you don't like the annotation, or you thought the joke was stupid, you can register for a free account and say so to the hivemind for posterity, or whatever platform for text comes next. Following this hour, this presentation will be available on Rap Genius via Creative Commons license for you to do just that. If you are interested in what you hear, please comment on the site and share it with your family, friends, and colleagues.

Before beginning my presentation, I need to cite a number of conflicts of interest. In fact, that's why I chose to give today’s talk on Rap Genius on the Rap Genius platform rather than on Power Point. This is the first time I've ever drafted a presentation on Rap Genius, and for someone prone to asides in my drafts, the format forces concision.

First, my remarks today are drawn in part from two earlier posts on this site, "HIPAA Hooray: Health Insurance and Hip-Hop" and "Mixing Up The Medicine" in A Taste of My Own Medicine, an essay collection on medical education that I published as part of Amazon.com’s Kindle Singles narrative non-fiction series. Second, it will be impossible for me to attribute all the sources I used, and the implicit assumption in RapGenius is that the link back to the original source is the attribution, like on Wikipedia.

Now that we've gotten that out of the way.

To clarify, I am not here to talk to you about the history of Rap Genius. For that, you should probably be reading "Signifying Rappers" by David Foster Wallace and Mark Costello, which was written decades before Rap Genius existed as a jokey Rap Exegesis wiki among nerdy ex-Yale English majors. You will learn how Rap Genius works by watching me use it to present this talk, and if you'd like you can follow along on your own laptops.

The title of my talk is “Mixing up the Medicine,” a line that may be familiar to some in the audience as the title of the single “Mixing Up the Medicine,” self-described "rap penicillin" from Juelz Santana and Yelawolf.

No?

I hope we know who this is.

With this presentation I hope to draw you back to how a few hip-hop artists think about the government from the perspective of the pavement. A lot of people complain that the health care insurance crisis is impenetrable to the layman. And "government from the perspective of the pavement" sounds unfortunately like something David Byrne from Talking Heads would've said on Fear of Music, and whatever his taste in music he is certainly one of the richest and whitest men alive. But I reference David Byrne and Bob Dylan because I wanted to talk about income inequality in the Silicon Valley counterculture. By that I mean how Silicon Valley wealth is like hip-hop industry wealth, and what that has to do with health: I mean it comes down to money.

This is a photograph taken by Rap Genius co-founder and managing editor Mahbod Moghadam at the home of Ben Horowitz, a chief investor in Rap Genius following a public announcement late last year. On the left we see Nas—my hope is that he needs no introduction—and Mark Zuckerberg, founder of Facebook. (I long for when he needed introduction.) Horowitz is in the center. The backstory of this photograph is either pretty funny or pretty appalling depending on how you look at it, but ends in Mark Zuckerberg’s publicist complaining to the San Francisco Chronicle that Mahbod posted the photograph without his permission and Mahbod saying something obscene about Zuckerberg that led him to recant and adopt a positivity mantra that he then posted for annotation on Rap Genius.

Very little attention has been paid in that coverage to the woman on the right, Priscilla Chan. She's Mark Zuckerberg’s wife, a Harvard alum and a pediatrics resident at the University of California at San Francisco. Of note, Dr. Chan used to be an elementary schoolteacher through Teach for America and is interested in child health research.

And this is Mahbod with co-founders Ilan Zechory and Tom Lehman and a reporter. My role in the website management is mostly irrelevant to this presentation, but here I’ll disclose that they’re friends of mine from college and I helped them build editorial content as a medical student at NYU.

And this is DJ Kool Herc, who hosted the first hip-hop turntable events at 1520 Sedgwick Avenue in the Bronx in the mid-1970s. Several years ago, DJ Kool Herc was diagnosed with debilitating kidney stones and could not afford to pay for his treatments despite world renown for hosting the first turntable party. The cultural critic Jeff Chang, who had Kool Herc write the introduction to his massive 2005 hip-hop history Can’t Stop Won’t Stop, happened to find out via the artist's website. Chang helped mobilize a fundraising campaign among fans and academic and journalism colleagues, and Kool Herc did relatively okay.

But then relative is not enough. Who can tell me the diagnosis from the blood smear? No pathologists or heme-onc fellows here? Well, here we have thrombotic thrombocytopenia purpura (TTP), which you can tell from the platelet feature. It has autoimmune origins but I’ll spare you the mangled version here.

There, on the peripheral blood smear, is a representation of what did in J Dilla, who died of multiorgan complications from lupus when he was uninsured. Every year since his death there have been health insurance fundraisers all over the country in his honor. Who can read that slide, though? I can barely identify a platelet in there. So here is that story, and that of Phife Dawg from A Tribe Called Quest, and Poetic from Gravediggaz, as told by the artist themselves and their families.

And if you have time, here is Phife Dawg's diabetes story again.

