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How Neglecting Minorities in Medical Research Has Led to Deadly Outcomes

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Re: How Neglecting Minorities in Medical Research Has Led to Deadly Outcomes

#91

Post by dragonwriter »

BearGoesChirp wrote: post #90
tptacek wrote: post #56

Earlier quoted context omitted.

When people try to explain why you're coming to broken conclusions due to broken reasoning, they get attacked as radical leftists for using the straightforward terminology we have for describing the phenomenon we're discussing. Here, you've provided a perfect illustration of why we have the term "structural racism". Structural racism is the emergent discrimination arising from the circumstances that created our statu…

Grandparent has been deleted and I can't see it, so I'm not sure what their post was, so I'm aiming this response in more at the terms being used and their underlying meaning. >When people try to explain why you're coming to broken conclusions due to broken reasoning, they get attacked as radical leftists for using the straightforward terminology we have for describing the phenomenon we're discussing. How much of thi…

> These seem like polar opposite lines of reasoning,

The problem is you are viewing them as reasoning about the cause from the effect alone rather than reasoning about the cause from a combination of the effect and masses of historical evidence.

Re: How Neglecting Minorities in Medical Research Has Led to Deadly Outcomes

#92

Post by ekianjo »

pkaye wrote: post #6
citricsquid wrote: post #2

https://www.propublica.org/article/nothing-protects-black-wo... This is a longer article on the subject of poorer health outcomes for minorities, covering the situation for black women and one family's experience, which is very much worth reading, but here are the key points: Statistics: * A black woman is 22% more likely to die from heart disease than a white woman * ...71 percent more likely to perish from cervical…

But this seems to be different situation from what the article is talking about which is the inadequate involvement of minorities in drug trials. You are highlighting the lack of adequate health coverage which is a different issue in the US. But this bring up a question if blacks and other minorities have the poorer health outcomes in other countries? Japan, China, South Korea for example does their own drug testing…

> Japan, China, South Korea for example does their own drug testing and development so would they find that a particular drug doesn't work on their population at all?

Yes, it happens sometimes that certains drugs approved in the US fail to make it in Japanese clinical trials. Recent one I can think of is Prozac:

https://clinicaltrials.gov/ct2/show/NCT01808612

It did not show to be better than Placebo in the Phase3 Japan trial. (https://clinicaltrials.gov/ct2/show/results/NCT01808612?sect...)

There could be multiple reasons for that, but in the end the drug is not approved in Japan.

Re: How Neglecting Minorities in Medical Research Has Led to Deadly Outcomes

#93

Post by PaulHoule »

Part of it is a lack of financial incentives on the part of the drug companies. Most pharmaceutical research is aimed at marketing drugs.

Take the example of hypertension, which is more prevalent among blacks than whites. At the moment, all of the major antihypertensive families are available as generic drugs. The best way to help black people quickly is to do a comparative study of drugs already on the market. No drug company is going to do that because they won't be able to capture the value if the drugs are generic.

Maybe a drug company could try to develop a drug which is particularly good for blacks, but it will take a decade, may not work, won't sell as well (fewer people), and then it will be an expensive new drug and people will complain about the cost.

Re: How Neglecting Minorities in Medical Research Has Led to Deadly Outcomes

#94

Post by Frqy3 »

blaurenceclark wrote: post #4

I'm the founder of HDP Health, if you have any questions or want clarifications please ask away!

Are you also planning to include pregnant women in your trials?

I'm not in the health field, so I don't know where the regulations stand, but I recall talking to someone who was advocating for this a couple of decades ago to avoid future cases like Thalidomide.

Re: How Neglecting Minorities in Medical Research Has Led to Deadly Outcomes

#95

Post by blaurenceclark »

PaulHoule wrote: post #93

Part of it is a lack of financial incentives on the part of the drug companies. Most pharmaceutical research is aimed at marketing drugs. Take the example of hypertension, which is more prevalent among blacks than whites. At the moment, all of the major antihypertensive families are available as generic drugs. The best way to help black people quickly is to do a comparative study of drugs already on the market. No dr…

That's 100% true, I'm not saying we have to create a new drug, but define what is the best treatments available, as well as take that into account when the treatments are being made. Especially as there become more black people if there is a treatment just for that minority it may be a quite profitable route for them.

Further down in the comments somewhere I posted another comment where it's as simple as certain chemo's cause toxicity levels in Asians where they don't in white Americans. So simply lowering the dosage would fix the problem but because that wasn't involved in the original research it wasn't known for quite sometime and Asian populations suffered.

When I say "focus on minorities for research" working any solution is fine, simple or not.

