Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3024 — Physicians’ Attitudes Regarding Race-Based Therapeutics

Frank D (VA Puget Sound Health Care System) , Gallagher T (University of Washington), Bonham V (NIH/NHGRI)

Objectives:
Differences in medication treatment effects for hypertension and congestive heart failure in Blacks and Whites have been widely reported in the medical literature and recent debates have focused on the role of genetic, social, and environmental factors in explaining racial variation in drug response. Angiotensin converting enzyme inhibitors (ace-inhibitors) and Bidil are two prominent examples of medications with reported differential effects across race. However, little is known about physicians’ attitudes toward race-based therapy and how they incorporate race-based therapy into their medical decision making. Our objective is to determine how physicians interpret and apply the literature on race-based therapies to their medical decision making.

Methods:
Ten focus groups of internal medicine physicians consisting of 5 groups of white physicians, and 5 groups of black physicians were organized. A total of 90 physicians in 5 US cities participated. Qualitative analysis was performed to determine physicians’ attitudes regarding race-based therapeutics and how physicians currently use BiDil and ace-inhibitors in their practices.

Results:
Both Black and White physicians were skeptical of the premise of BiDil, citing market forces as the primary impetus behind its creation. Physicians voiced concern that commercial considerations shaped the drug development of BiDil, thereby threatening the validity of the trial. Despite these concerns, both Black and White physicians reported using BiDil to treat their Black heart failure patients. In addition, Black physicians reported treating White patients with BiDil despite the lack of trial results. Most physicians did not feel that BiDil represented the future direction of medicine, rather they thought it would be an exception. Physicians hoped that eventually patients could be genotyped to determine if they would respond to a treatment or not but were skeptical of realizing the promise of genomic medicine. According to both Black and White physicians, hypertensive Whites respond better to ace-inhibitors as compared to hypertensive Blacks. However, physicians often recognized the potential renoprotective effects and post myocardial infarction benefits of ace-inhibitors in Black patients. Black physicians were more likely to start a Black patient on an ace-inhibitor as a first line agent for hypertension. White physicians were less likely to start Black patients on an ace-inhibitor in the absence of a compelling reason such as proteinuria. White physicians were more open to the concept of race-based therapeutics and the benefits it could bring when compared to the Black physicians. However, both White and Black physicians voiced concern about the consequences of race-based therapy.

Implications:
Both Black and White physicians were uncertain if they could identify patients who are most likely to benefit from a drug using race as a selection criterion. In addition, physicians were skeptical of drugs such as BiDil and expressed concerns about the design of the BiDil trial.

Impacts:
Physicians are skeptical of race-based therapeutics.