You Don’t Have to Tell Your Employer About a Serious Diagnosis—But You Still Might Want To

Originally published in GQ on August 31, 2020.
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On Friday, Actor Chadwick Boseman died of colon cancer at age 43. From an announcement posted to his Instagram, the public learned the star had originally received the diagnosis in 2016, and that he had filmed many of his best-loved films while undergoing chemotherapy and surgeries to fight the disease.

The news came as a shock not only to the general public, but even to directors, producers and colleagues he had worked closely with over the last four years. Sarah Halley Finn, the veteran casting director who picked Boseman to play T’Challa in Black Panther, told Vulture she had no idea the actor had cancer as the blockbuster was filmed in 2017. And in a tribute on Saturday, Spike Lee said it never crossed his mind while on set with Boseman. “I never, ever suspected that anything was wrong,” said the director of Da 5 Bloods. “No one knew he was going through treatment.”

The decision of whether to disclose a serious diagnosis like cancer to an employer is frequently a fraught one. Under federal law, no one is required to tell their employer as long as they assume they can reasonably do the work required, but disclosure is necessary to trigger the protections of the Americans with Disabilities Act, the main federal statute protecting cancer patients in the workplace.

Even if workers disclose, employers are limited in what they can ask about the cancer and must keep any medical information they learn confidential. Reasonable workplace accommodations for cancer patients include leaving for doctor’s appointments, time off to recover from treatment, and periodic breaks during the work day.

That Boseman kept his private life under wraps does not mean he never sought any accommodations to deal with his illness in the workplace, and he was potentially able to negotiate well beyond the legal minimum. “Given that it’s Hollywood, I could imagine a contract that [Boseman] enters into with a studio setting out his specific needs and binding anyone to secrecy,” said Sasha Samberg-Champion, a civil rights attorney who specializes in disability law. “If you have that kind of stature and a sophisticated agent you could work those things out. And the employer might not even be allowed to know why you need certain things.”

Gordon Firemark, a Los-Angeles based entertainment lawyer, told GQ that it’s “pretty typical” for an actor’s agent or manager to negotiate special accommodations for their clients like private dressing rooms, separate facilities, transportation or special foods. “If an actor of his stature is starring in a movie and he can’t be there because he had a chemo session, they’ll often just schedule around them, and that could be kept very quiet,” said Firemark.

For many workers who may have less negotiating power, having cancer in the workplace, even with the protections of the A.D.A., can be extremely difficult. To start with, the 30-year-old law does not protect independent contractors or those who work in businesses with fewer than 15 employees. But even employees covered by the law can still face discrimination, as some courts have ruled that extended periods of leave for cancer treatment can be legitimate grounds for termination.

Ann Hodges, a University of Virginia law professor and co-founder of CancerLINC, a nonprofit that helps cancer patients and their families navigate legal issues, said employers are often more willing to accommodate people working in higher-wage jobs.

“Sometimes it’s because they’re just not as easy to replace, or they may have more power in the organization,” she said. “Often those patients also have jobs that can more easily be done remotely.” According to the Economic Policy Institute, higher-wage workers are six times as likely to be able to work from home compared to lower-wage workers.

Hodges, a cancer survivor herself, points out that many Americans also lose their health insurance if they lose their jobs—a problem in the best of times, and an acute crisis for someone in treatment for cancer.

As a member of SAG-AFTRA, the union for film and television actors, Boseman would have had access to the union’s vaunted healthcare plans. But David White, the national executive director of SAG-AFTRA, noted that even these plans have been under strain—they’re “not immune” from the larger issues plaguing America’s healthcare system. Earlier this month, in light of projected deficits in the tens of millions of dollars, the entertainment union announced it would have to tighten eligibility requirements and raise premiums going forward. More than 17,000 people have signed a petition in protest.

“It’s a constant struggle to make sure that we are maximizing access for people like Chadwick and for people who can only dream of having Chadwick’s level of success,” White said.

The cost of sexually transmitted disease.

Originally published in the Baltimore Sun on April 1, 2013.

Doctors and patients alike are often uncomfortable talking about sexual health and sexually transmitted disease. But a new Centers for Disease Control and Prevention report shows that this squeamishness costs society millions of dollars spent trying to treat or cure diseases that could have been prevented, vaccinated against, screened for or detected at an earlier stage of development.

According to the CDC, about 19 million Americans each year are affected by sexually transmitted diseases and infections. Young people, ages 15-24, are disproportionately affected; they account for 50 percent of all new sexually transmitted infections despite representing just 25 percent of the total sexually active population.

The problem is particularly acute in Maryland, which has some of the highest rates of sexually transmitted infections in the country. Maryland ranks 9th highest among the 50 states in cumulative reported AIDS cases and 5th highest for syphilis, with signs that the problem is getting worse. Maryland has seen an upward trend of syphilis cases since 2002.

Conservative estimates from this CDC report show that the lifetime cost of treating eight of the most common STIs contracted in one year is $15.6 billion. Some STIs, like HIV require life-long therapy, and others, like the human papillomavirus, better known as HPV, can lead to cancer, which also demands costly treatment. Even among the STIs that are curable, the annual cost of treatment is $742 million. Chlamydia is the most common curable STI, with over 1 million cases reported each year.

These costs are almost entirely avoidable, but we also are operating in a culture where talking frankly about sex and its risks is not encouraged enough. The debates over sex education and the distribution of condoms in schools are well known, but a less obvious culprit in the spread of sexually transmitted infections is the failing of the health care system. According to a report from the National Cancer Institute, major hurdles to vaccination for example, are inadequate provider recommendations, a broken reminder system for urging patients to complete their doses, and concerns over cost and coverage.

According to the National Cancer Institute, in 2010 only 30 percent of American girls had received all three CDC-recommended doses of the HPV vaccines. Comparatively, in Canada, 50 percent to 85 percent of girls were vaccinated, and in the United Kingdom and Australia well over 70 percent of girls received the vaccination. These countries make efforts to provide access and affordable coverage but do not require the vaccine. The U.S. should follow suit and actively work to curb health care costs with preventative services. In 2007, Maryland established a task force to make recommendations for a state plan for the HPV vaccine, including possible requirements, cost and education efforts, but nothing came of it, and the task force was disbanded in 2009.

A positive development in the effort to stop the spread of STIs came in November, when the U.S. Preventive Services Task Force, a government-backed panel of scientists and medical professionals, made a new recommendation that every American between the ages of 15 and 65 be tested for HIV. Because the Affordable Care Act requires insurers to cover the preventative services that are recommended by this task force, regular HIV testing will now be covered as part of a routine check-up.

The idea that people would be tested for HIV just as routinely as they are screened for high blood pressure of cholesterol is promising, but it will only work if doctors and patients are willing to have what is often an uncomfortable discussion.

“Talking about [STIs and risk] at all in the ACA is big because it’s often not in the conversation,” said Barbara Conrad, chief of the Center for STI Prevention at the Maryland Department of Health and Mental Hygiene. “People don’t talk about things before they become real problems.”

The onus to change that will be on both doctors and patients, Ms. Conrad said. Patients may be too shy to raise the issue on their own, and doctors, pressured by the time constraints of medical visits, may not bring it up either.

We need to do better. For many, talking openly about sex, even with a doctor, may seem like a taboo. But that taboo hurts our economy and public health.