How anti-DEI healthcare policies are impacting patient care
The Trump administration has made it a priority to take federal funding away from any group it considers to be "DEI." These policies have even led to the removal of healthcare data from government websites.
Funding cuts have most directly impacted patient care for prevention programs aimed at underserved communities. They have also impacted patients involved in clinical trials looking specifically at female and non-white populations.
"It is an important issue for us at the University of Louisville because that is what we do. Our enterprise has a lot of cutting edge science, so a lot of research, and we are challenged now because of the anti-DEI legislation both in Kentucky and with presidential executive orders. We have to redirect so much of what we've done, and we have actually had to pull some research that's funded by the National Institutes of Health (NIH). We've had to redo grant applications," Kim Allan Williams, Sr., MD, chair of the department of medicine at the University of Louisville School of Medicine and a former American College of Cardiology (ACC) president, told Cardiovascular Business.
He is directly involved in a nutrition project focused on improving health in some of the impoverished neighborhoods of Louisville. In some cases, he said they have had to "undo" these programs completely.
"We're in the midst of doing all of that to comply with federal and state laws. It's difficult because we are staying behind the eight ball and addressing disease late, instead of developing the cutting-edge science that helps the people who are underserved and overrepresented in diseases," Williams said.
He cited the examples of Black patients having higher rates of stroke, heart attacks, heart failure and dialysis than white patients. Williams noted that his dad died after dialysis, so it is something that has impacted him directly.
"We are 12% of the population, yet we are 35% of the dialysis patients," Williams explained. He said dialysis is paid for by Medicare when you qualify by being on dialysis for two months. "The payment is about $99,000 per year. We don't have the tax base to pay that. Therefore, why wouldn't you have a DEI program that specifically goes into the neighborhoods like the West End like we're doing, find the people who have chronic kidney disease and get them treated before anything happens?"
He said screening programs in Black communities can screen patients for high blood pressure and the blood sugar levels and they can get preventive treatments based on evidence-based literature. He said interventions can also include lifestyle changes to get these individuals to change their diet and exercise more often.
"All these things that can help them to not progress to end-stage renal disease and save the country the money, because it's not our African-American community that's paying for all that dialysis, it's everyone else," Williams stressed.
Trump's policies toward DEI programs are based on the belief that they show favoritism towards minorities. In medicine, however, it's more complicated than that. Many of the programs and studies that are being impacted are attempting to gather more data to better understand the scope of sex differences between women and men in disease presentation, or attempting to better understand why some minorities have higher rates of certain diseases than their white, male counterparts.
"We need to take the people who are the most vulnerable and pay more attention to them. That's just a very simple principle if we want to get to the point where we're not all paying for healthcare issues that could have been prevented. We really want anyone who's concerned about DEI and its favoritism to just look at the data," Williams said.
Many health systems have embraced DEI executive positions
Over the past decade, there has been an increasing number of hospitals and health systems that created DEI executive positions to raise awareness about bias and increase the opportunities for qualified minorities in hiring, promotion and training. Part of this effort is aimed at recruiting and retaining more minority clinicians so they have more people who look like the patients they are treating. This is especially true in hospitals serving larger minority populations, where patient trust and buy-in for expensive or involved treatments often requires showing them there are people like them involved in their care. In cardiology, women and minorities make up a much smaller percentage of doctors because of historic barriers they faced in the profession.
But hospitals and academic medical centers are now under fire because of these anti-DEI efforts. In clinical studies funded by the NIH, for example, clinicians are now forced to come up with new approaches and different language to try and get grants for research that is needed to fill knowledge gaps.
"Wouldn't it be wonderful if we get to the point where none of this is necessary?" Williams asked. "The same thing is true for healthcare for women, which has been largely ignored. Look at the number of studies that have actually made recommendations based on outcome studies in men and applied them to women. We tried to undo that, and the NIH has really focused on it, but now they have to stop," Williams said.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]