via Key Immune System Genes Identified to Explain High COVID Deaths and Spread in Northern Italy Versus Fewer Cases and Deaths in the South

14th Annual BioPharma & Healthcare Summit, Friday, September 4, 2020, 8 AM EST to 3-30 PM EST – Virtual Edition

Real Time Press Coverage: Aviva Lev-Ari, PhD, RN

Founder & Director, LPBI Group








USAIC has created an ecosystem committed to driving a global dialogue on BioPharma & Healthcare innovation, attracting a diverse mix of senior industry professionals and catalyzing partnerships, new ideas, networks and regulatory reform. This unique platform creates mutually beneficial opportunities and relationships for the global Life Sciences & Healthcare industry.

In these unprecedented times due to COVID-19, USAIC is offering Free Registration for its annual summit.

Click for free registration



Chair and Master of Ceremonies (Emcee)– Dr. Andrew Plump, President of R&D, Takeda Pharmaceuticals
Summit Theme: “From N of One to N of a Billion”

  • Moderated Fireside Chat- Kenneth Frazier, Chairman of the Board and Chief Executive Officer, Merck & Co. and Stelios Papadopoulos, Chairman of the Board, Biogen
  • Moderated Fireside Chat- Roy Vagelos, Chairman of the Board, Regeneron Pharmaceuticals and Mathai Mammen, Global Head of R&D, Janssen Pharmaceutical Companies of Johnson & Johnson
  • Moderated Fireside Chat- K. VijayRaghavan, Principal Scientific Advisor, Government of India and Amitabh Kant, CEO, National Institution for Transforming India (NITI)

Panel Discussions:

  • Covid-19: Where are we now? Where are we going?
  • Oncology: A never ending tunnel?
  • Rare Diseases: Breaking Barriers for a Healthy Brain
  • Digital & Data Sciences: Leveraging data and digital to achieve healthcare solutions
  • Industry & Investment Outlook
  • R&D Strategies and Trends: Innovation – The Big I

Program and speakers subject to change*

14th Annual BioPharma & Healthcare Summit, Friday, September 4, 2020, 8 AM EST to 3-30 PM EST – Virtual Edition


Kenneth Frazier
Chairman of the Board & CEO
Merck & Co.

Dr. Andrew Plump
President of R&D
Takeda Pharmaceuticals

Dr. Laurie Glimcher
President & CEO
Dana-Farber Cancer Institute

Dr. Roy Vagelos
Chairman of the Board

Dr. Stelios Papadopoulos
Chairman of the Board

Christopher Viehbacher
Managing Partner
Gurnet Point Capital

Dr. Mathai Mammen
Global Head of R&D
Janssen- Johnson & Johnson

Kiran Mazumdar Shaw
Chairperson & Managing Director

Dr. Hal Barron
President, R&D and CSO

Prof. K. Vijay Raghavan
Principal Scientific Advisor
Government of India

Dr. George Yancopoulos
Co-Founder, President & CSO

Dr. Elias Zerhouni
Professor Emeritus
Johns Hopkins University

Daphne Zohar
Founder & CEO
PureTech Health

Sanat Chattopadhyay
President- Merck Manufacturing Division
Merck & Co.

Dr. David Reese
Executive Vice President- R&D

Hari Bhartia
Founder & Co-Chairman
Jubilant Bhartia Group

Dr. Alfred Sandrock
Exe Vice President R&D & CMO

Dr. Najat Khan
Chief Operating Officer, Data Sciences
Janssen- Johnson & Johnson

Dr. Richard Hatchett
Chief Executive Officer

Amitabh Kant
Chief Executive Officer
NITI Aayog

Dr. Martin Mackay

Dr. Daniel Curran
Head of the Rare Diseases TA
Takeda Pharmaceuticals

Dr. Alise Reicin
Former President, Global Clinical Dev.

Dr. David Meeker
Chairman & CEO
Rhythm Pharmaceuticals

Dr. John Orloff
EVP and Head of R&D

Dr. Barry Bloom
Professor & former Dean
Harvard School of Public Health

Dr. Mandeep Bhandari
Joint Secretary
Ministry of Health, India

Arpa Garay
President, Commercial Analytics
Merck & Co.

Dr. Steve Uden

Dr. Philip Larsen
Global Head of Research
Bayer AG

Sastry Chilukuri
Executive Vice President

Dr. William Chin
Professor of Medicine, Emeritus
Harvard Medical School

Dr. Anne Heatherington
Head of Data Sciences Institute
Takeda Pharmaceuticals

Dr. V G Somani
Drugs Controller General of India
Government of India

Dr. Rajeev Venkayya
President-Global Vaccines

Dr. Raju Kucherlapati
Professor of Genetics
Harvard Medical School

Matt Wilsey
Co-Founder & Chairman
Grace Science Foundation

Muna Bhanji
SVP, Global Market Access
Merck & Co.

Dr. Maya Said
Chief Executive Officer

Rehan Verjee
EMD Serono
Pharmasia News Biospectrum India Online



LPBI Group’s Founder – A Profile for a Wikipedia Entry

Curator: Zach Day, with editorial comments by Prof. Marcus W. Feldman, Dr. Joel T. Shertok, PhD and Gail S. Thornton, PhD(c), MA


Aviva Lev-Ari, Ph.D., R.N.



Aviva Lev-Ari, Ph.D., R.N., is the founder of Leaders in Pharmaceutical Business Intelligence Group (LPBI Group), a Newton, Massachusetts, start-up company launched in 2012 in the domain of Pharmaceutical Media.

The LPBI Group incorporates into three interrelated domains: an open-access online scientific journal, a series of 16 BioMed e-books covering five specialties of Medicine and Life Sciences (Cardiovascular, Genomic Medicine, Cancer, Immunology and Precision Medicine) and real-time press coverage of BioMed scientific and medical conferences.

Year over year, LPBI Group continues to increase its readership of medically valuable content, which includes more than 5,800 scientific articles with over 1.8 million views in its online scientific journal. The LPBI Group goal is to make scientific content universally accessible to the pharmaceutical media and electronic scientific publishing communities.

https://pharmaceuticalintelligence.com/ at @pharma_BI and @AVIVA1950. Additionally, the 16 BioMed e-books can be accessed on the website: https://pharmaceuticalintelligence.com/biomed-e-books/ and on https://lnkd.in/ekWGNqA

Please visit the LPBI Group Wikipedia page to learn more about our company. [ZACK: CAN YOU PUT A LINK TO THE LPBI GROUP Wikipedia Page here?] 

Ongoing Commitment to Life Sciences

The LPBI Group team curates life sciences and medical literature producing clinical interpretations of scientific findings and publishing the results as articles in LPBI Group’s open-access online scientific Journal http://pharmaceuticalintelligence.com.

Dr. Lev-Ari serves as Editor-in-Chief of the Journal and of the series of 16 BioMed e-books. The e-Books cover five cardinal Medical specialties https://lnkd.in/ekWGNqA. The books serve physicians in the community, allied healthcare professionals, medical students and an extensive global community of e-readers in life sciences and biomedicine. The books are also included in the medical curricula of several prominent medical schools in the United States.

