Racial Inequalities in the Use of Procedures for Ischemic Heart Disease-Reply

In Reply.—  Drs Holmes, Hodges, and Rich raise important concerns about the reasons white patients receive more cardiac procedures than black patients. Our primary intent in the study published in JAMA was to establish whether racial differences exist in the number of cardiac procedures performed. Despite the many methodological difficulties in examining this hypothesis, we are confident that our data demonstrate that a real difference does exist. Our limited data and the study design make it impossible to draw any firm conclusions on the origins of this discrepancy.To examine the troubling but unavoidable hypothesis that racial bias rather than other factors is the major cause of this difference, we propose a different database and study design. Several important variables to be included are clinical indications for procedure use, race and seniority (resident or staff attending) of physician, availability of support services and disability insurance, physicians' reasons for offering or