Second-Class Medicine

Implications of Evidence-Based Medicine for Improving Minority Access to the Correct Pharmaceutical Therapy
  • Randall W. Maxey
  • Richard Allen Williams


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.


Racial Disparity Ethnic Disparity Healthcare Disparity Drug Review Racial Inequity 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Poolsup, N., Li Wan Po, A., and Knight, T. L. (2000) Pharmacogenetics and psychopharmacotherapy. J. Clin. Pharm. Ther. 25, 197–220.PubMedCrossRefGoogle Scholar
  2. 2.
    Taylor, A. L., Ziesche, S., Yancy, C., et al. (2004) African American Heart Failure Trial. N. Engl. J. Med. 351, 2049–2057.PubMedCrossRefGoogle Scholar
  3. 3.
    Yancy, C. W. (2000) Heart failure in African Americans: A cardiovascular engima. J. Card. Fail. 6, 183–186.PubMedCrossRefGoogle Scholar
  4. 4.
    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.PubMedCrossRefGoogle Scholar
  5. 5.
    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.Google Scholar
  6. 6.
    DuBois, W. E. B. (1998) The Philadelphia Negro: A Social Study, University of Pennsylvania Press, Philadelphia.Google Scholar
  7. 7.
    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.Google Scholar
  8. 8.
    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.Google Scholar
  9. 9.
    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.Google Scholar
  10. 10.
    The Sullivan Commission on Diversity in the Healthcare Workforce (2004). Missing Persons: Minorities in the Health Professions, Washington, DC.Google Scholar
  11. 11.
    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.PubMedCrossRefGoogle Scholar
  12. 12.
    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.PubMedCrossRefGoogle Scholar
  13. 13.
    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.PubMedCrossRefGoogle Scholar
  14. 14.
    Steinberg, E. P. and Luce, B. R. (2005) Evidence Based? Caveat Emptor! Health Aff. 24(1), 80–92.CrossRefGoogle Scholar
  15. 15.
    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.CrossRefGoogle Scholar
  16. 16.
    Helfand, M. (2005) Using Evidence Reports: Progress and Challenges In Evidence-Based Decision Making. Health Aff. 24(1), 123–127.CrossRefGoogle Scholar
  17. 17.
    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.PubMedCrossRefGoogle Scholar
  18. 18.
    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.CrossRefGoogle Scholar
  19. 19.
    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.PubMedGoogle Scholar
  20. 20.
    Swanson, G. M. and Bailar, J. C. (2002) Selection and description of cancer clinical trials participants—Science or happenstance? Cancer 95(5), 950–959.PubMedCrossRefGoogle Scholar
  21. 21.
    Kaiser Family Foundation (2005) Fact Sheet: African Americans and HIV/AIDS Update, Kaiser Family Foundation.Google Scholar
  22. 22.
    Tucker, W. H. (1996) The Science and Politics of Racial Research. University of Illinois Press, Chicago.Google Scholar
  23. 23.
    Matthews, H. W. (1995) Racial, ethnic and gender differences in response to medicines. Drug Metabol. Drug Interact 12(2), 77–91.PubMedGoogle Scholar
  24. 24.
    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.CrossRefGoogle Scholar
  25. 25.
    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.PubMedCrossRefGoogle Scholar
  26. 26.
    Eddy, D. M. (2005) Evidence-Based Medicine: A Unified Approach. Health Aff. 24(1), 9–17.CrossRefGoogle Scholar
  27. 27.
    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.PubMedCrossRefGoogle Scholar
  28. 28.
    Bankole, K. K. (1998) Slavery and Medicine: Enslavement and Medical Practices in AnteBellum Louisiana. Taylor & Francis, Inc., New York.Google Scholar
  29. 29.
    Bediako, S. M. (2000) Reconceptualizing “ Health Disparities” in African American Communities.Google Scholar
  30. 30.
    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.Google Scholar
  31. 31.
    Fett, S. M. (2002) Working Cures: Healing, Health, and Power on Southern Slave Plantations. 1st ed., University of North Carolina Press, Chapel Hill.Google Scholar
  32. 32.
    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.Google Scholar
  33. 33.
    Airhihenbuwa, C. O. (1995) Health & Culture: Beyond the Western Paradigm. Sage Publications, Inc., Thousand Oaks.Google Scholar
  34. 34.
    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.PubMedGoogle Scholar
  35. 35.
    Fox, D. M. (2005) Evidence of Evidence-Based Health Policy: The Politics of Systematic Reviews In Coverage Decisions. Health Aff. 24(1), 114–122.CrossRefGoogle Scholar
  36. 36.
    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.Google Scholar
  37. 37.
    Mendelson, D. and Carino, T. V. (2005) Evidence-based Medicine in the United States—DeRigueur or Dream Deferred? Health Aff. 24(1), 133–136.CrossRefGoogle Scholar
  38. 38.
    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.Google Scholar
  39. 39.
    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.CrossRefGoogle Scholar
  40. 40.
    GRADE Working Group (2004). Grading quality of evidence and strength of recommendations. Brit. Med. J. 328(7454), 1490–1494.CrossRefGoogle Scholar
  41. 41.
    Rodwin, M. A. (2001) The Politics of Evidence-Based Medicine. J. Health Polit. Policy Law. 26(2), 439–446.PubMedCrossRefGoogle Scholar
  42. 42.
    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.Google Scholar
  43. 43.
    US Department of Health and Human Services (2004). Centers for Medicare & Medicaid Services, 2003 CMS Statistics, Scholar
  44. 44.
    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.Google Scholar
  45. 45.
    Allen, C. E. (2001) 2000 presidential address: eliminating health disparities. Am. J. Public Health 91(7), 1142–1143.PubMedGoogle Scholar
  46. 46.
    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.CrossRefGoogle Scholar
  47. 47.
    Semmes, C. E. (1996) Racism, Health and Post-Industrialism: A Theory of African American Health. Praeger Paperback, Westport, CT.Google Scholar
  48. 48.
    Cohen, H. W. and Northridge, M. E. (2000) Getting political: racism and urban health. Am. J. Public Health 90(6), 841–842.PubMedCrossRefGoogle Scholar
  49. 49.
    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.Google Scholar

Copyright information

© Humana Press Inc. 2007

Authors and Affiliations

  • Randall W. Maxey
    • 1
    • 2
    • 3
  • Richard Allen Williams
    • 4
    • 5
    • 6
  1. 1.National Medical AssociationUSA
  2. 2.Centinela/Freeman HospitalLos Angeles
  3. 3.Alliance of Minority Medical AssociationsUSA
  4. 4.The Daivd Geffen School of Medicine at UCLAUSA
  5. 5.The Minority Health Institute, Inc.USA
  6. 6.Institute for the Advancement of Multicultural and Minority MedicineLos Angeles

Personalised recommendations