August 30, 2002

Elders asks doctors to examine minority health care disparity

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Joycelyn Elders greets a member of the crowd after her Meharry lecture. (photo by Anne Rayner Pollo)

Elders asks doctors to examine minority health care disparity

Former U.S. Surgeon General M. Joycelyn Elders last week challenged doctors to get out of their “comfort zones” and help bridge the distressingly wide gap in the health status between white and black Americans.

Speaking at a research ethics conference at Meharry Medical College, Elders noted that African-American women in one study were 30 percent more likely to die from breast cancer than were white women, even when they had the same education level and insurance coverage.

The difference? White women were more likely to be offered corrective surgery and different treatment plans by their doctors. “Part of it is the doctors,” said Elders, a pediatric endocrinologist and professor emeritus at the University of Arkansas College of Medicine in Little Rock.

“Why is AIDS rising so rapidly in the black community?” she continued. “We learned how to reach white, educated, gay males, and we targeted all of our efforts to that group … The problem is, we didn’t tailor the message to fit the (African-American) population.”

Elders, the first African-American woman surgeon general, who served under former President Bill Clinton in 1993-94, gave the keynote address Aug. 22 during the two-day conference. Several Vanderbilt University faculty members also spoke at the conference, which was hosted by the Meharry Program in Clinical and Research Ethics.

“Some realignment of the national research agenda is needed if we are to bridge the gap in health disparities,” said Dr. PonJola Coney, senior vice president for health affairs and dean of the School of Medicine at Meharry, in introducing Elders. “It is critical to focus on the issues of racial bias in research and the ethical and regulatory issues surrounding experiments with humans, particularly involving minorities and the underserved.”

“Yes, there’s racism in medicine,” Elders agreed. “We doctors have always walked around and said, ‘Oh, we treat all patients the same. All blood’s red.’ Well, they lived in the community, they came out of the community, and we behaved just like we lived.”

There also are cultural barriers that keep minority groups from participating equally in research that could improve their health, Elders added. Some patients are afraid to be “experimented on,” while others have a hard time understanding the consent forms they must sign in order to participate.

“If you’re doctoring, and you know that there’s a wonderful protocol for a new drug, don’t make your patients wait until it goes through all the FDA approval, (when) it may have saved their lives 10 years earlier,” Elders said.

“You might need to bring in family, bring in close friends so they can be a part of getting informed consent,” she said. “We’ve got to be involved in the design of the protocols, especially if they’re going to be used in our community … You’ve got to take every opportunity you can get to make a difference.”

The disparity in health status between whites and African-Americans is due in large part to the lack of primary, preventive and accessible health care, Elders said.

“We spend almost 15 percent of our gross domestic product, $1.3 trillion (a year), and still we don’t provide health care for all of our people,” she said. “Universal access to health care for all people is a morally and ethically right thing to do. We say we can’t afford it. I’m concerned we can’t afford not to have it.”