The LPBI Group has competencies in real-time coverage of Medical and Biotech global conferences, using methodology developed by Dr. Lev-Ari. This method allows for the generation of e-Proceedings with a single click. Dr. Lev-Ari developed a series of templates used during the Conferences to generate Tweets representing quotes by speakers and their affiliations. To date Dr. Lev-Ari has generated 60 e-Proceedings and 36 Tweet Collections. Part Three: Conference eProceedings DELIVERABLES & Social Media Analytics


Early Life and Education

Dr. Aviva Lev-Ari was born in Bucharest, Romania, to a Jewish family with a 400-year history in Europe. Along with her father and older sister, Pnina Abir-Am, Ph.D. [Brandeis University], the family moved to Israel in December 1958. [Her mother succumbed to breast cancer in September 1956 when Aviva was 6 years old].  As a young girl in a 10-year-old State of Israel, the new reality was significantly different than that of her European early years. She loved oranges and bananas both of which were rare in Eastern Europe in the 50s. She bonded with the nature and the geography of Israel, the wild flowers of the hilly slopes of Mount Carmel and the wide panoramic view of the Western bound of the Valley of Jezreel from the window of her bedroom shared with her sister. Dr. Lev-Ari graduated with honors from the prestigious private institution, Huggim High School on Mount Carmel, in Haifa in 1968. This gymnasium was established in 1932 by German Jewish emigres, who were former German University Professors, forced to leave their Academic positions by the Nazis.

These high school years made a long lasting impression on Aviva, a studious, achievement–oriented, hardworking student who was motivated to excel in her studies.

Following her IDF military service, she studied at the Hebrew University (HUJI) in Jerusalem for six years, where she earned her B.A. and M.A. degrees (Cum Laude) in Urban Planning and Economic Geography in 1976. At HUJI she became a very scholarly-inclined student, motivated by the outstanding faculty members, i.e., Prof. S. Reichman and Prof. Louis Guttman.

Her Masters thesis applied Facet Theory, SSA, MSA & POSAC, the novel non-parametric paradigm in Statistics developed by Prof. Louis Guttman in 1946 and during the 60s and the 70s, while using the latest version of the computer programs that were included for the 1st year in SPSS in 1976. The thesis was filed with the Graduate Division in July 1976, conferring and confirming the highest GPA recorded at the registrar of the Faculty of Social Sciences at HUJI to-date (95/100).

She then worked at the Technion, which was known to hire chiefly its own graduates, in Applied Research as the first HUJI graduate to be hired. During 1977-1978 at the Technion, she applied Facet Theory in Urban Planning. She came to the United States to pursue her doctoral studies in September 1978. Her postgraduate studies were at the University of California – Berkeley, where she earned her doctorate in 1983 in Industrial Organization Economics and Location Theory under Prof. Allan Pred, a famous AAAG Fellow +40 years of the 20th century on the Faculty at Berkeley, the #2 Department of Geography in the country. The Berkeley academic environment was most conducive for interdisciplinary research and for expression of the highest level of creativity; both were Prof. Allan Pred’s contributions as mentor and as advisor to Aviva. The intellectual stimulation culminated in her Ph.D. thesis, and other milestones beyond the years at Berkeley. Prof. Pred presented a draft of her dissertation at MIT in October 1983. Recollections of Years at UC, Berkeley, Part 1 and Part 2:

  • Recollections: Part 1– My days at Berkeley, 9/1978 – 12/1983 – About my doctoral advisor, Prof. Allan Pred, other professors and other peers


  • Recollections: Part 2– “While Rolling” is preceded by “While Enrolling” Autobiographical Alumna Recollections of Berkeley – Aviva Lev-Ari, PhD’83



Additionally, Dr. Lev-Ari was Prof. Louis Guttman’s student in 1975-76. She was known for applying his methods in the top-tier consulting industry in the United States using the software licensed via Yissum (Technology Transfer Office of HUJI) at SRI International for Fortune 50 companies e.g., GM, Alcan, Rhone Poulenc. At the University of California – Berkeley, she taught upper division courses in Quantitative Methods using SSA, MSA & POSAC in 1979, 1980, 1981. In 1990-91, she was the developer of the models that made a cardinal organizational change from managerial to brokerage agencies by a top financial & insurance firm based in Boston, Massachusetts, where she spent the fall and winter of 1990/91 on the 52nd floor of one of the two tallest skyscrapers in Boston.

While in California, she also studied Organizational Behavior under James G. March and Harold J. Leavitt at Stanford University Graduate School of Business, in an Exchange Program between Berkeley and Stanford in 1980-81.

Autobiographical Annotations: Tribute to My Professors


Dr. Lev-Ari worked in the domains of her expertise for 25 years, at several of the most esteemed institutions in the United States, among them, SRI International – Menlo Park, California; MITRE – Bedford, Massachusetts; PSC – Cambridge, Massachusetts (HQS: Dallas, TX); and McGraw Hill – Monterey, California (HQS: NY, NY).

Dr. Lev-Ari reinvented her career toward a new direction in Health Care, by being admitted into the Bouve College of Health Sciences in 2005, and earning a nursing degree at Northeastern University (Nurse Practitioner Direct Entry track – 800 candidates for 26 places.) For comparison, at the Ph.D. Program Admission, there were 240 candidates for 12 places and only 8 earned the degree five years later.

At Northeastern University she researched cardiovascular pharmacotherapy with her professor of Pharmacology for four independent research courses during 2006-2007. Pharmacology was the domain she liked the most at Bouve College. She developed the concept of a combination drug therapy (three agents) for prevention of macro cardiovascular events. She already knew then, that she would return to pharmaceutical study some day.


Reflections on a Four-phase Career

Dr. Lev-Ari’s career, as presented in Reflections on a Four-phase Career: Aviva Lev-Ari, PhD, RN, March 2018, has the following phases:

  • Phase 1: Research, 1973 – 1983
  • Phase 2: Corporate Applied Research in the US, 1985 – 2005
  • Phase 3: Career Reinvention in Health Care, 2005 – 2012
  • Phase 4: Electronic Scientific Publishing, 4/2012 to present


This article was written in March 2018. It was prepared for publication in American Friends of the Hebrew University (AFHU), May 2018 Newsletter, Hebrew University’s HUJI Alumni Spotlight Section.

Aviva Lev-Ari’s profile was up on 5/3/2018 on AFHU website under the Alumni Spotlight at https://www.afhu.org/


Early Career

Dr. Lev-Ari started her career conducting research from 1973 -1983.  She then transitioned into Corporate Applied Research in the United States between 1985-2005.

Second Career

Dr. Lev-Ari reinvented her career in the Health Care arena, and earned her R.N. degree. She worked in Clinical Nursing Management, 2008–2012, in post-acute settings and was Supervisor of a Long-Term Acute Care Hospital (LTACH) in Waltham, Massachusetts.

