One medical student’s inquiry results in profession-wide changes.
During her second year of medical school, Adeiyewunmi “Ade” Osinubi ’18 MD’22 became aware of a commonly held belief that Black girls are prone to exhibit puberty at a younger age than white girls.
OK, she thought, but why? And what are the implications of that belief?
During her pediatrics clerkship the following year, she got the chance to seek answers to those questions, when Paula Lewis-de los Angeles RES’24, MD, PhD, invited her to present on the topic. In her research, Osinubi again encountered rhetoric (including in medical guidelines) suggesting race as a risk factor for precocious puberty but offering no information about possible underlying causes, let alone what might be the psychosocial consequences for Black girls.
Lewis-de los Angeles, a triple board (pediatrics, psychiatry, and child and adolescent psychiatry) resident, was impressed by the results, and encouraged Osinubi to delve deeper. She recruited Lisa Swartz Topor, MD, MMSc, program director of pediatric endocrinology at Rhode Island and Hasbro Children’s hospitals and an associate professor of pediatrics; and Patricia Poitevien ’94 MD’98, MSc, a pediatrician and the Medical School’s senior associate dean for diversity, equity, and inclusion, to work with them.
Swartz Topor was thrilled to join the team. “When you teach students and doctors and parents, ‘The textbook says this is happening because of that,’ there’s a closure that happens. No one questions it. You have to have a student like Ade, who is passionate and asks the questions,” she says.
Last July, the foursome published a feature article in Pediatrics that traces the putative race-puberty connection back to a 1997 study, which found that breast development in Black girls began a year earlier than in white girls. While guidelines were never officially recognized, connecting girls’ pubertal timing with race has been accepted in medicine ever since.
In their paper, however, the authors point to possible sociopolitical reasons that Black girls might begin puberty sooner, such as exposure to environmental hazards, chemicals in hair products, food insecurity, and early childhood stress. They warn that the notion can result in sub-par medical care and perpetuate adultification bias, in which Black girls are viewed as more mature than their peers, making them vulnerable to harsher punishments and sexual harassment.
“[I]t is important to move away from race-based medicine and adopt principles of race-conscious medicine [that]identifies racism as a primary driver of disparities,” they concluded.
The impacts of the paper have rippled through the pediatrics and endocrinology communities—and beyond. Swartz Topor has been invited to speak on the topic at other institutions, as well as at the 2023 Endocrine Society meeting. UpToDate, an evidence-based clinical decision-making platform, cited the paper and adapted its guidelines on puberty. And the American Academy of Pediatrics recently published a policy statement calling for the elimination of race-based medicine in pediatrics.
But Osinubi, now an emergency medicine resident at the University of Pennsylvania, wanted to reach the general public as well, especially Black girls. She pitched a piece titled “What Early Puberty Is Like for Black Girls” to Teen Vogue, which published it in February.
“This [research]is going to do a great service to a lot of moms and daughters in doctors’ offices,” Swartz Topor says. “It will empower them with knowledge.”
The “snowball” effect of Osinubi’s inquiry is significant for Poitevien.
“This is the magic of our medical community,” she says. “No other story better embodies how a student’s question gets elevated, researched, and supported by residents and faculty, and then makes a significant change for patients.”