Racial under-representation in clinical trials: Consequence, myth, and proposition

Abstract

The historical under-representation of Blacks in clinical trials is well-documented. The ethical ramifications of racial under-representation in clinical trials are exacerbated by the epidemiologic and clinical consequences. For example, persistent under-representation undermines generalizability and challenges inferences regarding treatment safety and efficacy for minority races. The potential for such consequences warrants greater racial diversity in clinical trials. However, investigators have assumed that recruiting Blacks for clinical trials is hampered by unwillingness to participate. Recent reports indicate that the perception of unwillingness may be unjustified. An often overlooked aspect is that conventional recruitment strategies may be ineffective for recruiting racial minorities. Public health professionals from all disciplines have the collective capacity to improve racial diversity in clinical trials primarily because of access to minority communities. Public health professionals could facilitate an effort to encourage collaboration between trial centers and community health clinics in predominantly minority settings.