Dr. Morgan Philbin is an Assistant Professor of Sociomedical Sciences at the Mailman School of Public Health at Columbia University. Morgan’s work explores how social-structural factors impact health outcomes for vulnerable populations, particularly racial/ethnic and sexual minority youth. Morgan talks with Valerie and Carly about her research on cannabis policies, challenges in studying how policies impact health, and the role of scientists in policy change. Morgan describes how her experiences studying and working abroad have informed her research, and advises students to take time off before starting graduate school.
Read more about Dr. Philbin’s work here: https://www.publichealth.columbia.edu/people/our-faculty/mp3243
Follow Dr. Philbin on Twitter: @morgan_philbin
Dr. Morgan Philbin is an Assistant Professor of Sociomedical Sciences at the Mailman School of Public Health at Columbia University. Morgan’s work explores how social-structural factors impact health outcomes for vulnerable populations, particularly racial/ethnic and sexual minority youth. Morgan talks with Valerie and Carly about her research on cannabis policies, challenges in studying how policies impact health, and the role of scientists in policy change. Morgan describes how her experiences studying and working abroad have informed her research, and advises students to take time off before starting graduate school.
Read more about Dr. Philbin’s work here: https://www.publichealth.columbia.edu/people/our-faculty/mp3243
Follow Dr. Philbin on Twitter: @morgan_philbin
I'm Valerie Earnshaw.
Carly Hill:I'm Carly hill.
Valerie Earnshaw:and this is Sex Drugs and Science
Carly Hill:Today's conversation is with Dr. Morgan Philbin. Morgan is an assistant professor at the Mailman School of Public Health at Columbia University, her work explores how social structural factors impact health outcomes for vulnerable populations, particularly racial, ethnic, and sexual minority youth.
Valerie Earnshaw:We're continuing our focus on policy this week by hearing from Morgan about how policy shapes health outcomes, Morgan studies several different policies and health contexts. So for the most part, we focused in on cannabis policies with her because we are Sex, Drugs, and Science. And we hope that you enjoy this episode with Dr. Philbin. Dr. Philbin, welcome to the podcast. It's great to see your face.
Morgan Philbin:Wonderful. Seeing both of you as well. Thank you for having me.
Valerie Earnshaw:Thanks for joining us. So we are going to start with a little bit of background. So you're joining us from New York City, but you are a native, and I would say like very proud lover, of California.
Morgan Philbin:I've maintained a lot of California pride, even though I haven't lived there in a really long time,
Valerie Earnshaw:Well, especially, you know, when you talk about where you grew up, I mean, it sounds so beautiful and idyllic, like Carly, Morgan was telling me that where her parents live and where she grew up, it's like nestled it's like on the shore nestled between these like gorgeous volcanoes. So just this idea of like Morgan, just like hiking and biking and like running on the water all the time when she's out there.
Carly Hill:So it's like every kid's dream.
Morgan Philbin:Yeah It's pretty great. Actually, we sort of joke about it. Like we can go for a hike in the morning and then we can go to the beach in the afternoon. It's a wonderful place. I got really lucky that I got to grow up there. I thank my grandma all the time, actually for moving there in the 50's.
Valerie Earnshaw:Yeah. And it's a little bit of a university town, right? There is a university there and your dad works, worked for the university while you were-- or still does?
Morgan Philbin:My grandfathers, actually, my dad taught at a community college nearby, but my grandfathers were both engineering professors there back when you can do that with an undergrad degree, which I didn't realize,
Valerie Earnshaw:oh, I didn't really, I didn't catch that in the background either. Okay. That's no, that's impressive. I, yeah. And I definitely count folks, you know, working at community colleges, as local professor types. So, so, okay. So you grew up in this family where you had this history of grandparents working in academia and your dad worked in academia. And just by way of a little bit of detour, one of the things that I find to be super interesting about you is how, how much time you spent, like getting off the path, getting back on the path. And your parents sort of role modeled this. So when you were in middle school, it sounds like your dad, um, or it was your dad, right, who got a Fulbright to go to Denmark, right?
Morgan Philbin:Yeah. So he got a teaching Fulbright with the requirement being, we had to move somewhere that spoke English or the chemistry would be in English. So he taught in an international baccalaureate program and then they just put my brother and I in local Danish schools and sort of figured that, you know, we make it work and we did, it was, I would basically could do math and English class. Although I learned... I didn't realize as a 12 year old that you weren't supposed to correct the teacher. She kept talking about... this was around the holidays. And she was telling the story of this elf that was eating porridge out of a bowel, and I kept trying to explain to her that that was not what you would say, that it was a bowl. And she was like British pronunciation. And I was like, no, bowel has an E in it it's different. And then I told my parents and they were like,"don't do that". They were like..
Valerie Earnshaw:For as long as we're here, people eat porridge out of bowels. That's the way that it is here in Denmark...
Morgan Philbin:They were like"I know you think you're being helpful, but you're actually undermining the teacher."
Valerie Earnshaw:That's amazing. Well, Hey, that's like a good lesson in hierarchy from an early age.
Morgan Philbin:So we were there for two years. So I actually, probably given what I heard from my friends, luckily avoided junior high in the United States.
Valerie Earnshaw:Oh yeah, yeah, yeah.
Carly Hill:I think so!
Valerie Earnshaw:Yeah, that's definitely not, definitely not an experience that one would need to go through for sure.
Morgan Philbin:Yeah. So I came back, so yeah, so I did... so I grew up in, in actually the same town and my parents still live in the same house that they brought me home to when I was born. But aside from that two year stint in Denmark that's where I've always gone home to.
Valerie Earnshaw:Yeah. So, okay. So we, we grew up in California. We spent some time in Denmark. We, we wrap up, um, high school in California and then you check out to the east coast for college because you went to Wesleyan university, which is in Middletown Connecticut. And I think I told you this, Morgan, I don't know if we've talked about it, Carly, but the husband character Brian is, is like the only person, probably on the planet who has such a love of Middletown, Connecticut, that he wants to have a vacation home there. It's just like random town in Connecticut college town. He just, he loves it so much.
Carly Hill:Any like, are there bodies of water? Are there any like, sort of like vacation-esque characteristics too? No. Okay. So for the viewers trying to picture it...
Valerie Earnshaw:Not a vacation place.
Carly Hill:Okay, cool. Cool. That lines up for me. So just double checking.
Morgan Philbin:I was trying to think if there's anything in particular about Middletown that would draw other people there as a vacation spot. But I mean, there's some, there was a nice diner that has since burned down, there's a pond nearby but there are a lot of ponds in the state of Connecticut.
