CWWeekly presents this feature as a way to put the spotlight on issues faced by executives in the clinical trials space. Owen Garrick, M.D., is the CEO of Bridge Clinical Research in Oakland, Calif., which is dedicated to increasing the number of minorities and encouraging more Principal Investigators to participate in clinical trials.
Q: Assuming some areas of the country have been more successful recruiting and other minorities, what have they done differently to reach out and develop trust to gain clinical trial participants?
A: In areas where there are [large quantities of] minorities like Philadelphia, the Bay Area/San Francisco and New York, we found clinical practices that have been successful recruiting minorities. However, in the same geography, there are sites that are not successful.
We have also seen rural areas where they have minorities—not large numbers, but a high percentage of minorities—and some of those communities tend to do well in trial recruitment and retention. They treat their patients well and that word of mouth spreads about the quality of care they provide.
The investigators and staff, white or minority, are generally comfortable discussing clinical trials with all patients. They take the same focused approach with people of all ethnicities. If they take that general caring approach, I think that resonates well.
Q: Given the paucity of minority principal investigators, what’s needed to encourage minority physicians to become PIs in minority communities and what can sponsors do to encourage their involvement in clinical trials?
A: There is a structural issue here. There are fewer people of color on a percentage and aggregate basis in medical school. So you fast-forward and there are fewer minority physicians. Unless there is something very deliberate going on, there will be fewer minority PIs. I am not sure industry can solve that big structural issue because that involves developing a pipeline and some might argue you need to go back to grade school and high school for that.
That said, the philosophical issue with clinical trials is that [as] a physician, you have to be invited to do clinical studies. It’s not like an event where you can buy a ticket or even a party you can crash. So you have to be asked to participate. And the ones doing the asking are the sponsors and the CROs.
You start with them and they can have success by starting to make the PI process more transparent. You generally know that experience matters and having SOPs matter, but if they can make the evaluation process a little bit more transparent, that could help. And if sponsors have conversations with potential minority PIs where they provide timely and actionable feedback, that can help.
There have been efforts and training around the issue of engaging minority PIs, but for whatever reason, those efforts have not been sustained. I would be interested to figure out why sponsors are not getting the return they expected or not meeting the targets they had in mind.
Q: Lack of affordable healthcare insurance for many low-income populations can reduce the chance for minorities to become aware of clinical trials. What would you suggest to a site, a pharmaceutical company or a CRO that wants to recruit and engage more minorities in clinical research?
A: Most patients find out about clinical trials from their doctor or another physician. If you don’t have access to a physician—especially one that is participating in clinical trials—you are likely to miss out on this critical information source.
But there is some good news. Recently, the Kaiser Family Foundation did a survey and found that 68% of previously uninsured Californians have now gained coverage since the Affordable Care Act was implemented. Internally, here at Bridge Clinical, we did a focus group that was not geared at this question, but were surprised by the large number of low-income black men that now had insurance coverage.
The challenge we found with this focus group was not all of these men had a primary care physician or what we may now call a “medical home.” So they still don’t have that primary access and distribution point to find out about clinical trials.
Internally we started to address this issue with a technology service that culls social networks and begins to target and advertise studies to people who are talking online about a particular disease. In terms of what a site or a drug company or an IRB can do, given the Affordable Care Act, I see many more minorities having coverage. Redoubling their efforts to make minority physician practices aware of clinical trials should produce results.
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This article was reprinted from Volume 19, Issue 34, of CWWeekly, a leading clinical research industry newsletter providing expanded analysis on breaking news, study leads, trial results and more. Subscribe »