Advancing Health Equity in Dermatology
November 29, 2022
Strides have been made in medical dermatology to address the unique needs of communities of color. However, many patients continue to face biases in access, treatment and care, harbor distrust, and face socioeconomic and visibility obstacles. An overall lack of patients with adequate exposure to research, diversity in clinical trials and representation of darker skin tones in dermatology poses risks to those populations.
We convened health industry leaders, researchers, practitioners and advocates for in-depth conversations on dermatological disparities and various ways to accelerate equity in dermatology.
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- Cheryl M. Burgess, MD, FAAD, Founder, Medical Director & President, Center for Dermatology and Dermatologic Surgery, PC; Assistant Clinical Professor at Georgetown University and The George Washington University
- Seemal R. Desai, MD, FAAD, Past President of the Skin of Color Society, Founder of Innovative Dermatology, Clinical Assistant Professor of Dermatology at the University of Texas Southwestern Medical Center
- Leslie Koby, U.S. Commercial Inflammation & Immunology (I&I) Lead, Pfizer
- Jack Resneck Jr., MD, President, American Medical Association; Professor & Chair of Dermatology, UCSF
- Maryam Sadeghi, Ph.D., CEO & Co-Founder, MetaOptima Technology Inc.
- Susan C. Taylor, MD, FAAD, Bernett Johnson Endowed Professor of Dermatology & Vice Chair for Diversity, Equity and Inclusion for the Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania
- Ann-Hunter van Kirk, Senior Equity Research Analyst, Biopharmaceuticals, Bloomberg Intelligence
- Duane Wright, Senior Research Analyst, Health Care, Bloomberg Intelligence
Biases in Care: Combating Dermatologic Disparities
Among the most common systemic failures are access to care, clinical trials that don’t foster access and trust, and the paucity of images of people of color in medical manuals, according to Susan C. Taylor, MD, FAAD, Bernett Johnson Endowed Professor of Dermatology & Vice Chair for Diversity, Equity and Inclusion for the Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania. “It’s critically important that the physician population reflects our overall U.S. population.” Physicians of African descent make up about 3% of dermatologists, and Latinx are about 4.2%. Clinical trials are not considering how race factors into medical developments. “We need to make sure that for every single medication or device that’s approved by the FDA, that there’s adequate testing in regard to safety, as well as efficacy.”
Publicly reckoning with its history of racism and harm created in the space is among the first steps for the AMA in moving forward, said Jack Resneck Jr., MD, President, American Medical Association; Professor & Chair of Dermatology, UCSF. “We had past leaders, such as J. Marion Sims, who was considered the father of OB-GYN in this country, but who did experiments on slaves without anesthesia.” Reports show the AMA eventually initiating some reform, while at the same time, closing a number of historically Black medical schools.
“Looking upstream” is their Center for Health Equity, where initiatives include campaigns to ensure diversity in the medical education pipeline and blocking discriminatory laws.
Pfizer Sponsor Spotlight: Ensuring Patients of Every Skin Color Feel Seen and Understood
Seemal R. Desai, MD, FAAD, Past President of the Skin of Color Society, Founder of Innovative Dermatology, Clinical Assistant Professor of Dermatology at the University of Texas Southwestern Medical Center noted that dermatology is a science based on visual exams. “Health equity transcends all paradigms of what we do. And no one’s skin looks or feels the exact same way.” There are a myriad of differences due to racial and ethnic backgrounds and cultural practices. “We really have to be aware that significant differences do exist in how disease presents in different populations.” For instance, Black children are 1.7 times more likely to develop atopic dermatitis than White children, yet the symptoms are harder to detect on darker skin.
Interviewer Leslie Koby, U.S. Commercial Inflammation & Immunology (I&I) Lead, Pfizer, said that her company is looking at the role they play, including uncovering data that 38% of their Inflammation & Immunology trials achieved racial and ethnic distribution levels at or above US census levels for Black participants. “So, good progress, but we need to do better.”
Bloomberg Intelligence Presentation
Duane Wright, Senior Research Analyst, Health Care, Bloomberg Intelligence offered alarming, but not surprising statistics for participants in trials for new drugs; 8% for Black Americans and 10% for Hispanics, compared to demographics of about 14% and 19%. Dermatological studies are only slightly more diverse. Factoring in may be awareness of trials, site locations, lack of transportation, and lack of diversity in the dermatology workforce and among clinical trial investigators.
Showing great promise among solutions and opportunities are decentralized, tech-enabled trials, with wearables and smart phone apps that collect data more reliably than subjective methods, such as participant diaries.
Seeing Color: Diversity in Research and Technology
Dermatology has already been left behind by technology, stated Maryam Sadeghi, Ph.D., CEO & Co-Founder, MetaOptima Technology Inc. “We need better tools and more digital data on skin type differences. We need to understand where the biases are,” she said, advocating for broader data sets. She noted there are many skin issues beyond cancer, which also need to be focused on. “It is not that difficult to identify basal cell melanoma in a skin type 1 patient, but it’s very difficult when it comes to skin types 5 and 6. And that’s where we need technology to help.”
When it comes to clinical trials, most that claim sufficient diversity of skin color don’t go beyond type 4, said Cheryl M. Burgess, MD, FAAD, Founder, Medical Director & President, Center for Dermatology and Dermatologic Surgery, PC; Assistant Clinical Professor at Georgetown University and The George Washington University. “And that data doesn’t go any deeper than asking participants if they have skin of color.” Before technology is introduced, there has to be better diagnoses of pigmented basal cells, and more physicians of color. “If they are misdiagnosing, how are they going to use AI to substantiate? It has to start way back in the chain.”
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