Recent Career

Dr. Lev-Ari’s most recent transition has been into Electronic Scientific Publishing, from April 2012 to the Present. Currently she is the Director & Founder of the Leaders in Pharmaceutical Business Intelligence (LPBI) Group. She is the developer of several curation methodologies for scientific content, and developed a unique methodology for the creation of an electronic Table of Contents (eTOCs). She was initiated into the development of workflow procedures involved in the systematic population of all eTOCs by Expert Editors, that culled articles from the journals’ research categories to create a one of a kind eTOCs for each volume [except for Cancer Volume 1].

In 2012, Dr. Lev-Ari launched, and currently leads the Journal, PharmaceuticalIntelligence.com. She is the Editor in Chief of the Journal and of the BioMed e-Series. The transformative work done at LPBI Group allows cutting-edge biomedical research innovation to be widely disseminated and accessible to the research and the non-research communities. Her method of curation represents a mode of scientific communication including synthesis, analysis, and interpretation.

Experts, authors, and writers add their knowledge and expertise in re-thinking and conceptualizing subjects selected in their domain of expertise, to form new curations or updating existing ones. The books are transformative in their capacity to accelerate diffusion of scientific innovations. To date 115,000 pages have been downloaded form the 16 Volumes.

The curation is done by experts with a perspective within each field, allowing for the creation of scientific content that combines conceptual evolution within the scientific breakthroughs analyzed with their anticipated future implications.

Dr. Lev-Ari’s work is innovative and creative. She has perfected the art of scientific curation for medical evaluation of cutting-edge literature. It is available through LPBI Group’s open access Journal. Dr. Lev-Ari has tutored numerous students and young adults in her career. LPBi is enjoying an excellent reputation within the field, for the valuable information it provides. Dr. Stephen Williams, a Professor of Pharmacology at the Sbarro Health Research Organization at Temple University said of Dr. Lev-Ari,

“I have never met anyone so driven as Dr. Lev-Ari. She had a great vision and knows how to put that vision into practice. She has an impressive amount and quality of people she has direct contact with.” Regarding Dr. Lev-Ari’s accomplishments and personal character, he noted: “She has more energy than some 20 and 30-somethings. She does not stop until she sees her vision realized.”

Personal Life

Dr. Lev-Ari married in 1971 a newly minted graduate of the Technion and Officer in the Signal Corps of IDF. Hanoch Lev-Ari, Ph.D., Fellow IEEE, has been a Professor of EE at Northeastern University since 1990. He is a graduate of Stanford University, Ph.D. ’84 in EE, and the Technion, BSEE ’71 & MSEE ’76. They lived in Palo Alto, California from 1978-1990 and in Newton Center, Massachusetts since September 1990. They have one married son, Edan, a 2007 Cornell University graduate working at Natick Lab, Natick, MA

Dr. Lev-Ari enjoys swimming, classical music, Jazz, non-fiction literature, fashion design, fashion photography, orchids and peonies.




Dr. Lev-Ari’s expertise is in Cardiovascular Diseases



  1. Cardiovascular Diseases, Volume One: Perspectives on Nitric Oxide in Disease Mechanisms. On comsince 6/21/2013 https://lnkd.in/8DANfq
  2. Cardiovascular Diseases, Volume Two: Cardiovascular Original Research: Cases in Methodology Design for Content Co-Curation. On comsince 11/30/2015 https://lnkd.in/ekbuNZ3
  3. Cardiovascular Diseases, Volume Three: Etiologies of Cardiovascular Diseases: Epigenetics, Genetics and Genomics. On comsince 11/29/2015 https://lnkd.in/ecp5mrA
  4. Cardiovascular Diseases, Volume Four: Regenerative and Translational Medicine: The Therapeutics Promise for Cardiovascular Diseases. On comsince 12/26/2015 https://lnkd.in/dwqM3K3
  5. Cardiovascular Diseases, Volume Five: Pharmacological Agents in Treatment of Cardiovascular Diseases. On comsince 12/23/2018 https://lnkd.in/e3r87cQ
  6. Cardiovascular Diseases, Volume Six: Interventional Cardiology for Disease Diagnosis and Cardiac Surgery for Condition Treatment. On comsince 12/24/2018 https://lnkd.in/e_CTb4R





















Nomination for 2018 Yidan Prize, recognition in the field of medical education: development of curation methodologies for scientific content – 2018 Nominee, Aviva Lev-Ari, PhD, RN


  • Dr. Lev-Ari was nominated for the 2020 Campanile Excellence in Achievement Award, December 5, 2019.
  • Dr. Lev-Ari was nominated for 2019 Berkeley Alumna of the Year Achievement Award, December 7, 2018,








Reporter: Gail S. Thornton, M.A.


JULY 21, 2020

When dermatologist Jenna Lester learned that rashes on skin and toes were a symptom of Covid-19, she started searching the medical literature for images of what the rashes looked like on Black skin so she’d recognize it in her Black patients. She couldn’t find a single picture.

“I was frustrated because we know Covid-19 is disproportionately impacting communities of color,” said Lester, an assistant professor of dermatology at the University of California, San Francisco who recently published her analysis. “I felt like I was seeing a disparity being built right before my eyes.”

The dearth of images in the Covid-19 literature is just the newest example of the glaring lack of representation of Black and brown skin that has persisted in dermatology research journals and textbooks for decades. The issue is coming under closer scrutiny now as dermatologists, like many physicians, grapple more openly with systemic racism and the health disparities it is causing in their field.


“Black Lives Matter is forcing a lot of people to look inward and say, ‘Where are our shortcomings?’” said Nada Elbuluk, an associate professor of clinical dermatology at the University of Southern California and the founder of a diversity and inclusion program in her department. “Dermatology is no different.”



The discrimination in her specialty extends beyond images and gaps in training, to restrictive insurance coverage for skin conditions that affect people with heavily pigmented skin, and to the many dermatologists who don’t accept patients with Medicaid.


It may be no surprise that a field that focuses on skin is now reckoning with skin color. In dermatology, where images are critical for diagnoses, the lack of images of darker skin poses a roadblock to proper treatment and medical education. Skin conditions that involve redness or pinkness in light skin can be subtler or harder to see in dark skin, and physicians who haven’t been adequately trained with such images are prone to misdiagnose people of color. “We absolutely need a diversity of images,” said Elbuluk.

An analysis of textbooks by Jules Lipoff, an assistant professor of clinical dermatology at the University of Pennsylvania, showed the percentage of images of dark skin ranged from 4% to 18%. “We are not teaching (and possibly not learning) skin of color,” Lester wrote in a separate analysis she conducted. Many worry the field’s shift toward using artificial intelligence to aid diagnosis of disease will further deepen the divide, because the machine learning algorithms are trained with datasets consisting primarily of fair-skinned images.

