January 21, 2022

5 Lessons Ash Wellness CEO David Stein Learned from His Doctor Mom

David Stein

Debbie Cohen, MD is a nephrologist in Philadelphia. She has been recognized by Best Doctors in America two years in a row. She is affiliated with a world-renowned academic medical center, Penn Medicine. Her research has been published in more than a dozen academic journals, including The New England Journal of Medicine. Her expertise ranges from complex hypertension to chronic kidney disease and adrenal hypertension with a focus on pheochromocytoma and primary aldosteronism. She is a bilingual immigrant mother who raised four sons while serving communities in West Philadelphia. 

She is also my mom. 

In some ways, the Ash Wellness at-home diagnostic testing solution is an extension of the lessons I learned watching my parents work in clinical medicine for thirty years. 1. Help underserved communities. 2. Address medical inequality. 3. Healthcare needs to be financially accessible. 4. Sexual healthcare is for everyone. 5. Be passionate and compassionate about your work. 

I know one thing for sure: Ash Wellness wouldn’t be what it is today without these 5 lessons I learned from my mom, Debbie Cohen, MD. 

Help underserved populations 

My mom runs nephrology, hypertension and dialysis clinics in West Philadelphia. Her patients come from marginalized communities. Some of her dialysis patients experience homelessness, most live below the poverty line, and they or their families frequently deal with various types of addiction diseases. She not only manages issues related to kidney disease, but often takes on the role of  a primary care provider to manage PrEP prescriptions and STI testing. Some patients need her to fill in forms to keep their power running as they cannot afford to pay their bills.  

This is not necessarily what my mom trained for, but observing her commitment to the overall health of her patients drives me to find creative solutions to serve Ash Wellness end-users, especially those whom healthcare normally leaves behind. 

Due to structural inequality, POC experience bias in healthcare  

Last year, my mom – along with a dozen doctors and healthcare professionals – published an article in The New England Journal of Medicine about the inclusion of race in equations to estimate glomerular filtration rate (GFR) based on serum creatinine level. GFR determines kidney function and how well the kidneys are filtering. It is also used to decide when a patient is eligible to receive a kidney transplant. 

Participants who identify as Black are more likely to have higher serum creatinine levels on average, and GFR equations take into account Black versus non-Black. A patient is only able to list for a kidney transplant when GFR falls below 20 cc/minute. Since Black people have higher GFR based on traditional GFR equations, they list for kidney transplants later in their course of kidney disease than non-Black people. 

My mom and the research team argued that Black people are likely negatively impacted by traditional race based equations, particularly with access to renal transplantation. This highlights social inequities in health and healthcare delivery in Black communities. Her article argued to remove the “negative consequences of race-based approaches” to determine transplant candidates.    

I have always been inspired by my mom’s determination to reduce structural inequality in medicine. We must continue to check our own care systems and structures – Ash Wellness included! – for bias. 

Healthcare needs to be financially accessible 

When I first pitched the idea of an at-home STI test kit to my mom, I explained how useful it could be for working people, disabled people, pregnant people or those who had recently given birth – anyone who might struggle to visit a lab in person. “You wouldn’t have to take off work to get lab tests done,” I said.  

My mom was not convinced. “It’s great in theory, David,” she said “but none of my patients could afford it without insurance.”

When Ash Wellness transitioned from a D2C company to a B2B at-home diagnostic testing partner in 2020, we started the long, complicated process of integrating with insurance providers to make our solution financially accessible. Mom was right. (She usually is.) No healthcare solution, no matter how theoretically accessible, helps disenfranchised people without insurance and Medicaid.   

Sexual healthcare and STI testing is crucial 

My parents grew up on a continent ravaged by AIDS. South Africa, where my parents are from and where they first trained to become doctors, has some of the best infectious disease doctors and HIV/AIDS specialists in the world. My mom was never shy about talking to her sons about safe sex, even after I came out as gay in college. While Ash Wellness offers a wide range of at-home self-test kits for our partners, our niche is still at-home PrEP kits and other telemedicine services related to sexual healthcare. 

If there’s one thing that prepares a person to speak with donors and business partners about safe sex and at-home STI testing, it’s growing up with my South African mom.  

Be passionate about your work

When my doctor parents immigrated to the United States in the early 90s, they applied to become medical residents (again) before they could legally work in the American healthcare system. We went from living on two doctor salaries in Johannesburg to a family of four making ends meet on thirty thousand dollars a year in the Philadelphia suburbs. Neither of my parents complained. They loved their work. 

For all the ills of the American healthcare system – and there are many! – I’ve always been inspired by the quality of American doctors. I knew from watching my mom serve her patients that both passion and compassion can, and should, be an integral part of work. I’m grateful to continue my mom’s legacy of serving people through better delivery and access to healthcare.

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