The ethnic diversity of the United States is poorly reflected in the make-up of its clinical trials, despite the efforts of the NIH Revitalization Act of 1993, which asked the National Institutes of Heath (NIH) to ensure women and minorities were included in clinical research.
One contributory problem is the lack of ethnic diversity in US physicians taking part in studies as investigators. A new collaboration between AstraZeneca and two US physicians’ associations aims to address this issue by stepping up educational and certification programmes geared to better representation of physicians from minority backgrounds in the clinical trial process.
The UK-based company has teamed up with the National Medical Association (NMA), which represents the interests of more than 30,000 African-American physicians in the US, and the Interamerican College of Physicians and Surgeons (ICPS), the professional association for more than 39,000 Hispanic physicians in the US and Puerto Rico. AstraZeneca will provide “multi-million dollar” grants to each of these organisations over a five-year period, specifically in support of NMA’s Project Impact programme and ICPS’ Hispanic Research Network, the company says.
Project Impact is focused on increasing the involvement of African-American physicians and their patients in clinical trials. It has established a database of more than 500 African-American physicians interested in clinical research and has conducted over 33 training sessions for its members, as well as developing and disseminating culturally sensitive educational material to consumers. The Hispanic Research Network performs a similar service for the Hispanic community, working to recruit Hispanic physicians as clinical investigators through tools and resources provided at the local level.
Of the 800,000 physicians currently practising in the US, just over 3% are African American and fewer than 3% are Hispanic/Latino, AstraZeneca notes. Yet very few of the 13% of US physicians who have participated, or are participating, in clinical trials as investigators are African American or Hispanic. Moreover, these communities are underrepresented as patients in clinical development.
Research indicates that African American and Hispanic physicians are more likely to treat patients who share their ethnicity, which puts them in as better position to enrol African American and Hispanic patients into clinical trials, AstraZeneca points out. And physicians from diverse backgrounds can provide valuable insights into the cultural nuances of specific communities, including how diseases are viewed and discussed by these populations.
There is also evidence that African American and Hispanic physicians often mistrust the clinical trial process due to the historic mistreatment of minorities in this context, the company adds. Among other barriers to participation in clinical trials, minority physicians have cited lack of awareness and experience; fear of losing patients if they actively recruit for clinical trials; and inadequate infrastructure (office staff, storage facilities, etc) to manage study data.