Wall Street Journal - August 9, 2004
Christopher Windham, christopher.windham@wsj.com

Now Johns Hopkins needs the help of blacks in its surrounding East Baltimore neighborhood to meet federal rules requiring academic centers to take steps to include more minorities in government-funded research. The mandate is important to Johns Hopkins, which collected $556 million in awards last year from the National Institutes of Health.

These days, Johns Hopkins is overcoming the problem with the help of a white researcher, a former nurse in those segregated wards, who is working to bring the community and institution together.

The former nurse, Diane Becker, began reaching out to African-Americans in 1987, when she sought local black churches to help her find participants for a study on smoking cessation. Her initial reception was icy: One minister, the 61-year-old epidemiologist says, called her a "white middle-class suburban matron." But over the years, she earned the trust of the community, in part by trying to ensure some continuing public health benefit to trial participants and by giving leaders in predominantly black neighborhoods more than the usual say in running clinical trials.

To achieve that level of mutual trust and respect, Dr. Becker, who is on the faculty at Hopkins, had to overcome local residents' long history of suspicion. "When I was a child," says Melvin Tuggle, a minister who was born at Johns Hopkins and raised blocks away, distrust of the hospital, with its history of segregation, "was passed down from parents and community people."

African-Americans also have long been wary of medical research in light of the federal government's notorious Tuskegee experiment, in which hundreds of African-American men were left untreated for syphilis between 1932 and 1972. Compounding suspicion among blacks is the dearth of African-American doctors and health professionals and the wide gap in wealth and education between medical practitioners and the largely poor minority community surrounding the hospital.

Recruiting minorities into clinical trials has never been easy, researchers say. But when the NIH mandated in 1993 that researchers make an effort to do so, Hopkins renewed its outreach to minority communities. Admittedly, the hospital has a strong financial incentive to do so: It's the top recipient of NIH money in the U.S. But Hopkins launched its recruitment efforts in East Baltimore years before the NIH mandate went into effect.

In 1990, Dr. Becker bucked the traditional approach to research by writing a grant proposal on behalf of a community-controlled nonprofit called Heart Body & Soul. HBS won the grant and soon pegged local residents to recruit blacks for clinical trials and to warn African-Americans about conditions including hypertension that affected them disproportionately. Hundreds of neighborhood health workers were trained to hit the streets, often going door-to-door and to supermarkets to provide free blood-pressure screenings and doctor and dental referrals.

"That's a very creative approach," says G. Marie Swanson, dean and professor at the Mel and Enid Zuckerman Arizona College of Public Health, an expert in recruiting minorities.

At the same time, Dr. Becker went to work forging ties with local church leaders. A year later her efforts began to bear fruit when the Rev. Tuggle delivered a startling sermon one Sunday to his 100-member congregation.

"Smoking will kill you," he intoned. Using data from research papers supplied by Dr. Becker and other scientists, the Rev. Tuggle used biblical references to preach about the dangerous effects a poor diet and smoking have on the heart. It was the first of many health-focused sermons he gave.

Thanks to researchers like Dr. Becker, other Hopkins researchers have been successful in recruiting minorities as well, says Edward D. Miller, dean and chief executive of Johns Hopkins University School of Medicine.

Since that first step, community leaders have helped Dr. Becker conduct several studies, and she also has published research looking at heart disease, stress and hypertension. In 2001, she published in Circulation a widely noted study of 600 people that suggested optimism may help people beat heart disease. In the past five years, Dr. Becker has recruited about 2,000 African Americans into Hopkins clinical trials. In the past decade, she has pulled in more than $10 million in grant money for community-based research.

Her efforts have helped greatly improve community and hospital relations. School administrators and several department chairmen have attended occasional local church services and community events. Hopkins administrators attend meetings in church basements, and local ministers sit in on some Hopkins faculty and staff job interviews as community representatives. "It was a breakthrough," says Nelson Sabatini, secretary of the Maryland Department of Health and Mental Hygiene.

Hopkins's success has critical implications for medical treatment of blacks and other minorities. Many diseases, including prostate cancer, hypertension and diabetes, afflict minorities at higher rates than whites.

African-Americans make up half of all new HIV cases and about a third of all people living with HIV/AIDS, according to the Centers for Disease Control and Prevention. But they accounted for only about 23% of those enrolled in HIV/AIDS trials and 17% of those getting experimental drugs for the disease, according to a recent study in the New England Journal of Medicine. What's more, some scientists believe that blacks, Hispanics and Asians respond differently than whites to some widely sold medicines.

Now a proposed biotech research park threatens to drive a wedge between Dr. Becker and some community leaders, including the Rev. Tuggle. Hopkins officials support the idea of creating a 22-acre research park in East Baltimore; the Rev. Tuggle opposes it. Community activists are against the park, proposed for a site north of the Hopkins campus, because many residents have been evicted and others must move to make way for it. Such disputes "put me in between a rock and a hard place," says Dr. Becker. "It's very hard being the person who worked on pulling all this together with the pastors."

Despite these differences, church leaders say local residents have a much better view of the hospital today. "We had to learn that their way was not always negative," says the Rev. Marshall Prentice, a founding member of Heart Body & Soul.

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