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What's New
- Optimal effectiveness and compliance is achieved by individualized prescribing that considers biological, cultural and environmental factors.
- IOM report in 2002 stated that "Hispanic subgroups metabolize drugs differently depending on their genetic mixture; genetic variations contribute to differences in drug metabolism and responsiveness in many conditions common in Hispanics and "equivalent" drugs may not be as effective, requiring more costly drug adjustment and office visits.
- Pharmacogenetic research in the past few decades has uncovered significant differences among racial ethnic groups in the metabolism, clinical effectiveness and side effect profiles of many clinically important drugs. These differences must be taken into account in the design of costs management policies. These programs should be broad and flexible enough to enable rational choices and individualized treatment for all patients. (Burroughs, Maxey, Levy)
- The data may be sold to states who implement cost containment programs such as formularies, without consideration for potential discriminatory effects on racial and ethnic groups.
- Available clinical studies may have been done on patient populations with different demographics, characteristics and co-morbidities than the individual seeking treatment.
- For many conditions there are no clinical studies available. Will the absence of studies translate into the absence of appropriate treatment that has a record of success based on the clinical experience of the physician.
- If EBM means using guidelines as a kind of one size fits all treatment grid, it will lead to poor health outcomes and increased costs, particularly for populations who are already underserved or marginalized in the health care system.
- How can a state assure its patients that bias or generalizations are not built into the studies, questions or recommendations?
- Treatment guidelines must be voluntary, culturally competent and flexible.
- Dosing, packaging and different metabolic pathways may make particular compounds in a therapeutic class suitable for one person but not for another with the same condition." (Gorman, L. Medicaid Drug Formularies. Independence Institute, Issue Paper Number 2-2002. April 2002)
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