Class and Discrimination in Medical Studies in North America

Most medical studies are conducted in North America, with over 46.4% of the worlds funding for these studies coming from Canada and The United States. Including all Western civilizations this number increases to 80.6% of all funding. This is quite far from the actual distribution of demographics of the world with Canada and The United States only making up 5% of the words population. This inequality and lack of representation of many minority groups around the whole world has profound consequences on these peoples, as many of these studies are found to be not generalizable from the participants selected from these groups. In a 2011 meta-study it was found that of 31 studies “only six (38%) examined how trials without individual participant data might affect the conclusions. In nine (29%) of the meta-analyses reviewer selection bias was a potential issue, as the identification of relevant trials was either not stated or based on a more selective, non-systematic approach.” This shows that many studies cannot be generalized to a degree, yet we rely on these studies for diagnostic medicine, diseases, and for our mental health.

Types of Discrimination In Studies

Gender

There is a growing concern that women are underrepresented in many medical trials. The main issue with using woman in medical studies is the variation caused by their hormonal schedules. Women have monthly hormonal cycles, meaning they have a vastly inconsistent body chemistry. This inconsistency makes for poor test subjects. There is also fear from some female test subjects about the lasting effects the experiments could have on their reproductive systems. This leads to a majority of test subjects being men. Only 31% of cardiovascular clinical trials included woman. Even worse, the majority of clinical lab studies use male animals as test subjects. This is a fundamentally flawed as women metabolize drugs very differently compared to men. Lung cancer, which is more prevalent then breast cancer, is frequently found in young women, as it was later found that estrogen had a role on the development of this cancer. Only after this was discovered there was a greater inclusion of women in lung cancer trials. It was found that there were better treatment alternatives for women compared to men. After a more diverse study done in 2014 the FDA cut the recommended Ambien dosage for women in half. Ambien could be potentially life threatening if taken in large amounts or combined with alcohol. There is progress in including women in more studies; however it is occurring very slowly. Many medical agencies, such as the FDA and NIH, have introduced new policies mandating a certain amount of women in the study. However these are not being strictly enforced and many agencies are looking to re-write their policies to be stricter.

Race

Many clinical studies outside of the United States do not ask their participants for their ethnic backgrounds. These countries have realised that race is not an important factor in clinical studies for the most part. In France it would be quite difficult gaining for approval for their studies if they required information of the participant’s race. However in the United States it is mandated by the government for certain medical studies. Even more concerning is that a pool of 600 U.S doctors found that 81% of doctors still believe that “race should be used as a biological basis for diagnosing disease” It has been found that race is merely a social construct and does not affect medical trials. There are some groups that have found to share geographic regions to share common physiological similarities, such as drug intolerances, or predisposition to certain illnesses. However just by asking race alone does not screen for these conditions, it would be better to actually examine participant’s physiology.

Age

In North America there is an upper and lower age limit to who can participate in clinical trials. Generally most studies contain the age group of 18-64. While experimenting on children is undoubted unethical, as their brain and body are still growing and any upset to their delicate chemical balance could have potentially lifetime effects. Experimenting on seniors has created quite a rift in the scientific community. While seniors can be more vulnerable to certain drug reactions, not having information on how they react to certain drugs can be very costly. As the age group 65 and older is the fast growing age group in North America information on how this group handles drugs is vital. Without including them into studies, these studies lose their external validity, which means they are not generalizable to the greater population, or at the very least there is a lack of medical data for seniors. This group also tends to be the one that requires the most care too. In India they are expected to raise the age of who participate in studies, so there may a precedent to be set for other countries.

Economic

Many studies have a monetary reward for participating in the study. The money incentive is supposed to be low enough as not to have participants force themselves through painful conditions. This is the case if you have a moderate amount of wealth, unfortunately for those that do not have too much wealth this money can be quite substantial. As such many participants in disadvantaged situations are less likely to complain about unsavoury conditions as they place a higher value on the monetary gain compared to those who have more money. Some of these participants can actually make more money participating in clinical trials then that of a minimum wage job. So if the side effects, or any part of the study becomes very unpleasant they cannot drop out of the study as they rely on this income for their livelihood, and out of fear of being excluded from future trials. A suggested fix would be to eliminate the economically disadvantaged from qualifying from studies. However this would result in a new form of discrimination, and could impact the generalizability of the study if we exclude a socioeconomic group from studies. The best approach is to ensure researchers do not exclusively take advantage of this group of people, and that you provide all with fair adequate compensation for the studies.

WEIRD Psychology

An example of the Müller-Lyer illusion, where WEIRD participants see different sized lines when in reality they are both the same length.

WEIRD stands for: western, educated, industrialized, rich and democratic. This is the usual make up of most psychology studies done in North America. WEIRD studies account for 96% of behavioural science studies and are 68% Americans, most of which are college students. This has led to a profound impact on the study of psychology where some traits once thought to be universal turns out to be only true for the WEIRD demographic. For example the Müller-Lyer illusion once thought to be an illusion that fooled our brains on physical level of perception was shown to be cultural. When researchers tested this illusion with participants from African tribes they found that these participants perceived the two lines to be perfectly identical in length. Also since 67% of American psychology studies use undergrad college students many of these studies have skewed results due to these participants’ brains not being fully formed. It has been found that none fully developed brains place a higher value of reward and less of an aversion to punishment, leading to some potentially different models of risk reward schemas then the ones currently modeled after WEIRD students. This is not to say some studies that have come from WEIRD participant pool have been truly generalizable to the human population, but it is almost impossible to tell which studies these are as so many studies being done with WEIRD populations means that the current state of behavioural psychology may only be true for a very small subgroup of individuals. Diversifying and adding incentives for underrepresented minority groups in psychological studies will increase external validity and potentially give these studies a greater understanding of how human minds work.