Monday, February 9, 2009

Rectifying Institutional Bias in Medical Research

Below is link to editoiral on our study in the ARCH PEDIATR ADOLESC MED/VOL 163 (NO. 2), FEB 2009 (click below)

INCREASING THE REPRESENTATION OF WOMEN AND racial and ethnic minorities in human research has become a national priority. Federal agencies have made inclusion of women and minorities an explicit criterion on which applications for clinical research funding are judged. The need for this affirmative action stems from a historical bias favoring white men. As with most other institutions in the United States, medical research no longer actively excludes women and minorities. But the history of these institutions, the way they were designed and built— predominantly by and for white men—slants them in a way that continues to limit access for other groups.

click below for full article:

Letter to PG Editor

Below is the text of our letter to the editor. Not sure when or if it will be published:

Your editorial, “Unhealthy Suspicion: A Study Reveals Harsh Attitudes Toward Medicine,” (Post Gazette, February 6, 2009) is timely. You highlight our scientific finding that African American parents were more distrusting of medical research than white parents. Such high levels of distrust may be a barrier for enrollment of African American children into clinical research.
However, calling the response of black parents the “…height of irresponsibility -- and superstition...,” for their distrust of enrollment of their children in medical research, is offensive and misses the point. Racial discrimination in medicine and research would be easy to ignore were it not so well documented. As the Institute of Medicine reported in 2002, African American patients, even with the same insurance coverage, income and disease, receive worse medical care than their white counterparts. These are the facts, not superstitious conspiracy theories.

One solution is to increase the racial/ethnic diversity of the health professional workforce. Unfortunately, across this nation, the proportion of African American physicians, dentists, pharmacists and other health professionals is far lower than the proportion of African Americans in the society. Some schools of the health sciences have zero black faculty and few black students. Health professional schools in Pittsburgh are not immune to this dire situation.
As long as African Americans in Pittsburgh live sicker and die younger than their white neighbors there is a logical reason for their legitimate discontent. Now, more than ever our entire community must join the national campaign to eliminate racial and ethnic health disparities. Part of that effort must be to hold our health care systems accountable to increase the number of minority professionals. However, it is not just increasing the numbers but it is making sure that our health professionals and institutions are ever vigilant in insuring that all patients, regardless of income, race, sexual orientation, religion or education, are treated equally.

As for increasing participation of African Americans in clinical research, there are promising strategies that we, at the Center for Minority Health, have implemented in Pittsburgh. Our Community Research Advisory Board seeks to empower community members to better interact with research investigators. This interaction improves the ability of researchers to reach African American and Hispanic communities, as well as better disseminate information about research studies in those communities .

Finally, our finding that 50% of white and 67% of black parents “distrust medical research,” is cause for concern that clearly extends beyond African American parents. Our academic health centers, here in Pittsburgh and elsewhere, must be more effective in educating BOTH black and white communities about the value of participating in biomedical and public health research. Moreover, health researchers must become more effective in translating our research into services that can improve the health of all of our families. This approach will go a long way toward improving trust between communities in need and the health care system.

Stephen B. Thomas (412-996-6555)
Kumaravel Rajakumar
Donald Musa
Donna Almario
Mary Garza

Racial Differences in Parents’ Distrust

The published article is located at

Also important is the local news coverage on the topic. More specifically the Pittsburgh PostGazette Editorial, see below:

Unhealthy suspicion: A study reveals harsh attitudes toward medicine
Friday, February 06, 2009
Pittsburgh Post-Gazette

There was a time when the indifference of the American medical establishment toward the health of African Americans was as much a matter of policy as prejudice. The bitter taste of those days apparently still lingers in the memory of some and the imaginations of others.
The Children's Hospital of Pittsburgh and the University of Pittsburgh released a study this week that says suspicions about clinical trials and medical research in the African-American community may be having a negative impact on black people's health.

According to the report, black parents are more likely than white parents to distrust medical research (67 percent to 50 percent) and more blacks than whites suspect doctors of experimenting on their children with risky medicines (40 percent to 28 percent). Almost 25 percent of black parents also believe, compared to 10 percent of whites, that doctors won't be honest regarding their child's participation in a medical study.

These are devastating numbers on attitudes that may account for some of the disparity in health care between whites and African Americans. Lack of education is behind much of the suspicion, but even those with college educations aren't immune to thinking the worst of the medical establishment. Knowledge of the Tuskegee Syphilis Experiments between 1932 and 1972, for instance, casts a long shadow.

