Junko Takeshita, MD, PhD, MSCE, is a physician-scientist who is driven to address the racial and ethnic disparities she sees in dermatology, from clinical practice to research. Specifically, her research has highlighted the lack of racial and ethnic diversity of participants in clinical trials of psoriasis treatments, something she believes is a critical barrier to equitably advancing the understanding and treatment of psoriasis (Sevagamoorthy et al. 2022).
She has received the first DF Bristol Myers Squibb Psoriasis Research Award to advance her work to increase participant diversity in clinical trials through video education. This award provides $100,000 of funding per year for three years for extraordinary mid-career researchers.
“The BMS award provides essential grant support to keep my work going and set the stage for obtaining larger awards to further the work we do,” said Dr. Takeshita.
“Having poor diversity in our clinical trial populations has multiple consequences on psoriasis treatment,” Dr. Takeshita said. For example, Black adults are much less likely to receive biologic therapies than white adults (Takeshita et al. 2015). “When clinicians don’t see the patients they treat or psoriasis patients don’t see themselves represented in the pivotal trials that test new medications, it’s natural that they might have questions. Does this treatment work for my patient population? Is this treatment applicable to me?”
Promoting diversity through video education
A recent review of the use of videos to inform and educate patients showed that the practice is growing and can enhance patient experience and treatment outcomes (Chatterjee et al. 2021). Medical videos serve many functions, from answering patient questions to easing potential anxiety about treatment. They have also been shown to be more effective at improving knowledge about sleep apnea among patients with low literacy (Murphy et al. 2000). Another review concluded that videos are more effective at changing patient behavior when they show real people in action (Abu Abed et al. 2014). These results are pertinent to Dr. Takeshita’s research on the use of video to improve clinical trial participation.
Among the many factors contributing to the lack of diversity in psoriasis clinical trials, Dr. Takeshita lists possible lack of trust between potential study participants and study investigators, poor communication and education about the value of clinical trials and the importance of having a diverse clinical trial population, as well as many other logistical and practical barriers. She hopes to address some of these barriers with patient-facing educational videos that include basic information about clinical trials and depict participants, investigators, and research team members from different backgrounds, races, and ethnicities.
“We’re likely to engage more diverse clinical trial participants when people see and hear from a diverse research team and others who look like them who have participated in, and have had good experiences, in research studies,” she said. She also hopes the videos will make recruitment easier. “If we find the videos to be effective, we hope that clinicians and investigators can use them to recruit participants for their studies more widely rather than relying solely on individual communication between a clinician or an investigator and a potential participant.”
It’s not just clinical trials that suffer from a lack of diversity. Dr. Takeshita’s research has also investigated the diversity of people portrayed in direct-to-consumer (DTC) advertisements, which have been shown to affect healthcare use and are an important source of medical information. She and her colleagues found a lack of diversity among characters in DTC ads for psoriasis, concluding that this is a missed opportunity to address existing treatment disparities (Holmes et al. 2021).
“This BMS Psoriasis Research Award comes at a critical transition period in my career,” said Dr. Takeshita. “It provides necessary grant support to sustain my work and generate the data needed to obtain future and larger grants to further the work we do.”
The award funding will be used to create a patient-facing and culturally mindful educational video about clinical trials and test whether it’s effective at increasing a racial or ethnic minoritized person’s willingness to participate in a clinical study. If it is effective, the next step would be to determine the best way to share the video. Dr. Takeshita imagines the video could be shown in clinic waiting rooms, online, and by community organizations involved with people who have psoriasis.
Positive impact of increasing dermatology investigator diversity
The urgency to increase diversity extends to dermatology clinicians and researchers. “We know that the dermatology workforce is one of the least diverse among the medical specialties,” Dr. Takeshita said. “There’s evidence to suggest that patients have better experiences with, and may have better health outcomes when, they are treated by a doctor of the same race.”
For example, she has found patients are more likely to give those physicians higher scores in patient-doctor surveys (Takeshita et al. 2020). And, in a study on the effects of physician diversity on health outcomes, Black men were more likely to express their health concerns to Black doctors, a finding which could have significant impacts on reducing the difference in cardiovascular mortality between white and Black patients (Alsan et al. 2019).
