A team of all-female physicians and scientists is leveraging personal experiences with underrepresentation in medicine to begin identifying a solution toward implicit bias in clinical research.
Azra Bihorac, M.D., M.S., Crystal Johnson-Mann, M.D., and Della V. Mosley, Ph.D., received an inaugural grant from UF Research, in conjunction with the UF Office of the Chief Diversity Officer, to advance and catalyze sustainable efforts toward racial justice, diversity, equity, and inclusion at the University of Florida.
After all, when it comes to clinical research, representation can mean the difference between life and death.
Intuitively, clinical trials for new therapies in areas that disproportionately affect Black patients should include Black participants at a comparable proportion of enrollment. However, the data reflects otherwise.
For example: obesity, diabetes, hypertension, stroke, heart and kidney (ODSH2K) disease affect more than 50 million Americans. For Black Americans, these diseases occur even more frequently— and with worse outcomes. In fact, they account for 40% of all deaths.
“This is a population whose risk of developing kidney failure and being on dialysis is three-fold,” said Crystal Johnson-Mann, M.D., an assistant professor of surgery and only Black female surgeon at UF. “And at the same time, they’re less likely to receive a kidney transplant.”
But among 102,416 participants in 11 trials for a diabetes medication that prevents kidney failure, only 4% were Black.
The issue, like others rooted in health inequities, is systemic. So, Bihorac, Johnson-Mann and Mosley, are starting small—if you can call addressing racial equity in clinical trials at one of the largest R1 universities in the country small.
“One of the first steps to achieving racial equity in clinical trials at UF is an assessment of racial diversity among those who participate in trials and those who work with them,” said Bihorac, a professor of medicine, surgery, and anesthesiology in the UF College of Medicine.
The three investigators intend to identify barriers to inclusive trial recruitment and participation at UF and develop a training intervention to reduce the impact of racial bias and discrimination among clinical researchers.
“Our collective expertise in clinical research, nephrology, obesity, surgery, racial justice and psychology lends us a complementary set of skills to address this issue comprehensively,” said Della V. Mosley, Ph.D and assistant professor of counseling psychology. “Most importantly, we want to approach this systemic issue from a critical yet compassionate perspective.”
Each of the researchers’ backgrounds uniquely shape their approach to the issue. Bihorac is a survivor of Bosnian genocide as a religious minority and was a refugee in Turkey and the United States. Mosley is an established scholar of Black psychology, racism, and antiracism interventions. Johnson-Mann is nationally involved in advocacy for Black female physicians, and is all too familiar with the number of patients who are overwhelmingly affected by ODSH2K diseases due to obesity.
“Lack of racial and gender diversity amongst PIs and those responsible for trial recruitment can deter gender and diversity among participants,” Johnson-Mann said. “It starts at the top.”