When I worked at AIDS Project Los Angeles, I had a wristwatch with the organization’s name on it. Once when I was being examined by a heterosexual physician, he glanced at my watch and immediately asked why I had it on. I explained that I worked there. I no sooner got the words out of my mouth than he asked me if he could give me an HIV test. In fact, I often found this to be the case when I went to heterosexual physicans. They made inappropriate assumptions about me based on their cultural bias. My experience is an example of the kind of disconnect that can often occur between culturally discordant patients and doctors.
Of the many, many advisory committees I’ve attended, I have almost always heard an advisory committee panelist ask a drug sponsor – "So what did you do to recruit minorities for your clinical trial?"
In nearly every instance, I heard drug sponsors, who suddenly became self-conscious or defensive because, in fact, the profile of minorities in their clinical testing program was out of step with the profile of minorities bearing the actual disease burden, say that they had "advertised" or recruited in malls.
When it comes to minorities, there are a lot of reasons for people not to trust the "medical establishment". Rather, a greater reservoir of trust is held by physicians who people are seeing on a regular basis, people they can trust not to say or do the insensitive thing, however unintentional.
The reason that minorities are often not well represented in clinical trials is not because they don’t read the ads. It is because they have concerns that aren’t addressed by an ad or a recruiter with a clip board in a mall. Therefore, if drug sponsors want to avoid that awkward moment in the advisory committee meeting, and later awkward media inquiry, it might be prudent to begin formal programs of minority investigator training and recruitment with minority professional associations, such as the National Medical Association, the National Hispanic Medical Association, the Black Nurses Association or the Association of Black Cardiologists. That kind of investment would pay off for both companies, and minority patients.