Racism seems to find its way everywhere, even in the field of medicine, affecting everyone from patients to doctors to nurses. This bias has not only held back the development of the medical field but also millions of people who haven’t received the treatment they deserve.
Participants in clinical trials are overwhelmingly caucasian.
First, let’s examine racial bias in clinical trials, which are profoundly white. For years, many ethnic minorities have been excluded from the clinical and medical trials of numerous drugs and treatments. A research study by Meghan E. McGarry and Susanna A. McColley titled “Minorities Are Underrepresented in Clinical Trials of Pharmaceutical Agents for Cystic Fibrosis” found that between 1999 and 2015, 94.4% of subjects in the 147 pharmacology clinical trials on treatments for Cystic Fibrosis were white. Only three clinical trials reported Asian subjects.
This is concerning because many diseases and conditions affect different ethnicities in different ways. According to a 2016 study “Novel genetic risk factors for asthma in African American children: Precision Medicine and the SAGE II Study” only 5% of the genetic traits linked to asthma in European Americans are found in African Americans. Hence the treatment that is developed may not be as effective on asthmatic African Americans as compared to European Americans.
A 2009 research study “Ethnic Differences in Bronchodilator Responsiveness Among African Americans, Puerto Ricans, and Mexicans with Asthma” showed that 47% of African American children with moderate-to-severe asthma portrayed a diminished response to Albuterol, the most prescribed drug for asthma.
And this problem isn’t going away. The 2015 research study “Moving toward True Inclusion of Racial/Ethnic Minorities in Federally Funded Studies: Key Step for Achieving Respiratory Health Equality in the United States” by Esteban G. Burchard found that over 20 years, the inclusion of racial minorities in respiratory disease studies published between 1993 and 2013, only increased slightly from 2% to nearly 5%. This is particularly concerning considering that African Americans are more prone to developing respiratory afflictions than White Americans.
Why does racial bias in clinical trials occur? A 2020 study titled “Bias and stereotyping among research and clinical professionals: Perspectives on minority recruitment for oncology clinical trials”, showed results from 91 qualitative interviews which were conducted at 5 US cancer centres. The study showed five prominent reasons ranging from the belief that race is irrelevant to clinic-level barriers and negative perceptions towards ethnic and racial minorities.
The study also revealed issues such as perceptions that African Americans were less knowledgeable and were not competent enough to take part in the research study. Another reason for the under-representation of ethnic and racial minorities in clinical trials was their fear of discrimination, exploitation, and lack of resources to be able to access the centres that enlist the subjects for these clinical trials.
But racial discrimination and bias also occur when patients seek treatment.
The quality of treatment given to two people might differ according to their race even when checked by the same doctor.
“Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites”, a study published in 2016 and conducted amongst 222 white medical students and residents is quite revealing. According to this research, about half of the participants who have false beliefs about the biological differences between black people and white people rated black patients’ pain lower as compared to white patients for the same injuries.
Thus, they were also more likely to suggest inappropriate treatment for black patients. Racial bias against patients is also often seen in the ERs, where the patients from racial and ethnic minorities don’t receive the required medication and treatment. This bias is also prevalent in the diagnosis of conditions as well as long term treatment.
A 2014 study titled “Racial disparities in psychotic disorder diagnosis: A review of empirical literature” by Robert C Schwartz and David M Blankenship showed that doctors were more likely to diagnose black patients with psychotic disorders than with depression. In December 2017, a Canadian Rapper, John River, had to wait 60 days for an emergency procedure. Visiting more than 5 hospitals, he was accused of imagining his symptoms as well as being a drug user or dealer. Sadly stories like this abound.
However, discrimination based on race does not also occur only against medical professionals. According to a survey including more than 800 US physicians conducted by WebMD, Medscape, and STAT, 59% of the physicians had been a victim of offensive remarks about a personal characteristic like their gender, race, and ethnicity with African American and Asian American doctors being most likely to face them. 47% of these physicians were requested by patients to be referred to a different clinician, while 14% stated that they had faced situations with written complaints from the patients about their physical characteristics.
There have been some positive developments though. The NIH Revitalization Act of 1993 mandated NIH to frame guidelines for the inclusion of women and minorities in clinical research. However, clinical research which is conducted under NIH only represents 6% of all clinical trials. Thus we need similar efforts by governments as well as health organizations for mandatory inclusion of racial and ethnic minorities in an equitable ratio in all clinical trials.
Further, strict laws must be brought in punishing those who indulge in racial discrimination in clinical trials, and institutions that involve more marginalized communities in clinical trials must be incentivized.
Apart from changes in legal and regulatory frameworks, steps must be taken to reduce racial bias in healthcare by educating clinicians, staff, and even patients, through workshops and sessions. The raw discrimination and racism in the healthcare system, if not remedied, will continue to the disadvantage of the marginalized communities, who are disadvantaged enough. As we battle this pandemic the need to be aware of such issues is only heightened.