AP Biology class blog for discussing current research in Biology

Tag: Racism

How the Healthcare Industry Disadvantages Minorities

Although our country is built on the principle that “all men are created equal,” this notion has yet to be completely true in modern America or our history. The disproportionate death rate from COVID-19 in Black Americans is a telltale sign of the inequities, or injustices, in place in the healthcare industry. While it’s easy to blame these inequities on higher obesity, diabetes, or hypertension rates in Black Americans, there is more to it than that.

These inequities are also very prevalent in prostate cancer mortality, as the numbers are far higher in Black men than white. This results from a multitude of factors, including that they “generally get fewer PSA screenings, are more likely to be diagnosed with later stage cancer, are less likely to have health insurance, have less access to high-quality care,” or perhaps even other factors, according to Daniel Spratt, M.D. These are all indications of structural inequality, a system of unfairness created by institutions, in our country, not just circumstantial or individual biases. 

Black and minority patients are likely to feel more comfortable with minority doctors, but unfortunately this isn’t always possible. For obvious reasons, this reduces implicit bias from the physicians. Aside from a harder time getting proper care, minorities also suffer from an unequal amount of expenses. According to a UMichigan team, “the last six months of life is $7,100 more expensive to the Medicare system for Black people, and $6,100 more expensive for Hispanics, compared with white people,” although more research must be done to determine exactly why this is. One of the root causes for these trends could be lack of nutrition. Even before the pandemic, many minority adults and children didn’t have access to nutritious foods, which plays a major role in health status. This also continues to be perpetuated by institutional racism and the vicious cycle of poverty in America. Unfortunately, many situations only worsened with the emergence of COVID-19. This is a very pressing issue that must be addressed sooner rather than later, in order to ensure the safety of many adults and children.

As we have learned in bio class, the use of masks to prevent the spread of COVID-19 is absolutely essential. Especially in urban or tightly packed communities, where COVID-19 can easily spread from person to person, masks are needed more than ever. Additionally, these communities often have high amounts of minorities, worsening their odds of becoming seriously ill. Fortunately, with the development of safe and effective vaccines, there is finally a light at the end of the tunnel. Minority communities desperately need vaccines in order to prevent any more lives lost, and luckily distribution is gradually picking up. Although this has been a tragic year, I hope America will learn from this situation, becoming more prepared for future unpredictable scenarios and fixing the inequities prevalent in our country.

Is Racial Bias Ruining Science?

In this video posted by Wonder Collective on Youtube, Dr.Esteban Bruchard gives a general overview of how racial biases have been implemented into medicine and general science. Primarily, Dr.Esteban Bruchard shed light on the exclusion of minorities from clinical research. By doing this the scientific conclusions had to be generalized to other groups who haven’t been included in the research. Specifically, a graphic that was shown in the video, showed that a drastic 81% of the participants of a “Recent genome study” were European.  Other races making up only 19% of the participants. The underrepresentation of other races will cause an inability to properly assess certain situations regarding other races. An example of this, as touched upon in the video, was how a difference in gene frequency in Blacks caused many African-Americans to be misdiagnosed with an enlarged heart.

Black patient getting attended to by a doctor

This isn’t the only instance of racial biases affecting science and medicine. In an article by Mathieu Rees, the topic of racism in healthcare is further discussed. Rees, dives into how certain aspects such as pregnancy, emergency care, pain treatment, etc. One thing that Rees highlights in his summary is that these racial biases can lead to inaccurate diagnoses. Rees also uses some statistics to show the racial disparities in healthcare. A specific statistic that I found alarming was a study that was conducted with white medical students in 2016. In this study, “73% held at least one false belief about the biological differences between races”. Examples of some of their beliefs were “Black people having thicker skin, less sensitive nerve endings, or stronger immune systems.” Not only are these biases alarming because of the obvious racial assumptions, but it is also so problematic because the people with these preconceived notions are those who will potentially be leading the healthcare of the future.

Going forward there are many steps that need to be taken to prevent the prevalence of racial biases in healthcare and sciences. One big step that can be taken is the involvement of more POC in the science world. Not only in hospitals as leading figures like doctors and physicians, but also as participants in things like clinical trials, advanced studies, etc. Also, the acknowledgment of various “social factors that affect health outcomes“. Finally, addressing these biases head on is one of the best ways to avoid them from being prominent in the line of work and in the development of science.

