Medicine Is Getting More Precise … For White People

The following excerpt is from an article by Rob Arthur published August 2, 2017, on FiveThirtyEight.

Every human on earth is unique — our genes are different, we eat different things, we live in different places. As a result, medical treatments tend to work differently on different people. Depending on your genes, a drug might cure your sickness — or it might cause a side effect that makes you sicker.

In the past, many of humanity’s individual variations were invisible to us, but today, new technology offers us a way to peer into each person’s genome, allowing doctors to personalize treatments for each patient. This approach, called precision medicine, has been a major focus of research and investment in the last few years.

But precision medicine only works if scientists have studied people who are similar to you. If your genes are rare or unusual compared to those researchers have examined in the past, you could end up getting the wrong treatment. Since the vast majority of genetics studies are done on people of European ancestry, members of other racial groups may lose out on the benefits of precision medicine entirely. Those same groups already often receive worse health care in the United States than people of European descent get, and personalized medical treatment could make the gap in care larger.

Precision medicine is based on the idea that genes can be linked to diseases. To study this, scientists assemble a group of people, some with a disease and some without, and identify their genetic differences. If particular differences are common among the people who have the disease and absent from the people without it, then scientists can infer that those genetic patterns might be involved in the disease.

But each person has their own catalogue of genetic characteristics. Some are common in people of certain ancestral backgrounds and rare in those from other backgrounds. If scientists exclusively study individuals of one ethnic group, they may not know how to refine their treatments for a person from a different group.

A 2009 analysis of the studies that can link a genetic variant to a disease or trait showed that fully 96 percent of participants were of European descent. In a 2016 commentary in the journal Nature, Alice Popejoy and Stephanie Fullerton, respectively a graduate student and a professor at the University of Washington, showed that these studies had grown more diverse and people of European ancestry now account for 81 percent of research subjects. “Things are getting better, and it’s still pretty darn slow,” Fullerton said in an interview. And of the progress that has been made, much of it is attributable not to an increase in diversity in U.S. research but to studies conducted in Asian countries, which involve local participants.

Disparities in biomedical research exacerbate an existing gap in U.S. health care. African-Americans and Latinos are less likely to have health insurance and more likely to suffer from chronic diseases. Even controlling for wealth differences between populations, African-Americans receive worse health care.

The science underlying precision medicine threatens to make these disparities worse because it could leave any genetic differences that primarily affect non-white groups unstudied. Some genetic differences are prevalent in one population and rare in another. A prominent example is a gene called APOL1. Differences in this gene are common in people whose ancestors are from sub-Saharan Africa but rare in those of other backgrounds. Some of these variations increase the risk of developing kidney disease more than sevenfold, but they also seem to confer protection against African sleeping sickness. Knowing a patient’s APOL1 genetic makeup might be useful for guiding kidney disease treatment, and APOL1 is likely one of many genes that must be studied within a nonwhite population.

It’s possible to solve the problem of underrepresentation. The National Institutes of Health fund a number of large-scale genetic research projects in the United States, and scientists there consider this a major issue. “We are aware of this situation, and work is being funded to rectify the situation,” said Charles Rotimi, an investigator at NIH. He pointed to initiatives like Human Heredity and Health in Africa and the Population Architecture using Genomics and Epidemiology Consortium. These projects are developing more diverse study populations to address the underrepresentation of people of non-European ancestries, in some cases going to African countries to collect genetic data. In the United States, individual investigators can also apply for smaller-scale NIH grants to study particular diseases.

Read the full article.


Travel Ban Spotlights U.S. Dependence On Foreign-Born Doctors

From the article by Lauren Silverman on Kaiser Health News:

Patients in Alexandria, La., were the friendliest people Dr. Muhammad Tauseef ever treated. They’d drive long distances to see him, and often brought gifts.

“It’s a small town, so they will sometimes bring you chickens, bring you eggs, bring you homemade cakes,” he said. One woman even gave him a puppy. “That was really nice.”

Tauseef was born and raised in Pakistan. After going to medical school there, he applied to come to the U.S. to train as a pediatrician.

