Preface

Publications that revealed the dirty truths about the Tuskegee syphilis study performed between 1936 and 1972, in which treatment for syphilis was withheld from black men, did more to highlight racial/ethnic disparities and to cause minorities to be skeptical of American health care than perhaps any other single event in modern history. Fortunately, one important result of this federally sponsored travesty was the reformation of federal standards for the ethical conduct of research involving human subjects, including the mandatory use of informed consent.

Such misadventures in human research have, among other things, resulted in a natural and deep distrust of the health care system amongst minorities. This distrust equates to a reduced number of minorities seeking timely medical care as well as volunteering to participate in research studies. Studies that fail to include adequate numbers of minorities have the net effect of failing to produce the data required to ameliorate health care disparities.

In this issue of the Clinics in Chest Medicine, a review is undertaken of health care disparities in respiratory and critical care medicine in an attempt to address disparities in the intensive care unit as well as in diseases of the respiratory tract, including asthma, chronic obstructive pulmonary disease, HIV infection, lung cancer, sarcoidosis, and sickle cell lung disease. Researchers are collectively at the tip of the iceberg in their discovery of genetic factors contributing to disparities commonly seen today.

This issue also explores the impact of cultural incompetency on health care disparities. The complexion of the United States is changing rapidly, and an increasing proportion of the population is represented by persons of color. Priority must be placed on the appropriate education of future health care providers so that racial/ethnic disparities can be overcome. A culturally competent health care work force is absolutely necessary if we seriously hope to have a significant and positive impact on the health of our country. Richard Carmona, MD, Surgeon General of the United States, while addressing the members of the American College of Chest Physicians in Washington, DC, said of the current state of health care disparities in our country: “Let us be judged by our deeds, and not by our words.” He continued, the “only difference between failure and success is that the person gets up one more time.”

It is time to move from simple repetitive documentation of the incidence of health care disparities and instead focus our time, energy, and resources on the search for required solutions to positively affect outcomes. We invite you to join us in extending a charge to Congress and other decision-makers in our country to provide the required funding to appropriately and definitively address this serious blight on our country.

Finally, we wish to thank our colleagues who voluntarily labored to share their knowledge with you, the reader. We also thank Sarah Barth, Editor of the Clinics in Chest Medicine, who expertly and graciously guided the production of this issue. We fully understand that a difference is not necessarily a disparity. Our sincere hope is that this issue will enlighten and stir the reader toward a better understanding of racial/ethnic health outcome inequalities that are disproportionate, discrepant, and remediable, and to take the necessary action to eliminate these gaps for all.