Study Shows Doctors Discriminate on Heart Disease Care

By Sean Gormley Hoya Staff Writer

Doctors in the United States are significantly more likely to give an important heart disease test to white males than to women or blacks, according to a study led by Kevin Schulman, .D., of the Georgetown University Medical Center. The study, entitled “The Effect of Race and Sex on Physicians’ Recommendations for Cardiac Catheterization,” was published in the Feb. 25 issue of The New England Journal of Medicine.

The study did not specifically examine the source of these biases, but Schulman said in the press release announcing the publication of the study’s results that “Education programs to combat race and sex bias in medical care should be established at all levels of physician training.”

The study was conducted with 720 doctors from around the country who interacted with patient actors. The actors read off scripts complimented by medical histories and personal information.

The experiment found that women and blacks were only 60 percent as likely to be referred for cardiac catheterization – the primary diagnostic procedure for coronary artery disease – as white males. Black women in the study were only 40 percent as likely to have the procedure recommended as white men.

Through cardiac catheterization, physicians can find blockage in the coronary arteries around the heart. The procedure, which uses x-rays, is regularly recommended for patients exhibiting symptoms of coronary artery disease, an often fatal condition, and is essential in diagnosing and treating those patients.

The research team used a computer program to help come up with similar patient scenarios, in terms of insurance, occupation and risk factors. Lead statistician Jesse Berlin, of the University of Pennsylvania, said in a Georgetown Medical Center press release that “the design we implemented is one of the most rigorous means of addressing this question” of whether there is race or sex bias in heart disease care in the United States.

Schulman is an associate professor of medicine and director of the Clinical Economics Research Unit, a health services research center at the Medical Center established in 1992. Schulman, who was unavailable for comment, said in the Medical Center release, “The study suggests that physicians do contribute to differences in treatment recommendations based on patient race and sex.”

In the release, he added, “Race and sex differences in heart disease management had previously been reported . but it had remained unclear whether physicians contributed to the disparities. Now we know that they do.”

The study was the first large-scale experiment, in terms of the number of physicians involved, to conclude that doctors contribute to race and sex inequalities in heart disease treatment.

Jose Escarce, M.D., Ph.D., co-principal investigator with Schulman said in the Medical Center release, “Regardless of the underlying reasons, our findings are disturbing.” Escarce is not associated with the university but with RAND Corp., the largest private health care research program in the United States.

Other Georgetown University study investigators included Jon Kerner, Shryl Sistrunk, M.D., Bernard Gersh, William Ayers, M.D and John Eisenberg, M.D.

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