Dr. Adrian Jacques Ambrose is Medical Director at Columbia University Irving Medical Center and Assistant Professor of Psychiatry at Columbia University in New York. Previously he was Medical Director at Beth Israel Lahey Health Behavioral Services in Danvers, Massachusetts. Prior to that, he was a Child and Adolescent Psychiatry fellow at Massachusetts General Hospital (MGH)/McLean Hospital, Harvard Medical School, in Boston, MA, and staff psychiatrist specializing in telemedicine and consult-liaison psychiatry for the MGH Psychiatry Academy. Professionally, Dr. Ambrose is passionate about the systemic factors of healthcare delivery and mental health inequity in pediatric ethnic and sexual minorities. Dr. Ambrose's clinical interests include health policy, health finance, and technological innovations in pediatric mental health care. As a physician leader, he has served on the governing council and board of trustees for national organizations, such as the American Psychiatric Association (APA) and the American Medical Association (AMA). Dr. Ambrose received his medical degree in 2014 from the John A. Burns School of Medicine, University of Hawaii, and completed his residency in Adult Psychiatry at Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, in 2017. Dr. Ambrose has completed a fellowship in public health at the National Center for Primary Care (NCPC) as a Satcher Fellow and honored a postgraduate training program at the Dartmouth Institute for Health Policy and Clinical Practice in value-based healthcare and clinical innovations.
Adrian Jacques Ambrose, MD, MPH
Medical Director, Columbia University Irving Medical Center; Assistant Professor of Psychiatry, Columbia University, New York, NY
“Conceptualizing Health Equity Framework in Precision Medicine Innovation Research and Development”
Objectives:
1. To explore potential areas of inequities in the research framework for precision medicine
2. To develop a concrete tool to assess dimensions of inequities in precision medicine research
Background:
Precision medicine (PM) recognizes that medical interventions must resemble the uniqueness of each patient and utilizes an approach to prevention and treatment that “takes into account individual differences in people’s genes, environments, and lifestyles” (Precision Medicine Initiative, 2016). PM has been defined as a technology-based process that involves 1) deep phenotyping of patients and 2) conversion of processed phenotyping data into precise interventions based on scientific predictions of clinical outcomes and treatment responses. Historically, minorities are significantly underrepresented in clinical trials for medication development or to establish treatment guidelines; as a result, precision medicine technology has the potentials to mitigate the current inequities by tailoring treatments and diagnostics to the individuals.
On a population-level, PM’s high costs, disparity in access, and limited inclusivity pose salient challenges to socioeconomic and ethnic minorities. The concept of “precision” must also apply to the increasingly intercultural and interethnic demographics. While significant disparities in genomic testing rates have emerged even among insured populations, black Americans are underrepresented in studies involving genomic sequencing initiatives such as The Cancer Genome Atlas. In addition to the challenge of having representatively diverse populations in genetic studies, there is a growing evidence of inequities regarding access and use of PM applications. For example, persistent disparities by race remain in rates of the use of genetic testing for the BRCA1/2 breast cancer genes, even after adjusting for sociodemographic factors. In addition, given that many health inequities of minorities and underserved communities lie in social determinants, the PM movement also highlights the potential dual role of healthcare innovations: to ameliorate health inequities, or to further expand the unjust health disparities among minorities.
As the PM technology advances and improves, we must ensure a central tenet of equity in its tailored approach to diagnosis, treatment, and prevention.
Methods:
1. Performed a literature review to identify potential core areas of deficits in minority health research.
2. Developed tools for equity validation in the research and technology development framework
3. Began preliminary stages of validation for health equity framework in clinical research and technology development
Results:
The creation of preliminary tools (e.g. Basic Equity Validation and Advanced Equity Validation) for health equity validation in clinical research and technology development.
Future Directions
1. Completing additional validation assessments for AEV, compare the effects of intervention pre- vs post- equity validation
2. Engaging other health industries and funding organizations to gauge interests for collaboration
Preceptors: Kamal Jethani, MD MPH, Associate Professor of Dermatology, Harvard Medical School
