Temple dermatologist selected for new program working to improve diversity in clinical trials

Temple dermatologist Candrice Heath hears the same question from patients time and again: “Are you going to experiment on me?”

As a physician of color, Heath understands the anxiety and distrust of medicine that many of her patients experience. Historical mistreatment of and medical experimentation on people of color have contributed to distrust of doctors and large health institutions. Racism and bias continue to fuel deep race disparities in health outcomes and the care people receive.

Heath does her best to answer their questions and provide reassurance.

Soon, she’ll have even more tools to do that. Heath is among the doctors selected for the Robert A. Winn Diversity on Clinical Trials Award, a two-year grant established by the Bristol Meyers Squibb Foundation. The program awards grants to physician scholars working to improve diversity in clinical trials. We recently spoke with Heath, one of the first two faculty scholars in Temple’s Office of Health Equity, Diversity and Inclusion, about the challenges of inclusion in clinical trials.

In the U.S., only 20% of clinical trial participants are people of color.

From a science standpoint, we want to be sure that when conditions are being studied — particularly conditions that happen more commonly in people of color or that may affect people of color more adversely — we have diversity among the trial participants. But all too often, when the research is done, and a person of color asks, “Was this studied on anyone like me?” it kind of makes my heart drop. I’ll say, “It was done on humans, but I can’t say there was a large percentage of patients in the study who look like you.”

First, people have biases about who they offer clinical trials to. That is part of it.

Another problem is that companies who are funding the trials want to fill them quickly so they can get the results quickly. In order to do that, they tend to go back to the same sites — the same clinics — over and over again. And most of those sites are not diverse.

A lot of times, we hear that people of color don’t trust the medical system. Yes, that has been documented time and time again. But there is also research that shows that if patients feel comfortable with the medical community that’s taking care of them, they are open to being in clinical trials. That data is based on research in the community around Temple University Hospital. I hold that close to me. That is my community.

It is a known fact that physicians of color often end up practicing in communities of color. We have a sense of relationship with our patients. We’re here because we want to be here. And we’re passionate about serving our community. But often, we are overlooked for clinical trials because we may not have the resources — the time or the funding. But we have the most important thing: a passion for the patients who live in our community and whom we serve, and they have a relationship with us. Research is showing it is that relationship that really leads people to enroll in clinical trials. That is something that needs to be fostered.

Sometimes you are able to access medications or therapies that are not yet approved for your condition. In drug development, it may take 10 years to go from concept to approval. So if you have exhausted everything else, you may be able to have access to a treatment on the horizon, or a treatment that, even if it had been approved, your insurance might not pay for.

Some patients tell me the driving factor for them is that they want us to learn from them. They say, “I don’t want anyone else in my family to have to go through what I went through.” They sign up purely because they want to make the lives of other people better.

Also, in a research setting, we often do far more testing and other data-driven things. We may follow a patient more closely. So some people are interested because they may have more touch points with a research team that details their medical journey and health journey in a way that has never been documented before.

Recently, in a diversity dialogue session hosted by LKSOM’s [Lewis Katz School of Medicine] Office of Health Equity, Diversity and Inclusion, students asked me what types of disparities I see that they could understand and relate to. I talked about the example of medical light therapy, a proven therapy for psoriasis, which is a chronic skin disorder. It’s easy to get that approved by an insurance company.

Medical light therapy also can benefit patients suffering from vitiligo, an absence of pigmentation in the skin. The therapy helps to stimulate pigment-producing cells. The condition doesn’t happen more commonly in people of color, but for people with darker skin, having patches of white skin against your darker tones can be stigmatizing.

However, the same light treatment that is covered by insurance companies for people who have psoriasis is not covered for patients with vitiligo. Maybe, if we had more research involving people of color, we would be able to demonstrate treatments that are helpful for a condition and get them approved.

Just a few months ago, the first topical medication was approved for vitiligo. For conditions like psoriasis, we’ve had a plethora of medications. It seems like the conditions that adversely affect people of color just don’t have the same research dollars and efforts put behind them. I’ve been trying to change that.

I’m hoping to be able to learn not only how to conduct high-level clinical research, but also to really become an expert in involving the community, my community, from Day 1 of research conception, all the way to disseminating in the community what my results were, whether they were positive or negative. And being able to drive further research questions that the community — the people of my community, not the research community — care about. That’s what I’m excited about most.

By the end of the two-year program, I hope that I will have the start of a thriving community-focused research program. And I hope that communities like the one surrounding Temple will see themselves as a partner with me, and with researchers like me, across the country.

sandybauers10@gmail.com