Dr. Jenna Lester w/ patient
Dermatologist Jenna Lester treats Geoffry Blair Hutto at the UCSF skin of color clinic.COURTESY BARBARA RIES, UCSF

It gets worse. While many textbooks depict the vast majority of skin diseases using light skin, there is one notable exception: Black skin is more often used to depict sexually transmitted diseases, a glaring example of stereotyping that is all the more painful given the U.S. government’s complicity in the notorious Tuskegee experiments that left syphilis untreated for decades in a group of poor, Black men.

Lipoff’s analysis, published this year, showed many dermatology textbooks had zero images of dark skin with acne, psoriasis, or dermatitis. When it came to syphilis, however, many books relied heavily on images of dark skin. Lester’s analysis found that while 28% of images of infectious diseases used images of darker skin, the number of depictions of dark skin was twice as high for infections that were sexually transmitted.

“In the textbooks I used in medical school, every penis was a Black penis showing an STD. We’ve got to stop that,” said Susan Taylor, a pioneer in the push for better dermatologic care for patients with dark skin and the Sandra Lazarus professor of dermatology at the Perelman School of Medicine at the University of Pennsylvania.

Considered a trailblazer in the field of dermatology, Taylor established the nation’s first “Skin of Color” dermatology clinic at Mount Sinai in New York in the late 1990s. In 2004, she founded the Skin of Color Society to help educate fellow dermatologists about how to treat patients of color, push for research and clinical trials to include people with darker skin, and mentor and encourage medical students of color to enter dermatology, where only 3% of practitioners are Black and 4% are Hispanic. “These are really abysmal numbers,” Taylor said. “That’s got to change.”

Taylor is also the lead author of the textbook Dermatology for Skin of Color, a guide considered invaluable by many dermatologists. But even those who rely on the book say it’s frustrating that a separate book on dark skin is still required — when as a nation we are just a few decades away from a majority of residents having skin of color.

“This is the white patient treated as the default and the Black patient as the asterisk,” said Lipoff. “You can’t make skin of color a lecture that students get once a year. It can’t be ‘otherized’ or put in a separate textbook.”

Taylor agrees. “Nothing would make me happier than to not have to publish another edition of that book,” she said.


Dermatologists say the lack of images is one reason why many conditions, including Lyme disease, spider bites, and cancers can go misdiagnosed or underdiagnosed in darker skinned patients, sometimes with dangerous results. The five-year melanoma survival rate for Black patients is just 70% compared with 94% for white patients.

The mother of a mixed-race 13-year-old from Connecticut said she was told by her child’s pediatrician when she was 8 that the white patches on her skin were pityriasis alba, a skin rash that’s usually not considered a serious condition. She was given a lotion, but the skin patches never went away. “I kept going online and looking at things but I couldn’t see anyone with issues that looked like hers,” said the mother, who didn’t want her name used to protect the girl’s privacy. “And the doctor was casual about it.”

Partly because of insurance issues, and partly because the mother thought there was nothing to worry about, it took five years before her daughter’s white patches were properly diagnosed: She had T-cell lymphoma, a cancer. While she will require maintenance light therapy for life, her overall prognosis is good. But her case highlights the difficult and sometimes frightening challenge many patients of color face to get a proper dermatologic diagnosis.

“Black Lives Matter is forcing a lot of people to look inward and say, ‘Where are our shortcomings?’ Dermatology is no different.”


When Ellen Buchanan Weiss noticed patches on the dark brown skin of her toddler son, she wondered if it was eczema, or something more serious. “I Googled it and noticed immediately the pictures were all of white skin,” she said. “I Googled other conditions and it was the same. No matter what I searched, there were almost no images of dark skin.”

The patches did turn out to be eczema and were easily treated. Still, the disparity bothered her for months. About a year ago, Weiss, a stay-at-home mom in Raleigh, N.C., decided to create an Instagram account called “Brown Skin Matters.” She posted images of skin conditions in darker skin next to images of the same condition in white skin and asked followers to send in more photos. The account exploded almost immediately.

“I’ve had tons of medical schools, physicians, nurses, and pharmacists all contact me saying this was useful,” she said. “I never thought this was going to become a diagnostic tool.”

Instagram is not exactly the best platform for making medical diagnoses, so Weiss is now working with medical experts to help create a more rigorous and searchable web-based tool for diagnosis of skin diseases in darker skin. It still floors Weiss that she, a person with no medical background, is at the center of it. “It’s curious to me, and troubling, that this is 2020 and this gap is still here,” she said. “Some large medical institution should have been taking care of this, not me.”

atopic dermatitis in infants
Comparison of atopic dermatitis in infants with darkly pigmented versus lightly pigmented skin, from the widely used textbook, Dermatology.COURTESY BOLOGNIA JL, SCHAFFER JV, AND CERRONI L, EDS. DERMATOLOGY. 4TH ED. ELSEVIER

Bolognia said she is extremely sensitive about not stigmatizing people of color by using only images of darkly pigmented skin to illustrate sexually transmitted diseases or drug users. “I noticed this as a student, the images of STDs were nearly all of patients with darkly pigmented skin, but the people I saw with syphilis were often fair-skinned,” she said. “I wondered about the possibility that pictures were being taken of individuals who were less likely to say no.”

The issue of textbooks failing to adequately represent skin of color is not a new one. Yet Lipoff’s study compared today’s textbooks with those of 15 years ago and found little has changed. Jean Bolognia, a professor of dermatology at the Yale School of Medicine, has spent more than two decades editing the widely used textbook, Dermatology; she said providing a wide spectrum of skin tones is critical and something she’s worked hard to include, though she acknowledged there’s more work to do.

“I’m not saying it’s perfect, but we’ve been working really hard for over 15 years to show the whole spectrum,” said Bolognia, who is now working on the fifth edition of the textbook. “I feel you can always do better and I realize I don’t have enough images of Asian skin, so that is something I’m addressing.”Related: 

The field’s other widely used textbook is Andrews’ Diseases of the Skin. That book’s lead author, William James, is a longtime champion of diversity in dermatology, according to his colleagues at Penn, who include Taylor and Lipoff. James said representing a variety of skin tones was an important issue, but said authors were challenged by limits placed on the number of photos by textbook publishers and because findings of redness or pinkness can be hard to see in images of darker skin. “Deciding if an entity is represented at all, or more than once, is always difficult,” he said in an email.

James said his textbook includes more photos of Black skin than white skin in conditions that are more common in Black patients, and noted that eight of 14 photos of syphilis are in lighter skin.

Agrowing number of dermatologists are following Taylor’s lead and opening skin of color clinics that provide care for darker-skinned patients. Lester opened one at UCSF last year. Elbuluk has worked at or founded three skin of color clinics throughout her training and early career, including at Penn, NYU Medical School, and, in 2018, at USC, where she hopes to also spur much-needed clinical research on darker skin. “It’s surprising to me when large cities don’t have these,” Elbuluk said.

