Some have called for increased accrual of minorities to clinical trials and suggested that this might help find treatments for diseases frequently seen in minorities. Reviews have demonstrated that, with few exceptions, equal treatment yields equal outcome among equal patients. Race or ethnicity is not a factor in outcome, although pertinent molecular markers with differing racial/ethnic prevalences can be. Shavers and Brown have published a wonderful review demonstrating that treatment is not equal among the races. Indeed, they cite evidence for significantly disparate treatment patterns in a number of diseases.
The authors correctly point out that cultural differences in the acceptance of therapy and a misunderstanding of cancer biology and principles of medical treatment are common reasons that optimal therapy is refused. We believe that health-care providers do not need to be of the same race as the patient, but do need to be sensitive to the needs, fears, and concerns of the patient (and open to dealing with those needs, fears, and concerns).
Another factor that must be considered beyond the availability of good health care is the lack of convenience of therapy. Even when therapy is available, it may be refused or underutilized if it is inconvenient. We are personally aware of women with limited-stage breast cancer walking out on therapy at an indigent care facility, because they found that obtaining care was unpleasant. They had long waits for surgery and frequent postponements of scheduled procedures.
Several years ago, the federal government initiated a major effort to define the reasons why people are medically underserved. Many of us who worked on that project quickly realized that "the underserved are underserved because they are underserved, and the solution is to get them service." A major effort in minority health and health disparities research must be to determine how we can provide adequate high-quality care to populations that so often have not received it, regardless of race/ethnicity or socioeconomic status.
—Otis W. Brawley, MD
—Mitchell Berger, MD, MMM, CPE