scholarly journals The Systemic Exclusion of Native Americans from Cancer Clinical Trials.

2021 ◽  
Author(s):  
Joseph Angel De Soto ◽  
Gabriel Selassie ◽  
Gilberta Yazzie
Keyword(s):  
Health Care ◽  
Clinical Trials ◽  
Native American ◽  
African Americans ◽  
Native Americans ◽  
Ethnic Minorities ◽  
Health Care Disparities ◽  
The United States ◽  
Cancer Clinical Trials ◽  
Unnecessary Death

Introduction: A major source of health care disparities derives from the underrepresentation of ethnic minorities in clinical trials. The inclusion of ethnic minorities is necessary to generalize the results in terms of efficacy and toxicology of medications in cancer treatment. Methodology: In this retrospective study, 80 cancer clinical trials with an aggregate of 278,470 participants performed within the last ten years were selected at random. The number of ethnic minorities participating and inclusion of them in the results were evaluated. Results: Only, 42.5% of cancer clinical trials reported the ethnic background of participants in their trials while even less 5% reported the efficacy or toxicology of the therapeutic intervention for ethnic minorities. Whites, Hispanics, African Americans, and Native Americans make up 60.1%, 18.5%, 13.4% and 1.5% of the population they made up 85.3%, 2.54%, 7.6% and 0.12% of the participants that reported ethnicity, respectively. Out of 278,470 participants in cancer clinicals trials only 133 (0.048%) could be identified as Native American . Conclusion: Native Americans were nearly completely excluded from cancer clinical trials. African Americans and Hispanics were greatly underrepresented. Cancer Clinical trials may not be generalizable and have been inherently racist in the United States. This has led to the unnecessary death and suffering of Native Americans from cancer.

scholarly journals The Underrepresentation of Minorities and Non-Generalizability of Breast Cancer Clinical Trials?

2021 ◽  
Author(s):  
Joseph Angel De Soto
Keyword(s):  
Breast Cancer ◽  
United States ◽  
Clinical Trials ◽  
African Americans ◽  
Native Americans ◽  
Ethnic Minorities ◽  
Minority Groups ◽  
The United States ◽  
Cancer Clinical Trials ◽  
High Death

Introduction This year 43,000 women will die from breast cancer in the United States. African Americans and Native Americans though less likely to get breast cancer, once diagnosed they are much more likely to die from breast cancer. This increased death rate may in part be due to the non-generalizability of breast cancer clinical trials. In this study, we evaluate the participation of ethnic minorities from breast cancer clinical trials. Methodology In this study, fifty-six breast cancer clinical trials completed in the last ten years in the United States were evaluated for the inclusion of ethnic minorities in the breast cancer clinical trials. Results Only 21% of breast cancer clinical trials include information on ethnicity in the methodology while only 7% provided any information on the effect or toxicity of the therapeutic intervention in minority groups while 100% report the results for Whites. Though Whites only make up 60.1% of the population, they were 87.5% of the clinical trial participants while African Americans were 6.2%, Hispanics 3.1%, Asians 2.9% and Native Americans were 0.2% of the participants. Conclusion Racial minorities have been underrepresented in breast cancer clinical trials which may contribute to unnecessarily high death rates in these groups while suggesting limited generalizability of breast cancer clinical trials.

scholarly journals Colon Cancer: The Exclusion of Native Americans and Hispanics from Clinical Trials in the United States

2021 ◽  
Author(s):  
Joseph Angel De Soto
Keyword(s):  
United States ◽  
Clinical Trial ◽  
Colon Cancer ◽  
Clinical Trials ◽  
African Americans ◽  
Native Americans ◽  
The United States ◽  
Cancer Clinical Trial ◽  
Cancer Clinical Trials ◽  
Trial Participants

