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Co-authored-by: Casey Greene <cgreene@users.noreply.github.com>
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HM Rando and cgreene authored Nov 12, 2020
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Experimental treatments are often made available to patients primarily or even exclusively through clinical trials.
The advantage of this approach is that clinical trials are designed to collect rigorous data about the effects of a treatment on patients.
The disadvantage, however, is that access to clinical trials is not equal among all people who suffer from a disease.
The disadvantage is that access to clinical trials is not equal among all people who suffer from a disease.
Two important considerations that can impact an individual's access to clinical trials are geography and social perceptions of clinical trials.
For the first, the geographic distribution of trial recruitment efforts are typically bounded and can vary widely among difference locations, and for the second, the social context of medical interactions can impact strategies for and the success of outreach to different communities.
Differential access to clinical trials raises concerns because it introduces biases that can influence scientific and medical research on therapeutics and prophylactics broadly.
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Early evidence suggests that the proportion of Black, Latinx, and Native American participants in clinical trials for drugs such as remdesivir is much lower than the representation of these groups among COVID-19 patients [@doi:10.1056/NEJMp2021971].
One proposed explanation for differences among racial and ethnic groups in clinical trial enrollment refers to different experiences in healthcare settings.
While some plausible reasons for the disparity in communication between physicians and patients could be a lack of awareness and education, mistrust in healthcare professionals, and a lack of health insurance [@doi:10.1002/cncr.28483], a major concern is that patients from certain racial and ethnic groups are marginalized even while seeking healthcare.
In the United States, many patients experience othering" from physicians and other medical professionals due to their race or other external characteristics such as gender (e.g., [@doi:10.1207/S15327027HC1602_7]).
In the United States, many patients experience "othering" from physicians and other medical professionals due to their race or other external characteristics such as gender (e.g., [@doi:10.1207/S15327027HC1602_7]).
Many studies have sought to characterize implicit biases in healthcare providers and whether they affect their perceptions or treatment of patients.
A systematic review that examined 37 such studies reported that most (31) identified racial and/or ethnic biases in healthcare providers in many different roles, although the evidence about whether these biases translated to different attitudes towards patients was mixed [@doi:10.1016/j.socscimed.2017.05.009], with similar findings reported by a second systematic review [@doi:10.1111/acem.13214].
However, data about real-world patient outcomes are very limited, with most studies relying on clinical vignette-based exercises [@doi:10.1016/j.socscimed.2017.05.009], and other analyses suggest that physician implicit bias could impact the patient's perception of the negativity/positivity of the interaction regardless of the physician's explicit behavior towards the patient [@doi:10.1016/j.jesp.2009.11.004].
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