I have the honor of being a black female dermatologist in the United States of America.
And with that honor comes a great responsibility and a dedication to raising awareness on matters
of importance. As people blessed with careers in medicine we are all granted opportunities not
only to deliver care but to educate and we have a responsibility to do so. To our patients, our
colleagues and ourselves. But what is our broader responsibility? Save the obvious to do no harm.
To me that answer must include raising awareness. But about what? What should my personal focus be?
I asked myself that constantly early in my dermatology career.
Part of my answer came from an unexpected source from a teacher, a friend, a colleague,
a 70-something-year-old white male named Dr. Jim Marks, one of the founders of Penn State
dermatology's department. You see each year all derm residents are charged with giving expert
talks on a topic of their choosing at grand rounds. Now I was a new resident back in the
fall of 2016 and I did not feel like I was an expert on anything. One day in clinic in slight
freakout mode as the clock run down on choosing a topic, I asked Jim "what should my talk be
about ?" And the answer helped narrow my focus. Jim turned around, with his classic warm smile,
folded his hands behind his head and said you could do your lecture on black hair. You
should talk to Jeff to guide you. He's the hair expert. Jeff Miller being our department chair.
In agreement and feeling excited about my topic I met with Jeff who was incredibly helpful. The
expert talk went great and with positive feedback from the audience I felt a spark.
Skin of color dermatology was a topic on which I could develop expertise and raise awareness. I
had knowledge in something that other people were uneducated about and I had exactly zero percent
interest in holding that knowledge back. I had a responsibility to share it for our patients. Now i
will be the literal first person to tell you that I had never really considered being a researcher,
doctor, yes, researcher? Mwah? Nah, but research is kind of what happens when you stay in academics
as i did after graduation. You end up being around researchers, power houses, like doctors Andrea
Zaenglein and Jocelyn Kirby. You get swept up in it and it's fun. But what research would I do?
My mind landed on disparities. Which brings me to the research part of my talk. I'm going to focus
on a few areas I want you to all be aware of. Funding and payer bias, diversifying dermatology,
some quick hits on my own research and finally action items everyone
can take to help drive long-term change. To start we need more funding and interest to
address disparities in health care. Take for example what was found in a 2020 JAMA study
regarding NIH research funding for two rare genetic diseases cystic fibrosis and sickle cell
disease. Which aren't dermatologic i know but bear with me because this is going to make you think.
The sickle cell disease birth rate is 1 in 365 black babies while CF occurs in 1 in
2,500 white babies. Through the retrospective review researchers found that NIH funding allowed
$2,800 per patient to those suffering from CF but just $800 for those with sickle cell disease.
And among philanthropic funding the disparity is even worse. $7,600 to just $100.
Now let's take two dermatologic diseases. Have you guys ever noticed how many commercials there are
and thus research dollars there is for psoriasis therapies? Psoriasis affects two percent of the
US population and 87 percent of those patients are of European descent. Another inflammatory disease
called central centrifugal cicatricial alopecia or ccca leads to irreversible scarring hair loss
and has been called an epidemic in the black women that it affects. With numerous psychosocial
implications. Up to six percent of black women are affected with this a number many think is grossly
under reported. It has exactly zero dedicated treatments. No fancy commercials, very little deep
dive research dedicated to it. Or how about keloid therapy. Same painful treatments for decades
even though keloids affect 10 of the population mostly in skin of color patients.
For all three examples, why is that so? Because in part there is not enough funding interest
or researchers researching things that affect mostly black people.
Another issue is insurance coverage bias. Recent research out of Wake Forest shows that one of
the top reasons black patients come to the dermatologist is for help with pigmentation
disorders yet many of the most helpful treatments for pigment correction are considered cosmetic.
Read not covered by insurance and thus too expensive for most people.
So part of my research is in raising awareness about what's paid for and what is not. So with
the help of a team we have found that treatments for the common facial disorder melasma,
typically diagnosed in darker skin patients, are almost never covered. While treatments for
the common facial disorder, rosacea, typically diagnosed in lighter skin patients are considered
medically necessary thus almost always covered by insurance. What we found was that rosacea patients
are 26 times as likely as melasma patients to have their prescription treatments covered.
Let's move on to diversifying dermatology. It seems people are more likely to research what
they can get funded yes but also what they know from personal lived experience. Thus we need
more black dermatologists. Currently representing just three percent of derms in America. So another
one of my research projects aims at evaluating every American dermatology program's commitment
to diversity and inclusion on their websites. What we have found is that only 32 percent of programs
even mention the words diversity and inclusion on their program pages and just 20 percent of
all programs had diversity and inclusion action items embedded in their program goals. Programs
with a diversity commitment message however had higher percentages of skin of color residents.
And so with more black dermatologists we can hope to retain more black academics. Who can
in turn help lead the change and the charge for advocacy and more research on conditions affecting
black patients. Since so few others are doing so now hopefully interest and commitment will
blossom in our non-black colleagues bringing more care to those who may need it most.
And now for some quick hits with the help of many others I work with a lot of people, I have a lot
of research going on. We have done research in hair washing patterns in black patients and
in another research project we evaluated and identified a lack of skin of color images and
photographs in top dermatology journals. With several colleagues we are raising awareness
in the community among young people at the Milton Hershey School. Helping them
understand that hair styling should never hurt and their scalps should never be chronically itchy.
Both statements that are aimed at reducing traction alopecia and seborrheic dermatitis which
are conditions affecting black girls and women at alarming rates. Finally with another work group,
we produced a call to action editorial addressing gaps in skin of color dermatology and provided
steps to make meaningful and intentional changes in our beloved field. Our letter has been accepted
for publication in our premier dermatology journal the JAD. So in conclusion let's end
with action items. We can all take action to lobby for more research funding and insurance
coverage for diagnoses affecting black people and we can help figure out how to attract more black
docs to dermatology and provide more support for black academics to increase retention rates. We
need allies in positions of power to act on these pressing issues willing to do the work alongside
us. We must put pressure on our country's institutions to change the culture of inequality
and start viewing health care disparities not as an individual failing but as a system failure,
as we already do for medical errors .Why are there still so many disparities in our country?
Part of the answer lies in problematic policies and societal norms. So let's reject those old
norms and change the policies. We're all the same race, one race, human. So question the
thoughts we have about each other that have gotten us to this point and seek the truth
no matter how inconvenient, no matter what you grew up thinking or still think. Use your place
in society to help improve black lives. Be the change. Come raise awareness with me. Thank you.