JAMA : the journal of the American Medical Association
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Persistent, and sometimes substantial, differences continue to exist in the quality of health among Americans. Blacks have higher infant mortality rates and shorter life expectancies than whites. Underlying the disparities in the quality of health among Americans are differences in both need and access. ⋯ These studies have examined treatments in several area, including cardiology and cardiac surgery, kidney transplantation, general internal medicine, and obstetrics. Whether the disparities in treatment decisions are caused by differences in income and education, sociocultural factors, or failures by the medical profession, they are unjustifiable and must be eliminated. In this report, the Council on Ethical and Judicial Affairs of the American Medical Association emphasizes the need for (1) greater access to necessary health care for black Americans, (2) greater awareness among physicians of existing and potential disparities in treatment, and (3) the continued development of practice parameters, including criteria that would preclude or diminish racial disparities in health care decisions.
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Data from two pharmaceutical marketing research databases, the National Prescription Audit and the National Disease and Therapeutic Index, were used to study trends in outpatient use of cholesterol-lowering drugs in the United States from 1978 through 1988. Retail pharmacies dispensed an estimated 4.4 million prescriptions for cholesterol-lowering drugs in 1978. This declined to 2.6 million in 1983 and increased dramatically to nearly 13 million in 1988. ⋯ From 1978 through 1988, an average 54% of individuals using cholesterol-lowering drugs were 60 years of age or older. The 13 million prescriptions for cholesterol-lowering drugs in 1988 represent a maximum estimate of 13 million treated individuals. This number compares with the 60 million Americans with high cholesterol levels who are candidates for dietary advice, and, if cholesterol levels do not improve, for combined diet and drug intervention.