Carly Hill:Also the fact that you were like reaching for things and the first thing that came to mind was like"a diner!" Pretty much says it all. I think really.
Morgan Philbin:And it's probably improved since I left in 2004, but.
Valerie Earnshaw:Well, it's a, it's a super beloved town, by some, including, including Brian. But while you were there, you studied, um, psychology and government as well as international relations, which was interesting for me to see just tracking what you now study, because we're going to go there in the conversation. But now you study policy and you study the impact of policy on health. So did this sort of help to lay the foundation for some of the things that you're thinking about today?
Morgan Philbin:It did. I think the psychology piece definitely made me think more about individual level behavior and you know, why people do what they do. And I think how we often as researchers try to start from this place of, oh, what would be, what we would consider rational behavior and why do people do or do not do it. And then I think as I started studying international relations more, thinking about these structural drivers and then, okay, what constrains people to do that? And I think part of the other reason of sending international relations was I had just always been fascinated with how other political systems worked. And I think for me, one of the reasons I got into health and HIV more broadly is it really becomes the synergy of individual level behavior, policy drivers, structural factors like stigma and discrimination, communities, families. And so it's, it is about health and it is also about everything else. And so it was, there would always be so many different ways to study HIV, that it would always be interesting and important work. And I think that's true of a lot of diseases, but to that, for me, HIV felt so relevant because of so many different moving parts that were happening that affected again, whether somebody is even at risk, whether they get tested, whether they get engaged in care and how well they do in care.
Valerie Earnshaw:That's such a great observation. I mean, I also think about HIV as a really interesting thing to study or particular health condition to study because as a, as a stigma scientist, it's so profoundly stigmatized in so many areas of the world. So that's also really interesting that, you know, from this different frame that it's, it's a particularly interesting thing to study due to these other dynamics. So does this mean that... because I know that immediately after college, you went to Beijing, you lived there for a year, you were a program officer focused on HIV prevention and care among youth. So did you develop some interest in HIV while you were still in undergrad? I was wondering if it popped up there or if it popped up once you landed in Beijing.
Morgan Philbin:Yeah. That's a good question. I had popped up earlier. I think I had always been interested in more sexual health. I think that I was going to say sexual reproductive health. I mean, it's both, but you know, so on campus, I worked at the career resources center and so was working a lot with young people and tutoring programs. And so as part of that was involved with some, you know, lectures around sexual health and started thinking more about it. And I think for me, one of the reasons that drew me to HIV in China was the policy and the governmental response. And I think, not that the us is the model by any means, there are a lot of things that the us does wrong, but to see a place like China, where the government for many years just ignored it and pretended HIV didn't exist and actually jailed or expelled many of the activists who were trying to bring awareness to the fact that HIV was running rampant in certain communities. They didn't even acknowledge that HIV transmission was occurring among men who have sex with men in their annual report, I think until 2006. And they also, I saw often when we talk about HIV, when we're talking about populations at risk, we think about men who have sex with men, transgender women, sex workers, and people who inject drugs. But in China, there was this unique population of people in two main provinces and Hunan and Huanhai? Who donated blood. So in China, they don't have a, like a volunteer sort of mentality around blood donation. You can get paid for it, for donating plasma actually. And so what they would do is they would take people's blood and then slice off the plasma. And when they would do it, they pull it by type and then they would re-inject it. So it's an incredibly efficient way to transmit HIV, but this population was relatively insular. And so the Chinese government did very, very little to prevent it and to treat people once they found out. And so that's where a lot of the activism came because the people who made the decisions about the plasma donations were also political officials. And so we started getting these numbers where they were saying, you know, more people were on treatment than actually were living with HIV. And it was just so clear that that intersection of policy, and politics, and health was occurring in incredibly problematic ways. And so when I went, when I was in Beijing and went down to visit I, and at this point I'm 22, I remember touring some of the villages and setting up programs there. And somebody came out to me with this effect, this almost manifesto of sorts saying, like, take this to Beijing, give this to a journalist. Like we need to get this information out there. And nobody listens to us. And for me being like, I'm 22, I have no agency, obviously simply because of my race and my nationality, there was a perceived power, which I understand, but I simply didn't have. And then my colleagues, Like"don't take that. You don't want that". Like, that's going to put you in the... and just... So this idea of me realizing like how complicated HIV was as a problem in a country like China. And so that really got me into studying the policy piece.
Valerie Earnshaw:Wow. So I feel like, yeah, it's funny too. So what's so funny. So we're like, what, 10 minutes into this podcast episode? So Morgan was my first post. Like we were both vaccinated and Morgan came down to visit and we spent like four days hanging out. And then Brian, the husband was like,"you and Morgan talked for four straight days. Do you realize that?" He's like,"are you tired of talking?" And I was like, no, she could come for another four days and I could talk straight. And what's really amazing to me is how you can spend four days straight talking to somebody and not get all over their stories until you bring them on the podcast and tell them about how they became interested in HIV. That's so that's so interesting, Morgan. And yeah, I mean, the thing that I'm thinking about also is just how sometimes I feel like our policy, our policy environment is sort of like the water and w e're the fish, you know? And when you take us out of our current pond and you put them, put us in a different pond and you look around and you're like, oh, the water is different here or something. Like, I think that, I think sometimes you can observe things in an environment that's, that's a new environment, you know, that you may not think about as much or question as much in the one that you're living within. Did you find that to be the case for you? Or was that at all part of, y ou k now, what y ou're thinking about or how you think about it now?
Morgan Philbin:Yeah, I think that's a really good point. And especially because the only places I had lived abroad up until that point were Western Europe. So in Denmark and I had studied abroad in Spain in college, I mean, I spent a summer in China, but then went back. And so I think to go from a place where, you know, cultural norms are relatively similar policies were similar. Obviously Western Europe has a much better healthcare system than we do, but it is structured more similarly. And to be in a place where, I mean, going into some of the clinics, even when I was studying abroad, the university clinic, I remember a friend of mine had to go in and I think had the flu or something and the doctor pulled out like a pencil case and unzipped it. It started pulling out like the tools they were going to use to like, look at my friend's ear and this, and this idea of like, okay, this is how, obviously a thing from a disease transmission perspective. It's like basic tools aren't sterilized, you know, this is not where we need to be. Or a friend of mine had to get a colposcopy while we were there. And she went in and it was just a, you know, it was a giant room and there were just curtains, you know, and then a bed she could lay on, but there's no privacy. Right. And so when you're having a conversation and you walk in, everybody else knows why you're there. And so I think when we think about these issues of, you know, stigma and disclosure, and whether somebody comes in for care, those are things that in the US you know, there's a certain level of assumed privacy because you can shut a clinic door, or you see somebody unwrap the needle that they're using for... And, and so I think that just sort of on a very basic level, being like, oh, this makes sense then. And particularly in the rural areas, when, you know, some of the schools didn't have electricity or running water, and you have three students sitting in a desk, you're not going to be spending time on sex, ed, you're just not.
