JAMA : the journal of the American Medical Association
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Blacks represent about 12% of the nation's population, but only 6% of the total medical school enrollment, 5% of medical school graduates, 5% of postgraduate trainees, 3% of physicians in practice, and 2% of medical school faculties. Addressing this underrepresentation of blacks in medicine not only is a matter of justice, equity, and national conscience but also has implications for the provision of quality physician care to this nation's minority and medically underserved populations. ⋯ Black physicians are also more likely to practice in communities whose residents lack adequate access to medical care. An approach to addressing the problem of underrepresentation is proposed, consisting of activities at the precollege, college, and medical school levels.
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Investigations that have revealed racial differences in drug response and disposition indicate the need for adequate representation of racial minorities in clinical drug trials. There is concern, however, that there may be a disproportionate use of racial and ethnic minorities in clinical research due to the inner city location of most university hospitals. ⋯ It also was found that in the majority of studies, the proportion of black subjects is less than their proportion in the general population. This underrepresentation in clinical trials suggests that insufficient data exist to accurately assess the safety and efficacy of many new drugs in American blacks.
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To examine interracial differences in the utilization of coronary angiography, coronary artery bypass grafting, and coronary angioplasty for white and black patients, we examined all admissions for circulatory diseases or chest pain to Massachusetts hospitals in 1985. After controlling for age, sex, payer, income, primary diagnoses, and the number of secondary diagnoses, whites underwent significantly more angiography and coronary artery bypass grafting procedures. Whites also underwent more angioplasty procedures, but the difference was not statistically significant. Although utilization differences may reflect patient preference or different levels of disease severity and socioeconomic status not adequately accounted for, this study suggests that substantial racial inequalities exist in the use of procedures for patients hospitalized with coronary heart disease.