There are many reasons why people of color, particularly those who do not have private health insurance, lack access to dermatologists. Lipoff, who has examined the issue, said many dermatologists do not take Medicaid. Racial bias that discourages the treatment of Black patients, he said, is literally built into the physician reimbursement system. Many conditions that affect darker skin are often not covered by insurance because they are considered cosmetic.

Meanwhile, the highest revenue procedures, Lipoff said, include those for the diagnosis and treatment of skin cancer, which is more likely to occur in white patients. This difference in how procedures are valued and reimbursed, he said, is a perfect example of structural racism that drives practices to directly and indirectly focus on white patients and marginalize Black patients. “If Black patients earned practices three times the revenue,” he said, “the disparity would disappear overnight.”

“It’s curious to me, and troubling, that this is 2020 and this gap is still here. Some large medical institution should have been taking care of this, not me.”


Until it does, physicians who run skin of color clinics are hoping to address the lack of care, and poor care, Black and brown patients have received. The clinics are a welcome addition to people like Dar Bray, a 45-year-old behavioral therapist and darker-skinned Black man from Los Angeles.

Bray had dealt for years with deep and persistent scars caused by acne, trying bleaching creams and expensive cosmetic products, all with no success. “I went to so many doctors who didn’t know what to do with my skin. All the pictures they had on their wall were fair-skinned people,” Bray said. “It didn’t feel like racism, it felt like just plain ignorance.”

Seeing Elbuluk, he said, was immediately different. Bray is now undergoing chemical peels to remove scarring and using simple (and inexpensive) cleansers and moisturizers, and says he sees a huge improvement in his skin. He’s also wearing sunscreen, something no physician had ever told him was necessary; like many, he had believed the myth “Black don’t crack.” “When I went to the beach, I never wore sunscreen,” he said. “Now I have years of sun damage.”

Mistrust of white physicians led Gregory Hines, a 63-year-old longshoreman who lives in Oakland, to go years without seeing a doctor about growths under his arm, on his back, and on his neck, even as they puffed up and became, in his words “kind of weird and ugly.”

“I experience it a lot, going to doctors — especially white, male doctors — they assume they know more than you. They assume they already know what your problem is the minute you walk through the door,” he said.

When he heard UCSF’s Skin of Color clinic had opened, he was willing to give it a try. “When Dr. Lester walked in, I said, ‘Whoa, this is great,’” he said. “I wanted a Black doctor who understands Black skin.”

Lester ended up removing the masses, one of which was nearly as large as a golf ball, and sent them for tests to see if they were cancerous. Fortunately, they were not.

Lester is the only Black dermatologist in San Francisco. She’s hoping that will change after her current crop of residents decides where they will establish their practices. Her Black patients, she said, are often shocked when she walks in the door.

“I’ve had patients ask if they can take a picture with me to show their grandkids,” she said. “They want to talk all about me and how I got here, and I have to say, ‘No, this time is for you.’”




Inflammation BioMarker C-Reactive Protein Guides Use of Systemic Glucocorticoids in Patients with COVID-19: The Effects on Mortality or Use of Mechanical Ventilation – (CRP) ≥20 mg/dL was associated with significantly reduced risk of Mortality or Mechanical Ventilation Efficacy

Reporter: Aviva Lev-Ari, PhD, RN


In patients with high levels of inflammation — at least 20 mg/dL — steroid treatment was associated with a 77% reduction in the risk of needing mechanical ventilation or dying (odds ratio [OR], 0.23).

Importantly, treating with steroids when CRP levels were less than 10 mg/dL was associated with an almost threefold increased risk of going on mechanical ventilation or dying (OR, 2.64).

“The laboratory test could potentially be very helpful,” Keller told Medscape Medical News.


Effect of Systemic Glucocorticoids on Mortality or Mechanical Ventilation in Patients With COVID-19

Article has an altmetric score of 299


The efficacy of glucocorticoids in COVID-19 is unclear. This study was designed to determine whether systemic glucocorticoid treatment in COVID-19 patients is associated with reduced mortality or mechanical ventilation. This observational study included 1,806 hospitalized COVID-19 patients; 140 were treated with glucocorticoids within 48 hours of admission. Early use of glucocorticoids was not associated with mortality or mechanical ventilation. However, glucocorticoid treatment of patients with initial C-reactive protein (CRP) ≥20 mg/dL was associated with significantly reduced risk of mortality or mechanical ventilation (odds ratio, 0.23; 95% CI, 0.08-0.70), while glucocorticoid treatment of patients with CRP <10 mg/dL was associated with significantly increased risk of mortality or mechanical ventilation (OR, 2.64; 95% CI, 1.39-5.03). Whether glucocorticoid treatment is associated with changes in mortality or mechanical ventilation in patients with high or low CRP needs study in prospective, randomized clinical trials.

Glucocorticoids are useful as adjunctive treatment for some infections with inflammatory responses, but their efficacy in COVID-19 is unclear. Prior experience with influenza and other coronaviruses may be relevant. A recent meta-analysis of influenza pneumonia showed increased mortality and a higher rate of secondary infections in patients who were administered glucocorticoids.3 For Middle East respiratory syndrome, severe acute respiratory syndrome, and influenza, some studies have demonstrated an association between glucocorticoid use and delayed viral clearance.4-7 However, a recent retrospective series of patients with COVID-19 and ARDS demonstrated a decrease in mortality with glucocorticoid use.8 Glucocorticoids are easily obtained and familiar to providers caring for COVID-19 patients. Hence their empiric use is widespread.8,9

The primary goal of this study was to determine whether early glucocorticoid treatment is associated with reduced mortality or need for MV in COVID-19 patients.


The results of this study indicate that early treatment with glucocorticoids is not associated with mortality or need for MV in unselected patients with COVID-19. Subgroup analyses suggest that glucocorticoid-treated patients with markedly elevated CRP may benefit from glucocorticoid treatment, whereas those patients with lower CRP may be harmed. Our findings were consistent after adjustment for clinical characteristics. The public health implications of these findings are hard to overestimate. Given the global growth of the pandemic and that glucocorticoids are widely available and inexpensive, glucocorticoid therapy may save many thousands of lives. Equally important because we have been able to identify a group that may be harmed, some patients may be saved because glucocorticoids will not be given.

Our study reaffirms the finding of the as yet unpublished Randomised Evaluation of COVID-19 Therapy (RECOVERY) trial that there is a subset of patients with COVID-19 who benefit from treatment with glucocorticoids.10 Our study extends the findings of the RECOVERY trial in two important ways. First, in addition to finding some patients who may benefit, we also have identified patient groups that may experience harm from treatment with glucocorticoids. This finding suggests choosing the right patients for glucocorticoid treatment is critical to maximize the likelihood of benefit and minimize the risk of harm. Second, we have identified patient groups who are likely to benefit (or be harmed) on the basis of a widely available lab test (CRP).

