In an effort to reduce costs, most HMOs require those insured use the generic version of a prescription drug rather than the name brand. Some states, most recently New York, are insisting that Medicaid recipients use only generic drugs unless their physicians demand otherwise. While that movement may save money, it is costing us in other ways because, simply put, the generic alternative is not metabolized by people of color the same way it is by non-Blacks.

That’s the alarm being sounded by the National Medical Association (NMA), the premier organization of African-American physicians. In briefings on Capitol Hill and in medical papers, the group warns that generic or “therapeutically equivalent” drugs are not processed in the body the same way by different groups.

A report, “Racial and Ethnic Differences in Response to Medicines: Towards Individualized Pharmaceutical Treatment,” by Dr. Valentine J. Burroughs, chairman of the NMA board of trustee’s health policy committee, and Dr. Richard Levy, vice president for scientific affairs at the National Pharmaceutical Council, essentially says that so-called “equivalent” drugs are not equivalent for everyone.

“Pharmacogenetic research in the past few decades has uncovered significant differences among racial and ethnic groups in the metabolism, clinical effectiveness, and side effect profiles of therapeutically important drugs,” the study reports.

Most of the published research has centered on cardiovascular agents, such as beta-blockers, or central nervous system agents, such as antidepressants.

The research report refers to a study by the Institute on Medicine titled, “Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare.” The NMA says the other study “illustrates in eloquent scientific detail that racial and ethnic disparities in health care do exist and are prevalent in both the treatment of medical illness and in the delivery of health care services to minorities in the United States.

“Of greater significance is the finding that these disparities still exist even after adjustment for differences in socioeconomic status, insurance coverage, income, age, co-morbid conditions, expression of symptoms and access-related factors,” it continues. “These disparities are not confined to any one aspect of the health care setting and can even be found in the delivery of pharmaceutical services, which are under increasing cost control measures.”

And those efforts to control costs have caused more health plans to rely more heavily on generic drugs. But that can spell trouble.

“There is good evidence to show that therapeutic substitutes of drugs within the same class places minority patients at greater risk,” the NMA study reports. “This is because effectiveness and toxicity can vary among racial and ethnic groups.”

Therefore, the report observes, physicians and managed care plans should look more carefully for “atypical drug responses or unexpected untoward side effects when treating patients from racial and ethnic minority groups.”

It further warns that “dosage adjustments might be necessary in using generic drugs as therapeutic substitutions… There is a distinct possibility of a toxic accumulation of such drugs from slower metabolism.”

These findings place a greater burden on patients to ask more questions of their physicians and, when necessary, be firm in requesting the brand name prescription rather than a generic substitute that might prove less effective. It also means that our lawmakers and policymakers need to think twice before allowing the wholesale substitutions of drugs in tax-support health care plans.

Clearly, the pharmaceutical industry has a stake on wanting physicians to prescribe their brands, earning millions and millions of dollars in profit. That notwithstanding, if the brand-name drugs are more effective, they should be prescribed over the cheaper generic alternative.

The notion that some drugs are more effective in Whites than Blacks underscores another problem in the health care industry. Because of the paucity of Blacks in many clinical trials, even well-meaning medical investigators are not able to tell if a drug may be highly effective in group but not another.

Before a drug is allowed to be marketed in the United States, it has to be tested. But if there are not enough Blacks involved in those tests, it is difficult to isolate diseases or to effectively treat them.

There are many reasons African-Americans are reluctant to participate in test trials. An article in the “Journal of the National Medical Association” last December by doctors Michael A. LeNoir and James H. Powell, along with Yolanda A. Fleming, observed:
“When asked which factors affected recruitment of a minority patient into a clinical trial, mistrust of the medical community and lack of awareness of clinical trials received the largest number of affirmative responses.”

To overcome this distrust, the authors wrote, “We believe the education of our communities regarding the value of appropriate clinical research, and the education and training of our physicians on the clinical research process, are important first steps in addressing these issues.”