Valerie Earnshaw:Right. Right, right. Yeah.
Morgan Philbin:You're not going to be getting medicine out to these people. Particularly if the populations for the most part were poor or illiterate, they're not going to be the ones that have the agency to really fight for what they should have access to. And so the government quite legitimately could ignore them. And so I think seeing all of those things, and obviously, you know, that happened in the beginning of the HIV epidemic, in the US as well, you know, there are certain populations that could mobilize and others because of social capital. But I think for me, just to see, especially as, you know, as a 22 year old really sort of hit home. Of, okay, this looks so incredibly different in different places, which is an obvious statement. And yet it just, you know, it landed more when I could see it.
Valerie Earnshaw:Well, I think it makes it so then easier when you come home to start seeing the water, to start seeing the policies, which is a lot of what you take a look at now. But, okay, so you have this experience and then you pursue a Master's of health sciences at Johns Hopkins. And one of the things I did learn over this four day, Gab-Fest was that you didn't know that getting a, uh, like a public health or health science degree from Hopkins was a deal. It was a big deal when you applied there. So for folks who are listening, Hopkins is like the top school of public health, or one of our top schools of public health in the nation. So I just, I really loved that Morgan applied there, not knowing that she was applying for- to the top program in the nation, and ended up going there.
Carly Hill:like, oh yeah, t his'll do.
Morgan Philbin:well, some good friends of mine suggested it. And I just trusted them.
Valerie Earnshaw:Yeah. So you do your master's degree there, and then you got back to China on a Fulbright. So this time when you were there, it looks like you were focusing on harm reduction programs among injection drug users. So it sounds like it might've been a little bit of a different experience, but, you know, focusing on HIV in China for what was it a year? A Fulbright is usually a year.
Morgan Philbin:Yeah. So the way that the master's of health science worked at Hopkins was there was a year of coursework and then a year of an internship. And so I spent that internship working with people at UC San Diego, but it was based out of Tijuana in Mexico. And that project was working with people who inject drugs in Tijuana and looking at access to needle exchange, to methadone, and harm reduction, and treatment more broadly. Which, it was the first time I think I- growing up in California, I had really encountered the like, oh,"you just pray it away", sort of approach to treatment. So I say treatment in very, very broad definition of treatment. And that also, when we were doing that- this was qualitative research. We were talking to people who inject drugs as well as stakeholders at all levels. So everyone from like the head of health for the, for the state of Baja, California, um, to, you know, people who were guards in the neighborhood, you know, people who own stores and restaurants nearby. And I think that really made me see these sort of intersecting levels of: you have the policy that regulates, you know, whether methadone clinics can even operate or a needle exchange program can operate. Legally, you have the tension between the police and the health department, and then you have all the players right at the community level. And that affects to your point, like the water in which these people who inject drugs would live right there, climate policy climate. And so seeing that as was one of the reasons why I shifted my focus from families, um, and HIV to people who inject drugs. And so then from there, when I went back to China on the Fulbright, I took a similar sort of lens and thinking more about people who inject drugs because in China, it's so highly stigmatized and the penalties are so harsh, including like forced labor camps and things like that. And there were partly because in a lot of areas in China that people who use drugs are also ethnic minorities. So thinking about Xinjiang being the most notable, which as people know it has been in the news for the horrific labor camps and forced expulsions from homes. But some of the Sentinel sites, when I was there, people who injected drugs, the rates of HIV were like 50, 60% it was a huge issue there. And so I wanted to go back and try to better understand, again, like now that we have these evidence-based interventions that we know work, what does that look like in the Chinese context? And the Chinese government is very good at scaling things up that they support. So once they decided they were going to do methadone, it was like almost from one week to the next, it was like 500 clinics across the country.
Valerie Earnshaw:Amazing.
Morgan Philbin:Needle exchange was one of these quasi illegal, like,They wouldn't fund it, but they wouldn't shut them down.
Valerie Earnshaw:Okay.
Morgan Philbin:So I ended up in Southern China in Yunnan, which is Kunming province, working with a needle exchange program there, and a methadone clinic interviewing people at the clinic, both staff and people who use drugs to better understand, you know, what they think about needle exchange programs and methadone, what the barriers are. And I also spent some time living in a rehabilitation center about two hours outside of there to understand again, like what that experience looked like. So I just like, they let me just stay in the dorms with everybody else. And like, as long as I participated in all the activities, which was definitely interesting trying to follow... This is all in Chinese. Right. So trying to follow what's going on. And, you know, it's like me trying to karaoke, which was super awkward,
Valerie Earnshaw:this is amazing.
Morgan Philbin:but yeah, just giving you...[inaudible].
Valerie Earnshaw:Other, other than karaoking. What did you learn? I mean, that's, that's really interesting because when I think about living with a population, I mean, that's, that's an anthropological approach sometimes to, to learning about learning about people, learning about a culture, learning about a group of people. So, so what, what, what did you learn from that? That's really interesting approach.
Morgan Philbin:Yeah. I think for this, it was an interesting hybrid of... it was more of a 12 step approach. So, which I have mixed feelings about in terms of how successful it is longterm. There was also a religious bent, which I think it was an approach that was used in the US, and so applied to the Chinese context was really interesting because religion in China has a completely different valence. And so to be in a Chinese context and have a photo of, or a photo, a painting of Jesus on the wall, there's like a huge disconnect. And, but it was a lot of the sort of sitting in circles and people talking about, you know, how they were feeling, how they would change, but many of them, because it was affiliated with a needle exchange program, and the methadone program, would oftentimes go from one to the other. And I think what was most interesting for me was trying to see how the program was working to build community and their notions of that and how, what, how they thought that would affect recovery trajectories of individuals. And so it was not just the specific activities related to people's history of drug use, but it was things like karaoke. We would do these activities where it would be like nearing dance moves. So like someone would stand across from you and start to dance and you would have to model whatever they were doing. There's like rapport building. There would be soccer games. I was the only female that would play with the guys, which they like at first, weren't kind of sure what to do, but like I grew up playing soccer and it was a fun thing to do or, you know, eating meals together. And so really it was, it was just a very different approach than I had seen coming from a straight sort of harm reduction lens that I had been trained in before.
