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Racial And Ethnic Gaps Remain A Big Question in Medicine

Hispanics living in the United States have a lower death rate than non-Hispanic whites for seven of the 10 leading causes of death. But, as the Centers for Disease Control and Prevention discovered, the three diseases for which Hispanic death rates are higher point to some pervasive problems in access to healthcare.

Although previous research has suggested that medicine may structurally neglect certain populations, there’s still a lot of work to do to reveal the gaps, let alone fix them.

Hispanic death rates are higher than non-Hispanic white patients’ for diabetes, chronic liver disease and kidney disease. These chronic conditions may be more deadly for Hispanics because they require repeated monitoring and interventions, and Hispanics living in the U.S. are more likely to have trouble accessing medical help. They are three times as likely to be uninsured as non-Hispanic white residents. And one in three Hispanic people living in the U.S. does not speak English well, and may have difficulty in conversations with a doctor.

But even when Hispanics make it to the doctor’s office to seek treatment, they may run into another problem. The medicines that they need were rarely tested on people like them. Some medicines act differently or are appropriate at different doses for particular demographic groups, so being left out of trials can prevent these benefits and side effects from being noticed. As of 2011, Hispanics were 16 percent of the U.S. population but only comprised 1 percent of clinical trial participants. African-Americans are also underrepresented, comprising only 5 percent of the clinical trial participants even though they are 12 percent of the population.

Missing out on trials can mean missing out on medicine. In 2005, the Food and Drug Administration approved a heart drug, BiDil, specifically for use with African-American patients. The drug had produced insignificant benefits when it was tested in a general population in its first study, but appeared to have a more pronounced effect among African-Americans, so the FDA asked the manufacturer to run an additional trial, confined to self-identified black patients.  Based on that second trial, the FDA approved BiDil for black heart-failure patients.

Under-representation in clinical trials doesn’t just cause patients to miss out on benefits, it sometimes produces direct harm.  The FDA had to revise its recommended Ambien dose in 2013, because the old dose worked fine for men, but was too much for most women because they metabolized it differently.  The FDA came up with a new women’s dose that was half the previous recommendation.

When population groups wind up with different medical outcomes, it’s not necessarily a matter of biology – it may be bias.  A 2008 study in Academic Emergency Medicine found that women who came to the emergency room with abdominal pain were less likely to be given strong pain medication than men.  Even when controlling for age, race, and pain level, women were 13 to 25 percent less likely than men to receive opiates in response to their symptoms.

A similar 1999 study in the New England Journal of Medicine hired actors to play patients with chest pain, and then asked doctors to recommend treatment.  Doctors were significantly less likely to recommend cardiac catheterization for women than for men, or for black patients than for white patients.

Each of these studies, including the CDC’s new profile of Hispanic health, identifies one symptom of a larger, chronic condition. Patients outside the model of the “default patient” can wind up left out of improved treatments, clinical trials and even routine care.  Gathering more data on the people left out of the aggregates can help doctors and administrators diagnose and address these disparities.

Leah Libresco is a former news writer for FiveThirtyEight.