Abstract:Introduction: Each year there are 150,000 new cases of colon cancer in the United States. The chance of death for Hispanics and Native Americans who get colon cancer is much higher than whites even though both groups are much less likely to get colon cancer than whites. In this study, we look at the inclusion or exclusion of Hispanics and Native Americans from colon cancer clinical trials. Methods: In this retrospective study, 48 colon cancer clinical trials in the United States with an aggregate of 421,530 participants performed within the last ten years were selected at random. These clinical trials were evaluated for the inclusion and exclusion of minorities. Results: Though whites make up only 60.1% of the population they make up 89% of the colon cancer clinical trial participants. African Americans, and Hispanics who make up 13.4% and 18.5% of the population only made up 5.6% and 0.6% of the colon cancer clinical trial participants. Only two native Americans out of 421,530 colon cancer clinical trial participants could be identified. Conclusion: Colon Cancer Clinical trials have systematically excluded Hispanics and Native Americans while minimizing the participation of African Americans. This may be directly related to the increased death rates seen in these groups and provides evidence for the non-generalizability of colon cancer clinical trials.

scholarly journals The Entanglements of Cultural Victimization and Cultural Healing within the Dominant White Apparatus: Tayo in Leslie Silko’s Ceremony and Bigger in Richard Wright’s Native Son

2018 ◽  
Vol 9 (6) ◽  
pp. 60
Author(s):  
Sameer M. Al-Shraah
Keyword(s):  
Native American ◽  
African Americans ◽  
Native Americans ◽  
The United States ◽  
The Other ◽  
Negative Effects ◽  
White Supremacist ◽  
Native Son ◽  
Cultural Healing ◽  
Mainstream Culture

The dominant white culture in the United States of America has always assumed the role of supremacy that victimizes other ethnicities and minorities and looked upon them as inferiors and unworthy of the privileges white people enjoy. Although the maltreatment of the Other-the non-white- differs from one ethnicity or minority to the other, it has always had sheer negative impacts on individuals as well as communities. This paper aims to show the victimization of African Americans as a community in America represented by the atrocity of Bigger and the victimization of Native Americans represented by trauma of Tayo. This paper will tackle the issue of victimization of the two communities-African American and native American-in general through the tough life journeys of the two protagonists of Richard Wright’s Native Son and Leslie Silko’s Ceremony and will try to show two different faces of maltreatment by the mainstream culture, but eventually same negative effects on both communities, African Americans and Native Americans. Thus, many Native Americans are subject to the mainstream culture instrumental policies that convince underprivileged ethnicities that they are integral part of the texture of the American society in time of national need. The irony is that such attitude is only meant to recruit non-whites to fight for the interest of the white supremacist apparatus. Silko eloquently displays patriotism and loyalty as the citizen who is eager and willing to fight and die for his people and country, and in that sense many Native Americans enlisted in the military so as to assert their masculinity. This, in fact, shows the negative effects of the pressure of white supremacist ideologies practiced against non-whites that they choose to act against their desires and choices in the hope that they will be accepted within the American social fabric. Finally, this paper explores some of the solutions available for the victimization and the atrocities of ethnic Americans, such as the communal support and the reconnection to one’s heritage and cultural roots to heal the damaged self-image and psyches of ethnic Americans.

scholarly journals Afrocentrism and the Peopling of the Americas

1996 ◽  
Vol 19 (2-3) ◽  
pp. 129-140
Author(s):  
Gabriel Haslip-Viera
Keyword(s):  
United States ◽  
Native American ◽  
African Americans ◽  
Native Americans ◽  
Human Development ◽  
Black People ◽  
The United States ◽  
Western Hemisphere ◽  
Peopling Of The Americas ◽  
Late Nineteenth

This essay focuses on a theory of human development that has been promoted aggressively by a group of Afrocentrists in recent years - that the Western Hemisphere was first populated by “Africoids” or “Black” people who came to the Americas by way of Asia and the Bering Straits with little or no change in their physical or racial characteristics. As discussed in this article, the theory has no support in the evidence collected by scientists in various fields. The essay focuses on the basic claims and methods used by the Afrocentrists to support their theory, including their misuse or misinterpretation of mostly outdated scholarship produced in Europe and the United States during the late nineteenth and early twentieth centuries. A brief concluding section makes reference to the potential repercussions of this theory on relations between African Americans, Native Americans and Latinos of Native American and part Native American background.

