In 2021, LUNGevity Foundation announced our inaugural Health Equity and Inclusiveness Workforce Development Awards to help combat the lack of diversity among lung cancer researchers as well as disparities in the lung cancer research itself. To learn more about the health disparities research and why it matters to all people, LUNGevity Foundation spoke with Robert Winn, MD, director of the Virginia Commonwealth University Massey Cancer Center and member of LUNGevity’s Board of Directors.
LUNGevity Foundation: How do we know these disparities exist?
Dr. Robert Winn: Over the past several years, the National Institutes of Health (NIH) and other groups documented the lower percentages of women researchers and researchers from diverse backgrounds.
In addition, multiple studies have shown a lack of diversity within patient populations on clinical trials and a limited understanding of how to deliver health care to underrepresented populations.
This is a three-fold issue. There are diversity gaps in: 1) the scientists conducting the research and trials, 2) the translation of the scientific discoveries into the communities and 3) the health delivery and implementation of the sciences into underrepresented populations.
LUNGevity’s Workforce Development Awards for Minority Scientists are unique and exciting because they attempt to address all three aspects of health disparities research.
LF: What is health disparities research?
RW: In the early 1900s, science was focused on matter and energy, because that’s what are scientific tools allowed us to study. Along came Watson, Crick, and Franklin’s discovery of DNA. The secret nature of the human cell was unlocked and the stage was set to research how cancer worked on the cellular level.
However, in our fervor for scientific discovery, we forgot our humanity at times. There were a number of examples of these shortcomings through this period of time, e.g. Henrietta Lacks and the creation of the HeLa cells.
Research is not just the conquest of obtaining knowledge; it’s also the application of this knowledge to our communities; it’s the very center and heartbeat of the health sciences.
LF: Can you give us an example of how health disparities research can help patients?
RW: A recent study by Joshua Campbell, et al. investigated whether there were driver mutation differences in lung cancer between whites and blacks. In short, the study did not find any difference between blacks and whites. However, it’s known that blacks die more commonly from lung cancer than whites.
I think this study, which suggests that genetics may not be the cause of the higher lung cancer death rate in blacks, helped the field of lung cancer research by prompting us to ask a few different questions. What’s the impact of ancestry on the poorer outcome of blacks with lung cancer? What role does the disparity in lung cancer screening play in the different outcomes seen between white and black lung cancer patients? The focus on health disparities research will help to answer these questions.
LF: Do people sometimes act like health disparities research is a soft science?
RW: For decades, people have thought that health disparities research was a soft science. I don’t, and never have seen disparity research as a soft science. In fact, I think that health disparities research represents the convergence of some of the best sciences we have in the 21st century. It’s precision-based medicine in action.
Health disparities research requires that our communities and scientists have open lines of communication. Health disparity research is going to be an increasing part of the 21st century of high-impact science. Disparity research has the potential to push science beyond the wet or dry laboratories into the community that we serve.
LF: Does health disparities research only focus on race?
RW: Health disparities research is about so much more than just race. In addition to race and ethnicity, it’s about place and space, too.
Let’s consider two 65-year-old white males, one from Utah, and the other from Kentucky. The man from Kentucky is 3 times more likely to get and have a poorer outcome from lung cancer than his counterpart living in Utah. Why is that? There are probably a number of contributing factors. It however points out the importance of factors beyond race, like geography that also contribute to health disparity.
In the past, we didn’t recognize that all these factors (ancestry, ethnicity, race, age, location, education etc.) have an overall impact on our health.
Health disparities research doesn’t divide us as much as it unites us in the fight against cancer.
LF: What are some of the challenges for health disparities researchers in lung cancer?
RW: Unfortunately, lung cancer research is not as well funded as other cancers, and the low funding levels of the NIH means that even the most compelling health disparities research in lung cancer may be likely to go unfunded. This is a significant challenge. Those young researchers who are unable to get initial funding frequently end up discouraged and frustrated and some will change career paths entirely for opportunities that are more lucrative. Foundations like LUNGevity are critical to addressing this challenge and turning the tide. LUNGevity has been a lifeline for many.
LF: How do LUNGevity’s Workforce Development Awards for Minority Scientists help address these challenges?
RW: The awards from LUNGevity are critical to advancing disparity research. They help investigators stay on the path of research, have the protected time to collect compelling preliminary data, and fine-tune their models to successfully move ahead. The researchers who earn these awards will have the support and time needed to be competitive in their chosen field of lung cancer research.
LF: If you had a magic wand and could do three things to eliminate disparities in academic funding, what would they be?
RW: First, I’d ensure there were resources to supply more junior faculty with opportunities to do more health disparities research. Second, I’d raise the visibility of disparity research and make sure people understood that health disparities research isn’t just for minorities – it impacts all of us. And third, I’d want more communities to benefit from the outstanding research being conducted through the health disparities sciences.
High quality disparity research and the desire to serve our communities more effectively should be woven into the fabric of the lung cancer scientific community.