VA Ann Arbor Healthcare System, Ambulatory Care 11A, 2215 Fuller Road, Ann Arbor, MI 48105, USA.
J Gen Intern Med. 2010 May;25(5):384-9. doi: 10.1007/s11606-009-1190-7.
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.
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.
Qualitative study involving 10 focus groups with 90 general internists.
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.
The focus groups were transcribed verbatim, and the data were analyzed using template analysis.
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.
Primary care physicians' opinions regarding race-based therapy reveal a nuanced understanding of race-based therapies and a wariness of their use by physicians.
在医疗照护和治疗患者的过程中，很少有信息表明医生是否应该考虑种族因素。初级保健医生如何理解基因、种族和药物之间的关系，有可能会影响到个人护理以及种族和族裔健康的差异。
描述医生使用基于种族的疗法，特别关注 BiDil（硝酸异山梨酯/肼屈嗪）的情况，这是 FDA 批准的第一种针对特定种族的药物，以及血管紧张素转换酶（ACE）抑制剂在其黑人和白人患者中的应用。
一项涉及 10 个焦点小组的 90 名普通内科医生的定性研究。
从社区和学术内科实践中招募的黑人和白人普通内科医生参加了焦点小组。参与者中，64%的人年龄小于 45 岁，73%的人为男性。
焦点小组的转录逐字记录，并使用模板分析方法对数据进行分析。
与基于种族的疗法实践相关的观点存在一定的差异。支持基于种族的疗法的医生引用了一些潜在的好处，包括激励患者遵守医疗治疗和通过创造药物和疗法专门为他们量身定制的观念来促进健康行为的改变。医生承认，在临床实践中，一些药物在不同种族群体中的疗效存在差异，一些医生引用了 ACE 抑制剂的例子。然而，医生担心那些可以从 ACE 抑制剂中受益的黑人患者可能没有接受这些药物。他们还担心种族这一类别反映了在基因层面上的显著差异。在 BiDil 的情况下，医生对商业利益是其研发背后的主要推动力表示担忧。
初级保健医生对基于种族的治疗的看法揭示了他们对基于种族的治疗的理解的细微差别，以及对医生使用这些治疗的谨慎态度。
