New Statements Focus on Different Aspects of Health Inequities
By Timothy Beardsley, PhD, Executive Editor of Publications
“Of all the forms of inequality, injustice in health is the most shocking and the most inhuman because it often results in physical death.” That 1966 declaration from Dr. Martin Luther King, Jr., remains undeniable more than half a century later. And it might be the impetus for two Scientific Statements that we published recently in JCEM:
The first of the two represents a magnificent effort by an eight-member group of authors led by Alicia M. Diaz-Thomas, MD, MPH, and Sherita Hill Golden, MD, MHS. This statement, in particular, seems to most obviously address injustice. It is an extension and update of a 2012 Scientific Statement from the Endocrine Society that focused on endocrine health disparities across racial, sexual, and ethnic boundaries broadly.
On behalf of our Committee on Diversity and Inclusion, Golden, who was an author of the earlier disparities Statement, and Diaz-Thomas came to the Society requesting an update to reflect new information and dimensions of disparity left unaddressed in the first Statement on the topic.
With the approval in hand, Golden and Diaz-Thomas got to work recruiting coauthors.
I was a fly on the wall in the early stages of its development and was impressed by how the writing group got to work. They started by building long and complex PubMed searches designed to interrogate the endocrine literature for any studies that might shed light on the disparities it wanted to explore.
Later, the statement when through successive drafts, expert review, Society review, and much editing aimed at smoothing the text and ensuring consistent, modern terminology, all completed in record time.
The result is an important document that fully delivers on the promise of the Scientific Statement Subcommittee’s multifaceted charge (updated in 2022) to position the Society “as the experts on critical public health issues and emerging scientific issues…[and]…to create a more diverse and inclusive culture in endocrinology and ensure that under-represented groups are included in writing teams.”
The Statement will not itself right endocrine health disparities. But it can provide an invaluable guide for researchers and physicians of goodwill who aim to counter the pervasive bias, ignorance, and neglect of the needs of the pediatric and sexual and gender minority populations that the Statement explores. The Statement was described and discussed at ENDO 2023
Addressing Another Potential Inequality: Aging
“Hormones and Aging: An Endocrine Society Scientific Statement” was crafted over many months by a distinguished group of nine experts led by Anne R. Cappola, MD, ScM. The statement was previewed at ENDO in 2022 and released in its final form at ENDO 2023. It too can be said to address a form of inequality—one that will become only more important in coming years.
The world’s population is aging at a record clip, a triumph of medicine and public health that is not recognized as much as it ought to be. But the flip side of the triumph is that older people have unique medical needs, and there are gaping holes in our knowledge about how best to treat them.
According to the statement, our “existing knowledge of hormones and aging is largely based on results of observational and uncontrolled studies,” a situation that provides less than a full picture of the needs of aging patients. For example, pharmacokinetics may be altered in older individuals, so regimens appropriate for young people might be suboptimal in octogenarians. And, of course, hormones are active in different ways at different ages.
One key point that the Hormones and Aging Scientific Statement makes is that some hormonal “remedies” touted by the anti-aging industry may, in fact, do more harm than good. For instance, evidence supports harms from growth hormone and sex steroids that “outweigh benefits in unselected populations of older individuals.”
Yet there also is every reason to believe that targeted investigations can lead to more effective treatments for the many age-related ailments. These include conditions affecting the adrenal, growth hormone, ovarian, testicular, diabetes, thyroid, vitamin D, bone, and hypothalamic-neurohypophyseal-renal axes, all discussed in depth in the statement.
Just as important, a better understanding of hormonal connections in aging can provide insights into ways of preventing age-related illness. As the population continues to age, we all stand to benefit.
Both of the new Scientific Statements show ways to help extend the promise of endocrine science as far as it can go. I encourage you to read them and our many other Scientific Statements. If you have suggestions for topics for future Scientific Statements that the Scientific Statement Subcommittee might consider, please feel free to write me.