Our results are also consistent with previous studies of patients with SARS-CoV and MERS-CoV, in which no associations between glucocorticoid treatment and mortality were found.7 However, the results of studies examining the effect of glucocorticoids in patients with COVID-19 are less consistent.8,11,12

Few of the previous studies examined the effects of glucocorticoids in subgroups of patients. In our study, the improved outcomes associated with glucocorticoid use in patients with elevated CRPs is intriguing and may be clinically important. Proinflammatory cytokines, especially interleukin-6, acutely increase CRP levels. Cytokine storm syndrome (CSS) is a hyperinflammatory condition that occurs in a subset of COVID-19 patients, often resulting in multiorgan dysfunction.13 CRP is markedly elevated in CSS,14 and improved outcomes with glucocorticoid therapy in this subgroup may indicate benefit in this inflammatory phenotype. Patients with lower CRP are less likely to have CSS and may experience more harm than benefit associated with glucocorticoid treatment.

Several limitations are inherent to this study. Since it was done at a single center, the results may not be generalizable. As a retrospective analysis, it is subject to confounding and bias. In addition, because patients were included only if they had reached the outcome of death/MV or hospital discharge, the sample size was truncated. We believe glucocorticoid use in hospitalized patients excluded from the study reflects increased use with time because of a growing belief in their effectiveness.

Preliminary analysis from the RECOVERY study showed a reduced rate of mortality in patients randomized to dexamethasone, compared with those who received standard of care.10 These results led to the National Institutes for Health COVID-19 Treatment Guidelines Panel recommendation for dexamethasone treatment in patients with COVID-19 who require supplemental oxygen or MV.15 Our findings suggest a role for CRP to identify patients who may benefit from glucocorticoid therapy, as well as those in whom it may be harmful. Additional studies to further elucidate the role of CRP in guiding glucocorticoid therapy and to predict clinical response are needed.

Severe COVID-19 in Patients experiencing Cytokine Storm: Positive Outcomes (faster respiratory recovery, a lower likelihood of mechanical ventilation, and fewer in-hospital deaths) of high dose methylprednisolone plus tocilizumab (Actemra, Genentech) vs Supportive Care Alone

Reporter: Aviva Lev-Ari, PhD, RN


“COVID-19-associated cytokine storm syndrome [CSS] is an important complication of severe acute respiratory syndrome coronavirus-2 infection in up to 25% of the patients,” lead author Sofia Ramiro, MD, PhD, told Medscape Medical News.

The researchers assessed outcomes of 86 individuals with COVID-19-associated CSS treated with high-dose methylprednisolone plus/minus tocilizumab, an anti-interleukin-6 receptor monoclonal antibody. They compared them with another 86 patients with COVID-19 treated with supportive care before initiation of the combination therapy protocol.

Participants with CSS had an oxygen saturation of 94% or lower at rest or tachypnea exceeding 30 breaths per minute.

They also had at least two of the following:

  • C-reactive protein > 100 mg/L;
  • serum ferritin > 900 μg/L at one occasion or
  • a twofold increase at admission within 48 hours; or
  • D-dimer levels > 1500 μg/L.


Historically controlled comparison of glucocorticoids with or without tocilizumab versus supportive care only in patients with COVID-19-associated cytokine storm syndrome: results of the CHIC study

  1. Sofia Ramiro1,2,
  2. Rémy L M Mostard3,
  3. César Magro-Checa1,
  4. Christel M P van Dongen1,
  5. Tom Dormans4,
  6. Jacqueline Buijs5,
  7. Michiel Gronenschild3,
  8. Martijn D de Kruif3,
  9. Eric H J van Haren3,
  10. Tom van Kraaij3,
  11. Mathie P G Leers6,
  12. Ralph Peeters1,
  13. Dennis R Wong7,
  14. Robert B M Landewé1,8

Author affiliations


WordCloud Visualization of LPBI’s Top Twelve Articles by Views at All Time and their Research Categories in the Ontology of PharmaceuticalIntelligence.com

Curators: Daniel Menzin, Noam Steiner-Tomer, Zach Day, Ofer Markman, PhD, Aviva Lev-Ari, PhD, RN


Article Name
Live Link
All Time
Categories of Research 


Is the Warburg Effect the Cause or the Effect of Cancer: A 21st Century View?

17,140Biological NetworksCANCER BIOLOGY & Innovations in Cancer TherapyCell BiologyDisease BiologyGenome BiologyImaging-based Cancer Patient ManagementInternational Global Work in PharmaceuticalLiver & Digestive Diseases ResearchMetabolomicsMolecular Genetics & PharmaceuticalNutritionPharmaceutical Industry Competitive IntelligencePharmaceutical R&D InvestmentPopulation Health ManagementProteomicsStem Cells for Regenerative MedicineTechnology Transfer: Biotech and Pharmaceutical | Tagged Adenosine triphosphateATPGlycolysisHypoxia-inducible factorsKrebLactate dehydrogenaseMammalian target of rapamycinMitochondrionWarburg Effect


Recent comprehensive review on the role of ultrasound in breast cancer management

14,553Biomarkers & Medical DiagnosticsHealth Economics and Outcomes ResearchHealthcare costs and reimbursementImaging-based Cancer Patient ManagementMedical Device Therapies for Altzheimer’s DiseaseMedical Devices R&D InvestmentMedical Imaging Technology, Image Processing/Computing, MRI, CT, Nuclear Medicine, Ultra Sound | Tagged breast biopsiesbreast cancerbreast cancer managementbreast cancer screeningbreast cystbreast lesionsbreast ultrasoundmammographyMRIPersonalized medicinePETsupport breast cancertomosynthesisyale university schoolyale university school of medicine 


Do Novel Anticoagulants Affect the PT/INR? The Cases of XARELTO (rivaroxaban) and PRADAXA (dabigatran)

13,893Coagulation Therapy and Internal BleedingElectrophysiologyFDA Regulatory AffairsOrigins of Cardiovascular DiseasePharmacotherapy of Cardiovascular Disease | Tagged Academic Medical CenterAmsterdamAnticoagulantApixabanDabigatranDirect thrombin inhibitorDirect Xa inhibitorFood and Drug AdministrationNew England Journal of MedicineNon-steroidal anti-inflammatory drugNortheastern UniversityPRADAXAProthrombin timeRivaroxabanVTEWarfarin 


Paclitaxel vs Abraxane (albumin-bound paclitaxel)cent comprehensive review on the role of ultrasound in breast cancer management

13,878BioSimilarsCANCER BIOLOGY & Innovations in Cancer TherapyDisease Biology, Small Molecules in Development of Therapeutic DrugsNanotechnology for Drug DeliveryPharmaceutical AnalyticsPharmaceutical R&D InvestmentRegulated Clinical Trials: Design, Methods, Components and IRB related issues | Tagged Abraxanealbumin-bound paclitaxelbreast cancerclinical studiesFREE paclitaxellinear PKnon-linear PKPaclitaxelPharmacokineticsPKside effectsTaxol 


Apixaban (Eliquis): Mechanism of Action, Drug Comparison and Additional Indications

