The Urgent Need for Diversity and Inclusion in Myeloma Clinical Trials: The Maui Declaration

Dr. Joseph Mikhael:
My favorite hashtag is #whereisdrjoe. My name is Dr. Joseph Mikhael. I'm the Chief Medical Officer of the International Myeloma Foundation, and I want to spend a few minutes telling you why I would go all the way to Hawaii for less than 24 hours. First of all, I shouldn't complain going to Hawaii. Any trip to Hawaii is a good thing, but this was for a very important purpose. We were in Maui because we gathered to sign the Maui Declaration. This declaration really signifies the commitment of myeloma doctors and lymphoma doctors to the principles of diversity in clinical trials, that we would do all that we can, personally and professionally in our multiple institutions across the country, to promote diversity in clinical trials.

The meeting was hosted by a very good friend, Dr. Ruemu Birhiray, out of Indianapolis, who's created the DRIVE Initiative, which is an acronym that you can read more about, in the blog that I wrote at myeloma.org, to understand the importance of having a diversity officer for our clinical trials, for validating what we're doing in diversity, and indeed ensuring that we're engaging the community so that we can provide the best therapy to all patients with multiple myeloma. Clinical trials are an important part of regular care in multiple myeloma. These aren't just special things that very few people should have access to. We want to normalize what we do in clinical trials because it gives access to patients, new agents, new strategies, even before they're FDA approved. Myeloma is a disease where, unfortunately, we've seen very poor representation of certain populations in clinical trials in particular. About 20% of all myeloma patients, for example, are like me, of African descent, and yet most clinical trials have two, three, four, five, maybe 6% representation of African Americans. It's not just a number. It's giving people access to these therapies. It's providing them that same opportunity.

But it's also important because we want to understand, do these therapies apply to all myeloma patients? Are they just as safe? Are they just as effective in all populations? And this meeting was so important to me. I knew I had to be there. The Maui Declaration was a group of investigators who do clinical trials committing to diversity in clinical trials, but we're still a small group of people. The goal and the hope is this will spread from institution to institution, from place to place, that others will sign on to this principle and will sign on to the specific practice of an enhancing diversity in clinical trials. We even engaged the National Institute of Health, as well as the National Cancer Institute. We engaged the key players within this. This is going to take everybody working together, and the Maui Declaration really the tip of that iceberg as we spread the word and as we engage others to make sure that we tackle this important issue.

What a gratifying experience. What an exciting time to sign the Maui Declaration. And then it feels like I was rushing right back to the airport. People think I'm crazy, but when you're inspired with the work that you do and you've trained yourself to sleep at any moment...
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