Dr. Chesahna Kindred is a board-certified dermatologist and founder of Kindred Hair & Skin Center in Marriottsville, Maryland. Because dermatological conditions often present differently on melanin-rich skin, the Black patients that Kindred treats often face challenges unaddressed by clinical research trials. Black patients account for just five percent of all clinical trial participants.
In an interview with The American Journal of Managed Care, Dr. Kindred explained that some members of the Black community historically mistrust the medical industry. This is partly due to the 1932 Tuskegee Experiment, in which Black men with syphilis were observed over forty years, but not treated for the disease. This resulted in severe health problems and even death—but trust remains a concern even today.
For example, Black patients are more likely to bring up health concerns to their Black doctors and tend to better respect the opinions of doctors of the same race. Beyond that, though, many Black patients remain missing from clinical trials.
Lack of diversity in clinical studies can cause misdiagnosis or delayed diagnosis of skin conditions on melanin-rich skin. In the example of psoriasis, this can lead to the overuse of treatments like topical steroids that could damage the skin over time. With more diverse professionals enrolling Black patients in clinical trials, the overall result could potentially alleviate mistrust and provide better health outcomes.
To reduce some of the mistrust of the medical industry within the Black community, Kindred suggests recruiting Principal Investigators (PIs), or clinical trial facilitators, from diverse backgrounds to bridge that gap.
Doing so could create a positive snowball effect. Black patients visit their PI-trained Black doctors, begin to receive care through clinical trials, and potentially feel heard and understood.
Kindred provided an example from her field. Because the skin condition, psoriasis, presents differently on Black skin than it does on white skin, getting Black patients to participate in trials is important. However, those enrolling patients into clinical trials—from the PIs to the coordinators—must understand and be committed to diversity, equity, and inclusion (DEI).
“That way, we get biases out of the clinical trials, Kindred explained. “We have to unravel some of those layers, and part of it is the PIs being diverse.”
The main facet of DEI is to ensure that people of all backgrounds feel welcomed and included, and have what they need to prosper. Doctors who understand this can meet a patient where they are and will tailor their conversations in a way that makes the patient feel comfortable and heard.
In the case of psoriasis, Kindred says, “If we approach the patient saying, ‘scaling plaques,’ well, that sounds pretty scary, right? We just want to say, ‘thick, flaky bumps.'” Doctors should ensure that the patient understands what is happening to them and that they speak in clear and concise language rather than use medical terms. It comes back to the importance of DEI.
Recruiting patients from a variety of communities is key to reducing bias and promoting social justice and health equity. All too often, sites where clinical trials are facilitated are out of reach for Black patients.
This could be a result of geography, transportation, or socio-economic factors. In diverse communities where Black patients seek out Black doctors, it makes sense that the doctors are trained PIs so they can recruit patients who might be a good fit for clinical trials.
“We shouldn’t do an ‘if you build it, they will come’ approach, Kindred advised. “Go to the patient, and that will really help to make sure that there’s a diverse population in clinical trials.”
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