A problem of social injustice  pg. 3

How important are cohort studies and epidemiological research?

Weeks: I think Dr. Freeman’s story about the navigator program, it’s a little like penicillin. You know, it’s so obviously worked that it’s definitely worth pursuing.

But what other things would work? Are there lower cost alternatives that would also work? Do we best put our resources into reengineering the health care system or providing one-on-one support for individual patients? I think those are the open questions, and the best way to begin to answer those questions is with cohort studies and epidemiology.

It’s where research always starts. It generates hypotheses. It generates ideas. Then you can narrow down with a randomized trial of a specific intervention and test to see whether it works. It’s very inefficient to do that without first understanding the lay of the land, and that’s what the cohort studies and epidemiology do for you.

Isn’t it difficult to ensure continued funding for studies that last a long time?

Weeks: I think it is true and there are several reasons for that. One of them is the equity issue.

If you are a congressman and you have great health insurance and disparities are not a part of your life and you’re looking at the way the NCI spends research money, you want them to spend every single dime on finding the cure for the cancer that you might get. It’s human nature.

And when research funding is ample and there’s plenty to go around, it’s also great to spend some money on understanding the causes of disparities. But when the budget shrinks, as it is right now, that’s the first thing to go.

Are we not investing enough in these kinds of studies?

Weeks: I would say we are absolutely not investing enough.

Freeman: I fully agree with the need to invest more money in these areas… but maybe even an overriding issue is that the problem of disparities finally comes down to the delivering what we already know…

There is this huge disconnect between our discovery system and our delivery system… To the extent that we don’t connect what we find to helping everyday people, I think it’s a moral and ethical dilemma…

The biggest thing we could do to reduce disparities this day and this year would be to apply everything we know, that we believe should be done for people, to all people, irrespective of their race, their ethnicity, their age, their sex or their ability to pay. That I think is the great challenge ...

You cannot solve the disparities problem solely within biomedicine. Something else has to occur… If the problems are occurring in communities, which they are, then we need to bring in the social scientists like sociologists, anthropologists, even the historians to help us to understand what’s going on in our communities.

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