Clearing Up Lingering Racial Bias in Medicine

Douglas L. Jennings, PharmD, FACC, FAHA, FCCP, FHFSA, BCPS

The integration of racial bias in medical decision-making has frequently resulted in a reduced level of health care quality for patients from various backgrounds. And it didn’t end with debacles like the Tuskegee Airman experience; these types of racially tinged failures are still occurring today. For instance, the Modified Diet in Renal Disease (MDRD) formula, which includes a race-based modifier, was recently proved erroneous, but not after it damaged the health care of Black patients for decades.

There has long been a theory that Black patients respond less favorably to renin-angiotensin-aldosterone (RAAS) inhibitors. This has led to a reduced rate of prescribing of these lifesaving medications for Black patients with hypertension and heart failure (HF) with a reduced ejection fraction (HFrEF). In this installment of Talking Therapeutics, we discuss a new paper that explores some old evidence addressing this important topic.

Talking Point: No Signal for a Race-Associated Impact

In this new paper, authors conducted a meta-analysis involving more than 16 000 patients from 5 randomized trials that evaluated the effectiveness of RAAS inhibitors in patients with HFrEF.

The analysis showed that rates of death and hospitalization for HF were substantially higher in Black patients than other ethnicities. The HR for RAAS blockade vs placebo for the compositive of hospitalization for HF or cardiovascular death was 0.84 (95% CI, 0.69-1.03) in Black patients and 0.73 (95% CI, 0.67-0.79) in other patients (P for interaction = .14). For total hospitalizations for HF and cardiovascular deaths, the corresponding rate ratios were 0.82 (95% CI, 0.66-1.02) and 0.72 (95% CI, 0.66-0.80), respectively (P for interaction = .27).

Talking Point: Time to Change Race-Based Medicine

Whenever theoretical race-based responses in medicine are challenged with science, the race-based premise is nearly always disproven. This new paper confirms that Black patients with HFrEF achieve the same clinical benefits with RAAS as other patients, demonstrating that race does not influence a treatment outcome.

The larger lesson here is that whenever we encounter premise that patients of a certain race respond differently to specific treatments, we should consider it inaccurate, and question the underlying science before implementing it.