These findings also extend to adherence to medical advice. Concordance of race and ethnicity between patient and physician led to improved treatment compliance for hypertension and cardiovascular disease (Nguyen et al. 2020). However, Dr. Takeshita emphasizes that these research findings are not meant to send the message that patients should only see physicians of the same ethnicity. She says, “We need to better understand how visits where the physician and patient are of the same race are different than visits where the physician and patient are of different races.
“We need to make sure that all physicians are trained to care for a diverse population of patients in a culturally mindful manner.”
Teaching, research, and clinical work
Dr. Takeshita is a Dermatology Foundation (DF) multi-award recipient. She has received a DF Public Health Career Development Award (2013), and eight DF Diversity Research Supplement Awards (2018–2023) to supplement her research and attract and train the next generation of dermatologists and researchers. She credits all her DF awards with supporting and advancing her research career.
“The CDA was absolutely essential in supporting my early training and creating a path towards obtaining a K23 award from the NIH,” she said. The K23 award is a mentored patient-oriented research career development award that comes with multi-year annual funding for an investigator’s salary and research activities. That grant allowed her to get additional training and develop an independent research program focused on health disparities related to chronic inflammatory skin diseases. “Receiving DRSAs to support my research aligns with my personal goals to help diversify our dermatology clinical and scientific workforce, and train the next generation of health disparity researchers.”
Dr. Takeshita teaches a graduate health disparities research course, gives a clinical lecture about psoriasis to second-year medical students, mentors trainees, and is in the clinic one half-day per week.
“It’s essential for anyone doing work in health equity to understand the basic concepts that are central to doing rigorous health disparities research,” she said. “At a minimum, these basic concepts are what I want every trainee or student to learn in my lab or class and be able to apply to their own work.”
The BMS Psoriasis Research Award will help Dr. Takeshita explore additional areas of research. While the award focuses on her psoriasis research, she also studies health disparities in other chronic inflammatory diseases, like atopic dermatitis and acne.
“Foundation support has been critical to fostering the careers of people like me,” she said. “I cannot emphasize enough how important this BMS award is for mid-career investigators, especially those of us who need bridge funding to continue our research when there are funding gaps, which is, unfortunately, not an uncommon scenario. I hope the people and organizations whose donations make the DF research awards possible continue to recognize the value and huge impact their money is making, and also know that people like me are so grateful for this support.”
Her first love has always been research
Dr. Takeshita always saw research as being a major component of her work. “I was not one of those people who knew early on that I wanted to be a doctor, much less which specialty I wanted to enter. One of my classmates encouraged me to give dermatology a try and, when I returned to medical school for my clinical rotations after getting my PhD, I did. Like most other dermatologists, I was attracted to the visual aspect of dermatology. The specialty also appealed to me because of the wide variety possible in a clinical practice, from medical dermatology, to surgery, pathology, or cosmetics, and the many opportunities for research and creating new knowledge that could help improve how we treat and care for the many people who suffer from skin diseases.”
After graduating with an MD/PhD from Washington University in St. Louis and completing a dermatology residency at the University of Washington in Seattle, Dr. Takeshita arrived at the University of Pennsylvania as a postdoctoral fellow and clinical instructor in the Department of Dermatology at the Perelman School of Medicine at the University of Pennsylvania.
She joined the lab of Dr. Joel Gelfand, who studies the relationship between psoriasis and cardiovascular disease. “I was drawn to this topic because my PhD work was in cardiovascular disease, and I had hoped to combine my basic science training with my future epidemiology training to do translational work in this area.” When they studied treatment patterns for psoriasis, they found racial disparities, particularly with biologics. “That caught my attention, and I quickly learned that not much research was being done on health disparities in dermatology at the time. I thought, ‘We really need to address this issue.’”
Dr. Takeshita has been an Assistant Professor of Dermatology and Epidemiology at the University of Pennsylvania since 2016. Her research focuses on identifying, understanding, and eliminating health disparities related to chronic inflammatory skin diseases, including psoriasis, eczema/atopic dermatitis, and acne.
Advice to young dermatologists
For someone considering a career in investigative dermatology, she advises keeping an open mind. “I often tell my mentees to be open to opportunities that come your way because you never know where things may lead. There’s no single path to a career in investigative dermatology. It could mean getting a master’s degree or a PhD. It could be doing postdoctoral training in a lab without formal didactic training or an additional degree. What is important is getting trained in the fundamentals of the scientific process, learning how to ask the right questions, and developing an approach to answering those questions in a rigorous way.