Why African Americans Are a Potential Target for COVID-19 Infection in the United States (USA). (Preprint)

2020 ◽  
Author(s):  
Alireza Hamidian Jahromi ◽  
Anahid Hamidianjahromi
Keyword(s):  
United States ◽  
Health Care ◽  
African Americans ◽  
Crisis Management ◽  
Ethnic Minorities ◽  
Risk Groups ◽  
The Elderly ◽  
The United States ◽  
Exponential Phase ◽  
The Impact

UNSTRUCTURED While WHO has officially announced that COVID-19 outbreak reaching a pandemic level, things have significantly changed inside USA, as this infection spread has reached its exponential phase. A stringent analysis of the COVID-19 epidemiologic data requires much more time and would generally be expected to happen after the exponential phase of the disease is over and when the focus of the health-care system is diverted away from crisis-management. Although much is said about high-risk groups and the vulnerability of elderly and patients with underlying comorbidities, the impact of race and its implications on susceptibility of ethnic minorities in indigent societies towards COVID-19 has not been discussed. There are currently some data on disparities between African American and Caucasians for COVID-19 infection and mortality. While the health-care authorities are reorganizing their resources and the infrastructure to provide care for the COVID-19 symptomatic patients, they should not shy away from protecting the general public as a whole and specifically the most vulnerable members of society, such as the elderly, ethnic minorities, and people with underlying comorbidities as well as African Americans.

“I Hope to Hell Nothing Goes Back to The Way It Was Before”: COVID-19, Marginalization, and Native Nations

2021 ◽  
pp. 1-18
Author(s):  
Raymond Foxworth ◽  
Laura E. Evans ◽  
Gabriel R. Sanchez ◽  
Cheryl Ellenwood ◽  
Carmela M. Roybal
Keyword(s):  
Native American ◽  
Native Americans ◽  
Original Data ◽  
The United States ◽  
Federal Law ◽  
Native Languages ◽  
Native Communities ◽  
Tribal Health ◽  
Tribal Lands ◽  
Health Regulations

We draw on new and original data to examine both partisan and systemic inequities that have fueled the spread of COVID-19 in Native America. We show how continued political marginalization of Native Americans has compounded longstanding inequalities and endangered the lives of Native peoples. Native nations have experienced disproportionate effects from prior health epidemics and pandemics, and in 2020, Native communities have seen greater rates of infection, hospitalization, and death from COVID-19. We find that Native nations have more COVID-19 cases if they are located in states with a higher ratio of Trump supporters and reside in states with Republican governors. Where there is longstanding marginalization, measured by lack of clean water on tribal lands and health information in Native languages, we find more COVID-19 cases. Federal law enables non-members to flout tribal health regulations while on tribal lands, and correspondingly, we find that COVID-19 cases rise when non-members travel onto tribal lands. Our findings engage the literatures on Native American politics, health policy within U.S. federalism, and structural health inequalities, and should be of interest to both scholars and practitioners interested in understanding COVID-19 outcomes across Tribes in the United States.

Enrollment disparities in cancer clinical trials leading to FDA approvals between 2008 and 2020.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18501-e18501
Author(s):  
Ryan Huu-Tuan Nguyen ◽  
Yomaira Silva ◽  
Vijayakrishna K. Gadi
Keyword(s):  
Prostate Cancer ◽  
United States ◽  
Clinical Trials ◽  
Drug Approval ◽  
The United States ◽  
Cancer Clinical Trials ◽  
Cancer Prevalence ◽  
Fda Approval ◽  
The Us ◽  
Enrollment Data

