Mignonne Guy, a researcher at the Mayo Clinic Arizona, began the conversation by admitting that she didn’t have the answer to the question of why cancer is killing more African-Americans. “We want to take an easy out and make it a behavioral issue” related to smoking or diet, she said, but we know that’s not the only reason.

We can’t simply chalk it up to genetics, either. Leticia Márquez-Magaña, a biologist at the Health Equity Institute for Research, Practice, and Policy at San Francisco State University, said that social and environmental factors can change the way our DNA is read. People want to blame cancer on the genes, she said, but “what is clear in this country is that money is inherited. The genes you get, that’s not so clear.” Black families make less money than white families, and this decreases access to care, weakens social networks, and causes more stress. Márquez-Magaña pointed to studies showing that African-American women have very short telomeres—a region of DNA that protects chromosomes—compared to other groups. (Tibetan monks, she said, have very long telomeres.)

There’s research coming out on “weathering,” said Guy, which looks at how stress, cumulatively, impacts us at the biological level. Stress has been proven to be a cause of chronic illness.

Eleanor Hinton Hoytt, president and CEO of the Black Women’s Health Imperative, said that black women in particular are less likely to get a break from stressors—such as abuse, violence, harassment, and environmental and financial pressures—and that this continual “badgering” affects their physical health.

But if social and environmental factors are at the root of this disparity, asked Daniel Weintraub, editor of HealthyCal.org and the evening’s moderator, should we be focusing less on healthcare in order to end cancer disparities? Do we have to go deeper into society—into economics, governance, institutions?

Hinton Hoytt said that part of the problem is the nature of our healthcare system, which isn’t patient-centered or focused enough on prevention. When the politics of being black and female collide with the culture of a sick healthcare system, “there is no way to survive that, in addition to everything else.”

So, asked Weintraub, can medical doctors do anything at all to solve this disparity?

Guy said that scientists need to do more interdisciplinary research and to develop better early interventions. What’s rarely admitted aloud is that even many of our current recommendations for prevention—a better diet, for instance—haven’t been conclusively linked to cancer. This makes it all the more important to point out methods of prevention that have been shown to work; Hinton Hoytt pointed to the HPV vaccine, which prevents cervical cancer.

Prevention, said Márquez-Magaña, can begin within communities—as long as doctors are a part of those communities. She said that community-staffed clinics within neighborhoods, a model she’s seen work in Cuba, can go a long way toward prevention.

The panelists agreed that community-centric solutions can be effective on a number of levels. African-American men are not getting good healthcare, said Guy, and there’s a huge, dangerous gap in the research on them as compared to research on other ethnic groups. But she believes that change must come from within the community in the form of a demand for more research and more effective treatment.

Weintraub asked the panelists if and why African-Americans are sometimes reluctant to seek treatment even when they have access to healthcare.

Hinton Hoytt said she has seen mistrust in doctors and the medical establishment from African-Americans of all ages all over the country. “I think it’s historical, I think it’s cultural, I think it’s embedded, I think it’s fear,” she said. “But it’s so real.”

Márquez-Magaña said that a study has shown that African-Americans are much more likely to think they’ll be “a guinea pig” at the doctor’s office—and some doctors, in trying to work around these fears, offer lower-quality treatment: “If you look at what physicians prescribe for blacks versus whites with the exact same cancer, there’s a difference in the standard.” There’s a perception that white patients will comply better with more extensive treatment, and so they receive better treatment as a result.

Guy disagreed, however, saying that studies about African-Americans and medication compliance treat black populations as a monolithic group—and are often done in urban areas. Not all African-Americans all over the country feel the same way about doctors or are reluctant to take medication. She also asserted that “Tuskegee is gone,” and African-Americans no longer feel a stigma about participating in clinical trials or studies. “The most current evidence—national data—show the reason why African-Americans are not included in clinical trials is because clinicians are not asking them to be involved,” she said. African-Americans need to be in these trials, she said, so that they can start getting treated more effectively.

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We reached Kaiser, I had my vitals tested, my temperature taken, and a throat depressor and pin light used to analyze my tonsils. My tonsils weren’t that bad, the doctor said. Take some antibiotics and go home and rest. But I was very disappointed. I wanted those tonsils out.

You could blame TV for this. By age 7, I’d absorbed the TV-rerun trope of the tonsillitis episode. It always ended with Cindy Brady, Eddie Munster, or the Fonz in bed without tonsils and with a big bowl of ice cream. As far as I could tell, there was little risk and a big reward. My pain could be replaced by mint chocolate chip. But now the verdict from Kaiser was in—and it was depressingly ice-cream-free.