Valerie Earnshaw:And just to follow up for folks who may not be familiar, so harm reduction approaches like, um, so needle exchanges when they'd talking about, so for needle exchange that involves like changing out syringes that people have used for clean or new syringes, so that HIV transmission doesn't occur. And the sort of, I think the spirit of it, but correct me if I'm wrong, I think you've done more work in the area is, is exactly what it's sounds reducing the harms associated with, within this case, injection drug use. And then you also mentioned methadone, which is a medication that people with, uh, opioid use disorders can take as they sort of, you know, transitioned into recovery and such. One thing that this, you know, approach of like soccer and karaoke and all sorts of things makes me think about is, um, the literature that I've been reading about lately, about how opioid use disorders and social isolation have this like kind of deadly cyclical relationship. So opioid use leads to more social isolation, both due to sort of some psychobiological changes that happen that make people seek social connection less, at least that's what some of the literature is suggesting. That's what the neuroscientists are telling us. And also just the super pronounced stigma associated with opioid use. So people are rejected by others, and they also withdraw because they anticipate stigma. And then once people are socially isolated, that is then in turn associated with more opioid use, you know, as people cope with social isolation. And so it's like this really terrible relationship. And so i t's, it's really interesting to me that that a big part of this approach was s occer and karaoke and social connection and bonding because I was reading a paper that's, you know, a 20, 21 review and another one, you know, a big paper that was t he 2016 paper. And, and that's exactly what they were calling for. They were like, we need to think more about social isolation. We need to be thinking about more social connection. And it sounds like this is something that was already on people's minds in the mid two thousands while you were, while you were over in China.
Morgan Philbin:Yeah. I think it was, it's hard to know how it played out once people returned home.
Valerie Earnshaw:Sure.
Morgan Philbin:Especially in a, you know, pre smartphone, pre-, not pre-internet, but certainly internet was not available in rural parts of China. At that point. Not wi-fi. I'd be interested to see how that played out, but it is interesting.
Valerie Earnshaw:All right. Well, speaking of returning to home, so after this, uh, Fulbright time, you go back to Hopkins, you pursue your PhD in public health and, uh, we'll turn it over to your research in just a moment. But one of the things that's really curious to me about this, like trajectory of, you know, getting your degree, but even during the degree going and studying abroad, and then, you know, taking this position in China and then going back for a degree and then doing a Fulbright in China, going to San Diego. Is that, you know, it's not, it's, it's, it's, it's a linear path. I mean, you got from A to B, but you took some time, you took a little bit of time off in between. And I think a lot of students are often curious or they're hesitant as they're transitioning from undergrad and They're, they have their eyes set on a graduate career. You know, they're hesitant to like take gap time or to take time off. So I'm curious, like, you know, it seems to have worked spectacularly for you.
Carly Hill:And then some.
Valerie Earnshaw:So do you, do you tend to give students the advice, who are considering gap time to, to like A+ go for it or?
Morgan Philbin:Always, both for life experience and for their own sanity. I think it's harder and harder to step off this sort of academic train, as it were, the further along you get. And I think also to put yourself in situations that are going to challenge you and are going to force you to think differently is really important. And also just to give yourself a break. And I think both with the first year when I worked at[inaudible], which is the NGO there, and then as the Fulbright, I mean, I would say I really worked probably six to eight months out of that year. And then the rest, like I played. And even the time that I was working was like maybe 20, 25 hours a week. Which is just so different than the rest of my life had been, but that was part of the point, right? It's like, I think we're all so burned out and getting to be in a place where I could really prioritize just, you know, exploring or going for, you know, going for a walk or traveling or spending time with friends was so important for me. And I think that's also where you give yourself the time and the headspace to really be interested in things and see what's going on. And if you're just in school or work and sort of in this rut, I think it's really harder to take that moment to kind of look around and be like, okay, what am I interested in? What is going on? What makes me excited, um, Having that space to do that was really invaluable. So I always always tell students to take a break. And I think there is this idea, especially if you're going to graduate school for an extended period of time of acknowledging that, yes, it takes a long time if you do a master's and a PhD or an MD and fellowship, but even if you start work, if say you go straight through and you start work at 30 and you retire at 65 or 70, like that is 40 years of something that's quite similar. So like give yourself space on the front end. And even if you're still working for 30 years, right. You take five years, like I'm saying"off" sort of in quotes, like that's fine. I also think people who do that are often more interesting because they just... they have a life that they lived. And when you think about, who you want to be working with, who do you want to be studying next to, you know, you want people who can talk about things that are not school or work.
Valerie Earnshaw:I think that, you know, one of the things that really strikes me about this story is the concern I think of students is that they're, they're going to get off track that it's like a distraction. And it, it just really strikes me for you that you were very much on track. I mean, sure. You maybe were working a 20 to 25 hours a week and you're not doing research in China currently. Although I think you'd be happy to reconnect there, but the, the things that you experienced and the things that you observed, like very much shape your research today. So in that sense, all of that gathered up and helped to inform the scientist that you became. And so definitely not wasted time.
Morgan Philbin:I joke with students. I'm like, look, if you are worried about it, like find, say a research assistant job. No one is going to know if that RA job is 10 hours a week or 40 hours a week, have it on your CV, spend the other 30 hours a week, doing whatever you want. Like, you know, I think there are ways if that is what the worry is of it looking like there's a gap you can work around that, you know? And so I think really finding ways to give yourself that space to not only do what is going to be exciting for somebody, but to just again, give yourself a break to figure really what you're interested in. Cause I do think the idea... particularly more kind of technical schools that you have to choose a major at 18 and somehow know what you want. Like, forget it, like there's just no way. That's not how we're designed.
Valerie Earnshaw:Yeah. Your brain's not even fully developed yet, you have years to go.
Morgan Philbin:Exactly. So yeah, making sure students, and even if you already have a master's or even a PhD, that doesn't mean that you're really stuck in any sort of niche yet. I think there are always ways to think more broadly than maybe people tend to do given their training.
