Second-class medicine: Implications of evidence-based medicine for improving minority access to the correct pharmaceutical therapy

Abstract

The spectacular ascent of medical science at the dawn of the 21st century trumpets a new era in US healthcare and great possibilities for preserving human health. At the same time, it poses serious challenges for policymakers who must make crucial decisions about the safety, efficacy, and affordability of medical technologies. One of the most difficult and contentious matters confronting decision makers is the question of how to ensure the delivery of life-saving technologies to low-income and minority patient populations, whereas simultaneously controlling ever-rising healthcare costs. In theory, the increasingly popular concept of evidence-based medicine (EBM) suggests a potential tool for both cost containment and the reduction of severe racial and ethnic disparities in healthcare delivery. Drawn from systematic reviews of studies that use rigorous research methods, particularly the randomized controlled trial, the "evidence" guiding EBM protocols informs treatment decisions made by physicians, as well as policy decisions regarding the allocation of health technologies at the population level. © 2007 Humana Press Inc.