Primary care physicians' attitudes regarding race-based therapies.

BACKGROUND: 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. OBJECTIVE: 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. DESIGN: Qualitative study involving 10 focus groups with 90 general internists. PARTICIPANTS: 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. APPROACH: The focus groups were transcribed verbatim, and the data were analyzed using template analysis. RESULTS: 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. CONCLUSIONS: Primary care physicians' opinions regarding race-based therapy reveal a nuanced understanding of race-based therapies and a wariness of their use by physicians.

Physicians' attitudes toward race, genetics, and clinical medicine.

PURPOSE: This qualitative study explored black and white general internists' attitudes about the relevance of race in clinical care; views of the relationships among race, genetics, and disease; and expectations about the future of genetics and health. METHODS: We conducted 10 racially concordant focus groups of primary care physicians in five metropolitan areas in the United States. Ninety board certified or eligible general internists (50 self-identified whites and 40 self-identified blacks) participated in the study. Analysis included a two-stage independent review and adjudication process. RESULTS: Both black and white physicians concluded that the race of the patient is medically relevant but did not agree upon why race is important in clinical decisions. They were reticent to make connections among race, genetics, and disease and asserted that genetics has a limited role in explaining racial differences in health. However, they were enthusiastic about the future of genomic medicine, believing that the main benefit will be the potential to improve the efficacy of commonly used drugs. CONCLUSIONS: Understanding the similarities and differences between black and white physicians' attitudes and beliefs about race, health and genetics is important for the translation of genomics to clinical care.

Moving upstream: how interventions that address the social determinants of health can improve health and reduce disparities.

There is considerable scientific and policy interest in reducing socioeconomic and racial/ethnic disparities in healthcare and health status. Currently, much of the policy focus around reducing health disparities has been geared toward improving access, coverage, quality, and the intensity of healthcare. However, health is more a function of lifestyles linked to living and working conditions than of healthcare. Accordingly, effective efforts to improve health and reduce gaps in health need to pay greater attention to addressing the social determinants of health within and outside of the healthcare system. This article highlights research evidence documenting that tackling the social determinants of health can lead to reductions in health disparities. It focuses both on interventions within the healthcare system that address some of the social determinants of health and on interventions in upstream factors such as housing, neighborhood conditions, and increased socioeconomic status that can lead to improvements in health. The studies reviewed highlight the importance of systematic evaluation of social and economic policies that might have health consequences and the need for policy makers, healthcare providers, and leaders across multiple sectors of society to apply currently available knowledge to improve the underlying conditions that impact the health of populations.

Mixed Race: Understanding Difference in the Genome Era.

This article presents the findings of a qualitative study of multiracial individuals' understanding of identity, race and human genetic variation. The debate regarding the correlation between race, genetics and disease has expanded, but limited empirical data has been collected regarding the lay public's perspective. Participants in this study explore their identity and its relationships to their health care interactions. Participants also share their views on race-based therapeutics, health disparities and the connections between race, ancestry and genetics. Their voices highlight the limitations of racial categories in describing differences within our increasingly diverse communities. The genomic era will be a pivotal period in challenging current understandings and uses of racial categories in health.