There are many speculations about what predisposes rich people to illness even if they come from poor circumstances. I wish we had time to discuss the science of social epidemiology today, but I'll be more of a pragmatist: Recall that Jay-Z and Beyonce spent a reported $1.3 million to rent a floor of Lenox Hill Hospital in New York City for the birth of Blue Ivy. The real sticklers for purity among us could argue that Beyonce's participation in Michelle Obama's "Let's Move" childhood obesity campaign is an implicit endorsement of "corporate wellness" and personal responsibility, but I will not quite go there. Who interest me are the hundreds of aspiring rappers—and, we have heard, more than a few artists from the golden era of hip-hop—who lack basic health insurance. What interests me is the fragmentation of their community organizing around such an obvious injustice -- one in which they are ardently engaged as individual artists at the height of their success. As an outsider looking onto that community, I can only introduce you to their stories on one of the few very high traffic online cultural exchanges we have going. My point? We have already heard the stories over and over, and somehow the stories never translated into public policy campaigns. That a few are now is important to me, and should be to you as clinicians even if you know nothing about rap.

Doctor-patient relationships are really ubiquitous in hip-hop when you think to look for them. And they are not as goofy as these well-known examples about resuscitating hip-hop. Remember when Cam'ron described his diagnostic work-up for I.B.S. at the Mayo Clinic, or when Jadakiss needed a Medicaid card, or when Fabolous told us his flow was so sick it needed extra health care coverage? When pressed--by which I mean asked--virtually all of these rappers say something about the need for national health insurance. Lupe Fiasco’s “National Anthem” says flat-out that universal health care is a human right. Yet in researching this presentation I was only able to find a series of asides about underinsured and uninsured rappers on hip-hop gossip sites. The lengthiest pieces I found were on a spinoff of Slate magazine called The Root and another website called The Urban Daily. As some of you in the audience may know, I don't read, and so I need Rap Genius links to Hip Hop Wired and The Source and XXL in the like to maintain function.

This is the real kicker: When you search for KRS One, a legend and a prominent social activist for musician health insurance, you get an insurance exchange.

Maybe it will not come as a surprise that Genius Media Group, Inc. advertises "bomb health insurance" to employees, which last time I heard included 17 people in Brooklyn and Malibu Beach. And I know from those guys that it was really hard when they didn't have investors with their back. While I hesitate to call Silicon Valley venture capital relationships social solidarity--luckily, they are not investing in me--that is what some people still hope to get out of the Internet, a democratic social platform. Unfortunately I don't see it yet. I don't think we can see it if we don't free artists to create by insuring them cradle to grave. How else to write about lifecourses otherwise?

So how do we get from A to B?

As a public health professional I reflexively say "the community!" But where is the community? The online community that uses Rap Genius is not linked to the community that needs the help, which is to say an older generation that does not use the Internet in the same way.

One approach has been to create the new community: In partnership with Columbia Teachers College and GZA from Wu-Tang Clan, Rap Genius sponsors Science Genius, an education model incorporating hip-hop into science, technology, and engineering instruction. The idea there is to recruit students who identify strongly with hip-hop community as its future caretakers, whether as doctors or as basic scientists. Science Genius was an existing effort from the community that then became part of Rap Genius: They shared the same platform.

For other community organizers the approach has been to bring the older audience's stories to the Internet. In the case of DJ Kool Herc, they were quite successful in doing so, but I worry the design of some of the existing project websites doesn't inspire confidence. There are other smaller operations in New York City. I know New York best having worked there, but there may be others, and please comment on the site for reference if you know where they are!

Among the more interesting projects going is a 501.3(c) non-profit called Hip Hop Pioneers formed after Rodney Stone, a.k.a. Rodney C, featured in the 1983 film Wild Style. Rodney C stopped smiling for lack of appropriate dentures. It organized Tribute Showcases to fundraise for at least 25 hip-hop artists who registered with the organization, something like an insurance network of its own. I first heard of it when a woman affiliated with the program E-mailed my medical school looking to lecture the class. Unfortunately I got bogged in the boards. Barbara, if you see this presentation, this is for you and I want you to tell me via Rap Genius everything I got right and wrong. Merely by mentioning this topic in an academic space I hope I have done some good for the cause. It made it very clear to me how little I know, but Rap Genius means to help people help one another drop science.

Now, usually I don’t do this, but there is one thing here I am sure is right. And that is the thing I am about to tell you: I urge you to throw your support to H.R. 676, the national health program "Medicare-for-All" legislation in the House of Representatives. Consider state-based efforts to promote single payer insurance programs under the waiver system from the state exchanges. There will be one in Vermont inspired by health economics research by Harvard School of Public Health’s Bill Hsiao, a bill up for vote in the New York General Assembly. In fact I think there's something I forget I think in Kentucky -- yes, Kentucky! Somewhere Southern. It's coming everywhere because of stories like these, and even if we exist simply to tell them, we did our jobs better for the art that sustains us and our patients.

Thank you for your time. I'm happy to take any questions from the audience.