Black parents owe it to their children, however, to become more sophisticated about how American medical policy evolved over the decades. The Tuskegee Experiment, in which black men with syphilis were left untreated, should not be used by African Americans to justify suspicions of medicine in the 21st century.

As doctors of all races strive to take the Hippocratic Oath seriously, it is the height of irresponsibility -- and superstition -- for black patients to act as if a medical conspiracy is anywhere other than in the past.

First published on February 6, 2009 at 12:00 am

Sunday, September 21, 2008

Barbershops become urban community health centers

Barbershops become urban community health centers
Thu Sep 18, 2008 3:10pm EDT
By Terri Coles
TORONTO (Reuters) - African-American communities in the shadows of the University of Pittsburgh's buildings are getting sick and dying sooner than their white counterparts, of preventable diseases -- and Dr. Stephen Thomas wants to change it.
An outreach initiative involving local barbershops and beauty salons is a step in that direction.
Epidemiological data shows that African-Americans suffer a higher burden of premature illness and death than Caucasians, said Thomas, director of the university's Center for Minority Health. They have higher rates of infant mortality, HIV/AIDS and mental illness. HIV is the leading cause of death among African-Americans 25 to 44, for example, and rates of death from cardiovascular disease are 30 percent higher in black adults than white adults, according to the American Medical Student Association. Diabetes is 70 percent more prevalent in blacks than whites, and prostate cancer hits African-American men 66 percent more frequently than Caucasian men, with twice the death rate.
Pittsburgh is not unique in this, Thomas pointed out - there are black communities around universities across the United States where residents have higher rates of diabetes, obesity and heart disease. "Simply because they are geographically close does not mean they benefit from the technology that's there," he said of the schools.
But although the disparity has been measured, we don't fully know why it exists, or how to remove it, Thomas said. Culturally appropriate strategies to address and attack the health disparities between blacks and whites are needed, he said.
To that end, the Center for Minority Health has created Take a Health Professional to the People Day, which falls on September 18 this year, its seventh. The program works to bridge the academic community and African-American neighborhoods in Pittsburgh by developing a health partnership that involves neighborhood barbershops and beauty salons and their staff and owners as lay health advocates, Thomas said.
The program works with ten barbershops and salons in the city, and 200 Pittsburgh health professionals have signed up to visit the shops on Take a Health Professional to the People Day to provide health screening to people in the surrounding neighborhoods. The screening goes from basic exams to cancer screening directly in the barbershops with blood tests and rectal digital exams, Thomas explained. Last year the participating health professionals were able to screen 700 people in one day; with more signed up this year, he expects they'll be able to see a higher number of patients this year.
Private insurers will also be on-site at the barbershops in order to take people through signing up for private insurance. Many people qualify for insurance, Thomas said, but have never had someone help them through the complicated process of applying.
The work goes beyond the one-day screening, however. Barbers are trained in CPR and the use of automatic defibrillators, for example, and serve as conduits for getting health information out to community members.
The outreach effort is focusing on barbershops because they serve as meeting places in African-American communities, where the conversation frequently strays from hair and the owners are seen as leaders in the community.
"No conversation goes without commentary," Thomas said, recalling one incident in a barbershop that underscored why they can be such a powerful tool. A man who had recently had a heart attack was getting his hair cut, and he, the barber and the shop patrons were discussing the new medication he had been prescribed. The barber pointed out that the pills might prevent him from keeping up his "obligations," referring to the possibility of erectile dysfunction as a side effect of the medication.
He could tell by the look on the man's face during the conversation that with that knowledge, he wasn't going to take the pills, Thomas said. "That's when we realized that a barber can have more credibility than a doctor."
A lack of trust of health professionals among African-Americans is part of what is keeping them at a disadvantage, Thomas said. Much of that mistrust stems from the infamous Tuskegee experiment in which poor black men with syphilis were left untreated for decades.
That notorious episode eventually led to increased protection for clinical trial participants, but the effects of it are still seen in black communities today, Thomas said. President Clinton formally apologized for the clinical trial in 1997, and that began a change, he said, but more still needs to be done to reach these communities through their mistrust. "We believe that it's time for atonement."
The program has partnered with the Mayo Clinic in Rochester, Minn., which offers a credit course studying health disparity that uses Take a Health Professional to the People Day as an urban immersion experience for its graduate students.
The field work involved in the trip to Pittsburgh for Take a Health Professional to the People Day helps health professionals understand the realities of health disparities and gain cultural confidence, said Dr. W. Charles Huskins, associate director for the Mayo Clinic Center for Translational Science Activities in Rochester, Minnesota. It also allows them to see first-hand some strategies for engaging the community in prevention initiatives.
The feedback has been incredible so far, Huskins said while in Pittsburgh. "They're seeing things that they would not necessarily have seen in Rochester," he said.
Increasing the diversity among health professional is an important step towards engaging communities in public health and their own care, said Dr. Eddie Greene, director of Health Disparities curriculum development and director of the Office of Diversity at Mayo Clinic Rochester. But it is also important to make sure that health professionals who are already working have that same sensitivity, he said, and initiatives like Take a Health Professional to the People Day and the Mayo Clinic's course help to achieve that cultural competence.
Thomas, Huskins and Greene hope the program in Pittsburgh can serve as a model for expansion to other parts of the country and other groups, such as Native Americans, Hispanics and rural Americans, who also experience health care disparities. With their programs and Take a Health Professional to the People, the University of Pittsburgh and the Mayo Clinic want to be a role model of cooperation for other institutions surrounded by minority communities dying from things they are experts in, Thomas said. "That is no longer acceptable morally, and it is no longer acceptable scientifically."
How do you think health disparities can be reduced? Let us know:
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Sunday, January 20, 2008