Bias in Science: History, Representation, and Medicine

Science is not objective. Scientists may value fact, but they are still people too, influenced by identity and implicit and explicit biases in their research. Racism has pervaded every aspect of society since the country’s founding, and scientific institutions are no exception. From historical racist research practices to a modern reluctance to support Black Lives Matter or actively diversify the field, scientists have participated in and promoted racism for centuries. Scientists cannot claim objectivity now as an excuse to not be antiracist.

Throughout American history, unethical, racist research has contributed to scientific “progress”, but that is not regularly acknowledged. Although the past cannot be undone, fields should at least recognize the horrific means by which some research was done. For example, gynecology was borne of unethical experiments done on enslaved women and children. The “Tuskegee Experiment” withheld treatment of syphilis from hundreds of Black men just to see how the disease progressed. Henrietta Lacks, a Black woman with cervical cancer in 1951, had some cells taken from her tumor without being informed of this. The cells from her tumor, now known as HeLa cells, have been used since the 1950s for biomedical research. Since cancer is characterized by an improperly regulated cell cycle, with either too much cell growth or too little cell death, cancer cells can grow and divide excessively. This particular line of cells has been able to grow and divide endlessly, due to the presence of an active version of telomerase during cell division. This enzyme prevents the typical shortening of telomeres in cell division that leads to cell aging and death, making the cells “immortal” and the cell line usable to this day. Though they have been used in various research advances, her name was only connected to them in the 1970s. Her family, still with limited access to healthcare themselves, received no financial benefits and had no say in how the cells were used. Henrietta Lacks’ case is a more recent example of unethical research practices affecting Black people.

The questions scientists choose to study, whom they choose to include, and how they apply their results all bias research. Scientists of marginalized identities are much more likely to explore topics relevant to minority groups. So then, the lack of diversity among scientists also contributes to biased research priorities. In 2016, only 9% and 13.5% of science bachelors degrees were given to African Americans and Latinos respectively, and only 5% and 3.8% of doctoral degrees in science and engineering went to women and men from underrepresented minorities. Almost 70% of scientists and engineers employed full time are white. When issues like COVID-19 and climate change disproportionately affect marginalized groups, the lack of diverse representation can prevent representative research or solutions. Scientific institutions need to work on hiring and retention of Black, Latinx, and Indigenous scientists, in part by creating less hostile work environments and increasing DEI efforts.

The lack of diversity in clinical trials also decreases the inclusivity of science and medicine. Even though about 40% of Americans are nonwhite or Hispanic, the clinical trials for new drugs tend to have much whiter samples, with some having 80 to 90% white participants. Since these drugs will be used to treat all people, diverse samples are needed to determine the efficacy and side effects that can vary across ethnicity and sex. The 1993 National Institutes of Health Revitalization Act that required greater inclusion of women and minorities in NIH research samples did improve the proportion of female subjects, but not so much for minority groups. Even for diseases that disproportionately affect marginalized groups, those groups are grievously underrepresented in the clinical trials. 

One such disease is COVID-19. Even though the rates of infection, severity, and death are greater for Black, Latinx, and Indigenous Americans, these groups are underrepresented in clinical trials. Trials for drugs to treat COVID-19 did not accurately reflect the most affected populations at the research sites. Some studies also did not report the race and ethnicity of participants as required by the FDA. Remdesivir has shown to somewhat decrease recovery time, but since disease severity and outcomes are worse for minority groups, the benefits of improvement may not necessarily extend to them. This is why proportional representation of affected populations is so important in clinical trials for drugs.

One cause for lack of diversity in clinical trials is that minority groups can be unwilling or unable to take part, for reasons including fear of discrimination, lack of time or resources, inaccessibility of recruitment centers, language barriers, and fear of exploitation based in historical precedent. However, these barriers should be on the researchers to address, not on the marginalized groups. A possible solution could be to have the FDA enforce that drugs should be tested on samples that demographically reflect the populations that will be using them.

In the end, research institutions and scientists need to examine their biases in order to determine who they are serving, and then who they mean to serve. Efforts to increase diversity cannot be passive, but instead should involve active recruitment and work to eliminate the barriers in place. In an academic institution, that might mean a more inclusive work environment and better outreach and mentorship programs. For clinical trials, this could be reducing the financial burden of participation and building better relationships with minority communities that may have been hurt in the past. Science is meant to help people, so we need to be better moving forward, as well as acknowledge the damage scientists have done in the past.

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