8,367Coagulation Therapy and Internal BleedingFrontiers in Cardiology and Cardiovascular DisordersOrigins of Cardiovascular DiseasePharmacotherapy of Cardiovascular Disease, tagged Dabigatranrivaroxaban and apixaban for stroke prevention in atrial fibrillation 


Clinical Indications for Use of Inhaled Nitric Oxide (iNO) in the Adult Patient Market: Clinical Outcomes after Use, Therapy Demand and Cost of Care

8,068Medical Devices R&D InvestmentNitric Oxide in Health and DiseaseTechnology Transfer: Biotech and Pharmaceutical | Tagged ARDSAviva Lev-AriInhaled Nitric Oxidenitric oxideprostacyclinPulmonary hypertensionRespiratory failure 

Our Team

6,553LPBI Group, e-Scientific Media, DFP, R&D-M3DP, R&D-Drug Discovery, US Patents: SOPs and Team Management 
Mesothelin: An early detection biomarker for cancer (By Jack Andraka)
6,545Advanced Drug Manufacturing TechnologyBio Instrumentation in Experimental Life Sciences ResearchBiological Networks, Gene Regulation and EvolutionBiomarkers & Medical DiagnosticsBioSimilarsCANCER BIOLOGY & Innovations in Cancer TherapyCancer Prevention: Research & ProgramsCell Biology, Signaling & Cell CircuitsDisease Biology, Small Molecules in Development of Therapeutic DrugsHealth Economics and Outcomes ResearchMedical Devices R&D InvestmentNanotechnology for Drug DeliveryPharmaceutical R&D InvestmentPopulation Health Management, Genetics & PharmaceuticalRegulated Clinical Trials: Design, Methods, Components and IRB related issuesTechnology Transfer: Biotech and Pharmaceutical | Tagged Blood testcarbon nanotubesearly detectionMesothelinPancreatic cancer 


Biochemistry of the Coagulation Cascade and Platelet Aggregation: Nitric Oxide: Platelets, Circulatory Disorders, and Coagulation Effects

5,235Aortic Valve: TAVR, TAVI vs Open Heart SurgeryBiomarkers & Medical DiagnosticsCell Biology, Signaling & Cell CircuitsChemical Biology and its relations to Metabolic DiseaseCoagulation Therapy and Internal BleedingDisease Biology, Small Molecules in Development of Therapeutic DrugsMetabolomicsMitral Valve: Repair and ReplacementNitric Oxide in Health and DiseasePersonalized and Precision Medicine & Genomic ResearchPharmaceutical Industry Competitive IntelligencePharmacotherapy of Cardiovascular DiseasePopulation Health Management, Nutrition and PhytochemistryProteomics | Tagged anti-inflammatoryanti-TNFAnticoagulantAntithrombinblood flow resistancecell junctionscellular adhesionCoumadinEndothelial cellsFactor IX and IXaFactor VII and VIIaFactor VIII and Factor VIIIaFactor X and XafibrinogenfibrinolysisheparinHypoxia-inducible factorsNon-steroidal anti-inflammatory drugPartial thromboplastin timePhysiologyplasminplatelet aggregationplateletsprothrombinsoluble fibrinsubendothelial matrixThrombinthrombomodulinThrombustissue factorTNF-aVon Willebrand factorWH Seegers 

Interaction of enzymes and hormones

5,173Cell Biology, Signaling & Cell CircuitsChemical Biology and its relations to Metabolic DiseaseMetabolomicsPopulation Health Management, Genetics & PharmaceuticalPopulation Health Management, Nutrition and PhytochemistryReproductive Andrology, Embryology, Genomic Endocrinology, Preimplantation Genetic Diagnosis and Reproductive Genomics | Tagged active compoundsenzymehormoneinteractionMetabolismTherapy 


Akt inhibition for cancer treatment, where do we stand today?

4,865CANCER BIOLOGY & Innovations in Cancer TherapyCell Biology, Signaling & Cell Circuits | Tagged Cancer researchcancer therapyCell BiologymTORNF-κBPI3K/AKT pathwayPTENSignal transduction 



The History and Creators of Total Parenteral Nutrition




Disease BiologyGastroenterologyUncategorized | Tagged Amino acidsenteral nutritionNutritionTPN



Is the Warburg Effect the Cause or the Effect of Cancer: A 21st Century View?

Article #1: WordCloud by DM


Recent comprehensive review on the role of ultrasound in breast cancer management

Article #2: WordCloud by NT


Do Novel Anticoagulants Affect the PT/INR? The Cases of XARELTO (rivaroxaban) and PRADAXA (dabigatran)

Article #3: WordCloud by ZD


Paclitaxel vs Abraxane (albumin-bound paclitaxel)cent comprehensive review on the role of ultrasound in breast cancer management

Article #4: WordCloud by DM


Apixaban (Eliquis): Mechanism of Action, Drug Comparison and Additional Indications

Article #5: WordCloud by ZD


Clinical Indications for Use of Inhaled Nitric Oxide (iNO) in the Adult Patient Market: Clinical Outcomes after Use, Therapy Demand and Cost of Care

Article #6: WordCloud by NT


Our Team

Article #7: WordCloud by DM

Novel SARS-CoV-2 sybodies

Reporter: Irina Robu, PhD

Absolute Antibody Ltd., a leader of the market in recombinant antibody products announced a partnership with University of Zurich to offer synthetic nanobodies against the receptor binding domain (RBD) of SARS-CoV-2. Under the partnership, the original nanobodies and recently engineered formats are now accessible to the global research community for use as serological controls and in COVID-19 therapeutic development. The synthetic nanobodies hold a particular potential for the development of inhalable drugs, which could suggest a convenient treatment option for the COVID-19 pandemic.

The laboratory of Markus Seeger at University of Zurich designs a rapid in vitro selection platform to generate synthetic nanobodies, sybodies, against the receptor binding domain (RBD) of SARS-CoV-2. Within a two-week timeframe, the lab had recognized more than 60 unique anti-RBD sybodies from combinatorial display libraries. The sybodies are “designed to mimic the natural shape diversity of camelid nanobodies, consequently allowing for an optimal surface complementarity to the limited hydrophilic epitopes on membrane proteins. Due to their high thermal stabilities and low production costs, sybodies demonstrate a promise for diagnostic and therapeutic applications.

Sybodies are perfectly suited to trap intrinsically flexible membrane proteins and thereby facilitate structure determination by X-ray crystallography and cryo-EM.
Additional research indicate that six of the sybodies bound SARS-CoV-2 spike protein with very high affinity, while five of those also inhibited ACE2, the host cell receptor to which SARS-CoV-2 binds to initiate the COVID-19 infection. Furthermore, two of the sybodies can at the same time bind the RBD, which could permit the construction of a polyvalent antiviral drug. The SARS-CoV-2 sybodies are therefore valuable tools for coronavirus research, diagnostics and therapeutic development.

