Cancer researchers should pay more attention to minorities and the "medically underserved," according to a report issued last week by a panel of the Institute of Medicine (IOM) in Washington, D.C. The IOM report, ordered by Congress more than 2 years ago, contends that the National Cancer Institute is spending only about $24.2 million a year on studies involving minorities--considerably less than NCI's own estimate of $124.4 million. In addition, the report argues that federal researchers should change the way they gather data, replacing traditional racial categories with ethnic or cultural categories.
The 15-member IOM panel, chaired by M. Alfred Haynes, former president and dean of the Charles R. Drew University of Medicine and Science in Los Angeles, California, highlights differences between mainstream and minority populations. According to the report, cancer incidence is 15% higher among African-American men than among white, non-Hispanic men; all minority groups have higher rates of stomach cancer than white Americans; and the 5-year cancer survival rate of Native Americans is only about two-thirds that of whites.
Senator Arlen Specter (R-PA) homed in on these disparities and the difference between NCI's and IOM's estimates of minority-focused research at a hearing he chaired on 21 January, the day after the report's release. Specter said he saw a "fundamental question as to resource allocation." The funding dispute may be largely a matter of accounting, however. NCI's estimate counts the cost of enrolling minorities in clinical trials. But the IOM panel favors a narrower approach, arguing that NCI should count only projects that address "research questions uniquely affecting minority and medically underserved groups." Even if a restricted definition is used, NCI contends, its minority research spending is more than $43 million.
Potentially more significant is the panel's recommendation that NCI move away from the traditional concept of race, which "rests on unfounded assumptions," according to IOM. Instead, the report urges NCI to use new group definitions based on ethnicity, country of ancestry, and a range of "cultural and behavioral attitudes. ..." This approach, the IOM panel says, might better highlight group differences in risk and point to new directions for research.
NCI director Richard Klausner agreed that existing racial classifications "are not scientifically sound," and he told Specter's subcommittee that NCI "has gone well beyond" them in recent health surveillance efforts. But Klausner said that because it is important to link NCI with other data sources--such as the Census Bureau, Medicare records, and state health department records--NCI can't break away from existing population categories on its own.