临床中的BiDil：对一种基于种族的疗法医生处方模式的跨学科调查。
BiDil in the Clinic: An Interdisciplinary Investigation of Physicians' Prescription Patterns of a Race-Based Therapy.
作者信息
Maglo Koffi N, Rubinstein Jack, Huang Bin, Ittenbach Richard F
机构信息
Department of Philosophy, 206 McMicken Hall, PO Box 210374, University of Cincinnati, Cincinnati, OH 45221-0374, Tel (513) 556-6337,
University of Cincinnati College of Medicine.
出版信息
AJOB Empir Bioeth. 2014 Oct 2;5(4):37-52. doi: 10.1080/23294515.2014.907371.
BACKGROUND
The African American Heart Failure Trial (A-HeFT) and the FDA approval of BiDil for race-specific prescription have stirred the debate about the scientific and medical status of race. Yet there is no assessment of the potential fallouts of this dispute on physicians' willingness to prescribe the drug. We present here an analysis of the factors influencing physicians' prescription of BiDil and investigate whether exposure to the controversy has an impact on their therapeutic judgments about the drug.
METHODS
We conducted an electronic survey with physicians in the department of internal medicine at the University of Cincinnati. Participants were randomly assigned to two groups, with one group receiving information about the controversy over BiDil. We used various statistical tests, including a linear mixed effects model, to analyze the results.
RESULTS
27% of the participants reported using patients' race as a major factor in making treatment decisions. 33% reported the inefficacy of standard therapies, 25% the severity of the disease, and 15% other unspecified factors as primary determining criteria in prescribing BiDil. With respect to the controversy, 68% of physicians reported that they were not aware of any controversy surrounding BiDil. Physicians' willingness to prescribe BiDil as a therapy was associated with their awareness of the controversy surrounding A-HeFT ( < 0.003). But their willingness to prescribe the therapy along racial lines did not vary significantly with exposure to the controversy.
CONCLUSIONS
Overall, physicians prescribe and are willing to prescribe BiDil more to black patients than to white patients. However, physicians' lack of awareness about the controversial scientific status of A-HeFT suggests the need for more efficient ways to convey scientific information about BiDil to clinicians. Furthermore, the uncertainties about the determination of clinical utility of BiDil for the individual patient raise questions about whether this specific race-based therapy is in patients' best interest.
背景
非裔美国人心力衰竭试验（A-HeFT）以及美国食品药品监督管理局（FDA）批准针对特定种族处方使用BiDil引发了关于种族的科学和医学地位的争论。然而，尚未评估这场争论对医生开具该药物处方意愿的潜在影响。我们在此呈现对影响医生开具BiDil处方的因素的分析，并调查接触这场争论是否会对他们关于该药物的治疗判断产生影响。
方法
我们对辛辛那提大学内科的医生进行了一项电子调查。参与者被随机分为两组，其中一组收到关于BiDil争议的信息。我们使用了各种统计测试，包括线性混合效应模型，来分析结果。
结果
27%的参与者报告将患者种族作为做出治疗决策的主要因素。33%报告标准疗法无效，25%报告疾病严重程度，15%报告其他未明确说明的因素是开具BiDil处方的主要决定标准。关于这场争论，68%的医生报告他们不知道围绕BiDil的任何争议。医生开具BiDil作为一种疗法的意愿与他们对A-HeFT争议的知晓程度相关（<0.003）。但他们按种族开具该疗法的意愿并未因接触这场争论而有显著差异。
结论
总体而言，医生给黑人患者开具BiDil并愿意给黑人患者开具BiDil的情况比给白人患者更多。然而，医生对A-HeFT有争议的科学地位缺乏认识表明，需要有更有效的方式向临床医生传达关于BiDil的科学信息。此外，BiDil对个体患者临床效用判定的不确定性引发了关于这种基于特定种族的疗法是否符合患者最佳利益的问题。
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