Lady Business: Cancer, clinical trials, and the 40% mortality gap

Hello, and welcome to Lady Business, a newsletter about women, the business world, and all the ways they overlap. You can sign up for Lady Business and read previous issues here. This is the 105th issue, published July 5, 2020. 
 

Sobering Statistics 

Before this year, I didn’t pay that much professional attention to medical stats. But then, even before the pandemic centered healthcare news as The News, I started reporting on breast implants and the women who get them for cancer-related reasons, including those women at hereditary high risk of developing breast cancer.
 
Many of these women are of Ashkenazi Jewish descent, who are much more likely to have a specific genetic mutation that increases their likelihood of developing the disease -- which is already the most common non-skin cancer affecting women. One of every 8 of us is likely to develop it during our lifetimes.

The cancer itself wasn’t a main focus of my investigation into breast implants, but I was curious if other specific racial and ethnic backgrounds make women more likely to develop it. Some quick Googling led me to a breath-taking statistic on the CDC’s website: “Breast cancer death rates are 40% higher among Black women than white women.”
                                            
Forty percent. For decades. Even though Black women have historically had a lower likelihood of getting breast cancer, they are 40 percent more likely to die from it.
 
I kept that statistic in the back of my mind as I investigated the risks of breast implants, and last month I started reporting directly on some of its causes. There are many, most of which -- surprise! -- boil down to "racism and sexism."

It both is and isn't more nuanced than that. The combination of institutional racism and sexism damages the health of Black women in both specific and systemic ways, going far beyond their breast cancer mortality rates, as several doctors and public health experts explained to me for an article Fortune published this week. And then a story that began with an investigation into one awful statistic yielded more shocking numbers:
 

Black women are at higher risk for a particularly aggressive type of “triple-negative” breast cancer, yet they are still largely omitted from clinical trials of drugs that treat the disease….Women of all races could be legally omitted from government-funded clinical trials before 1993, and are still often underrepresented in most research studies of conditions that affect them. Pregnancy and menstrual cycles are thought to “complicate” the results of trials that are mostly conducted on white men, who are seen as the “norm.”

This can obviously backfire. In 2013, the U.S. Food and Drug Administration sharply cut its recommended dosages of Ambien for women, after years of complaints about grogginess and falling asleep while driving, when follow-up tests showed that women metabolized the active ingredient in sleeping aids much more slowly than men.

When it comes to clinical trials funded by pharmaceutical companies, “the FDA encourages but does not require diversity in clinical trials,” says Diana Zuckerman, a scientist and president of the National Center for Health Research. “Worse, the agency frequently approves drugs and devices for all adults, even if they were primarily studied on white adults.”

One treatment that the FDA approved in April, for the “triple-negative” type of breast cancer that disproportionately affects Black women, was approved after being tested on 108 patients. Eight of them, or 7%, were Black. Another breast-cancer treatment was approved last year after being tested on 234 patients; seven of them, or 3%, were Black.
 

This lack of diversity in clinical trials goes far beyond breast cancer. As just one recent example, the FDA in May approved a heart disease drug after a clinical trial that was 77 percent male -- even though women are three times more likely to die of a heart attack than men, and Black women are at particularly high risk of heart disease.

So this clinical-study status quo hurts all women, especially those who are already under-served by the medical and pharmaceutical establishment. It's a well-known problem in certain medical and regulatory circles -- if not one that seems likely to change anytime soon:
 

The FDA sets guidance for but does not run the clinical trials conducted by pharmaceutical companies. Agency spokesman Nathan Arnold tells Fortune the FDA has made various efforts, over the past few decades, to encourage clinical trials to enroll more diverse participants, “primarily through broadening eligibility criteria.

“Despite these efforts, challenges to participation in clinical trials remain,” he says, “and certain groups continue to be unnecessarily underrepresented in many clinical trials.”

Lady Bits

 
--"This is a moment in history that I just feel so honored to be a part of, and so the expansion of our business right now? It’s like, sure, whatever. It’s my guess we’ll get there, but I feel like there’s just so much more that we’re contributing than physical space.” I really enjoyed speaking with Alex West Steinman and Liz Giel, two cofounders of Minneapolis women’s coworking space The Coven, about how the pandemic and the national reckoning over racism are affecting their business and its mission.
 
--“Women have gone backwards during the pandemic.” Sallie Krawcheck, straight to the depressing point.
 
--"In the Covid-19 economy, you’re allowed only a kid or a job.” As Deb Perelman’s searing condemnation of the childcare impossibilities of this pandemic rightly makes the rounds, a recommendation for one of my favorite no-cook summer recipes from her Smitten Kitchen blog: zucchini carpaccio salad. (Which I first discovered through this equally satisfying, if oven-required, spinach quiche recipe of hers.)

--"Very few of those men understood having no choice about whether they were political or not: Unlike me, they weren’t people who’d had their existence politicized on their behalf.” I mostly enjoyed Lauren Wilkinson’s American Spy, a novel about a Black woman FBI agent in the 1980s, and her ambivalent involvement in American espionage in Burkina Faso. Like Tana French’s In the Woods, the book abruptly (if deliberately) ends before a confrontation that it’s seemingly been building to, which can’t help but be a little deflating. But the story is otherwise engrossing--and, frankly, educational about real-life 1980s political figures I never learned about growing up.

Thank you for reading, commenting, and subscribing to this newsletter! Please tell your friends to sign up here, let me know what you think about this week's issue, and what else you'd like to see me write about: maria.aspan@gmail.com