Academic Psychiatry 27:29-30, March 2003
© 2003 Academic Psychiatry
On Bridging the Gap
Lauren T. Bonner, M.D.
Dr. Bonner is affiliated with the Department of Veterans Affairs' Northwest Network Mental Illness Research, Education and Clinical Center (MIRECC) and the University of Washington Department of Psychiatry and Behavioral Sciences, Seattle, WA. Address correspondence to Dr. Bonner, VA Puget Sound Health Care System, S-116 MIRECC, 1660 S. Columbian Way, Seattle, WA 98108. E-mail: l.bonner{at}u.washington.edu
Key Words: Minority Issues • Research Design
The authors of "Bridging the Gap" (1) address a critically important topic: the recruitment of African-American women as mental health research subjects. It is well known that although African Americans represent 12% of the U.S. population (2), their representation as subjects in medical research is negligible (3). This disparity not only results in a dearth of data on African Americans and other ethnic communities, but may result in inappropriate generalization of clinical practice data generated from other ethnic groups. Use of such data in an evidence-based practice model may not provide maximum benefit to these unique patient populations.
There are numerous explanations for the underrepresentation of African-American women in medical research protocols. They include deficiencies in recruitment strategies and in study and protocol design, as well as the attributes of the community itself, including the low priority given to participation in research, concerns about the methods used in previous research protocols, and distrust of the researchers' motives (3).
I think the origin of the distrust of the African-American community toward the idea of research deserves further explanation in the context of this article. Unfortunately, the authors, as well as others before them, have oversimplified the causes of distrust of the scientific community by African Americans by sole attribution to the Tuskegee study (4). In this now infamous study, African-American men with syphilis were allowed to remain untreated as part of public health research documenting the effects of the disease. Just a brief mention of the effects of slavery, Jim Crow, segregation, and the continuing impact of racism would have demonstrated a more sophisticated understanding of the history of the relationship between the African-American community and the medical research establishment (4). The authors also make a vague reference to the fear of "[s]ome African Americans ... that their race are used as ‘guinea pigs’ in medical research." As reviewed by Gamble (5), this fear is a well-documented fact. It is well known that slaves were used as experimental subjects by a number of famous physicians, including the father of modern gynecology, Dr. J. Marion Sims (5). In addition, the involuntary sterilizations of African-American women in federally funded health care clinics in the 1960s and 1970s have left a legacy of distrust and fear in the African-American community (6).
To academic mental health professionals, this information may not be new. A number of legal and policy changes including the formation of the National Center on Minority Health and Disparities in 1993 and the NIH Revitalization Act of 1994 have attempted to address the issue of the lack of participation of minorities and women in clinical trials. However, what is new is the increasing recognition and acceptance of the active role we must take in acknowledging the heinous abuses of the past and in developing appropriate research protocols aimed at addressing this lack of representation. As demonstrated by the authors of this paper, we must shoulder more of the burden of responsibility for the development of academic–community partnerships within the ethnic communities we serve.
In a simple and ideal world, these academic–community partnerships would result in a collaborative effort in the design of research protocols that appropriately reflect the concerns and interests of the communities and improve our clinical base of knowledge. In reality, the implementation of appropriate interventions to significantly increase the representation of women and ethnic minorities in mental health research is difficult and complex. Although many of the ideas and concepts presented by the authors are not unique, this example of a successful collaborative academic–community partnership provides proof that such a partnership can be mutually beneficial. "Bridging the Gap" contributes valuable additional information to our fund of knowledge about the methods needed to connect with the African-American community.
As a female, African-American, academic geriatric psychiatrist who is an invested member of the world of academic research and of the African-American community, it is my hope and vision that all of my colleagues will develop an increasing understanding and appreciation of the critical importance of the need to invite everyone to the table.
ACKNOWLEDGMENTS
Supported by the Department of Veterans Affairs and NIH Grant R01 AG18644.
REFERENCES
- Meinert JA, Blehar MC, Peindl KS, et al: Bridging the gap: recruitment of African-American women into mental health research studies. Acad Psychiatry 2003; 27:21-28[Abstract/Free Full Text]
- US Bureau of the Census, 2001
- Shavers-Hornaday VL: Why are African Americans under-represented in medical research studies? Impediments to participation. Ethn Health 1997; 2:31-45[Medline]
- Jones J: Bad Blood: The Tuskegee Syphilis Experiment. New York, Macmillan, 1993
- Gamble VN: Under the shadow of Tuskegee: African Americans and health care. Am J Public Health 1997; 87:1773-1778[Abstract/Free Full Text]
- Dula A: African American suspicion of the healthcare system is justified. Camb Q Healthc Ethics 1994; 3:347-357[Medline]
Get information about faster international access.
Privacy Policy
Copyright © 2003
Academic Psychiatry.
All rights reserved.
Home
| Search
| Current Issue
| Past Issues
| Subscribe
| All APPI Journals
| Help
| Contact Us
|