Valerie Earnshaw:Yeah. Yeah. Yeah. I think it's phenomenal advice. I went straight through and I tell every student who ever asks me to take time off, do not do not do, what I did. Do, as I say. But in that case, I feel like it is proper advice. All right. So let's, let's then catch up and turn a little bit towards your, your research that you've, that you do and specifically this research on policy. So I feel like, you know, in hearing your story, we've got a pretty good sense. I was curious about how you landed with this interest in policy, but it sounds like, you know, there was some early interest, some focus in your undergraduate career. And then just by these different research experiences that you had, especially some of these international experiences, you've become more interested in policy. So now much of your policy work focuses on domestic policy. We've had several papers come out recently focused on medical marijuana laws. So first maybe we can just talk about what are medical marijuana laws? Because I feel like there's just a lot happening and the legalization landscape. So what are they?
Morgan Philbin:Yeah. So medical marijuana laws are the laws that regulate whether or not it is legal in a given state to use marijuana for medical purposes. So that means going to a doctor, getting a prescription, and then depending on the state, you can either get the marijuana through a dispensary. You can, there can be home cultivation. And so it is another way to, for people to have access to pain relief, for the most part, it can also be for anxiety. And so I think it's really important particularly, given-- and this is a broader piece that we can talk about later if we want-- but given where we are with the opioid epidemic and the increased reliance on opioid medication for pain relief to think about other options. And so right now there are 36 states that have legalized or excuse me, that have, well, I would say have marijuana for medical purposes. And then now I believe it's 14. Although it changes it's changed a lot, actually just in the last six months of states that have legalized marijuana for, we either say"adult use", or"recreational use". And so that then just means it is legal for people to use marijuana for whatever purpose, whether it is for pain, whether it's for fun, whatever they want. And so those are the policies that are most common in terms of regulating legal or the use of substances that used to be thought of as illegal. Obviously recently Oregon has passed decriminalization policies and t hey're also decriminalization policies for marijuana, which means that you c an n ot be arrested for carrying t hat certain amounts of d rug, u m, which we can also talk about w ith those three, the decriminalization, the medical use, and the recreational use tend to be sort of thought of in tandem because they all regulate the same substance, which in the work that I do i s marijuana.
Valerie Earnshaw:Okay. Okay. Uh, so that's super helpful. I feel like I learned some along the way and it is really interesting. I feel like the, the landscape around legalization is changing so quickly. I didn't even realize, I think your state New York just like flipped a week or two ago into legalization. Um, so it is a really, it is a super rapidly changing landscape, which actually is making me think like as a researcher, that's, that's a great place to be in because you're able to look at change over time if you, so if you would. So like, which is a unique thing to be able to do in terms of policy reasons.
Morgan Philbin:Yeah, it is. And I think one thing about policies that often happens is the first states to pass something, whether it's, you know, marijuana laws, abortion regulation, whatever, tend to have similar qualities. So whether states are more conservative or liberal, they tend to follow similar patterns in the type of policies they pass. Gun control being another example. But because these changes are happening so quickly, we're now seeing quite different types of states that are making these changes. And so we really are able to make these cross comparisons, you know, so initially if you compare say Colorado, Washington, Oregon, those are relatively similar. I mean, Colorado is a little more purple, but now as we're getting other states that are passing it, you know, you can actually start to see really interesting differences. The other piece about marijuana policies, both the decriminalization and the recreational laws. Is there such an important social justice component, which is one of the things that really drew me to this policy, because it's not just about regulating access to substances. It's about again, who tends to get arrested for what.
Valerie Earnshaw:Do you w ant t o take a moment to address that even a little more directly before we a sk you about your findings?
Morgan Philbin:Yeah. So I think one of the things that we have seen is that while rates of marijuana use do not tend to differ by race, ethnicity. I believe in New York City, it's 90% of arrests happen among people of color, which is insane, not surprising, given how given systemic racism, but to really think about what that means and to think about... It is not just then about being arrested. Obviously people were arrested, this goes on their record or they're incarcerated. And so the amount of people who are incarcerated on low-level drug offenses, particularly for marijuana is horrific. And so a lot of the states that are passing laws that would legalize marijuana are also thinking about retroactively, trying to waive the, the arrest records for people who have been arrested for this. So that's one of the main pushes is around the social justice narrative. One of the things that research has shown, however, is that even once policies are passed overall arrest rates go down, but the disparities do not. So again, this idea that it is important to think about this, but it is not sufficient. Obviously there are many other things we have to change around the way policing is done in the US but to think about how policies have these impacts beyond perhaps their stated intention, the policy, right? So marijuana policies are written to say it is legal or not to use marijuana. And also they have these really broad impacts around things like policing, for example,
Valerie Earnshaw:right right... a lot, uh, it's a complicated, it's complication station. Okay. So some of your work has looked at then in states where there are medical marijuana, you know, where, or I guess I should say in states where medical marijuana use is legal versus where it's not, you've looked at differences in both marijuana use among folks, as well as stimulant use. Right. And maybe, probably other things as well, because your CV has like, you know, approximately a gazillion publications on it. So I, maybe I miss them, but I know that these are some of your recent findings. So could you, um, walk us through a little bit what you found?
Morgan Philbin:Yeah. So those papers actually, and this is a point I'm glad you brought this up because I want to make we're looking at medical marijuana laws. So one of the challenges with policy research on a national level is that we are beholden to national level data sets. And often times, those take a really long time to come out. And these are data sets that are usually coordinated by the centers for disease control or health and human services. And so for example, some of them were just getting access to data from 2019. So there's this lag. So when we talk about recreational marijuana laws, even though right now, I think it's 14 states have legalized it. If we can only look at data from say 2018, we can only look across say seven states, right. Or eight, six. And so I say that because the data on those papers was looking at medical marijuana laws, partially because we have so few recreational laws, but also because the data set that we normally use, we actually, they shifted where it was housed. It was housed initially through our university, through university of Michigan and then Samson health and human services moved it to a remote data center, which meant that we then couldn't access it because it closed down during COVID.
Valerie Earnshaw:Oh, okay. Oh, okay.
Morgan Philbin:A nd t hat data set is that one where we can get data on state-by-state data. So where we could actually then connect which dates had which policies to these outcomes. Whereas the papers that you're mentioning, we had to write with the publicly available data set, which tells us whether a state has a medical marijuana law, but not which state it is.
Valerie Earnshaw:Fantastic.
Morgan Philbin:I would say that to note that we oftentimes, the research we can do is not the research we want to do, but only what we are able to do based on the data that are available.