For years afterwards, every time I got a cold, my tonsils got inflamed, and I blamed Kaiser for being too cheap to yank them. I spent a few decades believing that I’d received subpar care. Actually, though, what we need is precisely more doctors like the ones who treated me at Kaiser.

If you want an example of avoidable, wasteful care, tonsillectomies are Exhibit A. Dr. David Goodman of the Dartmouth Atlas, which measures variability in care and healthcare costs, has gone so far as to call tonsillectomies “a silent epidemic of unnecessary care,” according to an article in The Washington Post.

Here’s what he’s talking about: Between 1996 and 2006, the number of tonsillectomies performed in this country spiked by 74 percent. About half a million children will have a tonsillectomy this year, making it the most common surgery performed on children requiring general anesthesia. It’s held that title for a century.

According to Goodman, few, if any, of the supposed benefits of the tonsillectomy are backed up by science. This is where The Brady Bunch collides with our heavy healthcare burden—and where we as consumers of healthcare have to make some decisions. Do we go with what’s always been done, to alleviate temporary pain? Or do we take a risk, wait and see, and avoid skyrocketing healthcare costs and unnecessary care?

Awareness of the arbitrariness of tonsillectomies goes back decades. In 1938, Sir Allison Glover, an English doctor researching the procedure and its use, found that the rate of tonsillectomies depended almost entirely on each doctor’s preference. In the 1960s and 1970s, Dr. Jack Wennberg, a pioneering health researcher, found the same thing: In one Vermont town, 70 percent of the children had their tonsils out. In the next town over, only about 20 percent of the kids did.

What gives? According to Dr. Wennberg, in a transcript from a 2008 interview with the Dartmouth Institute for Health Policy and Clinical Practice, the culprit was the doctor. A surgeon who’s a proponent of a certain kind of surgery can influence a family’s decision of what to do. And with a lack of double-blind randomized-controlled trials on tonsillectomies to back up or guide doctors on how to proceed, we’ve all continued to fly blind.

Now, for some kids, there does appear to be a marked and measurable improvement in quality of life after tonsillectomy. But for kids like me—kids with pain and trouble swallowing, but no recurrent infections and no trouble sleeping through the night—a tonsillectomy is going to cut the average number of sore throats from three per year to two. That’s right: For a cost of anywhere from $5,200 in 2007 to $6,082 per procedure in Iowa in 2011—somewhere between $2.6 billion and $3.04 billion a year—a tonsillectomy can save your child from having one sore throat, according to a 2009 review of the medical literature by the Cochrane Library.

And that’s not all of it: Tonsillectomy is a major surgery, requiring children to be put under general anesthesia. The American Academy of Otolaryngology found that about one in 16,000 people who have tonsillectomies die from complications.

“Simply counting spending, in the narrow financial sense, misses the real cost of giving patients care that they may not want,” says Amitabh Chandra, a healthcare economist at the Kennedy School of Government at Harvard University. “Tonsillectomies are a metaphor for a wide range of treatments, such as radical prostatectomies, where the side effects of incontinence and impotence likely swamp the dollar cost of the treatment.”

By the time I developed tonsillitis in the 1980s, tonsillectomy rates were at their lowest in history. But they’ve since rebounded. Goodman, of the Darthmouth Atlas, believes it’s provider bias that accounts for the surge in operations. Another factor is patients: They, or at least their parents, want the treatment. As Dr. Emily Boss, assistant professor of otolaryngology at Johns Hopkins University and a pediatric ear, nose, and throat surgeon, told me, “What we don’t capture [in the research] is what it’s like as a surgeon to sit across from a family with a child who has significant breathing problems and is tired all the time.”

Many of these families are made up of people like me (or a younger me)—people who equate more care with better care. I spent every winter for years cursing Kaiser, insisting that they’d done me a disservice in the name of cutting healthcare costs. Then, one winter a few years ago, I spoke to a nurse who suggested that it was the cold medicine I was taking that was causing the inflammation because it was drying out my throat too much.

I changed medicines and haven’t had a tonsil infection since.

So now I know that appropriate care, in my case, was less care. But for most of us it’s very hard to tell. “Healthcare is almost the only industry in the U.S. where people can’t tell great service from bad service,” said Gerald Kominski, professor of health policy and management at the UCLA Fielding School of Public Health. “If healthcare were cell phones, you’d have people out there with iPhones and people with those old phones the size of a brick. And people would be saying, ‘No no no. I like my brick. It works great. I need it.’”

Plus you can sell a lot to a kid if you offer ice cream.

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