Shortcomings of Research Outreach in the Digital Age

Modern technology allows people to access and understand information at a level unprecedented in human history. In medicine, technological advances have been integral to our ability to create therapies, optimize and standardize care, and enable providers to connect with patients in the most remote areas. However, even though much of the country identifies as belonging to a minority group, a disproportionately large majority of clinical research is conducted among white patients.1 Thus, although technology has facilitated the dissemination of information and support, it has not translated into more inclusive and equitable clinical research recruitment and participation.

One of the most important arguments for increasing diversity in research is the need to rebuild trust between the medical system and people belonging to minority groups. Medical research has a history of mistreating—even harming—minority patients, the most well-known example being the Tuskegee syphilis study, in which African-American men were intentionally left untreated for syphilis, despite the availability of effective treatment. This study, among others, left minority patients with an abiding mistrust of the medical system. Despite the establishment of laws to prevent such studies in the future, not enough has been done to restore the trust of minority patients in the medical system. As a result, minority patients are less likely to seek medical help or follow medical advice.2

Interestingly, increasing the proportion of patients from a given minority group included in research has been shown to increase the likelihood that people in that minority group will use and therefore benefit from that therapy. A study from the National Bureau of Economic Research showed that African-American men suffering from hypertension were more likely to use therapy tested in a research population consisting of 15% African-Americans than one tested in a research population consisting of less than 1% African-Americans.3 Increased inclusion of minority groups greatly benefits minority patients and may also represent a step toward restoring trust in the medical system—where earning that trust is an innately human undertaking upon which technological advances have little or no bearing.

Another issue is that clinical research is often undertaken at academic hospitals which tend to recruit participants from their more affluent patient base, while clinical research is less common at community hospitals which tend to serve lower-income communities. Participation in research studies can also be unrealistic for individuals with inflexible jobs and family responsibilities that may not allow time to travel to such programs.4 Individuals who do participate in research typically incur costs that are not reimbursed, such as transportation or parking.5 While technology can allow researchers to conduct patient interviews remotely, important data is gleaned from sources like blood tests and diagnostic and radiologic imaging that must be collected in person. Resolving the socioeconomic inequities present in clinical research recruitment will require researchers who are willing to find ways to improve accessibility and reduce the cost of participation.

In its current state, we can safely assume that medical technology will continue to grow and develop advancements aimed at improving health. However, we cannot assume that these advancements will benefit all groups equally—that is a human side of medical research that we must work to improve.

Reviewed by: Heiley Tai

Graphic by: Jackie No

1. THE EDITORS. (2018). Clinical Trials Have Far Too Little Racial and Ethnic Diversity. Scientific American, 319(3). https://doi.org/10.1038/scientificamerican0918-10

2. Hostetter, M., & Klein, S. (2021, January 14). Understanding and ameliorating medical mistrust among black americans. The Commonwealth Fund. https://www.commonwealthfund.org/publications/newsletter-article/2021/jan/medical-mistrust-among-black-americans

3. Alsan, M., Durvasula, M., Gupta, H., Schwartzstein, J., & Williams, H. (2022). Representation and Extrapolation: Evidence from Clinical Trials. https://doi.org/10.3386/w30575

4. Rodríguez-Torres, E., González-Pérez, M. M., & Díaz-Pérez, C. (2021). Barriers and facilitators to the participation of subjects in clinical trials: An overview of reviews. Contemporary clinical trials communications, 23, 100829. https://doi.org/10.1016/j.conctc.2021.100829

5. Mills, E. J., Seely, D., Rachlis, B., Griffith, L., Wu, P., Wilson, K., Ellis, P., & Wright, J. R. (2006). Barriers to participation in clinical trials of cancer: a meta-analysis and systematic review of patient-reported factors. The Lancet. Oncology, 7(2), 141–148. https://doi.org/10.1016/S1470-2045(06)70576-9

Life-Saving Technology or Dystopia-Inducing Weapon: The Benefits and Risks of CRISPR

A world in which expectant parents meet with scientists to determine their child’s height, hair color, and intelligence seems nightmarish; it is essentially eugenics disguised as societal advancement. Luckily, a society in which the fate of an individual is determined entirely by their genetic modifications is the premise of the movie Gattaca, not real life. A few years ago, this society was purely fictional. However, new technology has allowed gene editing to move beyond its science-fiction past into reality. In 2012, Jennifer Doudna and Emmanuelle Charpentier developed CRISPR-Cas9, a revolutionary tool for editing genes (“Jennifer A. Doudna,” 2020). This novel technology possesses the potential to cure treatment-resistant genetic diseases, giving patients a second chance at life.

