Primary Care Physicians’ Attitudes Regarding Race-Based Therapies
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
There is little to no information on whether race should be considered in the exam room by those who care for and treat patients. How primary care physicians understand the relationship between genes, race and drugs has the potential to influence both individual care and racial and ethnic health disparities.
To describe physicians’ use of race-based therapies, with specific attention to the case of BiDil (isosorbide dinitrate/hydralazine), the first drug approved by the FDA for a race-specific indication, and angiotensin-converting enzyme (ace) inhibitors in their black and white patients.
Qualitative study involving 10 focus groups with 90 general internists.
Black and white general internists recruited from community and academic internal medicine practices participated in the focus groups.Of the participants 64% were less than 45 years of age, and 73% were male.
The focus groups were transcribed verbatim, and the data were analyzed using template analysis.
There was a range of opinions relating to the practice of race-based therapies. Physicians who were supportive of race-based therapies cited several potential benefits including motivating patients to comply with medical therapy and promoting changes in health behaviors by creating the perception that the medication and therapies were tailored specifically for them. Physicians acknowledged that in clinical practice some medications vary in their effectiveness across different racial groups, with some physicians citing the example of ace inhibitors. However, physicians voiced concern that black patients who could benefit from ace inhibitors may not be receiving them. They were also wary that the category of race reflected meaningful differences on a genetic level. In the case of BiDil, physicians were vocal in their concern that commercial interests were the primary impetus behind its creation.
Primary care physicians’ opinions regarding race-based therapy reveal a nuanced understanding of race-based therapies and a wariness of their use by physicians.
Sources of Funding
- Lee C, Morton CC. Structural genomic variation and personalized medicine. N Engl J Med. 2008;358(7):740–1. CrossRef
- Levy H, Young JH. Perspectives from the clinic: will the average physician embrace personalized medicine? Clin Pharmacol Ther. 2008;83(3):492–3. CrossRef
- Feero WG, Guttmacher AE, Collins FS. The genome gets personal–almost. Jama. 2008;299(11):1351–2. CrossRef
- Manolio TA, Collins FS. Genes, environment, health, and disease: facing up to complexity. Hum Hered. 2007;63(2):63–6. CrossRef
- Taylor AL, Ziesche S, Yancy C, et al. Combination of isosorbide dinitrate and hydralazine in blacks with heart failure. N Engl J Med. 2004;351(20):2049–57. CrossRef
- Yancy CW. Race-based therapeutics. Curr Hypertens Rep. 2008;10(4):276–85. CrossRef
- FDA. 2005 BiDil Press Release. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2005/ucm108445.htm. Accessed September 18, 2009. 2005.
- Bonham VL, Sellers SL, Gallagher TH, et al. Physicians’ attitudes toward race, genetics, and clinical medicine. Genet Med. 2009;11(4):279–86. CrossRef
- Patton MQ. Qualitative Research & Evaluation Methods. 3rd ed. Thousand Oaks: Sage Publications; 2002.
- Cassell C, Symon G. Qualitative Methods and Analysis in Organizational Research: a Practical Guide. London: Sage Publications; 1998.
- Bush TM, Bonomi AE, Nekhlyudov L, et al. How the Women’s Health Initiative (WHI) influenced physicians’ practice and attitudes. J Gen Intern Med. 2007;22(9):1311–6. CrossRef
- Barr DA. The practitioner’s dilemma: can we use a patient’s race to predict genetics, ancestry, and the expected outcomes of treatment? Ann Intern Med. 2005;143(11):809–15.
- Bloche MG. Race-based therapeutics. N Engl J Med. 2004;351(20):2035–7. CrossRef
- Cooper RS, Psaty BM. Should ethnicity serve as the basis for clinical trial design? Diversity and inclusiveness should remain the guiding principles for clinical trials. Circulation. 2005;112(23):3660–5. discussion 3665-3666.
- Kahn J. Race in a bottle. Drugmakers are eager to develop medicines targeted at ethnic groups, but so far they have made poor choices based on unsound science. Sci Am. 2007;297(2):40–5. CrossRef
- Crabtree BF, ed. Doing Qualitative Research. Thousand Oaks: Sage Publications; 1999.
- Primary Care Physicians’ Attitudes Regarding Race-Based Therapies
Journal of General Internal Medicine
Volume 25, Issue 5 , pp 384-389
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- race-based therapies
- personalized medicine
- Industry Sectors
- Author Affiliations
- 7. (152); VA Ann Arbor Healthcare System, Ambulatory Care 11A, 2215 Fuller Road, Ann Arbor, MI, 48105, USA
- 1. Department of Medicine, University of Washington, Seattle, WA, USA
- 2. School of Social Work, University of Wisconsin, Madison, WI, USA
- 3. Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- 4. Department of Medicine, Tulane University, New Orleans, LA, USA
- 5. School of Public Health, Harvard University, Boston, MA, USA
- 6. National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA