Abstract
The Promise of Evidence-Based Medicine. The spectacular ascent of medical science at the dawn of the twenty-first century trumpets a new era in US health care and great possibilities for preserving human health. At the same time, it poses serious challenges for policymakers who must make crucial decisions about the safety, efficacy, and affordability of medical technologies. One of the most difficult and contentious matters confronting decision-makers is the question of how to ensure the delivery of lifesaving technologies to low-income and minority patient populations, whereas simultaneously controlling ever-rising health-care costs. In theory, the increasingly popular concept of evidence-based medicine (EBM) suggests a potential tool for both cost containment and the reduction of severe racial and ethnic disparities in health-care delivery. Drawn from systematic reviews of studies that use rigorous research methods, particularly the randomized controlled trial, the “evidence” guiding EBM protocols informs treatment decisions made by physicians, as well as policy decisions regarding the allocation of health technologies at the population level. Operating largely out of the “average” American’s view, EBM protocols are policy devices that set the rules for who gets what medical care and on what terms. The foremost claim of some advocates of EBM is that it serves this function well by providing the best available “evidence” about therapeutic interventions, thereby enhancing the capacity of policymakers and physicians to make sound, defensible decisions. At least in theory, the use of EBM should lead invariably to rational decisions so that patients with the same illnesses and clinical indications receive appropriate interventions regardless of race or ethnicity. Again in theory, policy decisions made within EBM frameworks should lead to evenhandedness in the allocation of therapeutic interventions at the population level. Thus, EBM offers the “implicit promise of greater fairness than previously existed” (Poolsup et al., J Clin Pharm Ther 25:197–220, 2000; Taylor et al., N Engl J Med 351:2049–2057, 2004; Yancy, J Card Fail 6:183–186, 2000; Rogers, J Med Ethics 30(2):141–145, 2004).
R.W. Maxey
Past President, National Medical Association, President and Ceo, Executive Healthwatch, Inc., Los Angeles, California, USA
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References
Taylor SE, Braithwaite RL. African American health: an overview. In: Braithwaite RL, Taylor SE, editors. Health issues in the Black community. 2nd ed. San Francisco, CA: Jossey-Bass, Inc.; 2001. p. 371.
DuBois WEB. The Philadelphia Negro: a social study. Philadelphia, PA: University of Pennsylvania Press; 1998.
Byrd WM, Clayton LA. An American health dilemma: a medical history of African Americans and the problem of race: beginnings to 1900, vol. 1. 1st ed. New York: Routledge; 2000.
Byrd WM, Clayton LA. An American health dilemma: race, medicine, health care in the United States 1900–2000, vol. 2. 1st ed. New York: Brunner-Routledge; 2002.
Smedley BD, Stith AY, Nelson, AR. Unequal treatment: confronting racial and ethnic disparities in health care. Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, Washington, DC: Institute of Medicine National Academies Press; 2003.
The Sullivan Commission on Diversity in the Healthcare Workforce. Missing persons: minorities in the health professions. Washington, DC: National Academies Press; 2004.
Trivedi AN, Zaslavsky AM, Schneider EC, Ayanian JZ. Trends in the quality of care and racial disparities in medicare managed care. N Engl J Med. 2005;353(7):692–700.
Vaccarino V, Rathore SS, Wenger NK, et al. Sex and racial differences in the management of acute myocardial infarction, 1994 through 2002. N Engl J Med. 2005;353(7):671–82.
Jha AK, Fisher ES, Li Z, Orav EJ, Epstein AM. Racial trends in the use of major procedures among the elderly. N Engl J Med. 2005;353(7):683–91.
Steinberg EP, Luce BR. Evidence based? Caveat emptor! Health Aff. 2005;24(1):80–92.
Gelijins AC, Brown LD, Magnell C, Ronchi E, Moskowitz AJ. Evidence, politics, and technological change. Health Aff. 2005;24(1):29–40.
Helfand M. Using evidence reports: progress and challenges in evidence-based decision making. Health Aff. 2005;24(1):123–7.
Humphreys K, Weisner C. Use of exclusion criteria in selecting research subjects and its effect on the generalisability of alcohol treatment outcome studies. Am J Psychiatry. 2000;157(4):588–94.
Pablos-Mendez A, Barr RG, Shea S. Run-in periods in randomized trials: implications for the application of results in clinical practice. J Am Med Assoc. 1998;279(3):222–5.
Wells KB. Treatment research at the crossroads: the scientific interface of clinical trials and effectiveness research. Am J Psychiatry. 1999;156(1):5–10.
Swanson GM, Bailar JC. Selection and description of cancer clinical trials participants – science or happenstance? Cancer. 2002;95(5):950–9.
Kaiser Family Foundation (2005) Fact Sheet: African Americans and HIV/AIDS Update, Kaiser Family Foundation.
Tucker WH. The science and politics of racial research. Chicago, IL: University of Illinois Press; 1996.
Matthews HW. Racial, ethnic and gender differences in response to medicines. Drug Metabol Drug Interact. 1995;12(2):77–91.
Rosenthal MB, Frank RG, Li Z, Epstein AM. Early experience with pay-for-performance. J Am Med Assoc. 2005;294(14):1788–93.
Werner RM, Asch DA, Polsky D. Racial profiling: the unintended consequences of coronary artery bypass graft report cards. Circulation. 2005;111(10):1257–63.
Eddy DM. Evidence-based medicine: a unified approach. Health Aff. 2005;24(1):9–17.
Kerse N, Buetow S, Mainous AG, Young III G, Coster G, Arroll B. Physician-patient relationship and medication compliance: a primary care investigation. Ann Fam Med. 2004;2(5):455–61.
Bankole KK. Slavery and medicine: enslavement and medical practices in AnteBellum Louisiana. New York: Taylor & Francis; 1998.
Brandon DT, Isaac LA, LaVeist TA. The legacy of Tuskegee and trust in medical care: Is tuskegee responsible for race differences in mistrust of medical care? J Natl Med Assoc. 2005;97(7):951–6.
Fett SM. Working cures: healing, health, and power on southern slave plantations. 1st ed. Chapel Hill, NC: University of North Carolina Press; 2002.
Gamble VN. Under the shadow of Tuskegee: African Americans and health care. In: Reverby SM, editor. Tuskegee’s truths: rethinking the Tuskegee Syphilis Study. Chapel Hill, NC: Univeristy of North Carolina Press; 2000. p. 656.
Airhihenbuwa CO. Health and culture: beyond the western paradigm. Thousand Oaks, CA: Sage Publications; 1995.
Sackett DL, Rosenberg WMC, Muir Gray JA, Haynes RB, Richardson WS. Evidence-based medicine: what it is and what it isn’t. BMJ. 1996;312:71–2.
Fox DM. Evidence of evidence-based health policy: the politics of systematic reviews in coverage decisions. Health Aff. 2005;24(1):114–22.
Williams A. Priority setting in a needs-based system. In: Gelijns AC, editor. Medical innovations at the crossroads: technology and healthcare in an era of limits, vol. 3. Washington, DC: National Academies Press; 1992.
Mendelson D, Carino TV. Evidence-based medicine in the United States – DeRigueur or dream deferred? Health Aff. 2005;24(1):133–6.
Committee on Quality of Health Care in America. Institute of Medicine. In: Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy Press; 2001.
Claxton K, Cohen JT, Neumann PJ. When is evidence sufficient? A framework for making use of all available information in medical decision making and for deciding whether more is needed. Health Aff. 2005;24(1):93–101.
GRADE Working Group. Grading quality of evidence and strength of recommendations. BMJ. 2004;328(7454):1490–4.
Rodwin MA. The politics of evidence-based medicine. J Health Polit Policy Law. 2001;26(2):439–46.
Gadson SL. One more river to cross – looking back, moving forward: advancing the NMA “Equality Agenda” in the era of 21st-century medicine. J Natl Med Assoc. 2005;97(10):1327–33.
Rogers WA. Evidence based medicine and justice: a framework for looking at the impact of EBM upon vulnerable or disadvantaged groups. J Med Ethics. 2004;30(2):141–5.
US Department of Health and Human Services. 2004. Centers for medicare and medicaid services, 2003 CMS statistics, http://new.cms.hhs.gov/MedicareMedicaidStatSupp/downloads/03CMSstats.pdf.
US Department of Health and Human Services. Healthy people 2010: understanding and improving health. 2nd ed. Washington, DC: US Department of Health and Human Services; 2000.
Allen CE. 2000 presidential address: eliminating health disparities. Am J Public Health. 2001;91(7):1142–3.
Teutsch SM, Berger ML, Weinstein MC. Comparative effectiveness: asking the right questions, choosing the right method. Health Aff. 2005;24(1):128–32.
Semmes CE. Racism, health and post-industrialism: a theory of African American health. Westport, CT: Praeger Paperback; 1996.
Cohen HW, Northridge ME. Getting political: racism and urban health. Am J Public Health. 2000;90(6):841–2.
Kreiger N. Shades of difference: theoretical underpinnings of the medical controversy on Black-White differences in the United States, 1830–1870. Int J Health Serv. 1987;17(2):259–78.
Martin DF, Maguire MG, Fine SL. Identifying and eliminating the roadblocks to comparative-effectiveness research. N Engl J Med. 2010;362(3):105–7.
Poolsup N, Li Wan Po A, Knight TL. Pharmacogenetics and psychopharmacotherapy. J Clin Pharm Ther. 2000;25:197–220.
Taylor AL, Ziesche S, Yancy C, et al. African American heart failure trial. N Engl J Med. 2004;351:2049–57.
Yancy CW. Heart failure in African Americans: a cardiovascular enigma. J Card Fail. 2000;6:183–6.
Acknowledgments
Special thanks to the Alliance of Minority Medical Associations and the Commission on Health, Genetics, and Human Variation. The authors acknowledge the assistance of Health Policy Analyst and Science Writer, John Sankofa, who contributed significantly to the development of this chapter.
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Maxey, R.W., Williams, R.A. (2011). Perspective: Second-Class Medicine – Implications of Evidence-Based Medicine for Improving Minority Access to Health Care. In: Williams, R. (eds) Healthcare Disparities at the Crossroads with Healthcare Reform. Springer, Boston, MA. https://doi.org/10.1007/978-1-4419-7136-4_8
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