Abstract
The spectacular ascent of medical science at the dawn of the 21st century trumpets a new era in US healthcare 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 life-saving technologies to low-income and minority patient populations, whereas simultaneously controlling ever-rising healthcare 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 healthcare 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.
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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References
Poolsup, N., Li Wan Po, A., and Knight, T. L. (2000) Pharmacogenetics and psychopharmacotherapy. J. Clin. Pharm. Ther. 25, 197–220.
Taylor, A. L., Ziesche, S., Yancy, C., et al. (2004) African American Heart Failure Trial. N. Engl. J. Med. 351, 2049–2057.
Yancy, C. W. (2000) Heart failure in African Americans: A cardiovascular engima. J. Card. Fail. 6, 183–186.
Rogers, W. A. (2004) Evidence based medicine and justice: A framework for looking at the impact of EBM upon vulnerable or disadvantaged groups. J. Med. Ethics 30(2), 141–145.
Taylor, S. E. and Braithwaite, R. L. (2001) African American Health: An Overview, in Health Issues in the Black Community, 2nd ed. (Braithwaite, R. L. and Taylor, S. E. eds.) Jossey-Bass Inc., San Francisco, p. 371.
DuBois, W. E. B. (1998) The Philadelphia Negro: A Social Study, University of Pennsylvania Press, Philadelphia.
Byrd, W. M. and Clayton, L. A. (2000) An American Health Dilemma: A Medical History of African Americans and the Problem of Race: Beginnings to 1900, Vol. 1, 1st ed., Routledge, New York.
Byrd, W. M. and Clayton, L. A. (2002) An American Health Dilemma: Race, Medicine, Health Care in the United States 1900–2000, Vol. 2, 1st ed., Brunner-Routledge, New York.
Smedley, B. D., Stith, A. Y., and Nelson, A. R. (2003) Unequal treatment: confronting racial and ethnic disparities in health care, Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care, Institute of Medicine National Academies Press, Washington, DC.
The Sullivan Commission on Diversity in the Healthcare Workforce (2004). Missing Persons: Minorities in the Health Professions, Washington, DC.
Trivedi, A. N., Zaslavsky, A. M., Schneider, E. C., and Ayanian, J. Z. (2005) Trends in the Quality of Care and Racial Disparities in Medicare Managed Care. N. Engl. J. Med. 353(7), 692–700.
Vaccarino, V., Rathore, S. S., Wenger, N. K., et al. (2005) Sex and Racial Differences in the Management of Acute Myocardial Infarction, 1994 through 2002. N. Engl. J. Med. 353(7), 671–682.
Jha, A. K., Fisher, E. S., Li, Z., Orav, E. J., and Epstein, A. M. (2005) Racial Trends in the Use of Major Procedures among the Elderly. N. Engl. J. Med. 353(7), 683–691.
Steinberg, E. P. and Luce, B. R. (2005) Evidence Based? Caveat Emptor! Health Aff. 24(1), 80–92.
Gelijins, A. C., Brown, L. D., Magnell, C., Ronchi, E., and Moskowitz, A. J. (2005) Evidence, Politics, and Technological Change. Health Aff. 24(1), 29–40.
Helfand, M. (2005) Using Evidence Reports: Progress and Challenges In Evidence-Based Decision Making. Health Aff. 24(1), 123–127.
Humphreys, K. and Weisner, C. (2000) Use of Exclusion Criteria in Selecting Research Subjects and Its Effect on the Generalisability of Alcohol Treatment Outcome Studies. Am. J. Psychiatry 157(4), 588–594.
Pablos-Mendez, A., Barr, R. G., and Shea, S. (1998) Run-in Periods in Randomized Trials: Implications for the Application of Results in Clinical Practice. J. Am. Med. Assoc. 279(3), 222–225.
Wells, K. B. (1999) Treatment Research at the Crossroads: The Scientific Interface of Clinical Trials and Effectiveness Research. Am. J. Psychiatry 156(1), 5–10.
Swanson, G. M. and Bailar, J. C. (2002) Selection and description of cancer clinical trials participants—Science or happenstance? Cancer 95(5), 950–959.
Kaiser Family Foundation (2005) Fact Sheet: African Americans and HIV/AIDS Update, Kaiser Family Foundation.
Tucker, W. H. (1996) The Science and Politics of Racial Research. University of Illinois Press, Chicago.
Matthews, H. W. (1995) Racial, ethnic and gender differences in response to medicines. Drug Metabol. Drug Interact 12(2), 77–91.
Rosenthal, M. B., Frank, R. G., Li, Z., and Epstein, A. M. (2005) Early Experience With Pay-for-Performance. J. Am. Med. Assoc. 294(14), 1788–1793.
