Health Law & Business

Protests Prompt Re-Examination of Inequality in Medical Research

June 18, 2020, 9:30 AM

Scientists are grappling with historic inequities in medical research in light of racial justice protests gripping the U.S.

Breaking through decades of mistrust from the Black community to ensure medical research adequately reflects the U.S. population means scientists need to think more about how they engage with minority groups. With more than $16.5 billion pegged for clinical research in fiscal 2020, the National Institutes of Health could use its deep pockets to encourage researchers to improve their outreach to minority populations when readying studies, bioethicists said.

“Now is the time for us to really consider: How do we actively engage with communities and think about our own biases—not just those scientific biases that we talk about in the research literature but our personal biases that impact how we design our research?” said Joyce E. Balls-Berry, an assistant professor at the Mayo Clinic who works to make health research more diverse.

Diversity in medical research needs to be more than a box-checking exercise because various diseases and medications can affect populations differently. Adding only healthy minority volunteers to a clinical study isn’t real equity because that won’t reflect existing social and health challenges facing some minority groups, Elisa A. Hurley, executive director of Public Responsibility in Medicine & Research, said.

Improving outreach means the research institutions will have to work more closely with minority communities to understand their unique health challenges and concerns when recruiting study volunteers. But that work is difficult and often thankless, discouraging researchers from reaching out, Balls-Berry said.

The NIH touted its efforts to recruit more women and minorities for studies, gather statistics on inclusion for studies on various diseases, and prioritize diversity as it tackles Covid-19.

“Recent decades have seen more participation of women and racial and ethnic minority groups in research,” the agency said. “NIH’s goal is to ensure that these trends continue so that the knowledge gained from research is applicable to everyone affected by the disease or condition under study.”

NIH Director Francis S. Collins acknowledged the need to do more at a recent meeting of his advisers. Doing that “is going to require continued energy and determination and commitment by all of us.”

Grappling With History

Better outreach means confronting and learning from a history of racist medical policies under which Black people were used for research, often without their consent.

Cervical cancer patient Henrietta Lacks’ cells have been used in research for decades even though she never gave consent. As part of the Tuskegee experiment, hundreds of poor Black men were denied access to adequate syphilis treatments or lied to about their treatment so researchers could study the disease’s progress over four decades. That revelation in 1972 laid the ethical foundation for the human research subject protection regulations known as the Common Rule.

Keisha S. Ray, a bioethicist who works on justice questions related to biomedical enhancement at the University of Texas Health Science Center at Houston, draws a direct line from those violations to the current protests against police violence.

“It’s this tiredness of just government-sanctioned murder in the same way that we started getting regulations in biomedical research because it was this tiredness of using black bodies just for gain—and a lot of times it wasn’t for the benefit of the black community,” Ray said.

Power of the Purse

The NIH can keep those historic biases from creeping into new studies by using its funding