5 - Racial and Ethnic Inclusiveness in Clinical Trials

Summary

INTRODUCTION

It is now well documented that substantial disparities exist in the quality and quantity of medical care received by minority Americans, especially those of African, Asian, and Hispanic heritage. These disparities can be found across many aspects of healthcare, including the delivery of pharmaceutical services.

Implicit in this finding is the ultimate outcome of increased disease and mortality rates for African Americans and other minorities. This is mostly due to a diminished quality of medical care and health services. Studies in cancer patients demonstrate that chemotherapy and analgesic therapy are more likely to be given to nonminorities. In the area of cardiovascular care, there are clear differences, not related to clinical factors, in treatment regimens after coronary angiography. Studies have shown that African Americans and Hispanics receive fewer antidepressants for clinical depression and are relatively undertreated with analgesics for pain from fractures or postoperative pain. African American and Hispanic patients with severe pain are less likely to be able to obtain commonly prescribed pain medicine because pharmacies in predominately nonwhite communities do not normally carry adequate stocks of opiates.

The disparity is also due, however, to a conscious or unconscious predilection to avoid using better quality but higher-cost pharmaceuticals in the treatment of African American and other minorities on the part of healthcare practitioners and institutions. This matters particularly with minorities because there is good evidence that the substitution of generic drugs places minority patients at greater risk.