BiDil in the Clinic: An Interdisciplinary Investigation of Physicians’ Prescription Patterns of a Race-Based Therapy

Abstract

Background: The African American Heart Failure Trial (A-HeFT) and the Food and Drug Administration (FDA) approval of BiDil for race-specific prescription have stirred the debate about the scientific and medical status of race. Yet there is no assessment of the potential fallout of this dispute on physicians’ willingness to prescribe the drug. We present here an analysis of the factors influencing physicians’ prescription of BiDil and investigate whether exposure to the controversy has an impact on their therapeutic judgments about the drug. Methods: We conducted an electronic survey with physicians in the department of internal medicine at the University of Cincinnati. Participants were randomly assigned to two groups, with one group receiving information about the controversy over BiDil. We used various statistical tests, including a linear mixed effects model, to analyze the results. Results: Twenty-seven percent of the participants reported using patients’ race as a major factor in making treatment decisions. Thirty-three percent reported the inefficacy of standard therapies, 25% the severity of the disease, and 15% other unspecified factors as primary determining criteria in prescribing BiDil. With respect to the controversy, 68% of physicians reported that they were not aware of any controversy surrounding BiDil. Physicians’ willingness to prescribe BiDil as a therapy was associated with their awareness of the controversy surrounding A-HeFT (p < .003). But their willingness to prescribe the therapy along racial lines did not vary significantly with exposure to the controversy. Conclusions: Overall, physicians prescribe and are willing to prescribe BiDil more to black patients than to white patients. However, physicians’ lack of awareness about the controversial scientific status of A-HeFT suggests the need for more efficient ways to convey scientific information about BiDil to clinicians. Furthermore, the uncertainties about the determination of clinical utility of BiDil for the individual patient raise questions about whether this specific race-based therapy is in patients’ best interests.

Keywords::

• African American Heart Failure Trial (A-HeFT)
• BiDil
• clinical utility
• mixed-model
• race-based therapy
• race instrumentalism

Notes

1 . Some more recent estimates put this value at 99.5% (Rotimi and Jorde 2010).

2 . For more details, see, e.g., Bamshad et al. (2004), Krieger (2005), Maglo (2011), Maglo and Martin (2012), Rosenberg et al. (2002), Serre and Paabo (2004), and Wilson et al. (2001).

Additional information

Funding

This project was supported by an Institutional Clinical and Translational Science Award, NIH/NCRR grant UL1RR026314. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health (NIH).