“I wouldn’t have predicted this is where I’d end up. It can be very rewarding to do research in dermatology because there’s still so much we don’t know and, therefore, a lot of opportunity to contribute to advancing dermatologic science and improve the lives of the many people living with skin diseases.”
Abu Abed M, Himmel W, Vormfelde S, et al. Video-assisted patient education to modify behavior: a systematic review. Patient Educ Couns. 2014;97(1):16–22.Alsan M, Garrick O, Graziani G. Does Diversity Matter for Health? Experimental Evidence from Oakland. Amer Econ Rev. 2019;109(12):4071–4111.
Chatterjee A, Strong G, Meinert E, et al. The use of video for patient information and education: A scoping review of the variability and effectiveness of interventions. Patient Educ Couns. 2021;104(9):2189–2199.
Holmes A, Williams C, Wang S, et al. Content analysis of psoriasis and eczema direct-to-consumer advertisements. Cutis. 2020;106(3):147–150.
Murphy PW, Chesson AL, Walker L, et al. Comparing the effectiveness of video and written material for improving knowledge among sleep disorders clinic patients with limited literacy skills. South Med J. 2000;93(3):297–304.
Nguyen AM, Siman N, Barry N, et al. Patient‐Physician Race/Ethnicity Concordance Improves Adherence to Cardiovascular Disease Guidelines. Health Serv Res. 2020;55(Suppl 1):51.
Sevagamoorthy A, Sockler P, Akoh C, Takeshita J. Racial and ethnic diversity of US participants in clinical trials for acne, atopic dermatitis, and psoriasis: a comprehensive review. J Dermatolog Treat. 2022;33(8):3086–3097.
Takeshita J, Gelfand JM, Li P, Pinto L, et al. Psoriasis in the US Medicare Population: Prevalence, Treatment, and Factors Associated with Biologic Use. J Invest Dermatol. 2015;135(12):2955–2963.
Takeshita J, Wang S, Loren AW, et al. Association of Racial/Ethnic and Gender Concordance Between Patients and Physicians With Patient Experience Ratings. JAMA Netw Open. 2020;3(11):e2024583.
Dr. Junko Takeshita is assistant professor of dermatology and epidemiology at the University of Pennsylvania. Her research program is dedicated to identifying, understanding, and eliminating health and healthcare disparities related to dermatologic diseases, particularly chronic inflammatory diseases such as psoriasis, atopic dermatitis, and acne. She uses quantitative, qualitative, and mixed methods research techniques to study health disparities and has authored many scientific publications on the topics of racial and ethnic health and healthcare disparities in psoriasis, atopic dermatitis, and acne; psoriasis comorbidities; and comparative effectiveness research in psoriasis. Dr. Takeshita is a recipient of an Outstanding New Investigator Award and Distinguished Leader in Health Equity Award from the National Psoriasis Foundation, a Young Investigator Award from the American Academy of Dermatology, and a Young Physician-Scientist Award from the American Society for Clinical Investigation. She receives/has received funding from the National Institutes of Health, the Dermatology Foundation, the National Psoriasis Foundation, and the National Eczema Association.
Bazen A, Barg FK, Takeshita J: Research Techniques Made Simple: An Introduction to Qualitative Research. J Invest Dermatol 141(2): 241-47, Feb 2021.
Takeshita J, Wang S, Loren AW, Mitra N, Shults J, Shin DB, Sawinski D: Association of Racial/Ethnic and Gender Concordance Between Patients and Physicians with Patient Experience Ratings. JAMA Netw Open 3(11): e2024583, Nov 2020.
Holmes A, Williams C, Wang S, Barg FK, Takeshita J: Content Analysis of Psoriasis and Eczema Direct-to-Consumer Advertisements. Cutis 106(03): 147-50, Sep 2020.
Sevagamoorthy A, Sockler P, Akoh C, Takeshita J: Racial and ethnic diversity of US participants in clinical trials for acne, atopic dermatitis, and psoriasis: a comprehensive review. J Dermatolog Treat. 2022;33(8):3086–3097.