As biomedical research continues to advance into new treatments for conditions both relatively new and those as old as humanity, research continues to primarily focus on and benefit certain groups rather than others. For example, medicine has a long and troubled history of bias toward men over women. Research continues to favor men with the notable exceptions of issues primarily gendered as feminine such as breast cancer. In the UK, despite higher mortality and morbidity, coronary artery disease funding was dramatically higher for men as of 2007. This troubling distinction is not isolated to a single island however. Only in 1994 did the NIH issue a guideline on studying gender differences in clinical trials to ensure safety for all patients (Holdcroft). While women’s health exists as one striking example of research bias, health outcomes for minorities and underrepresented populations in research continue to plague biomedical research and public health. Disparities in health outcomes among non-traditional groups continue to plague society and demonstrate a failure in research priorities, public outreach, and public support for treatments.
The National Institute for Minority Health and Health Disparities is the leading government agency on health outcome equity. Established in 2000, its mission centers on studying and overcoming historical lapses in health equality, especially in three major disease areas: cardiovascular disease, diabetes, and cancer (NIMHD Fact Sheet). The populations it focuses on each have a long history of being underserved and include racial and ethnic minority groups, rural populations, and low socioeconomic status populations among others. One particularly recent case is the designation of sexual and gender minorities (SGM), as a health disparity population in 2016 (Perez-Stable). Historically, HIV/AIDS was viewed as a disease afflicting primarily populations often considered undesirable and was met with scorn and silence by the Reagan White House (La Ganga). As poignant as that particular note is, HIV/AIDS continues to serve as a fantastic example of health outcomes with a 2007 report by NIH finding that despite comprising only 13% of the total population, roughly half of the population with HIV/AIDS was African American with an incidence rate of approximately 8.5 times that found in whites, demonstrating a catastrophic failing in community outreach and treatment (NIMHD Health Disparities). Potential causes of such a disparity may have included public support for research primarily demanding protection for white Americans or interest only arising when the traditionally served population felt threatened. Both of which are supported by the private response of laughter from the White House.
While women are now required as part of drug testing, many “modern” pharmaceuticals were approved before this policy change. In fact, as much as 80% of the prescription drugs removed from the US market were withdrawn because of women’s health issues as of 2005 (Holdcroft). One major factor within health disparities for men and women is the complications arising from unsatisfactorily tested medications and the obvious ethical breach that implies. Unfortunately, the cost associated with retesting and recertifying old drugs to current standards is high enough that without outside pressure, it most likely would not happen. Long term disparities such as with drug testing cannot be erased overnight the same way that delays in public support for HIV/AIDS therapies can still be seen today with discrepancies between populations.
The gap in health research and treatment is a major challenge in biomedical research with historical roots leading to present day challenges. Public health efforts have previously been built on the underprivileged assuming the risk with society as a whole sharing the benefits. Public support for the first group associated with HIV/AIDS instead of stigma may have resulted in fewer lives lost with a treatment method coming years earlier. Even today, these historical failings continue to linger. While we try to move forward together, these echoes haunt public health efforts. When underserved groups do not place the degree of trust in research and health services that many others can, this needs to be recognized as a failing of the system to be overcome rather than the all too common approach of blaming a group all too aware of previous mistreatment. Mistakes in research priorities, outreach, and public support cannot be unmade easily. Efforts such as those of the NIMHD are extremely important, but are have not, and most likely will not be enough alone. As members of the public, we are all stakeholders in public health; accordingly, we owe it to ourselves and each other to address these disparities of both equality and equity to improve health efforts going forward.
References
Holdcroft, A. J. R. Soc. Med. 2007, 100 (1), 2–3.
La Ganga, M. L. (2016, March 11). The first lady who looked away: Nancy and the Reagans'
troubling Aids legacy. Retrieved March 05, 2018.
Perez-Stable, EJ. NIMHD Director’s Message. Oct 6, 2016.
U.S. National Institute for Minority Health and Health Disparities. Health Disparities.
U.S. National Institute for Minority Health and Health Disparities. National Institute on Minority
Health and Health Disparities Fact Sheet.
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