e18501 Background: Cancer clinical trials based in the United States (US) have lacked adequate representation of racial and ethnic minorities, the elderly, and women. Pivotal clinical trials leading to United States Food and Drug Administration (FDA) approval are often multi-national trials and may also lack generalizability to underrepresented populations in the United States. We determined the racial, ethnic, age, and sex enrollment in pivotal trials relative to the US cancer population. Methods: We reviewed the FDA’s Drug Approvals and Databases for novel and new use drug approvals for breast, colorectal, lung, and prostate cancer indications from 2008 through 2020. Drugs@FDA was searched for drug approval summaries and FDA labels to identify clinical trials used to justify clinical efficacy that led to FDA approval. For eligible trials, enrollment data were obtained from FDA approval summaries, FDA labels, ClinicalTrials.gov, and corresponding journal manuscripts. Enrollment Fraction (EF) was calculated as enrollment in identified clinical trials divided by 2017 SEER cancer prevalence. All data sources were publicly available. Results: From 2008 through 2020, 60 drugs received novel or new use drug approval for breast, colorectal, lung, or prostate cancer indications based on 66 clinical trials with a total enrollment of 36,830. North America accounted for 9,259 (31%) enrollees of the 73% of trials reporting location of enrollment. Racial demographics were reported in 78% of manuscripts, 66% of ClinicalTrials.gov pages, and 98% of FDA labels or approval summaries. Compared with a 0.4% enrollment fraction among White patients, lower enrollment fractions were noted in Hispanic (0.2%, odds ratio [OR] vs White, 0.46; 95% confidence interval [CI], 0.43 to 0.49, P< 0.001) and Black (0.1%, OR 0.29; 95% CI 0.28 to 0.31, P< 0.001) patients. Elderly patients (age ≥ 65 years) were less likely than younger patients to be enrollees (EF 0.3% vs 0.9%, OR 0.27; 95% CI 0.26 to 0.27, P< 0.001) despite accounting for 61.3% of cancer prevalence. For colorectal and lung cancer trials, females were less likely than males (EF 0.7% vs 1.1%, OR 0.66; 95% CI 0.63 to 0.68, P< 0.001) to be enrolled. Conclusions: Black, Hispanic, elderly, and female patients were less likely to enroll in cancer clinical trials leading to FDA approvals from 2008 to 2020. Race and geographic enrollment data were inconsistently reported in journal manuscripts and ClinicalTrials.gov. The lack of appropriate representation of specific patient populations in these key clinical trials limits their generalizability. Future efforts must be made to ensure equitable access, representation, and reporting of enrollees that adequately represent the US population of patients with cancer.

Practical Aspects of Implementing and Applying Health Care Cloud Computing Services and Informatics to Cancer Clinical Trial Data

2021 ◽  
pp. 826-832
Author(s):  
Jay G. Ronquillo ◽  
William T. Lester
Keyword(s):  
Health Care ◽  
Clinical Trial ◽  
Cancer Research ◽  
Cloud Computing ◽  
Clinical Trials ◽  
Laboratory Tests ◽  
Cancer Clinical Trial ◽  
Cancer Clinical Trials ◽  
Precision Oncology ◽  
Oncology Research

PURPOSE Cloud computing has led to dramatic growth in the volume, variety, and velocity of cancer data. However, cloud platforms and services present new challenges for cancer research, particularly in understanding the practical tradeoffs between cloud performance, cost, and complexity. The goal of this study was to describe the practical challenges when using a cloud-based service to improve the cancer clinical trial matching process. METHODS We collected information for all interventional cancer clinical trials from ClinicalTrials.gov and used the Google Cloud Healthcare Natural Language Application Programming Interface (API) to analyze clinical trial Title and Eligibility Criteria text. An informatics pipeline leveraging interoperability standards summarized the distribution of cancer clinical trials, genes, laboratory tests, and medications extracted from cloud-based entity analysis. RESULTS There were a total of 38,851 cancer-related clinical trials found in this study, with the distribution of cancer categories extracted from Title text significantly different than in ClinicalTrials.gov ( P < .001). Cloud-based entity analysis of clinical trial criteria identified a total of 949 genes, 1,782 laboratory tests, 2,086 medications, and 4,902 National Cancer Institute Thesaurus terms, with estimated detection accuracies ranging from 12.8% to 89.9%. A total of 77,702 API calls processed an estimated 167,179 text records, which took a total of 1,979 processing-minutes (33.0 processing-hours), or approximately 1.5 seconds per API call. CONCLUSION Current general-purpose cloud health care tools—like the Google service in this study—should not be used for automated clinical trial matching unless they can perform effective extraction and classification of the clinical, genetic, and medication concepts central to precision oncology research. A strong understanding of the practical aspects of cloud computing will help researchers effectively navigate the vast data ecosystems in cancer research.

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