AAMC's Comment Letter on
the Draft Trans-NIH Strategic Research Plan on Health Disparities
[In late Summer, 2000, the NIH released its draft
Trans-NIH Strategic Research Plan on Health Disparities for
public comment. Various related resources have been collected
on a new NIH web
site. The AAMC response to the draft strategic plan is
provided below.]
January 30, 2001
John Ruffin, Ph.D.
Director
National Center on Minority Health and Health Disparities
National Institutes of Health
Building 1, Room 252
1 Center Drive
Bethesda, MD 20892-2520
Dear Dr. Ruffin:
The Association of American Medical Colleges appreciates
being given the opportunity to comment on the draft Trans-NIH
Strategic Research Plan on Health Disparities. The Trans-NIH
Working Group is to be congratulated for developing a strategic
plan that recognizes that NIH's success is based on its ability
to marshal the full weight of all of its institutes to solve
fundamental scientific questions and to address the most urgent
challenges of disease. We strongly agree with the fundamental
premise underpinning the strategic plan: research on minority
health issues must be incorporated into the mission of each
of the NIH institutes and centers, building on the scientific
and clinical expertise that resides in these programs.
As you know, the AAMC represents the nation's 125 accredited
medical schools, nearly 400 major teaching hospitals and health
care systems, 91 academic societies representing more than
100,000 faculty members and the nation's 164,000 medical students
and residents. The Association's overarching mission is the
improvement of the health of the nation. As such, it is deeply
concerned about health disparities. Medical schools and teaching
hospitals have a unique responsibility to integrate knowledge
of these disparities into the education of medical students
and physicians and the delivery of health care, and to ensure
that these issues are high on the nation's research agenda.
We are supportive of the strategic research plan, but would
like to comment on a few of the specific provisions:
-
The Task Force wisely has adopted a broad definition
of health disparities ("…differences in the incidence,
prevalence, mortality, and burden of diseases and other
adverse health conditions that exist among specific population
groups in the United States."). We believe such a
definition provides a useful but flexible description
that will serve all of America's citizens.
-
While the Task Force's plan appreciates the importance
of training, facilities, and other infrastructure needs
to conduct vital research affecting health disparities,
it is important to stress the critical role played by
General Clinical Research Centers (GCRCs). As you know,
GCRCs are an indispensable component of the clinical investigation
and training infrastructure. In addition to housing the
Mentored Medical Student Clinical Research and Clinical
Scholars Programs, GCRCs also have made significant research
contributions related to health disparities. We would
urge the plan to promote an enhanced focus on health disparities
in the mentored patient oriented research investigator
training program (K23) and to further promote participation
by minority scientists in the program.
-
The plan recognizes the valuable contribution minority
institutions and minority researchers make in addressing
efforts to reduce and eliminate health disparities. However,
given the magnitude of the challenge, it is essential
that any institution with a well-documented commitment
of addressing issues of minority health should be eligible
for awards related to addressing health disparities. It
is very important that NIH and its institutes and centers
not leave the impression that research on minority health
issues is, or should be, the concern only of minority
investigators or only of researchers at minority institutes.
-
The Task Force's plan quite correctly stresses the potential
to expand and encourage clinical and basic research on
health disparities through enhanced clinical research
among institutions within Institutional Development Award
(IDeA)-eligible states. In addition to the new Centers
of Biomedical Research Excellence (COBRE) program mentioned
in the plan, we also believe the new Biomedical Research
Infrastructure Network (BRIN) should be recognized. The
BRIN program could become an important vehicle for institutions
within eligible states to conduct research on health disparities.
The BRIN program announcement explicitly urges eligible
states to incorporate minority institutions and to investigate
health disparities.
-
While the plan highlights biomedical and health research
topics, we urge that consideration be given to increasing
support for sociological and policy research on issues
related to minority health and health disparities. For
example, we recognize that it is the responsibility of
academic medical centers and other research institutions
(including NIH), to address issues of trust that impair
the participation of underrepresented minorities in clinical
research. However, there are little data or research on
how this trust may be established.
-
Lastly, the plan is silent on how NIH and its institutes
and centers will evaluate their performance in addressing
the success or failure of research initiatives that evolve
from the plan. We believe that evaluation and the establishment
of realistic, feasible outcome measures are vital.
We look forward to working with the NIH in implementing the
Trans-NIH Strategic Research Plan on Health Disparities and
appreciate the opportunity to share our views on the draft
plan.
Sincerely,
Jordan J. Cohen, M.D.
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