It’s a path thousands of foreign-born medical students follow every year — a path that’s been around for more than half a century. And, like most foreign-born physicians, Tauseef came on a J1 visa. That meant after training he had two options: return to Pakistan or work for three years in an area the U.S. government has identified as having a provider shortage. He chose to work with mostly uninsured kids at a pediatric practice in Alexandria, La.

“That was a challenge,” he said, “but it was rewarding as well, because you are taking care of people who there aren’t many to take care for.”

The U.S. medical system depends on doctors like Tauseef, said Andrew Gurman, president of the American Medical Association. He worries that President Donald Trump’s executive order on immigration, which is now on hold after a federal appeals court ruling.

“International medical graduates have been a resource to provide medical care to areas that don’t otherwise have access to physicians,” he said. “With the current uncertainty about those physicians’ immigration status, we don’t know whether or not these areas are going to receive care.”

According to the AMA, about 280,000 international medical graduates practice in the U.S. today — that’s about one in four doctors. Some are U.S. citizens who’ve gone abroad for medical school, but most aren’t.

“They don’t all have permanent visas and so a lot of them are concerned about what their status is going to be, whether they can stay, whether they can go home to visit family and still come back, and the communities they serve have similar questions,” he said.

And the care is top-notch. A study just published in the journal BMJ shows Medicare patients treated by doctors from foreign medical schools get just as good care — and sometimes better — than those treated by U.S. medical graduates.

Read the full article.


CDC task force recommends engagement with community health workers for diabetes prevention

From the article from Healio: Endocrine today:

Interventions that utilize community health workers for diabetes prevention, typically implemented in underserved communities, can improve health and reduce health disparities for adults with diabetes, according to a recent report released by a CDC task force.

The Community Preventive Services Task Force is recommending interventions that engage community health workers for diabetes prevention to improve glycemic control and weight-related outcomes among people at increased risk for type 2 diabetes. Some evidence suggests interventions may reduce rates of progression from prediabetes to type 2 diabetes, although more research is needed, the report noted. The task force finding is based on evidence from a Community Guide systematic review of 22 studies conducted through May 2015.

Community health workers are defined as front-line public health workers who serve as a bridge between underserved communities and health care systems. They typically are from or have a unique understanding of the community served, and they often receive on-the-job training and work without professional titles. Organizations may hire paid community health workers or recruit volunteers.

In the review, the task force evaluated the effectiveness of interventions in which community health workers connected with community groups or individuals who had one or more risk factors for type 2 diabetes. Included studies evaluated interventions that engaged community health workers as health education providers (n = 22); outreach, enrollment and information agents (n = 6); members of care delivery teams (n = 4); and patient navigators (n = 3).

Findings showed that interventions utilizing community health workers resulted in improved HbA1c, weight-related outcomes and rates of progression to type 2 diabetes, although the report noted that data on reduced progression came from three studies with small sample sizes.

Read the full article.

Study Offers Young Doctors Strategies To Deal With Discrimination

From the article by Carmen Heredia Rodriguez on Kaiser Health News:

n July 2013, a man arrived in the emergency room of a California hospital seeking treatment for his child. But when the intern on call walked in to see him, the father looked at her name tag and demanded another physician. As a Palestinian, he didn’t want his child treated by a Jewish doctor. The intern turned to her resident supervisor, Emily Whitgob, who told her colleagues about the incident.

The episode, Whitgob said, helped motivate her to study how doctors in training and their institutions should deal with patients’ prejudice and to publish a report that outlines strategies offered by the professionals she and the other authors consulted. The recommendations, published Wednesday in the Association of American Medical Colleges’ journal Academic Medicine, call for trainees to focus on their role as doctors by not taking hostile comments personally and meeting patients’ anxieties with empathy.

Researchers recruited 13 experienced faculty members from the pediatric department at Stanford University School of Medicine in California to review a series of scenarios illustrating patient discrimination against a medical trainee. Participants shared their reactions to the situation and outlined strategies for diffusing the tension in such encounters.

The issue has attracted national attention recently after Tamika Cross, a black physician from Houston, posted on social media that a flight attendant had dismissed her offer to help and disputed her credentials when looking for medical aid for a man who needed treatment mid-flight. Her Facebook post went viral, garnering over 48,500 shares as of Wednesday.

