$20 trillion in 2010 dollars (Alzheimer’s Association, 2010). The impact of advances from clinical trials in this field alone could have enormous economic consequences, and potentially could single-handedly bend the health care cost curve in a more affordable direction.

Implications for a Clinical Trials Workforce

A diverse, inclusive workforce helps to build trust among diverse research participants through outreach and engagement with communities. A diverse workforce can constitute the foundation for increased participation in research by underrepresented groups, and can even change the nature of the questions addressed by clinical trials.

Such a workforce strengthens the design, conduct, or support of clinical trials. A professional commitment to focusing on particular areas of disease, pursuing particular lines of research, or working with different communities or populations is greatly determined by personal experience. A diversity of backgrounds helps ensure a sufficient range of experiences, interests, and corresponding dedication among investigators to address relevant topics for clinical trials in a population as diverse as the United States’.

This is not to say that investigators and health workers should confine their interests to communities where they live or grew up; in academic settings, it appears to be the norm that clinical investigators and health professionals cross broad cultural, social, and geographic boundaries to conduct their research. But researchers uniformly cite their personal backgrounds, experiences, and early motivations as critical to the later development of their careers and as influential in their choice of the areas of medicine they practice.

A key requirement, which is common to the scientific and medical research enterprise at large, is to ensure that talent and skills are drawn from across all segments of the U.S. population. Despite a record of rapid growth in public and private investment in medical research up to the current decade, despite growing interests from minority and international students in medical and health care fields, and despite many notable instances of accomplishment by prominent minority scientists, academic research has not succeeded in expanding the participation of underrepresented groups, including African Americans and Hispanic or Latino Americans in the research career pipeline. Nor has academic medicine been notably successful in advancing or retaining minority scientists within research careers. There are also notable disparities by gender in recruitment, advancement, and retention of MD or PhD scientists, which in one sense can exacerbate underrepresentation by some minorities for whom women are more likely than men to earn baccalaureate degrees—a



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