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Looking gaunt but determined, 59 year-old Robert Tools was introduced on August 21, 2001, as a medical miracle-the first surviving recipient of a fully implantable artificial heart. At a news conference, Tools spoke with emotion about his second chance at life and the quality of his care. His physician looked on with obvious affection, grateful and honored to have extended Tools's life. Mr. Tools has since lost his battle for life, but will be remembered as a hero for undergoing an experimental technology and paving the way for other patients to undergo the procedure. Moreover, the fact that Tools was African American and his doctors were white seemed, for most Americans, to symbolize the irrelevance of race in 2001. According to two recent polls, a significant majority of Americans believe that African Americans like Tools receive the same quality of healthcare as whites.

Behind these perceptions, however, lie a sharply contrasting reality. A large body of published evidence reveals that racial and ethnic minorities experience a lower quality of health services, and are less likely to receive even routine medical procedures than are white Americans. Relative to whites, African Americans-and in some cases, Hispanics-are less likely to receive appropriate cardiac medication or to undergo coronary artery bypass surgery, are more likely to receive peritoneal dialysis and kidney transplantation, and are likely to receive a lower quality of basic clinical services, even when variations in such factors as insurance status, income, age, co-morbid conditions, and symptom expression are taken into account. Significantly, these differences are associated with greater mortality among African American patients. 2