Question 5: Sustaining the Healthy Black Family Project

Q5: HBFP Franchising ? ?

The word franchise is defined as “…the right or license granted to an individual or group to market a company's goods or services in a particular territory”

Sustaining the Healthy Black Family Project is critical. I am working on several options including, but not limited to, creation of a “franchise.” Franchise is one of several options I am exploring to find the best way to sustain the Healthy Black Family Project. The cost of operating the HBFP is over one million dollars per year. As you know the program is “NO CHARGE” to the over 6,000 participants. We benefit from grants by local and national foundations and the NIH as well as donations. We are now in the middle of a one million dollar fund raising campaign (click below).

My aim is that before we reach the 2010 deadline we will have a viable sustainability plan to keep HBFP going on into the future and spreading across the nation. Franchise is only one idea. Other ideas include service contracts with Highmark, UPMC Health Plan, Gateway Health Plan and other insurance companies that would actually fund CMH to deliver HBFP to their members. Another idea is to produce health education content in the form of DVDs and TV shows that would generate income to support the HBFP.

There are many more ideas that we must consider and I am open to any and all ideas for how to sustain the program.

Question 4: Barbers & Stylists in Research Center of Excellence

Q4: How can we 'train' barbers and stylists to be integral parts of Research Center of Excellence in Minority Health Disparities (RCEMHD)

The CMH works in partnership with 10 barbershops/salons located in the Health Empowerment Zone. Over the past six years this innovative collaboration has evolved into our Health Advocates In-Reach (HAIR) intervention under the leadership of Mr. Mario Browne, CMH Project director. Click below to learn more about HAIR

Within the context of the RCEMHD, the shops serve as portals of entry for individuals into the Healthy Black Family Project. They are also sites for dissemination of evidence based health information including, but not limited to, mental wellness, obesity prevention, access to health insurance, environmental justice and other material. The barbers and stylist have received "mini-grants" to support their efforts. Importantly, the shops provide a venue for the annual Take A Health Professional to the People Day each September.

The barbershops /salons are in intregral part of the RCEMHD Community Research Engagement Core (Dr. Angela Ford, Core Dir.). Click below to learn more about the Community Research Engagement Core

Click below to learn more about the integration of barbershops/salons into the RCEMHD.

Question 3: More Help

Q3: Will the Center be bringing in more support (students or staff) to work with the various interventions?

1. Response:

The short answer is yes. The CMH will have two Kellogg Health Disparity Scholars in 2007 and we continue to identify new junior faculty to work with us on a variety of research projects. However, the key is “…more staff/student support…” that will help reduce work load stress. I am working with the Dean’s office to make a case for new staff support. The justification requires that we conduct a workload audit demonstrating how current staff are deployed and where the gaps are that must be filled. Keep in mind, we have experienced tremendous growth over the past seven years (15 to 20 new staff) and the vast majority of them are supported on “soft-money” …. (grants / contracts). We need enough staff and the right staff to successfully carry out the work in order to secure additional grants / contracts to keep everyone employed. It is a matter of balance and management to keep the CMH moving forward.