Author: Susan Rahman, PharmD Published on 6/10/2020 1:45:00 PM
There are two things of which I could emphatically assure you as I was finishing pharmacy school; 1) I would not pursue a research career in infectious diseases, and 2) I would definitely NOT pursue a research career in dermatology. That certainty evaporated with a single conversation that took place when I was a postdoctoral fellow. A young black mother brought her son to the clinic for a condition I have long since forgotten; however, I noted he also had a fulminant case of tinea capitis. When I asked why it wasn’t on the problem list, she confessed that she had “given up” on trying to find a way to improve this condition and simply accepted it as “a way of life.” That single conversation led me to spend the next two-decades researching this fungal infection of the scalp prevalent in young black children. During that time, working almost exclusively with black families, I have met mothers like the first, hundreds of times over. I have listened to their fear that the weave being used to mask a daughter’s hair loss will make the child “grow up too fast.” I have listened to them challenge the diagnosis because it meant mandatory exclusion from school and by extension lost time from work without adequate child care, and I have listened to them express concern over the cost of generic prescription treatment that can exceed $500.
I have partnered with these mothers (and fathers) who have trusted me because I have listened. Thousands of children later, I still recall more names and faces than I have forgotten because we forged a research path together. Yet, I continue to encounter misrepresentations voiced by “experts” about a population that simply do not align with my observations. I have experienced disappointment in study sections and decision makers who verbally dismiss opportunities to address afflictions unique to black children because they fail to see the importance of this seemingly benign condition. I have been stunned to hear drug developers publicly defend R&D investments for related infections (tinea pedis and onychomycosis) because, unlike tinea capitis, “the patients affected by these conditions can afford to pay “for the medications.” And I have been exasperated when contacted by a public health agency to assist in tracing an outbreak of tinea capitis in six white children while thousands of infected black youth in my city attract no attention whatsoever.
The recent homicide of George Floyd at the hands of law enforcement has left me heartbroken. I honestly do not know how I, or we as clinical pharmacologists, could begin to impact the racial inequities in our criminal justice system that lead to this type of violence. However, we are in a position to address the health disparities that further exacerbate the burden of being black in America.
• We can demand federal funding to research conditions that are exclusively present in underrepresented populations,
• we can challenge our Pharma colleagues to ensure minority consideration in drug development and minority representation in clinical research,
• we can trust that our black patients, when engaged with sincerity and respect, will effectively partner with us to advance cures,
• we can call on regulatory agencies to emphasize the submission of data that support the safest and most effective use of medicines in the black population, and
• we can commit to supporting black trainees pursuing a career in medical research so that they, in turn, can direct us to solutions which we may be unable to see.
Frankly, this list of things that we, as clinical pharmacologists, can do should be a hell of a lot longer. However, I need the collective wisdom of my colleagues in clinical pharmacology to effectively enumerate how we can impact change. For now, I will begin where I started decades ago. I will listen.