Valerie Earnshaw:That's so thank you for saying that, because one of the conversations I think, you know, that we were having, and one of the things that I'm really interested in is we have research on policies and we have research on individual behaviors, and then you are doing work that fills in, you know, the black box of what's happening in between. But this is really helpful for me to understand why don't we have better research that looks at how policies impact people on the individual level. So part of it is just access to those data. I know that there are other issues, even beyond this, in terms of like, do those, you know, what data sets have, like the right geographical data, although you did mention like, you know, you know, if, if the place had a policy or not, but maybe not with the status, but there's just all these barriers to achieving that like linkage between different data sets to, to study the sort of things that we can study. Okay. So that's super interesting. Okay. So you're not always able to ask all of the questions that you want to ask, but of the questions that you've been interested in and that you've had data for. So this sort of like magical Venn diagram of like sweet spot in the middle. What have you been finding?
Morgan Philbin:Yeah. So there, there are multiple ways that I've been going about this. So one is with these national data sets that I mentioning. Which are wonderful because it does allow us to look across all 50 states, we have large enough numbers that we can look at some populations. So for example, we can look at Hispanic women or black men, or I do a lot of work on sexual and gender minorities, right? So we could look at gay men or bisexual women. And I bring that up because we have seen differences in patterns of substance use based on somebody's sexual orientation. And we've known that for awhile. That, again, going back to the policy environment, if you have individuals who are systematically discriminated against, oftentimes substance use becomes a coping mechanism. So we know that. And so I say that because when we looked at how medical marijuana laws affected people by, um, sexual orientation or sexual identity, specifically, in this case, we found that among heterosexuals people living in states with medical marijuana laws reported higher levels of marijuana use. We didn't find the same thing for people who identified as sexual minorities, particularly bisexual women. And one of the reasons for that is because of the stigma that they face, particularly as bisexuals, who oftentimes, what we call the"sexual minority stigma", they face minor-... stigma because they are a sexual minority. So they face it from heterosexuals. They also face stigma oftentimes from lesbian women, because they're sort of in this liminal in-between state. And so because of this and also issues of feeling like they can't be honest about who they are and feeling the need to stay hidden, they oftentimes have higher levels of substance use. So because their baseline rates were so high, being in a state that had a medical marijuana policy didn't make a difference for them.
Carly Hill:Okay, that makes sense.
Morgan Philbin:They sort of hit a ceiling. And the other part of that paper, which was really interesting for us was just to see how high some of the baseline rates are. And so I believe it was, I think it was 45% of bisexual women reported past year marijuana use, and it was 10% reported daily use. And so thinking about just what this means from a coping mechanism standpoint, and I think past year use, from a public health perspective, you need to know more about it. You know, if somebody smoked weed once last year, that's not that big of a deal at all, right. If somebody is spiking five times a day, that matters a lot more. And so I think, but thinking about, you know, why certain populations are affected differently by policies is something that I'm really interested in. And then also what we talked about earlier with the recreational policies is how those policies can have other impacts outside of their stated intent. So whether that's other substance use, so people have been increasingly looking at whether marijuana policies impact opioid prescriptions or opioid use. Um, we've seen potentially some shifts in volume of prescriptions, but not individual use, um, because people were hoping there'd be this substitution effect where people would shift away from opioids for when we were looking at whether medical marijuana policies had an impact on stimulant use, it did look like baseline rates were different based on whether somebody lived in a state with medical marijuana laws or not. But we actually, but once within that, there were no differences. So we actually think those baseline rates are probably due to something else other than the medical marijuana policies, which we can now explore because that data, um, the remote data center I mentioned is now open again. So we can start controlling now these outside factors to try and see.
Valerie Earnshaw:So this was one of your papers, that's, that's so new. And so breaking that it's still behind a paywall for me. So I wasn't able to get, I wasn't able to get this one and read it. Although I will say, I'm quite impressed. I'm actually looking at your article where you had the rates of marijuana use and states with versus without medical marijuana laws and that 10 and 40% number you quoted a spot on. So there's no way that I could remember that. So I just want to, you know, A+ like all around for that, and that's a 2019 papers. So it's like, you know, you probably wrote this in 2017 and 2018, so that's really impressive. But for the stimulant, um, for the stimulant finding, can you explain a little bit more, so it sounds like this baseline rate is quite, is important, but I don't think I'm totally understanding it. So was this, was this a study where you were looking at over time? So is it like baseline before?
Morgan Philbin:Sorry, I wasn't clear about that. I just meant that there was a difference in use between states that have medical marijuana laws and states that don't.
Valerie Earnshaw:okay.
Morgan Philbin:We find a significant difference, but we don't actually think it's meaningful.
Valerie Earnshaw:Oh, I see. Okay. Okay. Well, that's helpful because when I read the abstract, Carly and I read the abstract for this paper again, that was SO breaking I couldn't access. And then we were like, why would that be? So if you think that it's not meaningful, then that, that really helps to explain it.
Morgan Philbin:So what we think is going on, which is why we're excited to get into the data center, because then we'll know which states are, what is, because we think it actually has to do with patterns of cocaine and meth methamphetamine use based on geography.
Valerie Earnshaw:Oh, wow. Okay.
Morgan Philbin:So there's different patterns of meth use on the east coast versus the west coast. And so we think that that may actually be what's driving some of that difference.
Valerie Earnshaw:Okay.
Morgan Philbin:And I think just certain states tend to have different levels of substance use. Like we saw this with fentanyl, right?fentanyl made its way up the east coast before it started going up the west coast. And so... or even the types of heroin that exists coming up through, say like, Tijuana into California versus Ciudad Juarez into Texas. And so I think that it's more about that than it is actually medical marijuana laws driving anything.
Valerie Earnshaw:That is, that is so super interesting. Carly and I are becoming increasingly interested in this geography piece as we are in Delaware with the second highest rates of overdose deaths in the nation, right behind West Virginia. And if you, like, if you look at an opioid overdose map, it's just map, it's like this, this little cluster, right where we are. And it's really, I mean, it's just really thinking geographically, like, what is going on with this, with this location, with, you know, maybe supply and distribution of opioids. We've our rates have really skyrocketed since like fentanyl. And so, so to me, it's really like, well, can we follow the, the, the history of fentanyl in our area to figure it out? So that is so super interesting that you find this association and, you know, you've already sort of primed us that you don't, you don't have access to all of the data that you need. And so even though this association is there, it's probably accounted for by these, by these other differences that are not in your data sets. So, you know, my number one take home from this podcast so far is like, let's get Morgan more data, let's get her all the data. Let's remove the barriers. Let's integrate more data sets like let's get her all of the data.