It’s not clear how often these episodes occur. But the journal article notes that a 2015 survey found 15 percent of pediatric residents at Stanford had experienced or witnessed mistreatment of medical residents by patients or families. Of those incidents, 67 percent involved discrimination by patients’ families. Half the people in the survey said they did not know how to respond to the discrimination and a quarter thought that the hospital was not likely to take any action against the patients’ families.

The situations can be complicated by the lack of racial and ethnic diversity in many hospitals. According to the most recent data available from the medical colleges association, black and Hispanics make up about 9 percent of U.S. doctors.

Whitgob, now a developmental behavioral pediatrics fellow at Stanford, said the results of her research can help create a set of guidelines to give hospitals and medical students a framework to handle patient discrimination in the field.

“I wanted to help create the tools so that they can cope with these events in the future,” she said.

The experienced doctors in the study noted that if the patient needs immediate medical attention, providers should ignore any hostile comments and quickly deliver that care.

When the need is not immediate, the study participants also recommend doctors speak honestly to patients about underlying emotional triggers, which may perhaps allow a more constructive dialogue that will get to the patient’s or family’s hostility and may allow both sides to work toward establishing enough trust for care to be given.

Formal training is needed to equip doctors with the skills to engage in these discussions, according to the report. By developing self-awareness and sensitivity, medical personnel can shift the focus away from the discriminatory remarks and emphasize patient care. The group also advised providers to set expectations early in medical training by communicating that discrimination can happen to anyone.

Many of these concepts should not be new to trainees. As part of their accreditation, medical schools already are required to teach students about culturally competent health care.

Read the full article.

Useful Resources: Considering the Impact of Proposed Legislation on Populations of Color

In the the third report from its Race for Results Case Study Series, the Annie E. Casey Foundation describes the use of racial equity impact assessment tools to improve policy making. The report focuses on four areas:

  • Why it is critical to measure the impact of any proposed legislation or change in policy on communities of color.
  • How racial equity impact assessments can lead to smarter and more targeted public investments.
  • How racial equity impact assessments keep decision-making focused on data and facts, not assumptions and long-held subjective beliefs.
  • How advocating and using racial equity impact assessments can position leaders and elected officials as strong champions of equity.

Download the report to learn more.

September HDRG Recap: Sustaining Community Health Advocates for the Long-term

At the September 16, 2016, meeting of the Health Disparities Research Group, Ms. Sarah Wraight, graduate research assistant with the Center for Healthy Communities and Master’s candidate in the department of Sociology, Anthropology, and Social Work, together with

Ms. Candis Patterson, Health Education Specialist with the Center for Healthy Communities, presented “Will they stay or will they go? Long term commitment to a community health advocacy program.” Based on interviews with the several of the longest serving  and currently active Community Health Advocates (CHA), their presentation explored the factors that allowed this group of CHAs to continue working with the Center for Healthy Communities through the more than 10 years of the program’s history.

In describing the elements that have contributed to their continued relationship with the CHC, Ms. Wraight and Ms. Patterson discussed their findings with special emphasis on three key themes:

  • Spirituality and Community Trust
    • Support provided by individual pastors and churches
    • Key church ministries where CHAs can plug in the health advocacy work
    • Churches provide gathering place considered trustworthy and safe, providing an open space for health education activities
  • Self and Collective Efficacy
    • Pride in being able to give to their own community
    • Desire to pass the torch along to other individuals to continue the work
  • Professionalism and Networking
    • Professionalism comes from the support of the University staff in training and providing assistance with CHA events
    • Meetings and program activities provide opportunities to meet and brainstorm ideas for future projects

Ms. Wraight and Ms. Patterson also explained that in addition to describing the factors that kept them connected to the program, the CHAs interviewed shared their goals for future health advocacy efforts.  The strongest themes regarding future CHA work included:

  • Developing more partnerships with organizations and institutions in Mobile
  • Moving into advocacy to directly influence policy change
  • Addressing mental health issues

The presentation was based on a poster presentation given by Ms. Wraight, Dr. Roma Hanks (Co-Director of the Community Engagement Core with the Center for Healthy Communities and Chair of the Department of Sociology, Anthropology, and Social Work), and Ms. Patterson at the Women’s Health Update Conference held at UAB in August. Dr. Hanks, who was unable to attend the HDRG meeting, has directed the CHA work for several years and designed the project methodology used for the research presented in the poster. They are currently drafting a manuscript to further detail their research on the continuity of the CHAs.

