The panel discussion took place in the midst of unfolding national trauma—the murder of George Floyd in late May and emerging epidemiologic data revealing the disproportionate impact of the SARS-CoV-2 virus on Black, Latinx, and Native American people. These same populations continue to experience disparities in access to care, health outcomes, and an unequal burden of cancer.
Panelists talked openly about psychological, emotional, and physical pain resulting from the murder of George Floyd, the recent deaths of Breonna Taylor, Ahmaud Arbery, and other tragedies. Throughout the conversation, panelists expressed personal and professional commitment to ensuring these events will not have happened in vain.
The intersection of lethal racism and a highly contagious life-threatening viral pandemic has made the inequities in U.S. society and in the U.S. health system transparent. During the AACR session, panelists shared their views on action needed at every level—individual, in academia, institutional/systemic, and in society—to vanquish racism and achieve equity.
The following summarizes key points from the discussion.
What Individuals Can Do
Acknowledge racism. Individuals often do not recognize racist behaviors in themselves. As with a chronic disease, such as alcoholism, acknowledgment that a problem exists is a first step to change. “We have to get to a point where people can begin to feel comfortable recognizing racism,” said John D. Carpten, PhD, Professor and Chair of Translational Genomics; Director, Institute of Translational Genomics, USC Keck School of Medicine. “Racism is a hard word. We tend to want to use [the words] diversity and inclusion, because it sounds better and people are more comfortable with that. But we’ve really got to become uncomfortable if we’re going to move the needle and see racism dispelled in America.”
Speak up. Change will require more than being an ally to minority colleagues. Russell J. Ledet, PhD, emphasized the need for individuals who are not part of a marginalized group to speak up about racism. “We need disruptors,” he said. “We need people who will shake up conversations that they know are racist instead of being complicit at the dinner table. And it starts at the dinner table because a lot of our psychological thinking, the way we frame the world is built at a dinner table . . . in every realm, the people who are being marginalized can’t be the people to solve the problem. It’s the people doing the marginalizing that have to solve the problem.” Dr. Ledet is president and co-founder of The 15 White Coats and a third-year medical student in the MD/MBA program at Tulane University School of Medicine.
Call out racial bias. Distinct from overt racism, racial bias reflects an implicit attitude or mindset. For example, a mindset that implies people of color, racial and ethnic minorities, are not quite up to par, or that their achievements are not quite as legitimate as those of others. Whether minority individuals succeed or fail, this attitude paints the work of the marginalized individual or group as inferior. “I think calling out that mindset and recognizing how prevalent it is, is a big part of countering it,” said Levi A. Garraway, MD, PhD, Chief Medical Officer and Executive Vice President, Head of Global Product Development, Roche/Genentech.
Look in the mirror. Greater awareness and knowledge of existing disparities and inequities can spur individuals to assume personal responsibility for change. Hannah Valantine, MD, MRCP, Chief Officer for Scientific Workforce Diversity and Senior Investigator, National Institutes of Health (NIH), was moved by an editorial by Science Editor-in-Chief, Holden Thorp, PhD, “Time to Look in the Mirror,” that urges researchers, clinicians, and scientists across disciplines to reflect on disparities and inequities within their specialties. “What this [editorial] means to me is this: racism exists everywhere, including science . . . In looking in the mirror I began to reflect on the programs we have and to the extent we could be even more successful,” she said, emphasizing that NIH is committed to increasing the number of Black scientists in the pipeline and at the faculty level.
Be anti-racist. “It is no longer okay just to say you are not racist: be anti-racist,” said Robert A. Winn, MD, Director, Virginia Commonwealth University Massey Cancer Center; Professor, Division of Pulmonary Disease and Critical Care Medicine.
What Industry Can Do
Engage the community. Kenneth C. Frazier, JD, Chairman of the Board and CEO, Merck & Co., Inc., described Merck’s commitment to research around the world in countries with “diverse populations including people of varying age, race, ethnicity, gender and other characteristics.” Merck applies multiple approaches to understand what matters to patients, including patient advisory panels, consultations with experts, and more. “Community engagement has been especially helpful to increase awareness and education,” he said. “It’s really critical to build trust and help people regarding the importance and benefits of clinical trials. When people don’t see people like them conducting these clinical trials, they are not so sure whether we are doing something for them or doing something to them.” [emphasis added]
Begin equity training at the C-suite. Genentech and Roche have ongoing efforts to address racial bias, with a “large effort in inclusive research,” said Dr. Garraway. Equity training begins with the C-Suite at his organization, he said. Calling out and countering implicit bias when members of marginalized groups are not in the room is critical to creating a culture that does not allow racism to flourish. “This is something where everyone has to own the issue. You can’t just have a diversity office and expect these issues to go away,” he said.
Set measurable goals and report back. Lola A. Fashoyin-Aje, MD, MPH, Acting Deputy Director, Division of Oncology 3, Office of Oncologic Diseases, FDA, challenged her fellow panelists with leadership roles in industry to commit to developing and implementing an action plan to achieve more diverse racial and ethnic representation in clinical trials over the next 1 to 5 years. “I emphasize the action part of this because I think we need to see results. I think we’ve studied the issue extensively, and I think we just need to take bold action in order to really put some weight behind commitment to providing equitable access to clinical trials and generating data on racial and ethnic minorities. I think this is really what’s going to improve health outcomes for our patients, and our patients deserve this.” Both Mr. Frazier and Dr. Garraway accepted the challenge on behalf of their organizations.