Werner, R. M., Asch, D. A., and Polsky, D. (2005) Racial Profiling: The Unintended Consequences of Coronary Artery Bypass Graft Report Cards. Circulation 111(10), 1257–1263.
Eddy, D. M. (2005) Evidence-Based Medicine: A Unified Approach. Health Aff. 24(1), 9–17.
Kerse, N., Buetow, S., Mainous, A. G., Young, G., III, Coster, G., and Arroll, B. (2004) Physician-Patient Relationship and Medication Compliance: A Primary Care Investigation. Ann. Fam. Med. 2(5), 455–461.
Bankole, K. K. (1998) Slavery and Medicine: Enslavement and Medical Practices in AnteBellum Louisiana. Taylor & Francis, Inc., New York.
Bediako, S. M. (2000) Reconceptualizing “ Health Disparities” in African American Communities.
Brandon, D. T., Isaac, L. A., and LaVeist, T. A. (2005) The Legacy of Tuskegee and Trust in Medical Care: Is Tuskegee Responsible for Race Differences in Mistrust of Medical Care? J. Nat. Med. Assoc. 97(7), 951–956.
Fett, S. M. (2002) Working Cures: Healing, Health, and Power on Southern Slave Plantations. 1st ed., University of North Carolina Press, Chapel Hill.
Gamble, V. N. (2000) Under the Shadow of Tuskegee: African Americans and Health Care, in Tuskegee’s Truths: Rethinking the Tuskegee Syphilis Study, (Reverby, S. M. ed.) University of North Carolina Press, Chapel Hill, p. 656.
Airhihenbuwa, C. O. (1995) Health & Culture: Beyond the Western Paradigm. Sage Publications, Inc., Thousand Oaks.
Sackett, D. L., Rosenberg, W. M. C., Muir Gray, J. A., Haynes, R. B., and Richardson, W. S. (1996) Evidence-based medicine: what it is and what it isn’t. Brit. Med. J. 312, 71–72.
Fox, D. M. (2005) Evidence of Evidence-Based Health Policy: The Politics of Systematic Reviews In Coverage Decisions. Health Aff. 24(1), 114–122.
Williams, A. (1992) Priority Setting in a Needs-based System, in Medical Innovations at the Crossroads, Technology and Healthcare in an Era of Limits, Vol. 3 (Gelijns, A. C., ed.) National Academies Press, Washington.
Mendelson, D. and Carino, T. V. (2005) Evidence-based Medicine in the United States—DeRigueur or Dream Deferred? Health Aff. 24(1), 133–136.
Committee on Quality of Health Care in America (2001). Institute of Medicine, Crossing the quality chasm: a new health system for the 21st century, National Academy Press, Washington, DC.
Claxton, K., Cohen, J. T., and Neumann, P. J. (2005) 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. 24(1), 93–101.
GRADE Working Group (2004). Grading quality of evidence and strength of recommendations. Brit. Med. J. 328(7454), 1490–1494.
Rodwin, M. A. (2001) The Politics of Evidence-Based Medicine. J. Health Polit. Policy Law. 26(2), 439–446.
Gadson, S. L. (2005) One More River to Cross—Looking Back, Moving Forward: Advancing the NMA “Equality Agenda” in the Era of 21st-Century Medicine. J. Nat. Med. Assoc. 97(10), 1327–1333.
US Department of Health and Human Services (2004). Centers for Medicare & Medicaid Services, 2003 CMS Statistics, http://new.cms.hhs.gov/MedicareMedicaidStatSupp/downloads/03CMSstats.pdf.
US Department of Health and Human Services (2000). Healthy people 2010: understanding and improving health, 2nd ed. US Department of Health and Human Services, Washington, DC.
Allen, C. E. (2001) 2000 presidential address: eliminating health disparities. Am. J. Public Health 91(7), 1142–1143.
Teutsch, S. M., Berger, M. L., and Weinstein, M. C. (2005) Comparative Effectiveness: Asking the Right Questions, Choosing the Right Method. Health Aff. 24(1), 128–132.
Semmes, C. E. (1996) Racism, Health and Post-Industrialism: A Theory of African American Health. Praeger Paperback, Westport, CT.
Cohen, H. W. and Northridge, M. E. (2000) Getting political: racism and urban health. Am. J. Public Health 90(6), 841–842.
Kreiger, N. (1987) Shades of Difference: Theoretical Underpinnings of the Medical Controversy on Black-White Differences in the United States, 1830–1870. Int. J. Health Serv. 17(2), 259–278.
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Maxey, R.W., Williams, R.A. (2007). Second-Class Medicine. In: Williams, R.A. (eds) Eliminating Healthcare Disparities in America. Humana Press. https://doi.org/10.1007/978-1-59745-485-8_6
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