To commemorate the approaching Black History Month, HCPLive's editorial staff interviewed clinicians of color in more than six specialties to discuss how a lack of diversity in clinical trials affects their specialty and real-world patient care. I asked him if he had any kind of influence on him. In this series, we ask a group of experts a series of his three questions about our historic lack of diversity, how it manifests in medicine today, and what the future holds if left unchecked. I threw it.
This part of the series focuses on answering the first question. This question summarized the expert group's views on how the historical lack of diversity in clinical trials manifests itself in the care of patients from diverse backgrounds today. These answers are highlighted in the following video and transcribed below.
More in this series: Expert perspectives: How a lack of diversity in clinical trials impacts public health
HCP Live: How has the lack of diversity in clinical trials historically affected your specialty, and how does it affect providing equitable medical outcomes for all patients within your field? Did it pose any specific challenges?
(Left to Right): Alisha Blazer, MD; Elisha Ellis Cox, MD, MPH. Luisa N. Borel, DDS, Ph.D. Nasrian Ibrahim, MD, MPH. Dr. Girardin Jean-Louis; Dr. Ashwin Anantakrishnan, MBBS, MPH.and Maya Clark Cutaia, RN, MSN, Ph.D.
Nasrian Ibrahim, MD, MPH: So if you look at the state of trials in cardiology, specifically heart failure and transplant, enrollment across cardiology in particular has been abysmal, particularly among black patients. We also know that women are underrepresented in clinical trials, including people from other racial and ethnic minorities such as American Indians, Hispanics, Latinx-X, and, of course, women. And I think the biggest problem with that is that we're creating guidelines that apply to everyone based on these landmark trials, even though the trials are not representative of the patient population. It's making recommendations that are supposed to apply to everyone. The lack of diversity indicates that we are only looking at one particular patient population (white men). That is, the majority of patients are enrolled or individuals enrolled in clinical trials. For me, it's about how do you translate this into the real world if clinical trials don't really represent the real world?
Ashwin Anantakrishnan, MD, MBBS, MPH: TThe issue of racial and ethnic underrepresentation in gastroenterology clinical trials is a significant concern with significant implications for patient care. Historically, clinical trials have been conducted for more than 70 years, but there are times when the patient populations enrolled in these trials may not accurately reflect the diversity of the U.S. population. It's becoming increasingly clear.
This lack of representation is particularly concerning for several reasons. First, there are biological differences between races and ethnicities that can lead to variations in treatment response and side effects. Without adequate representation in clinical trials, it becomes difficult to accurately generalize treatment efficacy and safety across diverse patient populations. This can result in inequitable access to effective treatments and suboptimal care for certain racial and ethnic groups.
Additionally, clinical trials are often an important source of treatment for refractory patients who have exhausted standard treatment options. Underrepresentation in clinical trials means certain races and ethnicities may be denied access to potentially life-saving treatments if they do not respond to standard treatments. It means that there is a gender.
To address these issues, the field of gastroenterology must recognize the value of racial and ethnic diversity in clinical trials. Ensuring diverse representation allows researchers to generate more accurate and generalizable data, leading to equitable access to effective treatments for all patients. Additionally, efforts should be made to improve outreach and recruitment strategies to increase diversity in clinical trial participation, thereby addressing healthcare disparities and promoting patient-centered care in gastroenterology. There is.
Maya Clark Cutaia, RN, MSN, PhD: You know, I think the first part of that question is a really unfortunate question. Because minority groups are overrepresented in kidney disease, and therefore lack of representation means that the experiences of the minorities most harmed are not fully understood. . We understand the impact that that has on our socio-culture and how systemic, structural racism, not just discrimination, really impacts the interventions and medications that we want to provide to these patients. It goes even further because there isn't. So actually figuring out how to meet them where they are doesn't always happen.