Read more about the work of the CHA program.

The CHC Pipeline Program-An Opportunity to Explore a Career in Health Professions

The underrepresentation of African Americans in medicine and biomedical research professions means that for many students from health disparate communities, there are very few role models or mentors with similar backgrounds who can help guide them into careers in the medical professions. In an effort to address the problem, the USA Center for Healthy Communities Education Pipe-Line program was developed to provide opportunities for rising high school juniors from underrepresented communities to participate in an intensive summer training program. Consisting of two phases — Student Training for Academic Reinforcement in the Sciences (STARS for rising juniors) and Special Training to Raise Interest and Prepare for Entry into the Sciences (STRIPES for rising seniors) — the program engages students in team-based learning to increase their knowledge base in the sciences by developing critical reading, thinking, and analysis skills in preparation for college pre-health pursuits. Funded as a part of the NIMHD Center for Excellence, the Program activities have included:

  • visits to college campuses
  • medical career seminars
  • ACT preparation
  • development of a Family Health Tree
  • research skills development
  • advanced computer technology skills
Stars&Stripes MLK 2016 cropped
In January 2016, a group of S.T.A.R.S. participated in the National MLK Day of Service.

STARS and STRIPES students also have the opportunity to develop their leadership skills while simultaneously working to improve their community by taking part in volunteer projects, service activities, health-focused run/walk events, and health fairs.  Additionally, they build their public speaking skills by researching, preparing and making a presentation in a community setting on a pertinent health issue of concern to them and their fellow community members.

Jasmine new quoteOver the years, graduates of the program have applied the knowledge they have gained as they work toward their educational and career goals. Jasmine Patterson, a graduate of Mattie T. Blount High School and the STARS and STRIPES program, is currently pursuing a degree in Biology and Radiological Sciences at the University of South Alabama.  She describes her experiences as, “…an enriching program and I am glad I was accepted. Being in this program not only helped me enhance the skills that I needed help with, but it also prepared me for the upcoming academic year.”


Seven years after this Mobile, AL, native graduated at the top of her 2009 class at John L. LeFlore High School, and magna cum laude from Dillard University in New Orleans, LA, Alexandria Lynelle Broadnax, a second-year medical school student in the USA College of Medicine is steadily moving toward her dream of becoming a physician. A former pipeline participant, Alex began to focus on her goals by participating in the STARS. program. While an undergraduate at Dillard, she took part in the CHC Undergraduate Research summer experience and returned the following year to participate in the two phase D.R.E.A.M. (Diversity Recruitment and Enrichment for Admission into Medicine) Program. According to Alex, “…the (STARS.)program helped me have clearer and more realistic plans for after high school. I became a better-rounded individual as result of the numerous volunteer and academic activities I was involved in.”


Find more information about the STARS and STRIPES program.


Research Apprentices’ Presentation

In preparation for their upcoming formal presentation to  the 14th International Conference of the Community-Campus Partnerships for Health Research Apprentices Sherron Dortch, Valerie Grimes, and Carla Taylor together with Research Technician, Marcellus Hudson and Research Assistants, Lynette Parker and Andrea Hudson, spoke to members of the Health Disparities Research Group during the April meeting.  They provided the HDRG members with an overview of their work with the Sentinel Surveillance Project  which is currently being conducted by the CHC Research Core under the leadership of Dr. Martha Arrieta.

The discussion highlighted the research training experienced by the Research Apprentices who are members of the community who have a wide variety of backgrounds and interests, but no prior formal education in the research process.  Additionally, the group provided an overview of the Sentinel Surveillance Project and why the inclusion of community members as a part of the research team is integral to meeting the goals of and adhering to the values of community-based participatory research. Structured in an interview format, the team described recruitment and training of research apprentices, the work done in collecting, managing, and analyzing data gathered from the community.

