||For Dr. Giselle Corbie-Smith, an associate professor at the University of North Carolina Medical School, eliminating health disparities is both a passion and her career.
A recent conference on diabetes and obesity health disparities held at Natcher Conference Center was notable on a number of fronts. It had a unique scientific focus and was co-chaired by a remarkable young African-American
The focus was on understanding a health care systems approach—epidemiology, adults, children, adolescents and organizations—to find ways to eliminate health disparities. The cochair was Dr. Giselle Corbie-Smith, an associate
professor at the University of North Carolina
School of Medicine.
Corbie-Smith is a determined risk-taker. Eliminating
health disparities is both a passion and her career. She says it began with a series of anecdotal observations. “In 1995, when I was a resident at Yale, I was struck by the differing
levels of care patients received in my hospital.
It seemed to occur because many of the doctors did not know how to communicate or relate to poor patients.
“Most of the literature blamed the victims,” she said. “The reason many [patients] had inferior outcomes was because they didn’t do what their doctors told them to do. And the major reason why more African Americans and other minorities
were not in clinical trials was that they refused to participate.”
In Brooklyn, where Corbie-Smith grew up, more kids seemed to go to prison than to college. With support from her family and teachers, she ended up at Cornell University and later Yale School of Medicine. Her professors called her a rising star, but when she told them she wanted to do health disparities research many were not especially encouraging.
“She was a good doctor and effective teacher,” said Dr. Ralph Horowitz, her chief of medicine at the time, “but she was not prepared to pursue research. She didn’t have the background to be competitive, but she was driven and persistent.”
Horowitz, now at Stanford University, took a chance on her. NIH had begun a program to diversify its cadre of funded researchers. Horowitz advised Corbie-Smith to apply for the new diversity supplement grant and to study the recruitment patterns in a trial he was conducting
on how estrogen affects the stroke risk of menopausal women.
“The process helped her understand the rigor and creativity needed to be a good researcher,”
said Horowitz. “In addition, it helped her understand how to distill information and frame a research question to capture the attention
She got the grant and her research found that minority women in the estrogen trial participated
at about the same rate as non-minority
women. The reason was researchers were embedded in the community and had established
a good rapport with local doctors.
“What the experience really did,” said Corbie-Smith, “was enable me to hone my research skills and broaden my relationships inside and outside medicine.”
She began asking questions such as: can you measure the degree to which trust and distrust affect participation in research among minorities?
What are the methodological and ethical issues involved in the inclusion of minorities in research? What approaches to alleviating
work best in which communities?
However, as happens with many minority scientists, answering
pursuing her dream—became problematic.
“My medical training left me with so much debt,” said Corbie-Smith, “that I faced the possibility of having to moonlight
in hospital clinics which would mean abandoning
my research just as I was beginning to get answers to some vexing questions.”
Two NIH programs kept her dream alive. The Loan Repayment Program at the National Center
on Minority Health and Health Disparities relieved the pressure from her medical school debt and a K grant from the National Heart, Lung, and Blood Institute allowed her to spend 75 percent of her time conducting research.
“In NIH-supported research there is often a paradox,”
said Dr. Nathaniel Stinson, acting director,
Office of Scientific Programs, NCMHD. “In order to be most competitive to get a grant you have to have a history of obtaining such support.
The LRP and K grants are great vehicles to begin that process.”
With those grants, Corbie-Smith moved to UNC where her research took off. New NCMHD grants helped her bring UNC and Shaw University,
a small historically black school, together
to create an NCMHD Center of Excellence. Among other things, the center is working with African-American churches to develop effective academic-community research partnerships.
In 2003, Corbie-Smith achieved the NIH gold standard, an R01 award that she won on her first try. With that she created Project LeARN, which examines the perceptions, mistrust and other concerns of African Americans about participating
in genetic research. This is crucial information because a large and diverse group of research participants is important to the Human Genome Project’s next phase—developing
tools for understanding genetic variation and disease expression.
In 2006, Corbie-Smith received her second R01 award to support a project that increases access to HIV trials for rural minorities. One strategy uses a mobile van to bring prevention materials and the latest treatment options to this population. Use of a van in this context was a result of her earlier work that identified transportation as a barrier to care among the underserved in rural communities.
As that project moved forward, Corbie-Smith received an NCMHD grant to fund Project GRACE, an academic-community partnership addressing the social and behavioral factors contributing to the spread of HIV in poor rural communities.
“From her very first grant, Giselle has created
a pathway that she has marched down with increasing success,” said Horowitz. “It is an investment that continues to pay dividends.”
“The NIH can seem like an impenetrable colossus,”
said Corbie-Smith, “but if my career shows anything, it demonstrates that the hurdles
you face are not as high as they seem if you are well prepared, willing to take risks and are diligent in seeking out those who can help you the most.”