What Academia Can Do
Recruit talent. Pointing to existing programs that are succeeding in bringing Black, Latinx, and other minority students into the sciences, medicine, and the cancer research pipeline, Dr. Winn argued that we know what needs to be done. What is needed is consistent, focused, relentless prioritizing of what has already been shown to work. Simply put, the institutional “will” to do what needs to be done.
Knowledge of how to reduce the gap in minority healthcare professionals has been demonstrated by programs such as those conducted by Dr. Sanya Springfield and Dr. Valantine, Dr. Winn noted. “They already have programs, and programs been validated. Some of them 20 years ago. It’s not the issue that we don’t know. It's the issue of the will.”
Teach the history of medical experimentation. Medical students, residents, and faculty should be educated on the history of Black people and medical experimentation in the U.S. and around the world, urged Dr. Ledet. An understanding of these past abuses is integral to recognizing that these are a source of much of the distrust of medicine, doctors, research, and the healthcare system for Black individuals.
Close the funding gap for minority researchers and ESIs. Panelists pointed to the need to address disparities in research funding for minority investigators. A chilling effect due to implicit bias often occurs at the study section level, noted Dr. Carpten. “That needs to continue to be explored and those processes and approaches need to be modified and changed . . . so we can see more diversity on study sections, minority scientists can feel more confident that studies are judged on the contents of the science and not the race of the investigators.”
What Healthcare Institutions Can Do
Provide support for staff. Judith S. Kaur, MD, Professor of Oncology; Medical Director, Native American Programs, Mayo Clinic Cancer Center, shared a process underway at her institution in response to recent events. They’ve been holding “everybody in” conversations that bring staff together to “try to address these unspoken fears, racism, concerns, attitudes within ourselves.” Racism in healthcare can surface in all settings. “One of my hematology fellows came to me recently and was disturbed by a patient who was very offensive to one of our female Muslim fellows,” said Dr. Kaur. “So, we involved the leadership. We involved the attending physicians. We stand firmly on what we tell our patients that that is not allowed. If they abuse a team member, then the team can choose not to continue care for a patient who violates those basic values that we all hold necessary.”
Fill the pipeline. While education remains key, several panelists pointed to disparities at the faculty level as a disincentive for those entering the field. “We recognize it’s a vicious circle. If we are not successful in increasing the faculty-level diversity, in particular Black scientists, we will not make a difference: first, in the demographics; secondly in inclusion; and [third] in health disparities,” commented Dr. Valantine.
What Society Can Do
Immediate action: support hospitals and essential workers. Panelist Marcia R. Cruz-Correa, MD, PhD, AGAF, FASGE, raised immediate and mid-term action steps in response to the COVID-19 pandemic.
- Support hospitals caring for minority populations. Ensure resources are provided for those hospitals caring for marginalized populations that are suffering a disproportionate burden of the SARS-CoV-2 pandemic.
- Provide Medicaid coverage for essential workers. Immediate action is needed so that essential workers (the majority of whom are African American and Latino) and those who have been laid off or have lost jobs can access care.
- Double down on cancer screening and prevention for underserved populations. Once the pandemic starts to ease, don’t forget cancer prevention and early detection. “Minorities are by far the groups that present with cancer at advanced stage. And it’s usually a direct response to not having the right test at the right time. We cannot forget once this is moving forward, we need to go back to cancer screening, cancer prevention.”
Dr. Cruz-Correa is Director, GI Oncology Division, Oncologic Hospital; Professor of Medicine, Biochemistry & Surgery; Affiliated Investigator, Cancer Biology, University of Puerto Rico Comprehensive Cancer Center.
Promote economic inclusion. Lack of economic inclusion is a primary driver of health disparities, Mr. Frazier noted. “I think it’s important that we recognize that health disparities and access to cancer research and the promise of that research won’t really have an impact until we improve the economic inclusion among people of color which is the most important root cause of many of the disparities in our society,” he said. “We’re all contending with the COVID-19 pandemic, and I think what that has revealed is the stark inequities in our society that have led to a disproportionate impact on people of color.” Many of the structural elements of racism are not just occurring in the medical field, he noted. “Economic inclusion is a critical issue for African Americans all throughout the country. As leaders, scientists, researchers, academics, as business people—we need to prioritize economic inclusion.”
Panelists agreed that some progress has been made in addressing racism and racial inequities in cancer research, but that much remains to be done. AACR is committed to realizing social justice and equality for all Black and other racial and ethnic minorities, both nationally and globally.
Closing out the panel discussion, Dr. Winn said, “Let’s not let these recent events go in vain. Let’s reclaim our best selves. In that best self, we will do better, we will impact real lives. I think we are being called now to become and reclaim who we know we should be and that is our best selves.”
Access the AACR June 23 panel discussion on Racism and Racial Inequities in Cancer Research on the AACR Virtual Meeting II website at https://www.aacr.org/meeting/aacr-annual-meeting-2020.
