Increasing diversity in medical research: A conversation with Michael R. Jaff, D.O.

The Boston Scientific Close the Gap health equity program empowers care providers, community members and other stakeholders to address health disparities for women and people of color. Michael R. Jaff, D.O., chief medical officer and a vice president on our Peripheral Interventions team, leads work to address healthcare disparities at the community level, including increasing diverse representation of patients and physicians in clinical studies. In a conversation with Emily Anderson, Director of Global Corporate Communications, Dr. Jaff shares insights about how we can improve outreach to generate more participation from underrepresented populations and advance inclusive research.

To start, tell us about Close the Gap, some of the challenges the program is addressing and how increased diversity in clinical trials fits into that work.

Our Close the Gap health equity program is 15 years old, so addressing health inequities is a longstanding commitment at Boston Scientific.  The challenges of COVID-19 and social injustices of 2020 underscored the criticality of this work, and so we initiated a collective effort -- tapping into all levels of the organization -- to help support a larger anti-racism strategy. Our strategy is focused on five pillars: community, economic empowerment, education, government policy & disparities in healthcare delivery. Given the increased visibility of the importance of clinical research, a big area of focus for us is increasing the diversity of participants in clinical studies.

Why is greater diversity in clinical research so important, and what are the obstacles?

Increasing diversity in medical research is a critical step to ensure that everyone can benefit from treatments and therapies, not just a select population. Putting this into practice requires deliberate work, and there are many obstacles, some of which are deeply rooted in our national history.  For example, many underrepresented groups have an understandable lack of trust in clinical research because of the way these vulnerable communities have been inappropriately targeted and harmed. Patients trust their doctor, nurse practitioner, or physician's assistant, and women and people of color place a large amount of trust in providers who look like they do. Unfortunately, many of the care providers for underrepresented groups are not widely engaged as investigators in clinical research. Creating greater awareness of the benefits of getting involved could help them expand treatment options and opportunities to care for their sickest and most at-risk patients.

Tell us about the importance of collaboration and why it is so critical to address health inequities.

Health inequities have been present for decades. I've sat on five different National Institutes of Health steering committees for major national and international vascular device trials. For each trial, our intent before we enrolled the first patient was to have a significant proportion of enrollees from underrepresented minority groups and women. We failed every time because we didn't think it through well enough, and we didn't have the partnerships to make it work. These partnerships include everything from collaborating with local hospitals who care for the patients that we want to enroll in studies, to working with national patient advocacy groups, to engaging diverse professional societies  —like the Association for Black Cardiologists, among others. We now have an opportunity to get it right by getting everybody aligned to the same focus.

What do you think are the most critical gaps in needs that other organizations could help solve?

During the first wave of the COVID pandemic, people identified as Black, Hispanic, Latinx and from other underrepresented groups suffered at least twice as often from severe complications of COVID-19 than their white counterparts. The mortality rates in some urban areas were three times higher among these groups than in their white counterparts. This is not a new phenomenon. For example, in patients with peripheral artery disease of the legs, underrepresented groups suffer far worse manifestations of their illness. Unfortunately, they also present to doctors later when options to manage the disease are often very limited. Their risk of amputation is two-to-five times higher than in their white counterparts in the next zip code -- not the next state or the next country. Due to systemic challenges related to the social determinants of health, the rampant ravages of diabetes, obesity, the risk of cancer in underserved groups is often much higher than in their white patient counterparts. This is an issue that has long been recognized among healthcare professionals and at the federal level by the likes of the Congressional Black and Hispanic Caucuses. These groups look to companies like Boston Scientific to be an ally to help put facts out there and do something meaningful to help.

These are longstanding issues, but we are in the middle of a pandemic that has exacerbated them. Are there any lessons that we're learning from the pandemic that can help accelerate closing the gaps in health disparities, or even in preparing for the next pandemic?

We've learned a lot about the cultural and environmental impacts that go beyond formal healthcare delivery. One of the challenges that contributes to the severe illness and death rate from COVID-19 in underrepresented groups is that these patients often live and work in more high-risk environments. Many live in multi-generational housing or have jobs that are industries where they are on the frontline and exposed to the public at much higher rates. A silver lining is that many young people who have watched this unfold in their communities have decided to choose healthcare as a profession. We're seeing more diverse enrollment in programs for health professions like nursing, physical therapy and physician assistants because people want to be able to learn how to provide care in their own communities. Any initiative we can undertake to increase diverse representation of trained professionals who then go back to their communities will help build critical and foundational trust. It's not a fast solution, but it's one that we're active in. Boston Scientific has established scholarships for schools to facilitate greater access and opportunities for people of color looking to enter the healthcare workforce.

What does success tackling these challenges look like?

We just launched a large, international patient registry with the goal of having 30% - 40% of its patient population composed of women, Black, Hispanic or other underrepresented groups. We are working in partnership with local hospitals and patient advocacy groups to expand our network of investigators and include clinicians who have trusted relationships with vulnerable patient populations. I look forward to reporting back on our progress and hope to inspire other companies to take similar actions. This is a transformative moment in healthcare. We have an amazing opportunity and now is the time to eliminate disparities in healthcare—once and for all.