Diversity: A Critical Resource Requirement For The Future Direction Of Medical Research

The scientific community is best equipped to identify the resources needed to find answers to pressing medical problems. Understandably, scientists have discharged this responsibility largely by highlighting the financial and facilities resources required to keep pace with modern scientific opportunities. And scientists lament loudly, as they should, that available resources are insufficient to exploit the unprecedented opportunities within easy reach of contemporary science. However, the scientific community has been insufficiently strident in highlighting the inadequacy in another critical resource requirement, namely, racial/ethnic diversity in the scientific work force. Here too, spectacular opportunities exist for finding solutions to the most pressing medical problems of the United States, if only we could secure more of the essential resources now in short supply. The reasons for achieving greater racial/ethnic diversity among scientists are many. At the top of the list, of course, is the simple matter of justice and equity. However, there is another, more pragmatic need. The U.S. research agenda is set, in large part, by investigators. Individual investigators, in turn, tend to research problems that they "see" and have an interest in. And what people see, and what tickles their fancy, depends to a great extent on their particular cultural and ethnic filters. Add to this the fact that our society as a whole is plagued by many unsolved health problems, many of which swirl disproportionately around our minority populations. Recognizing these truths leads to the reality that finding solutions to the most recalcitrant health problems, even being able to conceptualize what the problems are, will require a research work force that is much more diverse racially, ethnically, and by gender than we now have. Creating that work force begins with ensuring diversity among those admitted to our M.D. and Ph.D. educational programs. Despite substantial progress percentage-wise in recent years, we still have a long way to go. Blacks, Hispanics, and Native Americans continue to be severely underrepresented in all research fields. Data from the National Science Foundation show that, while the percentage increase in underrepresented minority scientists in recent years has been impressive, the absolute numbers remain abysmally low. For example, in 1993, minority scientists in the aggregate Ph.D. work force numbered less than 10,000, representing only 5 percent of the total. For the life sciences, the fraction is as unacceptably low, just 4 percent. And looking down the education pipeline leading to the science Ph.D., we can see that substantial progress is still a long way off. Only 8 percent of the Ph.D. degrees awarded in 1995 went to individuals from underrepresented minority groups. In the biological sciences, only 7 percent, or 304 Ph.D.'s, were awarded to minority students. As disappointingly low as these numbers are, we must recognize that matters would be still worse were it not for the sustained and commendable efforts over the years of NSF, the National Institutes of Health, the Howard Hughes Medical Institute, and other organizations. The fact remains, however, that minority representation among scientists is falling further and further behind the growing representation of minority groups in our society. Blacks, Hispanics, and Native Americans today represent approximately 21 percent of the total U.S. population and, given the rapidly changing demographics of American society, will represent almost 50 percent of the population by the middle of the next century. What can be done to accelerate the pace of achieving appropriate diversity among medical scientists? The permanent fix to this daunting problem, of course, entails fundamental reform of the U.S. primary and secondary education system. It is at these early points along the education pipeline where the dismal stage of inadequate academic preparation is set. Until all students have equivalent opportunities for early academic achievement, applicants for advanced education and training in the sciences from all segments of society will not arrive at our admissions offices in sufficient numbers nor with equivalent academic credentials. And until the academic credentials of all groups in the applicant pool are indistinguishable, we simply cannot use the same criteria to evaluate all applicants. Let me be absolutely clear. Given the disparity in available measures of academic achievement among applicants grouped by race and ethnicity, there is simply no way admissions committees for M.D. and Ph.D. programs can select an adequately diverse class of students today without taking race and ethnicity-explicitly or implicitly-into account. Using surrogates for race and ethnicity can certainly help, but is not an adequate substitute, in my mind, for being forthright about what is needed. What is needed is affirmative action, for as long as necessary, to reach out to those whose race and ethnicity, per se, have subjected them to inferior academic preparation, but who-by dint of their character, intelligence, and drive-are fully prepared to succeed as medical scientists. But, as everyone knows, affirmative- action programs in higher education have never been under greater attack. Last summer the Supreme Court let stand a federal appeals court ruling that prohibits schools in Texas, Louisiana, and Mississippi from considering an applicant's race as a factor for admission. And last November, California passed Proposition 209, now immured in a court battle, which would effectively eliminate the use of affirmative action in all state-related programs, including its universities, colleges, and professional schools. Opponents of affirmative action argue that it is unneeded, ineffective, or unfair. Each of these arguments rings hollow. Affirmative action has been indispensable in securing the limited gains we have achieved thus far. This short-term tool also has been indispensable in establishing the necessary momentum behind the long-term, educational enrichment and partnership programs sponsored by NIH, the Association of American Medical Colleges, and many other institutions. Abandoning affirmative action prematurely, before these programs bear sufficient fruit, would be a tragedy for the future of science and would prolong unconscionably the day when the scientific community looks more like the America that it serves. Jordan J. Cohen is president of the Association of American Medical Colleges in Washington, D.C.

Diversity: A Critical Resource Requirement For The Future Direction Of Medical Research

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