Biology doesn’t explain disparities in cancer treatment – racial bias does

The story was all too familiar.  

A patient is diagnosed with locally aggressive prostate cancer. A few days before the surgery, the patient does not show up for his preoperative visit. We call the patient.

“We noticed you didn’t show up for the pre-op, is everything okay?” “I am sorry, doc. Had to cancel — something came up,” he sighed.  “No problem. Should we reschedule the procedure?”

“To be honest, Doc, I am not sure if I can afford to miss work right now. The surgery is going to have to wait.”

In this story, our patient is black. He has insurance provided to him by his employer, but his position in the company is — as many Americans, unfortunately, experience — directly tied to his ability to work, and to work now. This episode represents an individual account that national-level disparities research often miss.

Next week will mark the twenty-fifth anniversary of the NIH Revitalization Act of 1993, a federal law that requires conducting subset analysis by race on clinical trials funded by the NIH.

Although this law was enacted in order to increase representation of women and minorities in clinical research (something it hasn’t been able to achieve), it serves as a reminder of how race- or biology-based frameworks do not explain the stark disparities prevalent in health care.

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