Morgan Philbin:No, I think exactly because otherwise, you know, we just can't ask the questions we want. And I think, especially with populations that are smaller. So a lot of the work I do with sexual and gender minorities, it's really hard to look at disparities, If you know, you're doing a national level survey and say 2% of the population is transgender in the survey, you really start dealing with numbers that are so small that you can't look across states.
Valerie Earnshaw:Sure.
Morgan Philbin:That does make things challenging. And also, I think it made me think when you were talking about the geographic piece, we would see this in Tijuana of, because the, you know, the drugs would come up through from south America up through central America to Mexico. And when there would be crackdowns on the border from the US side. So when the U S would say, have these really strict immigration policy shifts, the drugs couldn't make their way up into the US and so they would get stuck in Tijuana. And so then that market would be flooded. And so you'd have this interesting effect where like the us policy on immigration affects the drug markets and the border cities.
Valerie Earnshaw:Wow. Okay. So now you're blowing my mind. Cause then another paper you wrote, we need to get away from what was it like one policy, one outcome approaches, which is which this is really clarifying. Like you can't just study the impact of one, like of a drug use policy on drug related outcomes. You need to be taking into account like the whole, as you're referring to it, like policy climate, like all of the water, if you want to be understanding what's going on. Wow. That's super interesting.
Morgan Philbin:And I think we do pretend also like policies get passed in a vacuum, passing a recreational marijuana law in a place like California looks very different than Montana, or it looks very different than New Jersey. And so thinking about what that means, and also even this is a different, like, a different piece, but like we have to think of the nitty gritty of the policies for policy work. So by that, I mean, you know, we can say New York, New Jersey, you know, Montana, New Mexico passed a policy. But if you look at the fine print or you actually look on the ground, maybe the entire state of I'm making this up, but maybe the entire state of New Mexico has three dispensary's. But if those are two are in Albuquerque and one are in Santa Fe, that is perhaps covering 50% of the state's population. But if California has three, that means that the majority of people don't actually have access to the marijuana that was then made legal. Right. So we actually have to think about how the policies look and how they get implemented on the ground to really think about. So that's what I mean, like the sort of broader climate, as well as like the details of the policies.
Valerie Earnshaw:I have 15 questions. I'm going to ask you right now, but let's, I'm going to prioritize. Okay. So one thing that I'm, you know, that I'm super interested in is what are the pathways through which policies impact these health outcomes? Because as we said earlier, like it's, it's not always super clear to me. And because now I'm having a better understanding because of the way that our datasets, like, are structured, we just were kind of limited until these data structures catch up with us in some of the questions that we've been able to ask so far. But I know that you've been doing some really neat work in this area where you're combining where you're both like, look, you've done some work looking across different studies to try to understand this. You did, that were in the context of immigration related policies. And then more recently you've done some work that's more qualitative in nature. And so to me, this is suggesting, you're really having to sort of like think outside of the box methodologically to answer some of these questions. So what are you finding and how do you think about the different pathways through which these policies impact individual level health and behavior?
Morgan Philbin:Yeah. I'm really glad you brought that up because I think it's a challenge in some ways, quantitatively. I mean, we can do mediation moderation analysis that you can describe better than I can. But I think oftentimes when we do those to try to see, you know, how is the state climate affecting an individual? We tend to think about the same(And obviously there are exceptions to this) but the same general things. It's like, is it race? Is it gender? Is it sexual identity? Is it stigma? And it is hard to know what else it may be unless you actually do qualitative research and ask people, I think. And also if you do it quantitatively, you are limited to what's in the d ataset. So there are very few data sets that include sexual identity, even fewer that include gender identity. And we know that, like I mentioned earlier, one of the main drivers of substance use based on sexual identity is the"sexual minority stigma". But if we're using d ata s ets, s ay, focused on drug use, they don't include any variables around that. Right? Or stigma at all. So that m eans when reviewers, like we submit a paper a nd o ur v iewer says, oh, did you look at this? We have to say we couldn't because the d ata s et doesn't have it and they're not going to add it. So I think I've really tried to tack back and forth between not just using qualitative research and interviewing people to learn what they think the pathways are and to use that, to inform the quantitative work, but also really to flesh it out. Because I think it's not just to inform the quantitative, but truly t o answer different questions, because I think there are things that... h ow d o I s ay t his? They're so complicated that the quantitative model would not work. Like it would kind of blow up if you tried...[inaudible]. Life is complicated, right? And so if you ask somebody, you know, tell me about how, you know, you started using drugs or this policy might have, you know, a shift in policy might've affected this. And the story could be something like,"well, you know, I had this job and before the policy shifted, I was walking to my friend's house, but because I'm black and my friend lives in a neighborhood that's mostly white. I get stopped. And so then, because I got stopped and I had this record, you know, like I then couldn't whatever buy a car or I didn't get this job. And then I didn't get this job." And then all of a sudden it's like, there are five different things, that then ended up with this mental health diagnosis or the substance use. And you're never going to be able to track that. Right? Or like"I was gay. And so my family kicked me out of my house. And so that meant that I couldn't finish high school because they wouldn't sign off for me to finish high school. And then I couldn't get a job or I got a job, but I was stigmatized because of how I looked." And so, you know, and all these things that we can only truly understand these pathways, by not only talking to people, but also thinking quite broadly about the different environments that they're in. Because even if I were to ask somebody, what do you think led to this? They probably will not give me that linear pathway. Right. That's just not how human brains work. And so it's for us to think about, okay, what for you? And I work a lot with young people. So what are the environments that are most salient to them? So it's probably education, it's employment, maybe it's housing, friendships. And so just think about like, okay, they can answer. If I say what's the pathway, they're probably gonna look at me sideways, but I say, you know, what was high school like for you? Right. What was your first job? Like, tell me about a time you felt sick and went to the clinic. Like, you know, where did you, you know, where, where did you spend most of your nights? Like, what would happen if you couldn't go home to your parents? Like those sorts of questions to really get at what is affecting their decisions. And then I can trace that back and say, okay, you got kicked out of your home and you didn't finish high school because your parents wouldn't sign, You know, sign a paper. Okay. Well that parental notification policy occurs at the county level here at the state level, here it is enforceable. Right? So like, I then take what I hear from people and bring in the knowledge that we have of policies that they may not even know exists. Right. Or somebody goes in for an HIV test and doesn't know that the provider in their state is allowed to tell their parents that they got a test. Right. And if they had that, they were living with HIV or whatever. Right. So trying to think again, of like this multi-layer of what someone tells you, and then what we know is happening in the broader climate.