Luisa N. Borel, DDS, PhD: We would like to inform you that certain asthma medications are primarily tested and developed with Caucasians in mind. However, when administered to African American children, it often proves ineffective. It is noteworthy that the prevalence of asthma is higher among African Americans and Puerto Ricans in the United States. An interesting aspect of this disparity lies in environmental factors related to the region of residence. Many African Americans and Puerto Ricans live in urban neighborhoods, such as public housing projects or areas near freeways. As a result, these communities are exposed to high levels of air pollution caused by vehicle exhaust, which has a significant impact on the air quality to which children are exposed. In addition, issues such as poor hygiene practices such as delayed garbage collection contribute to conditions that favor the infestation of pests such as cockroaches. These pests harbor allergens that can worsen asthma symptoms and interfere with your child's overall asthma control.
Elisha Ellis Cox, MD, MPH: Consider the many factors that influence mental health, from trauma, grief, and social isolation to genetics and family history. Additionally, racism and discrimination have a huge impact on mental health. Although the Black population makes up approximately 13-15% of the U.S. population, their representation in clinical trials is typically only 5-8%. While it may be tempting to attribute this underestimation to a lack of interest, such an assumption does not capture the whole story.
As a result, clinical trials often lack diversity, compromising the validity of their results. Failure to consider the effects of long-term stress, particularly elevated cortisol levels resulting from experiences of racism and discrimination, further compromises the effectiveness of treatment. As a result, what appears to be evidence-based interventions often overlook important physiological factors and become ineffective in diverse populations.
These trials primarily included Caucasian participants, making them unable to accurately represent broader demographics. As a result, treatment effectiveness and applicability is disproportionate, marginalizing Black and brown communities. Recognizing and addressing these disparities is essential to developing truly comprehensive and effective mental health interventions.
Asira Blazer, MD, MSCI: Like many other specialties, there is a notable lack of diversity in rheumatology, and this is particularly notable for several reasons. First, because rheumatic diseases are rare, the number of patients is small compared to diseases such as hypertension or diabetes, making it difficult to recruit participants for clinical trials. Furthermore, these trials are often conducted in large academic centers that are difficult to access for disadvantaged and underserved populations, further exacerbating the problem.
The lack of diversity among clinical trial participants is particularly concerning in diseases such as lupus, where the majority of trial participants are white, even though the majority of patients are people of color. As a result, our understanding of how lupus manifests and responds to treatment in a broader and more diverse patient population is limited.
Additionally, when considering the nuances of rheumatic diseases such as lupus, it is essential to recognize the wide range of symptoms that patients experience. Inflammatory status, such as the Lupus Activity Score, is important for assessing disease severity, but Type 2 conditions, such as pain, depression, and fibromyalgia, are less directly linked to inflammation and are more difficult to manage. There is also. Additionally, the presentation of these symptoms is often influenced by cultural factors, further complicating understanding and meeting the needs of diverse patient populations. Efforts to broaden the scope of clinical trials and incorporate diverse perspectives are essential to improving the understanding and management of rheumatic diseases.
Dr. Girardin Jean-Louis: I noticed differences between black, white, Latino, and Latino individuals in terms of sleep duration and quality, especially from 1990 to 1999. At the time, the debate was not focused on inequality per se, but rather on awareness and understanding. These differences. Consideration has been given to whether these differences are due to specific environmental factors or policies that favor one racial or ethnic group over another. The distinction between disparities and differences was critical because it highlights the potential link between observed variation and underlying policy and environmental influences.
Initially, my observations focused on differences in sleep patterns, but over time I realized that similar differences exist in other health areas such as blood pressure, HIV, cancer, diabetes, and heart disease. It became clear. In addition, variations in sleep and circadian rhythms also emerged as a concern. As a result, the concept of sleep equity has gained attention and led to the development of a dedicated field aimed at addressing these disparities.
This realization had a huge impact beyond my career choices. This has prompted broader efforts to address health disparities, not only by advancing research in this area but also by providing training opportunities for others interested in health equity. By empowering individuals to become health disparities researchers, we aim to contribute to a more equitable healthcare environment and foster meaningful change in addressing disparities across a variety of health conditions and domains. Masu.
