As a medical sociologist, Dr. Shawna V. Hudson is like a detective seeking clues as to how the health care system functions for people of different ethnic groups. She became interested in health care inequities as a Rutgers University doctoral student assisting a sociologist and a psychologist who were studying health issues among elderly African-Americans in the New Brunswick, N.J., area.
“I was really starting out with a focus on disparities — who has access, who doesn’t and how do we make sure we equalize the playing field — and trying to figure that out from a social approach,” she says. “As opposed to looking at it in terms of what do the big numbers say, what is going on at the local level? Why aren’t people getting access?”
Today, Hudson is director of community research for the Cancer Institute of New Jersey and an associate professor of family medicine and community health at the University of Medicine and Dentistry of New Jersey Robert Wood Johnson Medical School. She is also an adjunct associate member of the Division of Population Science at Fox Chase Cancer Center.
While most research at the cancer center deals with basic science or clinical work focused on drug therapies, Hudson says her work is more like social science or market research. She uses tools such as surveys of health providers, interviews with patients and focus groups with the public to find better ways to get people into treatment.
“Our research is really about how do you now get the products out to people in a way that they can use them in their real-world setting,” she says.
After finishing her doctoral studies, Hudson began investigating the reasons for the lack of minorities in clinical research trials.
“One of the things that was really important to us was trying to figure out if your doctor actually talked to you about the opportunities (to participate),” she says.
Her survey of doctors revealed that many in fact did not tell minority patients that clinical trials were available and rarely asked the patients if they were interested in participating.
“Some of the doctors, for whatever reason, think that their patient population wouldn’t be receptive, so they didn’t ask questions to begin with,” says Hudson. “That was a huge ‘aha!’ — because if people don’t know about it, how can they respond?”
The doctors’ pessimistic assumptions about the patients’ receptiveness may not be entirely unfounded, Hudson admits. African-Americans’ skepticism of clinical trials stems largely from historical abuses like the Tuskegee syphilis experiment, in which researchers observed but withheld treatment from infected Black men as their disease progressed.
“Getting people to understand that you are going to get treated regardless, that’s the key issue now,” says Hudson. “People just want to know that they are getting treated, and they are not just being analyzed and not treated.”
With current safeguards in place, Hudson says, patients are going to get the standard care, or something better.
Diversity in clinical trials is crucial, she says, especially for diseases such as breast and prostate cancers that affect different ethnic groups in different ways. Treatments developed from trials with inadequate diversity might prove ineffective for some groups.
African-American women diagnosed with breast cancer, for instance, generally have a different form of tumor that tends to be diagnosed later and proves more fatal.
“If your clinical trials are really only targeting Caucasians, then you are going to get some drugs that are fabulous for Caucasians but may or may not work for other groups,” Hudson says.