Since its inception, its power and benefits have grown exponentially. Clinical trials have utilized the tool in treating cancers, sickle-cell anemia, hereditary blindness, type 1 diabetes, and more (Henderson 2022). Currently, CRISPR is on the cusp of moving past the trial phase, providing more patients with innovative treatment options. On December 8th, 2023, the gene-editing tool is projected to be approved by the FDA for treating sickle-cell anemia, and more approvals are certain to follow (Kolata 2023). CRISPR is continuously proving to be an essential tool that may completely change the field of disease prevention and treatment.

The potential of CRISPR speaks for itself, but the implications of implementing it must not be ignored. As with many emerging technologies in healthcare, CRISPR treatments pose equity concerns. This is especially apparent in the treatment of sickle-cell anemia. Just one CRISPR treatment can cost up to $500,000, an unreachable threshold for many (Molteni 2023). Furthermore, many countries in Sub-Saharan Africa, a region where sickle-cell anemia is especially prevalent, lack the infrastructure necessary for the procedure (Molteni 2023). Even though CRISPR has the potential to provide life-saving treatment, its lack of accessibility will only reinforce socioeconomic stratification. Efforts must be made to allow for CRISPR treatments to reach those who need it most, despite their community’s resources and their personal level of income.

Finally, the ethical implications of a tool like CRISPR are best described by Jennifer Doudna herself: “It was Adolf Hitler… He had a pig face and I could only see him from behind and he was taking notes and he said, ‘I want to understand the uses and implications of this amazing technology.” (Knoepfler 2015). CRISPR contains the promise of a cure for many, but in the wrong hands, it could easily become weaponized and misused as a tool to eliminate “undesirable” traits from a population. Doudna’s fears reflect that this is an all-too-real possibility and that rules and regulations must be established before releasing CRISPR into the hands of any scientists who desire it.

The discovery of CRISPR was undeniably an incredible step forward in technology, healthcare, and medicine. However, researchers must understand the complicated ethical dilemma of genetic modification before using this revolutionary tool. A line must be drawn to maximize the benefits of CRISPR while preventing its consequences, ensuring Doudna’s nightmare never becomes a reality.

Reviewed by: Megan Tandar

Graphic by: Sonali Patel

The Robotic Renaissance in Healthcare

At the forefront of the technological revolution, unfolding in the landscape of healthcare, is the integration of robotics. Robots are beginning to transform the healthcare field both within and beyond the operating room. Robotic aids can streamline healthcare by improving surgical precision, enhancing rehabilitation through targeted exercises, and optimizing diagnostic procedures. This innovation meets precision within robotic-assisted surgeries, new procedures developed alongside our technological progress. Robots are becoming invaluable allies to surgeons, providing unprecedented levels of accuracy and control in the operating room.

During robotic surgery, a surgeon uses a specially trained robot and a high-definition, three-dimensional camera to perform the procedure. The camera magnifies the body tenfold, enhancing visualization and guiding the surgeon. Computer vision research is revolutionizing robotic surgery by enabling advanced image recognition and interpretation, allowing surgical robots to navigate with heightened precision, distinguishing vital structures rapidly, providing real-time feedback to surgeons for more informed decision-making during procedures.

However, the integration of robotics into surgery is one that can garner conflicted opinions from the general public and physicians. It undeniably stands as a tremendous asset, elevating the standards of precision and patient care. Still, as we embrace this technological leap, it is crucial to maintain a delicate balance. While robotics offer unparalleled advantages, we must resist the temptation to overly rely on automated processes. The optimal synergy lies in a symbiotic relationship, where human expertise and judgment harmonize with the precision and capabilities of robotic aids.

Robots are not only limited to the operating room; they are also making strides in rehabilitation and physical therapy. These robots can help physical therapists provide targeted exercises and a consistent training regime, ensuring improved recovery. Thus, the marriage of technology and therapy presents a new frontier in rehabilitation and patient care.

With the invention of new procedures and treatments that rely more and more on robotic assistance, physicians are facing conversations about the role of technology in healthcare. There are benefits and drawbacks to the increased reliance on robots, and it is necessary to determine where this balance lies. The future of healthcare is not a binary choice between human or machine but a dynamic synthesis, where the potential of both is harnessed to advance medical practices, ultimately ensuring a holistic and patient-centered approach to healing.

Reviewed by: Laila Khan-Farooqi

Graphic by: Heiley Tai