Feinberg OB-GYN physicians published a paper in December describing the ethnic and racial data disparities within clinical trials, which vary highly between fields.

As a whole, the paper states that there is insufficient representation of minoritized groups in OB-GYN trials.

Not all studies record race and ethnicity. In the data collected for the paper, 50.9% of trials and 74.6% of publications included race and ethnicity demographics, with a significant increase throughout the thirteen-year study.

Dr. Jecca Steinberg, a third-year OB-GYN resident and one of 16 authors, found this lack of reporting troubling, as did her co-authors.

“We as a field need to have a systematic, anti-racist method to measure these demographics to ensure that our research serves the communities that we hope to reach throughout the U.S.,” Steinberg said.

Clinical trials are considered the golden standard for verifying treatments, she added.

Steinberg also said that diagnostic tools that are not based on diverse data can lead to unequal efficacy. For example, tools made to diagnose endometrial cancer were tested in a primarily white population and were not as effective with Black women.

“Representation in research is critical for several aspects of our health system including social justice, equitable care, accurate and representative tools and diagnostic tools and clinical practices,” she said.

Clinical trials also offer the best care, Dr. Dario Roque, co-author and assistant professor of gynecologic oncology, said, which means that when minoritized communities do not have access to these trials, they do not benefit from these improved outcomes.

Roque noted the importance of diversity in oncology in particular, given the danger of cancer drugs. Since treatments can be so damaging, Roque wants to be sure that he is helping all his patients regardless of their backgrounds.

“My biggest fear will be that I’m treating someone with some of these very toxic drugs and they derive no benefit from it,” Roque said.

Steinberg also highlighted that different fields have distinct demographic breakdowns.

Obstetrics tends to have the least disparities. Roque hypothesized that this is due to the increased likelihood that pregnant people will have health insurance, which gives them more exposure to the trials. Gynecologic oncology, Roque’s field, has the highest disparities for Latine and Black people.

The reasons behind these data disparities are multifactorial. University hospitals only take certain insurance, which segregates populations based on demographics such as socioeconomic status. Non-white patients are not seen at these hospitals as often, meaning they are less likely to participate in a study. Similarly, rural areas often lack access to these studies.

Co-author Dr. Lynn Yee, Thomas J. Watkins Memorial Prof. of obstetrics and gynecology, said that historically, OB-GYNs have not prioritized reaching minoritized communities. 

The co-authors also emphasized the importance of the medical community avoiding assumptions about patients. Given the history of American OB-GYN’s abuse toward women of color, physicians often assume that women of color do not want to be a part of clinical trials. However, recent data shows there is no difference in interest, according to Steinberg.

Steinberg said that there is a set of “best practice” guidelines, which include community partnerships, language tools and the recruitment and retention of representative researchers.

Yee said that while the field can be “fatalistic” about improvement, she thinks the guidelines are well within reach. 

“An important point of this paper should be that diverse and equitable representation is achievable,” Yee said. “These data show that it is possible to have equitable representation and research, even if we aren’t there yet.”

Email: [email protected] 

Twitter: @kaavya_butaney

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