As a society, we have learned to value diversity. But can some strategies to achieve diversity mask deeper problems, ones that might require a different approach and different solutions? With Inclusion, Steven Epstein argues that in the field of medical research, the answer is an emphatic yes.Formal concern with diversity in American medical research, Epstein shows, is a fairly recent phenomenon. Until the mid-1980s, few paid close attention to who was included in research subject pools. Not uncommonly, scientists studied groups of mostly white, middle-aged men—and assumed that conclusions drawn from studying them would apply to the rest of the population. But struggles involving advocacy groups, experts, and Congress led to reforms that forced researchers and pharmaceutical companies to diversify the population from which they drew for clinical research. That change has gone hand in hand with bold assertions that group differences in society are encoded in our biology—for example, that there are important biological differences in the ways that people of different races and sexes respond to drugs and other treatments.While the prominence of these inclusive practices has offered hope to traditionally underserved groups, Epstein argues forcefully that it has drawn attention away from the tremendous inequalities in health that are rooted not in biology but in society. There is, for instance, a direct relationship between social class and health status—and Epstein believes that a focus on bodily differences can obscure the importance of this factor. Only when connected to a broad-based effort to address health disparities, Epstein explains, can a medical policy of inclusion achieve its intended effects.A fascinating history, powerful analysis, and call to action, Inclusion will be essential reading for medical professionals, policymakers, and any concerned citizen.
