Bow ties, rubber chickens and a heart for child health equity

When you sit across from him, the first thing that stands out is what's around his neck.

That's on purpose.

Gary Freed knows that you’ll probably forget his name but will remember the bow tie.

"I started wearing bow ties in medical school," says Freed. "My wife, Eileen, gave me one, and I started wearing it. I liked it and got more. And then it started to become a signature.

“By the time I was a resident, I only wore bow ties. I found that many people wouldn't necessarily remember me, but they'd remember the guy who wore the bow tie."

Hanging on two racks in his closet, Freed claims to have about 120 bow ties now, in a spectrum of colors and some for special occasions like the holidays. The ties also serve a practical purpose in his work as a pediatrician at C.S. Mott Children's Hospital and the Canton Health Center.

"Kids like them," says Freed. "And they can't grab and yank on my tie, and it won't fall into an open diaper."

An unusual travel companion

Freed seems attracted to whimsical things like bow ties. He also plays the banjo, likes adventure movies and has an unusual travel companion for the many trips he takes for business and leisure.

If you just happen to see a guy at Detroit Metro Airport wearing a bow tie and a backpack with a rubber chicken sticking out of one of the pockets, it's probably Freed.

"When I graduated high school, I was going to spend the summer in Israel, and on the way there, I backpacked through Europe for three weeks, taking trains," says Freed. "Before I left, somebody gave me – maybe, it was a graduation present – a rubber chicken, and I thought I would just bring it with me because it was good for a laugh.

“I had it sticking out of my backpack on the trains, either the feet or the head, and people started asking me about it. It was a great way to meet people."

It still is. To this day, Freed travels with a rubber chicken, although the original and some others have been lost or retired. He estimates that he's on chicken No. 8 or 9 and says that it's more than just a conversation piece now. 

"I started taking pictures of it with me wherever I was," says Freed. "And that grew over the years to not only taking pictures of it anywhere in the world I was or at famous landmarks, but then also with famous people. Whether they be elected officials or celebrities, everyone loves to take a picture with the chicken."

Freed says, among others, Nancy Polosi, Wolf Blitzer, Kerri Russel and Salman Rushdie have all posed with the chicken. He's also proud that his three adult children – Ben, Michele and Ariel – are carrying on the tradition.   

"Now my kids all have their own chickens," says Freed. "And they travel with their chickens and take pictures all over the world.”

His roots in child health equity

Rubber chickens and bow ties are just one side of Freed. The work Freed, the guy who cares for kids, is all business. When he talks about the job, his speech is polished and measured, but the occasional "y'all" betrays his roots in Texas, where the path to his research in child health equity began.

He tells the story of being a resident in Houston and working with a lot of Spanish-speaking immigrant families, some who would wait as long as 12 hours to be seen in the emergency room. Although he speaks some Spanish, Freed admits that he was always grateful to come across young kids who spoke English because it would speed up the process.

"Little kids can pick up languages fast, so sometimes you'd be working with a family and the 7-year-old kid spoke perfect English," says Freed. "If that happened, you'd think that it was a godsend, and you'd use that 7-year-old kid to translate for you. Sometimes you'd even take that 7-year-old kid and bring him into another room to translate for you, just to help move these patients through faster. I thought that was wonderful."

However, a couple of years later, after Freed's fellowship, he experienced an “aha” moment that changed his thinking. He heard a presentation by a Latino researcher who had done a study to see how good those 7-year-old translators really were.

"Not surprisingly, they were terrible," says Freed. "It wasn't that this was some elegant study. It wasn't the most methodologically-sound study. But what was striking to me and changed my life at that time was the realization that I never would have thought to do that study.

“It took a Latino researcher who had a totally different perspective than myself, who saw the world through a different lens, that helped me to see something I never would have seen on my own. That made me ask: How many other things am I missing out there?"  

His 'terminal' research projects

Freed is still asking that question as he pilots two new programs: the Program for Equity in Adolescent and Child Health (PEACH) and the Michigan Child Health Equity Collaborative (MI-CHEC).  PEACH is supported by the Children's Foundation, 10 clinical departments in the School of Medicine, Mott Hospital, the Office for Health Equity and Inclusion, Poverty Solutions, and several other units at the University of Michigan. MI-CHEC is a quality collaborative of the three largest pediatric health systems in Michigan, funded in collaboration with the State of Michigan Medicaid Program.

Both programs are the culmination of Freed’s more than 30 years of experience in children's health services research and his desire to find solutions, not just problems, for pediatric health equity.

“I realized that a big part of my career was finding problems,” says Freed. “In pediatrics, we’ve been finding problems for a really long time. We’ve been doing studies in social determinants of health since before I was born, and I’m old.

“Low and behold, we found it’s bad to be poor, and we found that out a long time ago. I realized that me doing another study that says it’s bad to be poor wasn’t probably going to change that. Even though I think I’m a really good guy and a pretty good researcher, I will not be curing poverty before I retire.

“I’m glad a lot of people are working on addressing poverty because it’s really important, and I don’t want to minimize that. But I started to think about which things are actually within the control of the health-care system. What are things we can do right now that can make a difference for kids and their families while the people who are working on those long-term problems like poverty try to fix them?”

Freed says that while he looked at numerous studies showing adults often receive inequitable care because of their gender, race, ethnicity, income level and other factors, he hypothesized – with very little research to draw on – that children probably experience the same fate, not because of evil intentions by providers but because we all have unconscious biases.

Freed then asked: “What would be a mechanism that we could see if we were treating kids differently without realizing it, whether it be treating boys and girls differently, or people in wheelchairs differently, or poor kids differently, or kids of different races and ethnicities? What if we are treating them differently, and what can we do about it?”

Freed – fiercely focused, with thoughts of bow ties and rubber chickens clearly now in the background – admits that these are tough questions but says they must be asked to bring about change.

“We have to be willing to be a little bit uncomfortable to drive change,” says Freed. “And I believe we can and should have the courage to look to see how we can do better, not to blame and shame, but to figure out from a systems level where we fall short and where we can make a difference and provide more equitable care.”

An eye on retirement

With retirement about five years away, Freed says that PEACH and Mi-CHEC are his “terminal” research projects. Back to his whimsical side, he talks of grandchildren – he’s still waiting for one but isn’t allowed mention it around his kids – and more travel, saying, “Often my favorite destination is the next place I haven’t been before.”

He also mentions retirement will give him the freedom of time to spend the day reading a book, to be able to visit faraway family and friends, and to reconnect and nurture those relationships that have been stymied by distance.

Freed then offers one final retirement desire as the interview concludes: “I want to play a lot of miniature golf,” he says with a laugh.