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August 2018

Culturally Competent Science

Author Affiliations
  • 1Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston
  • 2Francis Weld Peabody Society, Harvard Medical School, Boston, Massachusetts
JAMA Surg. 2018;153(8):699-700. doi:10.1001/jamasurg.2018.0877

Although social norms have eliminated many forms of overt discrimination, more subtle forms of bias persist. Unfortunately, the scientific community, and particularly those of us in the health sciences, may be unintentionally contributing to many of these biases. The study of population differences is important for the understanding of health outcomes. However, studies of population differences can be, and have been, negatively influenced by subjective value judgments. This has historically taken the form of the majority population being ascribed as having “normal” traits and being used to set norms for disease definitions and treatment standards. We hypothesize that this subtle “majority is normal” bias has resulted from a lack of broad-based participation in the scientific process. Although there have been great efforts to promote culturally competent care, less has been done to encourage culturally competent science. The former focuses on practicing physicians delivering culturally competent bedside care, such as accommodating language differences. The latter goes beyond this and involves physician-scientists striving to incorporate cultural competency into the scientific process that ultimately develops the knowledge base that underpins bedside care. This would involve incorporating cultural awareness in hypothesis generation, study design, and data interpretation and being open to the possibility that scientific findings from one population (eg, concepts of disease and harm and appropriateness of treatment) may not be generalizable to other populations. Our concerns are similar to those prompted by recent awareness regarding sex bias in clinical research, which has led to the unfounded extension of scientific findings in men to women and has resulted in harm to female patients.1 Culturally competent science requires that physician-scientists identify and understand their own biases and how those biases might influence the scientific process, and it necessitates the training and support of diverse physician-scientists.

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