Valerie Earnshaw:That's so interesting, Morgan, when I was looking over this paper that you're working on, which is fantastic, and I can't wait for you to spit it out so I can cite it all over the place. But what, one of the things that really struck me was was it kind of exactly what you're alluding to. Like you cited like dozens of policies. Like there were just so many policies that you could kind of connect, you could do that, like connect A to B to C like the policy leads to this leads, to that leads to substance use or, or, or, uh, lack of housing access or, you know, whatever. I mean, it was just, it really, again, I think speaks back to this, this point that you're making about the policy climate about like how all of these policies are like working together to impact, to impact people. And in this case, sexual gender, minority youth. Yeah.
Morgan Philbin:Yeah. It's very, it's really complicated. So is life, right? I mean, we all would know this, right? If you say, like, what are the different things that are going on in your life? People are going to give you seven different answers because that is what is true. And yet in research, we oftentimes look at one exposure and one outcome as if there are not all these other things going on in someone's life.
Valerie Earnshaw:Well, this is again, I mean, it's just amazing how you think, I think that you think creatively about how to get around that and use different methods in your research to ask the questions that you want to ask. And I think a lot of people, a lot of researchers kind of like get into a, into a habit of like, I run this type of analysis using this type of using this maybe data set, you know, and then all of their questions are constrained by that one data set. So it's really neat how you're reaching out and trying different things. But as a scientist, you know, that's super challenging to, you know, to... it's much easier just to, you know, hang out with your one data set and totally mine it and ask all of the questions there, cause you don't need to learn new methods and things. So it's really impressive. But so the last thing that I, that I, is on my mind that I'd really want to ask you about while we have you is: you spoke earlier about sort of like really needing to think through you call it like the nitty gritty of policies. And as we're, as people are enacting these new policies, I mean, we could just take cannabis legalization as an example that there's all of these things that need to be thought of. So as the scientists, do you think about trying to, to like communicate with policy researchers? Like, do you think about trying to bridge this like kind of like science policy gap, um, what does that look like for you?
Morgan Philbin:I'm really glad you brought that up. It's something that I've been thinking about for a long time and honestly struggling with for a long time. And I don't think there's an easier straightforward pathway. I think we all want our work to be relevant. That's why we do this. And I think there are a couple of things that make this challenging. I mean, I think one is in academia, Our incentive structure is to get grants and to publish, right? And so we do not have the time that supported per se, to engage with policy-, to spend the time doing the advocacy work or engaging with policy makers. I mean, maybe we'll hand off a brief or send them information about the work we do, but it oftentimes doesn't go beyond that. Although I do think there is a bigger shift around, you know, what is the impact of your work? I think one thing, and this is perhaps me being slightly cynical, but this discussion assumes that policymakers use evidence in the decisions that they make. And I don't think they do oftentimes. And we know that because we have seen the policies we have around substance use and HIV, right? HIV is still criminalized. And I haven't looked at the numbers lately, but it was something like 30 states.
Valerie Earnshaw:Yeah.
Morgan Philbin:And it's like, if we know that people who take medication and have an undetectable viral load, it cannot transmit. Like there are states where you can be prosecuted. Even if you have sex with a condom and your viral loads undetectable, like there is no science behind that, but politically you just try to repeal that law is going to be so hard for politicians to translate and explain to their constituents. Same thing with substance use, right? We know that safer consumption sites, which are in place. They have them all over Europe and Canada and Australia. Where somebody who uses drugs can go and can inject drugs safely. And people do not help them inject, but they're there in case they overdose. We don't have a single, a history of a single fatal, fatal overdose in a safer consumption site. And they have reversed thousands and thousands of overdoses over the years and save people's lives. But politically the US will not touch it. Right. There are some that exist underground in the U S but legally, right. And so that, to me suggests that evidence is not enough. So it is both thinking about what evidence can we produce to help move forward sort of daily life for people. And it's, how do we work with policy makers to help push things forward in ways where evidence alone is not enough? And I can tell you, we need that. I don't know how to do it.
Valerie Earnshaw:Well, uh, some nice advice that I've gotten is that we should be thinking about our careers as a book with many chapters. So that'll, you know, next chapter! I mean, it's a huge, it's a huge thing, but it's great food for thought.
Morgan Philbin:Yeah. And I think we're, we're, you know, in the work that I do, we work with advocacy groups. And so, you know, we share the information with them and I think in that sense, that is their strength. And so, well, I obviously want to make sure that the work that I do creates change. I also need to think too about what am I good at? And not that I can't be that advocate and I can't, you know, of course, I could go testify about things. And I think one of the spaces where my work has been used, which I actually really liked, was some work that I did based on HIV in Vietnam. I testified in an asylum case, you know? And so that had a very concrete impact in a way like, okay, this is actually showing why it is important for this individual to have access, to stay in the US and things like that. But that is quite different than like trying to get a state to shift its policy.
Valerie Earnshaw:I think that's, that is such a great thing to kind of end on and reflect on about how, you know, the scientist is like, is one piece of this like much larger puzzle. And so part of it is us. Yeah, sure. Communicating with policy makers, but the another part of it is just kind of like reaching out and touching all the puzzle pieces around us and working together for this, like, larger change. So, Morgan, you're one of my favorite people to talk to you. I mean, about life and science.
Carly Hill:Can I just say, I could just sit here and listen to you guys volley all day.
Morgan Philbin:That's why we could hang out for four days, and still have so much to talk about.
Valerie Earnshaw:P lease get back on a train and come back for four days s o w e c an d o i t again.
Carly Hill:Let me get in on that.
Valerie Earnshaw:Yeah. I just, I really love the work that you do. I think it's so smart. You're beautiful writer as well. And so it was like, it's a treat to talk to you and then it, it's a super treat to like delve into your research for a week and catch up on all of these pieces. So, you know, thanks for all that you're doing. And thanks for making the time to talk with us today.
Morgan Philbin:Of course. Thank you again for having me. This was so wonderful.
Valerie Earnshaw:Thanks to the Stigma and Health Inequities Lab at the University of Delaware for their help in the podcast, including Sarah Lopez, Molly Marine, James Wallace, and Ashley Roberts,
Carly Hill:Thanks to city girl for the music as always be sure to check us out on Instagram at sex, drugs, science, and stay up to date on new episodes by clicking subscribe.
Valerie Earnshaw:Thanks to all of you for listening.[inaudible].