Racial representation in clinical trials

Marcella Alsan

“DOES HOW A TECHNOLOGY IS DEVELOPED affect who adopts it?” HKS Professor of Public Policy Marcella Alsan and a group of researchers ask this question in the context of drug approval in the United States, where Black patients are consistently underrepresented in clinical trials. The median trial includes 5% Black participants, compared with a Black share of the population of about 12%. The gaps in clinical-trial enrollment have been well documented, but their consequences have not. The researchers surveyed doctors and patients and found that “Black patients, and the physicians who treat them, find trial evidence less relevant for their care, and are less likely to prescribe medications, when experimental samples are not representative.” But those gaps close when the participant base is more racially representative, the researchers find. The research also looks at the reasons for the gaps in representation. It finds that in the case of HIV/AIDS medicine—an outlier in the way it carefully represents populations—research sites have often been selected in “conversation with community partners and thus are not limited to large academic centers.” This highlights the extent to which “active, large-scale investments in inclusive infrastructure, in addition to incentives, can be important for improving health equity.”

The downsides of negative messaging

Nancy Gibbs and Jennifer Lerner

WHAT’S THE MOST EFFECTIVE WAY to get across a public health message: use positive wording to emphasize the benefits of certain behaviors or negative framing that might scare people who avoid those safeguards? A vast research project surveyed the responses of nearly 16,000 people around the world to contrasting COVID-19 health messages: Some messages focused on potential gains from taking actions such as wearing a mask, and others stressed the potential loss that could result from avoiding those actions. The study found that neither positive nor negative messaging shifted people’s attitudes or behavior related to those choices. However, the negatively framed messages did raise people’s anxiety—an emotion linked to ailments including high blood pressure and increased morbidity. The experimental research project was led by Charles Dorison, a postdoctoral fellow with joint appointments at HKS and Northwestern University. Among the coauthors were Jennifer Lerner, the Thornton Bradshaw Professor of Public Policy, Decision Science, and Management at Harvard Kennedy School, and Nancy Gibbs, the Edward R. Murrow Professor of the Practice of Press, Politics and Public Policy and Lombard Director of the Shorenstein Center on Media, Politics and Public Policy.

A group of anti-war protesters hold blue and yellow signs calling for peace for Ukraine

Blueprints for nonviolent resistance strategies

Erica Chenoweth and Zoe Marks

IN A RECENTLY published paper, Erica Chenoweth, the Frank Stanton Professor of the First Amendment, and Lecturer in Public Policy Zoe Marks explore the potential impact on democracy in the United States of the rise of authoritarian forces. Their report draws on numerous historical examples to offer an effective blueprint for implementing pro-democracy nonviolent-resistance strategies in the event of a nationwide authoritarian transition after the 2024 election. Their key recommendations include: building and maintaining a large-scale, multiracial, cross-class, pro-democracy alliance that continues to push for structural and institutional reforms and to contest for power; preventing, deterring, and strengthening resilience to increased threats of state or paramilitary violence through strategic planning, community power-building, and organized and disciplined actions at the grassroots level; and building pressure to induce defections among those loyal to the autocrat or authoritarian alliance, including through widespread economic noncooperation and labor action.

Campus News: Harvard announces a new president

ON DECEMBER 15, HARVARD UNIVERSITY named Claudine Gay as its 30th president. Gay will succeed President Larry Bacow MPP 1976 when she assumes the role on July 1. A highly experienced and respected academic leader and political scientist, Gay has served as the Edgerley Family Dean of Harvard’s Faculty of Arts and Sciences since 2018. She is the daughter of Haitian immigrants and will make history as the first Black president of Harvard. Looking ahead to her presidency, Gay said, “With the strength of this extraordinary institution behind us, we enter a moment of possibility, one that calls for deeper collaboration across the University, across all of our remarkable Schools. There is an urgency for Harvard to be engaged with the world and to bring bold, brave, pioneering thinking to our greatest challenges.”

The importance of measuring permafrost loss

John Holdren

PERMAFROST, AS THE NAME SUGGESTS, is permanently frozen ground, most famously below large swaths of Arctic tundra. For thousands of years, it has been a carbon sink. But with the Arctic warming more quickly than the rest of the world, the millions of square miles of permafrost are expected to become a carbon source, with enormous implications for climate change—some projections put permafrost carbon emission by century’s end at 550A graphic with a green cloud with “CO2” inside it, with the caption “550 gigaton: What some projections indicate permafrost carbon emissions will reach by 2100” gigatons, or about the current level of emissions by major fossil-fuel-emitting nations—and for the lives of Indigenous populations. In a new paper in Environmental Research Letters, John Holdren, the Teresa and John Heinz Professor of Environmental Policy, and coauthors lay out the gaps in our knowledge; the steps needed to plug them, including better surface-level and satellite monitoring; and the need for effective coalitions of scientists, policymakers, and Indigenous peoples. “Rapid advances in technology, coupled with an opening in the policy window, make this a critical moment to accelerate understanding of thawing permafrost and incorporate that knowledge into responsible global mitigation strategies and just and equitable adaptation measures,” the authors write.

An ankle with a monitor on it

The costs of electronic monitoring

Sandra Susan Smith

SINCE 2020, the number of individuals awaiting trial in San Francisco County who are required to wear an electronic monitoring (EM) device has increased by 308%. This explosion is the result of a decision in a case regarding defendants’ ability to pay cash bail and nonmonetary release options. While many have applauded the solution as a way to end mass incarceration and reduce jail populations, others have pointed to the costs associated with pretrial monitoring—including psychological, social, and economic ones—and described it as an alternative form of incarceration. In new research, Sandra Susan Smith, director of the Malcolm Wiener Center for Social Policy and faculty chair of the Program in Criminal Justice Policy and Management, followed the experiences of defendants enrolled in the pretrial monitoring program to study the effects of the new system. Smith’s research team found that prior life challenges, especially with housing insecurity and co-occurring disorders such as substance abuse, made it much more difficult for defendants to meet pretrial program obligations with an EM device; that EM devices made it more difficult for defendants to secure or keep a job and maintain vital social connections because of the stigma of appearing convicted of a crime; and that program compliance was made difficult by technical problems with the EM devices themselves, including inaccuracy, unreliability, and inconsistency.

Faculty Portraits by Martha Stewart, Lydia Rosenberg | Monitoring: Eric Gay/AP | Portrait of Claudine Gay by Stephanie Mitchell; Ukraine protest by Jenny Matthews/Getty