RA Presentation Quote -- SherronWhile describing their participation in the research team, the various research apprentices discussed both what they had brought to the research project and what they had learned. Sherron Dortch, a senior research apprentice, stated that her attention to detail and strong organizational skills allowed her to focus on quality data management while at the same time providing her with the opportunity to develop computer skills. At the same time, Sherron shared that through this research project she developed a deeper awareness and understanding of the health disparities that exist in a neighborhood and community where many of her friends and relatives live. This sentiment was echoed by Valerie Grimes and Carla Taylor who also work as Research Apprentices.

Marcellus Hudson, currently a Research Technician II with the Research Core, described his journey from Research Apprentice to a full-time staff member at the University. He talked about the many ways the experience provided avenues to foster his interest in computer programming and further enhanced his desire to learn and pursue his education. Marcellus also talked about the importance of uncovering the health situation in the community where he and many of his relatives live.

The research team will next make their presentation to an international audience of researchers and community members at the 14th International Conference of the Community-Campus Partnerships for Health. The presentation will take place on Thursday, May 12, at 3:30 pm. If you are in New Orleans, the team would love to see you there!

Wanted: More Black and Latino Doctors

from the article by Amy Scott on MarketPlace:

At 9:30 on a recent Saturday morning, when a lot of teenagers were still home in bed, 10 high school seniors sat in a conference room at Johns Hopkins Hospital in Baltimore, talking about what it takes to succeed in medical school.

“You’re going to need study groups, Jesus, Moses, Muhammad, Allah,” said instructor Damien Myers. “Everything you can get a hold of, you’ll need on your side.”

Myers is chief education officer of a program called MERIT, which helps prepare mostly black and Latino students to become doctors, medical examiners and public health leaders. Together, African-Americans, Latinos and Native Americans make up about a quarter of the U.S. population, but just 9 percent of doctors. Meanwhile, the number of black men applying to medical school is lower than it was in the late 1970s. Health experts say the lack of diversity in medicine contributes to disparities in the care patients receive.

When Myers finished medical school in 2007, he was one of only two black men in his class of 110. He left medicine to give students the kind of support he wishes he’d had.

“If you don’t have someone in your corner encouraging you, you can become discouraged and find an easier path,” he said. “We’re not going to lie and say it’s an easy path, but it is attainable. It’s doable.”

That’s not a message 18-year-old Christiona Harris said she and her fellow students have heard enough in their lives. She wants to be a pediatric trauma surgeon.

“A young black boy – if he’s tall, he’s a basketball player. If he’s stocky, he’s a football player. Why can’t he be a surgeon?” she said. “Or a black girl with a lot of knowledge. ‘Oh, you going to be a nurse?’ Why can’t I go that extra mile and be a doctor?”

Christiona and her fellow students have already gone the extra mile – and then some. Starting sophomore year, MERIT scholars give up most Saturday mornings to take classes on preparing for college, exploring different types of health careers, and understanding the role race plays in health care. In the summers they do paid internships in hospitals and laboratories.

Read the full article.

Community Health Workers: Roles and Opportunities in Health Care Delivery System Reform

In January, an ASPE Issue Brief published by the Department of Health and Human Services  explored the potential of Community Health Workers (CHW) in contributing to improved health care delivery. Focused on providing information of U.S. policymakers, the issue brief — Community Health Workers: Roles and Opportunities in Health Care Delivery System Reformcovers : 1) roles of CHWs in health care delivery; 2) CHW training and credentialing; 3) a national profile of CHWs; 4) and evidence on the clinical impact of CHWs.

The author lists the main findings for the report as:

  • Community Health Workers (CHWs) are an emerging group of health professionals that have recently drawn increased national attention because of their potential to deliver cost-effective, high quality, and culturally competent health services within team-based care models.
  • The apparent benefits of integrating CHWs into health care teams seem to depend on context. The strongest evidence of these benefits supports utilizing CHWs to deliver certain specific, high-value, preventive services – focused on reducing risk factors for cardiovascular disease and other chronic conditions – to low-income, minority, or other underserved populations.
  • Despite growing interest in engaging CHWs in national delivery system reform efforts, there are several uncertainties about how to best proceed with this. Questions remain around standardizing CHW training, certification, and licensure; establishing strong economic and other evidence to support their use; and securing reimbursement for their services to ensure financial sustainability of CHW programs.

Download the full ASPE Issue Brief to learn more about the potential of CHWs.