Wall Street Journal - May 2, 2002
Robert Tomsho, Staff Reporter Of The Wall Street Journal

Blacks and Hispanics with the AIDS virus are far less likely than their white counterparts to participate in clinical trials or to receive experimental medicines for the illness, a new research report says.

The study, published in the New England Journal of Medicine, adds to a growing body of evidence that racial disparities in health care persist despite governmental efforts to draw more minority patients into trials and erase inequities in care. The findings also come on the heels of a March report by the National Academy of Science's Institute of Medicine detailing inequities in treatment across a broad array of diseases and conditions.

While whites accounted for about 49% of all patients being treated for the human immunodeficiency virus, or HIV, the study found, they represented about 62% of those participating in medical trials and about 69% of those who had ever received experimental medicines.

About a third of all HIV patients are black, said the study, but they accounted for only about 23% of those enrolled in clinical trials and 17% of those getting experimental drugs. The research was led by the Rand Corp. and involved doctors and professors at a group of California hospitals and medical schools, and was based on interviews with nearly 2,900 patients between 1996 and 1998.

'It Remains Striking'

"We don't practice clinical care feeling as if we exist in a racially skewed environment," said Allen Gifford, a researcher on the HIV study and an assistant professor of medicine at the Veterans Affairs San Diego Healthcare System. "Still, it remains striking that there is something influencing systems of care, the attitudes of patients and our own attitudes that leads to these inequities."

While the study didn't attempt to pinpoint the causes of such disparities, Dr. Gifford said black and Hispanic HIV patients surveyed were only about half as likely as whites to ever receive any experimental treatment, whether through clinical trial or experimental drugs.

Far less likely to seek out such trials, blacks who did enroll in them were only about half as likely to still be involved two years later, according to the study.

Such disparities between whites and minorities persisted regardless of the HIV patients' health-care insurance, level of education or proximity to a medical-trial site.

'We Still Have Many Trials'

In 1994, the National Institutes of Health issued guidelines requiring researchers it funds to take steps to include more minority patients in their studies.

Those guidelines didn't cover privately financed research, however, noted James Powell, director of biomedical education and research for the National Medical Association, a black physicians' group in Washington, D.C. As a result, he said, "we still have many trials for new products being developed without adequate inclusion of minorities."

Stephen Thomas, director of the University of Pittsburgh's Center for Minority Health, said lower minority participation in such studies also reflects a distrust stemming from the federal government's notorious Tuskegee experiment in which, between 1932 and 1972, hundreds of African-American men were left untreated for syphilis.

"For many African Americans," he said, "the legacy of Tuskegee still casts a shadow over their attitudes toward research and even receiving care."

Write to Robert Tomsho at rob.tomsho@wsj.com1
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