Moreover, Absolute Antibody has used antibody engineering to fuse the nanobodies to Fc domains in different species, isotypes and subtypes. Absolute Antibody also offers supporting coronavirus research such as the production of gram quantities of human antibodies sequenced from recovering COVID-19 patients.




Three Stages to COVID-19 Brain Damage

Reporter: Irina Robu, PhD

According to a review published by Majid Fotuhi, PhD in the Journal of Alzheimer’s Disease, the impact of COVID-19 on the nervous system can be classified in three stages. In stage 1, viral damage is limited to the epithelial cells of the nose and mouth; stage 2, blood clots that form in the lungs can travel to the brain and in stage 3, the virus crosses the blood brain barrier and invades the brain.

Dr. Fotuhi recognized that patients with COVID-19 should have a neurological evaluation and an MRI before leaving the hospital, to distinguish if there are any anomalies. It has become increasingly obvious that SARS-CoV-2 can cause neurologic manifestations, including anosmia, seizures, stroke, confusion, encephalopathy, and total paralysis, the authors write. As stated by authors of the review, the SARS-CoV-2 binds to angiotensin-converting enzyme 2 (ACE2) that facilitates the conversion of angiotensin II to angiotensin. Subsequently ACE2 binds to respiratory epithelial cells, and then to epithelial cells in blood vessels, SARS-CoV-2 triggers the formation of a “cytokine storm.” The cytokines, increase vascular permeability, edema and widespread inflammation which can cause small or large blood clots that affect multiple organs.

They concluded, that If SARS-CoV-2 crosses the blood–brain barrier, directly entering the brain, it can contribute to demyelination or neurodegeneration. Scientists have limited information published about it, so doctors/scientists are uncertain why a virus this small can cause so many neurological things.



The Inequality and Health Disparity seen with the COVID-19 Pandemic Is Similar to Past Pandemics

Curator: Stephen J. Williams, PhD


It has become very evident, at least in during this pandemic within the United States, that African Americans and poorer communities have been disproportionately affected by the SARS-CoV2 outbreak . However, there are many other diseases such as diabetes, heart disease, and cancer in which these specific health disparities are evident as well :

Diversity and Health Disparity Issues Need to be Addressed for GWAS and Precision Medicine Studies

Personalized Medicine, Omics, and Health Disparities in Cancer:  Can Personalized Medicine Help Reduce the Disparity Problem?

Disease like cancer have been shown to have wide disparities based on socioeconomic status, with higher incidence rates seen in poorer and less educated sub-populations, not just here but underdeveloped countries as well (see Opinion Articles from the Lancet: COVID-19 and Cancer Care in China and Africa) and graphics below)











In an article in Science by Lizzie Wade, these disparities separated on socioeconomic status, have occurred in many other pandemics throughout history, and is not unique to the current COVID19 outbreak.  The article, entitled “An Unequal Blow”, reveal how

in past pandemics, people on the margins suffered the most.

Source: https://science.sciencemag.org/content/368/6492/700.summary

Health Disparities during the Black Death Bubonic Plague Pandemic in the 14th Century (1347-1351)

During the mid 14th century, all of Europe was affected by a plague induced by the bacterium Yersinia pestis, and killed anywhere between 30 – 60% of the European population.  According to reports by the time the Black Death had reached London by January 1349 there had already been horrendous reports coming out of Florence Italy where the deadly disease ravished the population there in the summer of 1348 (more than half of the city’s population died). And by mid 1349 the Black Death had killed more than half of Londoners.  It appeared that no one was safe from the deadly pandemic, affecting the rich, the poor, the young, the old.

However, after careful and meticulous archaeological and historical analysis in England and other sites, revealed a distinct social and economic inequalities that predominated and most likely guided the pandemics course throughout Europe.   According to Dr. Gwen Robbins Schug, a bio-archaeologist at Appalachian State University,

Bio-archaeology and other social sciences have repeatedly demonstrated that these kinds of crises play out along the preexisting fault lines of each society.  The people at greatest risk were often those already marginalized- the poor and minorities who faced discrimination in ways that damaged their health or limited their access to medical care even in pandemic times.

At the start of the Black Death, Europe had already gone under a climactic change with erratic weather.  As a result, a Great Famine struck Europe between 1315-17.  Wages fell and more people fell into poverty while the wealthiest expanded their riches, leading to an increased gap in wealth and social disparity.  In fact according to recordkeeping most of Englanders were living below the poverty line.

Author Lizzie Wade also interviewed Dr. Sharon, DeWitte, a biological anthropologist at University of South Carolina, who looks at skeletal remains of Black Death victims to get evidence on their health status, like evidence of malnutrition, osteoporosis, etc.   And it appears that most of the victims may have had preexisting health conditions indicative of poorer status.  And other evidence show that wealthy landowners had a lower mortality rate than poorer inner city dwellers.

1918 Spanish Flu

Socioeconomic and demographic studies have shown that both Native American Indians and African Americans on the lower end of the socioeconomic status were disproportionately affected by the 1918 Spanish flu pandemic.  According to census records, the poorest had a 50% higher mortality rate than wealthy areas in the city of Oslo.  In the US, minors and factory workers died at the highest rates.  In the US African Americans had already had bouts with preexisting issues like tuberculosis and may have contributed to the higher mortality.  In addition Jim Crow laws in the South, responsible for widespread discrimination, also impacted the ability of African Americans to seek proper medical care.

From the Atlantic

Source: https://www.theatlantic.com/politics/archive/2016/05/americas-health-segregation-problem/483219/

America’s Health Segregation Problem

Has the country done enough to overcome its Jim Crow health care history?


MAY 18, 2016

Like other forms of segregation, health-care segregation was originally a function of explicitly racist black codes and Jim Crow laws. Many hospitals, clinics, and doctor’s offices were totally segregated by race, and many more maintained separate wings or staff that could never intermingle under threat of law. The deficit of trained black medical professionals (itself caused by a number of factors including education segregation) meant that no matter where black people received health-care services, they would find their care to be subpar compared to that of whites. While there were some deaths that were directly attributable to being denied emergency service, most of the damage was done in establishing the same cumulative health disparities that plague black people today as a societal fate. The descendants of enslaved people lived much more dangerous and unhealthy lives than white counterparts, on disease-ridden and degraded environments. Within the confines of a segregated health-care system, these factors became poor health outcomes that shaped black America as if they were its genetic material.




R.A.HahnaB.I.TrumanbD.R.Williamsc.Civil rights as determinants of public health and racial and ethnic health equity: Health care, education, employment, and housing in the United States.

SSM – Population Health: Volume 4, April 2018, Pages 17-24


  • Civil rights are characterized as social determinants of health.
  • Four domains in civil rights history since 1950 are explored in—health care, education, employment, and housing.
  • Health care, education, employment show substantial benefits when civil rights are enforced.
  • Housing shows an overall failure to enforce existing civil rights and persistent discrimination.
  • Civil rights and their enforcement may be considered a powerful arena for public health theorizing, research, policy, and action.


For more articles on COVID-19 Please go to our Coronovirus Portal