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