Because Latinos make up more than 23 percent of Worcester residents, UMass Medical School has been actively addressing health disparities in the local Latino community through physician training and community outreach. In particular, the Latino Medical Student Association, which actively pursues community involvement to create relationships between the Medical School and the Worcester Latino community, is putting a spotlight on health care needs during National Hispanic Heritage Month. This commentary addresses the need for more Latinos to participate in clinical trials, and how to overcome the barriers that prevent them from doing so.
Clinical trials are the gold standard of evidence used by physicians to make informed decisions about best practices in the prevention and treatment of disease. As the U.S. population becomes more diverse, broad representation of racial and ethnic minorities needs to be included to ensure that results translate to population-effective treatments.
According to the 2010 United States Census, 16 percent of the population is Hispanic or Latino in origin, yet they make up only 3 percent of clinical trial participants. More worrisome is the disproportionately high number of Latinos affected by chronic and preventable diseases such as hypertension, cancer, diabetes and obesity. The discordance between the high prevalence of these diseases in the Latino community and the marked absence of Latino participation in trials highlights an important gap in medical knowledge that would benefit this community.
The importance of adequate representation has been proven by basic science which has shown racial differences in the metabolism of drugs and differences in therapeutic effect on outcomes. For example, trials with African American patients have shown differences in the metabolism of certain drugs, resulting in inadequate response to some blood pressure control medications such as ACE inhibitors and beta blockers that are part of the standard therapy prescribed for blood pressure control. Although some genetic studies have been able to explain these differences, the interplay between genes, therapies and outcomes still remains an important area of exploration.
To address this disparity in clinical trial participation, researchers have begun by focusing on why there aren’t more Latinos taking part. A study focusing on cancer clinical trials found that Latino patients cited lack of knowledge of clinical trials as a major barrier. Additional barriers included increased perception of risk, financial burden of participating, cultural differences and fear of legal problems for undocumented immigrants. Other smaller studies have shown that patients would be more likely to participate in trials if the physician spoke Spanish. Beyond these barriers, the diversity within the ethnicity of what it means to be Latino poses some challenges to researchers designing trials specific to this population. Latinos are a racially diverse group with a complex genetic mix that challenges study designers in addressing genetic-specific targeted therapies.
However, the current focus is on addressing the barriers that keep Latinos from participation. The data is clear. The medical community must address the growing disparity in data-driven research that affect the fastest growing minority group in the United States with tailored and focused interventions. Providing Spanish-speaking clinicians and advocates; training physicians to recognize cultural differences that can be a barrier to communication and effective care; and building strong relationships with the Latino community are just some of the first steps toward increasing participation by Latino patients in clinical trials.
Fourth-year medical student Sebastian Ramos is the founder and chair of the UMass Medical School chapter of the Latino Medical Student Association (LMSA). LMSA-UMass is an organization that promotes the recruitment, retention and academic advancement of future Latino physicians while working to improve the delivery of health care services to Latinos and medically underserved populations in the Worcester area.
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