Disparity Between Cancer Research and Care Delivery a ‘Moral Issue’

WASHINGTON—Despite the enormous progress that researchers have made againstcancer, the unequal disease burden borne by minority and under-servedpopulations constitutes "a moral and ethical dilemma for society,"said Harold P. Freeman, MD, who chairs the President’s Cancer Panel and alsoserves as director of the NCI’s Center to Reduce Cancer Health Disparities (CRCHD).

Inequity in cancer care and outcomes is a longstanding issue, he said at a plenary session of the 8th Biennial Symposium on Minorities, the Medically Underserved, and Cancer. He recalled facing it as a surgeon at Harlem Hospital and as an official of the American Cancer Society. Now, however, its "time has come."

His appointment a year ago to head the CRCHD is indicative of a new national commitment, he said. The CRCHD incorporates the old Office of Special Population Research, and its director reports directly to the NCI director.

The nation has seen great advances in biomedical knowledge in the 31 years since President Nixon declared war on cancer, Dr. Freeman said, but he noted that "the battle has not been fought well" in many communities, especially in those set in poor rural areas or composed of racial minorities.

Although the racial and ethnic categories that divide Americans are "real," Dr. Freeman continued, they are not, according to anthropologists, based on meaningful biological differences.

Among the initiatives underway at CRCHD to end health disparities are projects to establish sustainable infrastructures for awareness in underserved and minority populations.

Another priority is establishing partnerships with academic institutions that will increase these populations’ participation in clinical trials, train health disparity researchers, and build disparity research groups that can compete at the highest levels.

In addition, a series of CRCHD-sponsored "think tanks" bring together leading thinkers to examine such crucial issues as the meaning of "race" in science, the reasons that American women still die of cervical cancer, and the nature of "racialism" in medicine, which causes individuals of similar socioeconomic standing and insurance status but different racial identification to get different cancer care.

The "very great lesson" of the war on cancer to date is the need to close the gap between cancer research discovery and health care delivery, he said. The military, he said, does not develop weapons for their own sake, but uses them to destroy enemies. "It’s unacceptable for the research community to restrict its efforts only to research," he said. "We cannot allow a disconnect between what we discover and what we deliver to people."

Diminished survival in disadvantaged populations derives from a combination of inadequate environment, inadequate information, risk-promoting lifestyles and behavior, and diminished access to health care, he said.

"Disease always happens in human circumstances," Dr. Freeman said. "The nation’s medical and research community must give as much attention to human beings as to molecules."