New Book, Survey Highlight Differences in Care Among Whites, Minorities

Two Harvard doctors have released the second volume of a book that says African Americans have historically and "systematically suffered from inferior medical care," the Boston Globe reports. The 1,300-page work, "An American Health Care Dilemma," was written by Drs. W. Michael Byrd, a physician consultant at Beth Israel Deaconness Medical Center, and Linda Clayton, associate medical director of the Massachusetts Division of Medical Assistance, and is "widely regarded as the most persuasive and detailed account of blacks' troubled relationship with U.S. health care." The book examines the hurdles faced by African Americans who have attempted to enter medical school, practice medicine in hospitals dominated by white doctors and join professional organizations such as the American Medical Association. It also outlines the history of health care for African Americans since "colonial times" when an "alternative, slave health subsystem" existed. Byrd and Clayton write that "[n]ot until the Civil Rights movement of the 1960s ... did significant improvement in black health status occur." Since that time, however, African Americans have lost some of those gains, in part because of decreased funding for medical aid programs and community health centers. Dr. Augustus White of Harvard Medical School and Beth Israel said that the book should be required medical school reading. The Globe reports that the book has been published at the same time as a report from the Institute of Medicine found that African Americans "still receive inferior health care and are sicker" than whites. Byrd was also involved in the IOM research (Saltus, Boston Globe, 3/26).

Doctors' Perception of Racial Discrimination
Meanwhile, a preliminary report released last week by the Kaiser Family Foundation found that most physicians acknowledge that racial disparity exists in medicine, but they do not think it is a "widespread problem." Of 2,608 doctors surveyed prior to the IOM report, 65% said there are racial disparities in heart disease treatment, and 57% said there are such disparities in HIV/AIDS treatment (KFF release, 3/22). But 69% of the doctors also said that the U.S. health care system "rarely or never" treats patients unfairly because of race (Boston Globe, 3/26). Further, 52% percent of survey participants said that the health care system "rarely" or "never" treats people unfairly based on income, 55% said the same for fluency in English, 60% on educational status and 84% in regard to sexual orientation ( ReutersHealth, 3/25). In contrast, almost 80% of African-American doctors said that patients are treated unfairly "somewhat often" because of their race or ethnicity (Boston Globe, 3/26). Overall, doctors thought that patients were treated unfairly "very" or "somewhat" often because of their health insurance status, the survey found (KFF release, 3/22). Forty-seven percent of participants said that money, 43% said English-speaking skills and 39% said education also are factors in unfair treatment (ReutersHealth, 3/25). The complete results of the survey will be released later this year (KFF release, 3/22). The preliminary survey highlights are available online. Note: You will need Adobe Acrobat Reader to view the highlights.

Discrimination Through Genetic Testing?
In related news, the Minneapolis Star Tribune reports on the continuing "heated debate" over whether different drugs may be more effective in treating illnesses in people of certain racial groups (Schmickle, Minneapolis Star Tribune, 3/26). The controversy began when Dr. Jay Cohn, a cardiologist at the University of Minnesota, reported in 1999 that African-American heart failure patients do not respond as well as white patients to treatment with an ACE inhibitor. Cohn said the drugs might not work as well for African Americans because of "genetic differences" (American Health Line, 9/10/99). Since then, Cohn has discovered an alternative heart failure treatment that is more effective in African Americans, and the FDA has taken the "unprecedented step" of authorizing a clinical trial for African Americans only. However, some critics of the decision say such studies could lead to further racial discrimination in medicine. For example, drug makers could use the results of such genetic studies to "target products precisely toward whites," who are the largest and most affluent consumers of pharmaceuticals. Dr. Robert Schwartz, an editor at the New England Journal of Medicine, advised against such genetic studies and wrote in an opinion article accompanying one of Cohn's reports that "[r]ace is a social construct, not a scientific classification." But Cohn has responded by saying that it "flies in the face of reality" to believe there are not genetic differences between races. "I don't understand why there is this hue and cry that we should not use characteristics of people to help manage, diagnose and treat human disease," he said (Minneapolis Star Tribune, 3/26).