Diversity remains paramount in research from basic to clinical stages
Key takeaways:
- Diverse patient populations are needed for accurate clinical testing.
- Four experts discussed the challenges to creating diverse teams and recruiting diverse patients.
ORLANDO — Increasing diversity in research, from basic and translational to clinical science, is more important than ever and clinicians need to meet people where they are to do so, according to a panel discussion here.
John E. Harris, MD, PhD, professor and chair of the department of dermatology at UMass Chan Medical School, founding director of the Vitiligo Clinic and Research Center and of the Autoimmune Therapeutics Institute and a member of Healio Dermatology’s Peer Perspective Board, led the panel and kicked off by discussing how recent political and administrative changes have put the need for diversity back into the spotlight.
“If we’re really going to repair what’s been done in the past and improve diversity, it’s going to be a team effort,” Harris said.
Discussing feedback his research team recently received from the NIH regarding a vitiligo study they are working on, he told the audience at the Skin of Color Society Annual Symposium that they were instructed to reduce the number of times the word “diversity” was used in their progress report.
“This is a problem. This is a problem for science, it’s a problem for everything moving forward and I’m hoping we can do better,” Harris said. “We have to have deep important conversations about how to fix this problem that maybe we’ve created, maybe we’ve contributed to.”
Joining him on the panel was professor of dermatology at Howard University College of Medicine, medical director at Callender Dermatology & Cosmetic Center and founder and principle investigator for Callender Center for Clinical Research Valerie D. Callender, MD; associate professor and Thomas L. Shields Professor of Dermatology at UT Southwestern Medical Center Tamia A. Harris-Tryon, MD, PhD; and Dr. Joseph W. Burnett Professor and chair of dermatology at the University of Maryland School of Medicine Shawn G. Kwatra, MD.
The four experts explored the importance of having diverse voices on a scientific team, despite the level of research being done, and the need for diverse participants in translational and clinical research, as well as how best to recruit to hit those goals.
Asking the right questions
Having a diverse team in the lab is more important than optics, according to Harris-Tryon, who works predominantly in basic research focusing on mice models.
For her, having a wide range of voices at the table is necessary in order to pose the correct, wide-ranging questions needed to complete their research.
“I think it’s tremendously important that we have a diversified workforce or a diverse set of viewpoints that are asking basic science questions and are trained to ask them,” Harris-Tryon said.
Comparing her lab with the microbiome, which relies on diversity to complete the body’s necessary functions, she said she has chemists, biochemists, dermatologists and clinicians on her team, who happen to also be diverse in age, gender, race and sexuality.
“It’s incredible to me that we’re demonizing a critical concept that is ... a diverse environment of scientists. I need all of these [experts], and then my role is to get all of these people to talk to each other across their different lenses of training.” she said.
This extends to mentorships and sponsorships as well where diverse scientists can offer their own expertise.
“Us being at the table, training, engaging in research, being mentors and sponsors for people and providing spaces where unique people and unique voices are allowed to develop their ideas is imperative to me,” Harris-Tryon added.
Building trust
In terms of clinical and translational research, diversity is even more necessary, according to Harris.
“If we’re going to test drugs, we need to make sure they work in everybody,” he said.
However, recruiting diverse patients remains a roadblock for most clinical trials.
Callender, who is in both private practice and clinical research, advocates for making yourself known throughout communities and building trust with them there.
“You have to go into the community. You have to go where they are. So, if that’s a health fair at a church or convention center ... you need to go there. You need to get a table. You need to talk about your research center and try to bring them in,” she said. “It all has to do with communication and connection with your community, because that’s where you’re going to draw your patients or your subjects from.”
It is also necessary to be deliberate in your recruitment goals. Rather than allowing your team to recruit from fellow researchers or students, it should be a benchmark needed to proceed.
“I think we have to be intentional and go and find communities we are interested in and not be extractive,” Harris-Tryon said. “You have to make the relationships and say, ‘This is something I am particularly interested in.’”
Many individuals in underrepresented communities may not trust clinical trials, keeping them from participating, and it is the responsibility of the researcher to build the trust needed to increase diversity in these trials, the panel agreed.
Kwatra told the audience he often makes a point to have a personal conversation with patients when he thinks they would be a good candidate for clinical trials.
“When I see these patients, I’m their primary doctor and they’re not doing well or they’re searching for answers, I say ‘I’m trying to help you. ... People have not studied this condition in a lot of people like yourself, but I’m committed to it and want to figure out why.’”
And these conversations may not change an individual’s mind immediately, but it is a step toward building the trust needed.
“Our patients deserve to be in those clinical trials. We need to make sure that all skin types, all races are represented, especially if we’re treating them with different medications,” Callender said.
Leveraging resources
There is also a need to expand beyond direct recruitment and increase resources to diversify the patient population in trials.
Leveraging social media ads and community outreach are important, but academic centers, which are often in the most diverse parts of the country, need to be putting the resources into recruitment as well, according to Kwatra.
“I see a lot of handicaps even getting into these clinical trials,” he said. “We have such a big opportunity with our academic centers. ... We need to be putting a lot of resources into developing that clinical trial infrastructure.”
There is a “bottleneck” stopping many from entering trials, which needs to be addressed, he added, saying that dermatologists need to be given not only the resources, but the training needed to participate and recruit diverse patients.
A diverse future
Going beyond research and recruitment, the panel also discussed how to navigate in a world where diversity is not always championed.
For Callender, mentorship continues to be a way to show the next generation the importance of diversity in all stages of research. She has medical students and clinical research fellows in her practice, and she said it is essential to expose them to research, but also to a diverse team.
Harris agreed with Callender.
“It’s through the legacy, it’s through the mentorships, that we’ll be able to make the changes that will be lasting,” he added.
Kwatra touted the need for intentional language in publications.
“The hope is that if we promote and showcase diversity ... maybe it will stimulate someone to thing that way in the future,” he said.
Despite what some might say or push for, Harris-Tryon said she will continue to push for both diversity and inclusivity in her lab, leaning on the strides that were made in the past.
“This is such an interesting moment, but we can’t forget the things we learned in the last 5 to 10 years. Incredible language was built, and I’m still using that language every day,” she said. “How we talk across differences, how we leverage across differences, how we create inclusive spaces where everyone belongs — I learned how to do that in the past 5 years and I’m not planning to forget.”