Lab Coat Revolutionary

No one knows exactly why there exist such differences between whites and other races in medical care, only that throwing money at the problem doesn't work. Medicaid has become yet another program that has institutionalized discrepancies in health-care treatment. Blacks with the same levels of benefits as whites still experience significantly more health problems — problems that frequently go untreated.

When I ask Cunningham what he's done to help shape public policy on the matter of minority health care, he wonders whether I've read about how he helped get funding for the new National Center for Minority Health and Health Disparities — it's the fifth project on the sixth page of his résumé, he reminds me. I say no without apology: His résumé is 20 pages long. He also explains to me about the Ryan White Act, which he refers to as the "Ryan White Comprehensive AIDS Resources Emergency Act." The act provides funding to organizations that directly assist people with HIV and AIDS. Cunningham says, "My research supported the Ryan White Act in an effort to provide case management for non-medical care. This act provides money to case managers to assess problems with HIV necessary for social services."

"Okay," I say. "Thank you. I got it."

"Okay," he says. "All of that was a preamble. I haven't answered the question yet." He takes a deep breath. Then he tells me about the process of re-funding the act for another year. It was his research that helped show people that case managers needed to be employed to figure out where the problems were, and therefore funded as part of the act.

He talks more, and then he says, "Affecting policy takes time. Each individual publication contributes a little knowledge. And then there is controversy. And then similar studies come along with different conclusions. And then there is controversy about differences. It took 200 years from the time Newton discovered gravity to the time we could beat gravity by flying."

I say, "Okay, that's good for today. Thanks."

He says, "I feel like I didn't finish a thought."

Cunningham's mind for infinite detail is trapped in a world that is accustomed to boiling a health crisis down to one full-color photo spread in National Geographic.

Beginning in the 1930s, 399 African-American males signed up with the United States Public Health Service (USPHS) to receive free medical care. The service was studying the effects of syphilis on the human body, but the men were never told they had syphilis. Instead, the USPHS told the men they were being treated for "bad blood," and then the physicians in charge of the study ensured that these men went untreated so that they could study the effects of the disease. In 1947, penicillin was discovered to be a cure for syphilis, but none of the Tuskegee men received treatment. In 1972, when the study was exposed, 128 men had died of syphilis or related complications, 40 of their wives had been infected, and 19 children had contracted the disease at birth.

In the 30 years since its details were first revealed, the study has become a powerful symbol of racism in medicine. In fact, not until 1997 did the U.S. government formally apologize for the study — in a speech by President Clinton. Today, the legacy of Tuskegee is the African-American community's profound distrust of the medical establishment. In a 1997 survey, more than 20 percent of African-Americans in the Birmingham, Alabama, area said they would be unlikely to participate in any medical study.

Tuskegee is just one example of a slew of health-care injustices; after centuries of subpar medical treatment for people of color, the problem has become entrenched. Cunningham's job is not just to secure funding for studies, but to figure out how the medical establishment can once more earn the trust of people of color.

In recognition of research like Cunningham's, UCLA just received government funding for the Robert Wood Johnson Clinical Scholars program: $10 million. The crux of this program is to train physicians who research minority communities to understand why the medical system fails them. UCLA received the grant, in part, because it is in the forefront of minority health-care research, with its 12-person minority-research faculty the largest in the nation.

According to David Carlisle, California's director of statewide health planning and development, "UCLA has launched an institutional commitment to ending disparities in health care, and Dr. Cunningham is spearheading these efforts. He is plowing a new field."

The Robert Wood Johnson program will give minority medicine in Los Angeles the feel of a grass-roots political movement without losing the aura of the academy that so effectively sways politicians. Kenneth Wells, professor of psychiatry at UCLA and co-director of the scholars program, explains, "Minority communities require solutions that cannot be explored in academia. To ensure that research is relevant, we must engage with the community."

The express purpose of the grant is to "improve medical outcomes for people of color." Essentially, this is medical-speak for creating separate but equal medical treatment that specifically addresses the needs of minorities. Cunningham's research team has determined that to level out statistics like infant mortality among races, doctors must target different groups with different types of medical programs.