Clinical trial recruitment in areas like Alabama has faced challenges in recruiting non-White patients due to a lack of trust. Racial and ethnic minority patients have historically been underrepresented in clinical research in US medical systems, leading to health inequities and a lack of data on the safety and effectiveness of treatments for non-White populations. The COVID-19 pandemic highlighted these health inequities, with Black patients being disproportionately affected. The disparities can be attributed to pre-existing socioeconomic and healthcare disparities that impact the Black community.

The social determinants of health (SDOH) that contribute to these disparities were not widely addressed in medical communities, including medical and pharmacy schools, before the pandemic. However, there has been increased attention to SDOH in recent years, with new regulations and requirements being developed to address these issues. Community health workers (CHWs) have emerged as essential resources in addressing SDOH, particularly in medically underserved communities. CHWs, often pharmacy technicians, help solve patient challenges and improve access to services.

Despite efforts to address SDOH, a lack of trust in medical institutions and systems remains a significant challenge for racial and ethnic minority patients, especially among Black patients. The Tuskegee Syphilis Study conducted by the US Public Health Service (USPHS) from 1932 to 1972 is an example of a historical event that has contributed to this mistrust. The study enrolled 600 Black men, 399 of whom had syphilis, without obtaining informed consent. The participants were not provided with appropriate treatment even after penicillin was discovered as a cure. The study exploited racial stereotypes and violated ethical standards.

The legacy of the Tuskegee Study and the US government's involvement in its continuation have created a lasting mistrust among Black patients, particularly in Alabama where the study was conducted. This lack of trust hampers efforts to recruit participants for clinical trials assessing the safety and efficacy of treatments for these populations. Building trust requires understanding the historical context and addressing concerns through interventions such as hiring trusted community members as CHWs.

Pharmacists and pharmacy technicians, as trusted healthcare professionals, can play a crucial role in engaging underrepresented individuals in research and clinical trials. Representation of racial and ethnic minority patients in the study investigation team is also important to build trust. By addressing the barriers of trust and increasing representation, it becomes possible to bridge the gap in clinical trial participation and generate more inclusive and accurate medical data for racial and ethnic minority populations.