Progress in Equitable Medical Care and Research

Medical Care

It’s an unavoidable fact that medical science has lagged when it comes to diagnosing and treating diseases such as cancer in African American communities. A number of factors contribute to this, including a slow rebuilding of trust in medical institutions due to past mistreatment of minority community members, such as the Tuskegee study on Black men and the use of Henrietta Lacks’ biological materials without consent. It remains that white males are over represented in research studies. As of a 2015 study, Blacks and Latino community members constitute 30% of the U.S. population, but represent only about 6% in clinical trials.

Learn more about what happened in Tuskegee and how Lacks’ cancer cells aided research but violated ethics on the Black History in Two Minutes Podcast.

But, progress making healthcare and medical research equitable continues and new discoveries bolster ongoing projects, while seeming technological advances get a second look. Last year, the 2020 Robert F. Smith-PCF Special Challenge Award helped the Prostate Cancer Foundation fund research to find a genetic screening for prostate cancer to improve early detection and treatment in African American communities.

Research proving that such a test is essential was published early this year in Nature Genetics Journal (January, 2021). The paper showed that men with African ancestry are twice as likely to inherit a prostate cancer risk compared to men of European ancestry. These findings will help bolster the efforts to employ detection precision medicine such as the Smith Polygenic Risk Test to save lives.

According to Smith, gaining knowledge about African American men’s “risk profile and applying this knowledge earlier with strategic detection, care, and decisions about cancer risk management is of utmost importance to address health inequity in the U.S.”

Racial Algorithm Gets a Second Look

Kidney failure affects approximately four times as many Black Americans as white, according to current estimates. A study published in December 2020, Clinical Implications of Removing Race from Estimates of Kidney Function, shows that a “race-based correction” in the calculation used to diagnose kidney disease, might be preventing African American community members from getting timely treatment. This stems from the discovery by researchers in the 1990s, according to a recent analysis in Nature, that Black people in the U.S. typically have higher levels of creatinine in their bloodstreams. High creatinine levels combined with other factors can be a sign of kidney disease. The calculation was created to adjust for the overage, but the new study suggests that it might be an “over-correction,” and that approximately one million more Black U.S. citizens might be flagged for early stage kidney disease.

One of the originators of the original correction, Dr. Andrew Levy, a nephrologist and emeritus medical chief at Tufts University School of Medicine, suggested to Nature that better solutions combining biomarkers like creatinine would be more comprehensive and he helped develop a new calculation in response to the study’s findings.

But the new algorithm might not be readily available in clinical practice. According to Nature, the Tufts doctor suggested that going forward, doctors should be more transparent with patients regarding how their race or ethnicity might be used in clinical decisions.

“I don’t think that we have been transparent in speaking with our patients about how we do this,” Levy said.Find out how Smith is helping to address health disparities.