To ensure justice, fixed the fractured foundations of health care
Aashtha Shah is a second-year PharmD candidate at The Ohio State University School of Pharmacy.
The architecture of health care is unstable. Underneath the pillars of justice, beneficence, nonmaleficence, and autonomy, the foundation of medicine is fragile. Approaching the pillar of justice with speculative eyes reveals a fractured structure ready to topple. Justice stands on the grounds of fair and equal treatment of all patients, upholding integrity and individuality. Yet there is a disproportionate cultural divide in the health care system, with some bearing the burden of implicit biases and ignorance. This affects the day-to-day lives of millions of people, with proven negative outcomes. How fair and equal can this system really be?
The current model of therapeutics seldom recognizes marginalized communities. Clinical guidelines and medical decisions continue to be based on studies and trials consisting of primarily White participants, even though nearly 40% of the U.S. population belongs to a minority group.1 The exclusion of population-specific data in daily pharmacy practice translates to many non-White patients receiving potentially ineffective or dangerous treatments. Did you know that clopidogrel is nearly as effective as placebos in 75% of users who are Pacific Islanders?2 How about the fact that many asthma medications are significantly less effective in populations with the highest prevalence and severity of asthma, such as Puerto Ricans and Black Americans?2 Though these are isolated examples, our lack of attention to similar issues indicates a larger problem.
According to Ohio State University Advocacy Fellow Michael Murphy, PharmD, “Advocacy in its simplest form is education. The education of those [who have the power to fix] the inequities in our system that result in health disparities is paramount to filling the gaps that leave so many behind when they are sick.”
How can student pharmacists be the iron rods bridging these gaps and creating a truly just health care system? It starts with educating ourselves. Our duty is to identify and address discrepancies. A simple online search can reveal unlimited information about the lack of inclusivity in medicine. The next step is to change our behavior both in and out of clinical practice. Fostering discussions with our peers and educators, whether through organizations or during class, can help build momentum for the movement and raise awareness. It can create a chain reaction in persuading others to do their own research to better understand the subject. Educating ourselves can help translate our knowledge into practical application. By knowing areas that need improvement, we can tailor our conversations to be more inclusive. We can also be better advocates within clinical settings by asking the right questions.
The ultimate goal is to find an effective way to incorporate cultural sensitivity into our everyday practice in our internships and future profession so that we can provide comprehensive care to our patients. Only then can we create a stronger and more just foundation of health care.
1. Scientific American. Clinical trials need more diversity. Sci Am. 2018;319(3):10. doi:10.1038/scientificamerican0918-10.
2. Pérez-Stable EJ. Communicating the value of race and ethnicity in research. National Institutes of Health, U.S. Department of Health and Human Services. (27 June 2018). www.nih.gov/about-nih/what-we-do/science-health-public-trust/perspectives/science-health-public-trust/communicating-value-race-ethnicity-research.