appears to have supplanted rather than leveraged NCI resources for important research and program activities in many instances.

Much of the authority within NCI for establishing research priorities among ethnic minority and medically underserved populations would logically fall to the NCI Office of Special Populations Research (OSPR). Currently, however, OSPR lacks the institutional advantages that would ensure that an NCI commitment to research among special populations has a chance to be successful. It has no independent resources to fund a separate portfolio of initiatives for special populations research, has no clear criteria or guidance for recommending the priorities for such initiatives that are dependent on the resources of other parts of NCI, and holds no official position on any of the NCI advisory committees responsible for setting major intramural or extramural priorities. Rather, OSPR serves as the ''eyes and ears" to the NCI director regarding research on ethnic minority and medically underserved populations, as it monitors program activities and provides guidance and advice. For the reasons stated above, the committee finds that this model is insufficient to address the needs of ethnic minority and medically underserved populations. These conditions must be rectified or other lines of authority must be established for NCI to benefit from a coordinated program of research on cancer among ethnic minority and medically underserved populations.

Finally, the committee is doubtful that the incentives present in the scientific research marketplace will encourage efforts to address critical research questions among the most heavily burdened populations. To increase and improve the quality of research on cancer among ethnic minority and medically underserved populations, NCI must expand requests for applications and other funding mechanisms, especially in areas where critical gaps exist.

Clinical Trials and Cancer Information Dissemination

The inclusion of ethnic minority and medically underserved individuals in clinical trials and the dissemination of information to their communities and health care providers are critical links connecting scientific innovation with improvements in health and health care delivery. Enhancement of these links is clearly within the purview of NCI and NIH. Although many factors pose challenges to such improvements (e.g., mistrust of the scientific establishment among many members of ethnic minority communities), without a concerted effort to enhance this process, ethnic minority and medically underserved communities will continue to lag behind the American majority in benefiting from the tremendous recent scientific advancements and medical breakthroughs in cancer prevention, treatment, and control.

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