Re: How Neglecting Minorities in Medical Research Has Led to Deadly Outcomes

#96

Post by blaurenceclark »

Frqy3 wrote: post #94
blaurenceclark wrote: post #4

I'm the founder of HDP Health, if you have any questions or want clarifications please ask away!

Are you also planning to include pregnant women in your trials? I'm not in the health field, so I don't know where the regulations stand, but I recall talking to someone who was advocating for this a couple of decades ago to avoid future cases like Thalidomide.

I could write a whole other article on this as well. The pregnant women part actually fits extremely well in this context even more so, they aren't neglected, they are specifically left out because researchers don't want to have to explain their outliers. I'm a proponent of that, but the sponsors have to front the costs to make it happen, without a government mandate that gets very tricky.

Re: How Neglecting Minorities in Medical Research Has Led to Deadly Outcomes

#97

Post by blaurenceclark »

petroseskinder wrote: post #80
yipopov wrote: post #62

Good luck defending this as long as it's deemed political wrongthink to say there are any biological differences between races. If everyone is the same, why bother with diverse studies?

There's a lot of baggage with "race related medical research." At least within the US, it is currently deemed wrong think for a number of reasons. First, how are you defining race? The current American definitions of race are imprecise and sociologically constructed. Since the founding of America, the definition of white has expanded to include various groups that were previously excluded (e.g. Polish, Irish, Jewish…

Totally agree, "bucketing" is certainly hard, but to define every possible bucket would have me writing an entire book. This piece is meant to get the discussion started and open peoples eyes to the existing problem and consciously start to work on solutions. My African ancestry is all sub-saharan African (at least according to my 23andMe) so I'm quite familiar with those statistics you're providing.

Re: How Neglecting Minorities in Medical Research Has Led to Deadly Outcomes

#98

Post by Alex3917 »

blaurenceclark wrote: post #7
pkaye wrote: post #6

Earlier quoted context omitted.

But this seems to be different situation from what the article is talking about which is the inadequate involvement of minorities in drug trials. You are highlighting the lack of adequate health coverage which is a different issue in the US. But this bring up a question if blacks and other minorities have the poorer health outcomes in other countries? Japan, China, South Korea for example does their own drug testing…

We haven't done extensive research in populations outside of the United States, but for the last 50-100 years the US (and Europe) has been leading the charge, but in both these locations, Minorities have been a low percentage participation in research. As well, many of these outcomes he mentioned are the indirect result of years of research. Think of diabetes, 100 years of research was 99% spent on a white population…

> We haven't done extensive research in populations outside of the United States, but for the last 50-100 years the US (and Europe) has been leading the charge

I'm confused, I thought that over the last ten years a lot of the medical research formerly conducted by U.S. pharma companies has been outsourced to SROs, who in turn test their drugs on poor people in India or whatever. Is that not actually the case?

Re: How Neglecting Minorities in Medical Research Has Led to Deadly Outcomes

#99

Post by jsoc815 »

blaurenceclark wrote: post #86
jsoc815 wrote: post #79

Earlier quoted context omitted.

An incredibly complex issue. I'd be here all day trying to address it and my quibbles w/the article, e.g. "race" ≠ "ethnicity," nor is it uniformly defined across countries, since it's a (BS) social construct... In any event, my knowledge of the issue leads me to think that the outcome is more a feature than a bug. That said, while I think the article attempts to link (growing target) population size(s) with an incre…

If I were to cover every one of the points you called out in detail (which are all valid) I'd end up with an entire book haha.

Acknowledged. I actually have a few (of those books). More so raised the points to be objective and for those who don't know any better.

Serious question though, is there much (U.S.) interest (define it as you wish) in this subject? Or is this more a passion project and attempt to raise awareness. (I'll understand if you duck the question for various reasons.)

* Bonus historical example... Department of Energy (along w/ various universities et al.) and the radioactivity 'experiments' on unwilling/unknowing citizens of 'little importance'. Clinton issued an 'apology' at some point. Don't remember the specifics and don't feel like looking them up now.

Re: How Neglecting Minorities in Medical Research Has Led to Deadly Outcomes

#100

Post by gefh »

gozur88 wrote: post #78
blaurenceclark wrote: post #58

Earlier quoted context omitted.

I'm going to quote what someone said below because this is blatantly false "This is not only false, but dangerously false. We are in the process of discovering that certain classes of popularly-prescribed drugs (eg ACE inhibitors for blacks, certain chemotherapy drugs for Asians) are ineffective or even toxic for populations not represented in the relevant drug development research cohorts. It's not identity politics…

... which is why I listed genetics under "other explanations". Did you read the whole comment?

It's not that there aren't genetic differences - it's that there is structural racism that means drug trials don't even test safety for minorities.
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