Posted on 11/13/2004 5:23:54 PM PST by neverdem
RESEARCHERS last week described a new drug, called BiDil, that sharply reduces death from heart disease among African-Americans. That sounds like unalloyed good news, especially because African-Americans have been underrepresented in previous drug trials and because there is already an important class of heart drug that does not work as well in blacks as it does in whites.
But not everyone is cheering unreservedly. Many people, including some African-Americans, have long been uneasy with the concept of race-based medicine, in part from fear that it may legitimize less benign ideas about race.
Marketing BiDil as a drug for blacks is ''a classical example of using race as a surrogate for biology,'' said Dr. Georgia Dunston, a medical geneticist at Howard University, noting the drug does not work in all African-Americans and may well be of benefit to other groups.
The emergence of BiDil, described last week in The New England Journal of Medicine, is a sharp reality test for an academic debate about race and medicine that has long occupied the pages of medical journals. Is there a biological basis for race? If there is not, as many social scientists and others argue, how can a drug like BiDil work so well in one race? Even if there were a genetic reason for race, why drag race into medicine when a physician's only concern is with the specific genes that predispose to disease?
Advances stemming from the human genome project are likely to produce many new diagnostic tests and treatments tailored to specific population groups, including races and ethnicities within races. BiDil, however, had nothing to do with the genome project. It is a combination of two old drugs, invented some 30 years ago by Dr. Jay N. Cohn, a physician at the University of Minnesota. On its first trial, in a general population, it didn't seem particularly effective. But in reanalyzing the data a few years ago, Dr. Cohn found it had worked well in a specific group of patients, who happened to be black.
The Food and Drug Administration said it would license the drug if a second trial confirmed the result. The new trial, conducted with the help of the Association of Black Cardiologists, had to be stopped when it became clear the drug was so effective that it would be unethical to deny it to the control group.
This month, in a special issue on race published by the journal Nature Genetics, several geneticists wrote that people can generally be assigned to their continent of origin on the basis of their DNA, and that these broad geographical regions correspond to self-identified racial categories, such as African, East Asian, European and Native American. Race, in other words, does have a genetic basis, in their view.
But researchers from Howard University, a center of African-American scholarship, argued in the same journal that there was no biological basis for race and that any apparent link between genes and disease should be made directly, without taking race into account.
Most geneticists agree with the Howard researchers that the underlying genes, not race as such, is what is important for understanding disease. But many say that race can be a valuable clue. In the case of BiDil, race was essential to proving the drug's effectiveness. ''It was the only way we had - there was no other marker that would tell us how to select a population that would respond,'' Dr. Cohn said.
Findings based on race can be hard to interpret correctly because many other factors, from behavior to access to medical care, can track along with any genetic component. People are often too quick to assume that any difference found between two races is genetic and immutable, said Dr. David Altshuler, a medical geneticist at Harvard University. But race should still be taken into account, he said, even if as a last resort.
BiDil is designed to increase levels of a chemical signal known as nitric oxide, which tends to be lower in Africans, possibly because low levels help retain salt for people living in hot climates. Thus there may be a genetic basis for African-Americans' positive response to the drug. Dr. Cohn said he hoped to identify the particular gene, or set of genes, that is involved. Though that genetic combination is presumably more common in Africans, it may well exist in people of other races, who would also stand to benefit from the drug.
Whatever medical benefits geneticists may promise, people may be disconcerted at being defined genetically, particularly for the purpose of having a set of diseases associated with them. There has been fear of stigmatization among Jews following discovery of a number of Jewish genetic diseases.
Some African-Americans fear that if doctors start to make diagnoses by race, then some in the public may see that as a basis for imputing behavioral traits as well. ''If you think in terms of taxonomies of race, you will make the dangerous conclusion that race will explain violence,'' says Dr. Troy Duster, a sociologist at New York University.
Of course, every race and ethnic group has its own particular pattern of disease. The blood disorder hemochromatosis is more common among Scandinavians, and the predisposing gene is thought to have been spread elsewhere in Europe by the Vikings. But the danger of stigmatizing a population by linking its genetics with diseases is probably higher for groups of lower socioeconomic status.
''Anything that invites the perception of African Americans as biologically different is a huge worry,'' said Dr. Gregg Bloche, a Georgetown University physician who studies racial disparities in health care.
You're now on the record, Dr. Bloche....you're inference is to pull the plug on meds that could help a specific ethnicity.
Enjoy the hot seat.
This has got LAWSUIT written all over it.
Pull the plug. It's the politically correct thing to do, and you'll get no argument from anyone.
' ''Anything that invites the perception of African Americans as biologically different is a huge worry,'' said Dr. Gregg Bloche, a Georgetown University physician who studies racial disparities in health care.'
Well, look. Here's a pill that can save a minimum of 10,000 lives a year. Those invested in racial politics don't want it distributed. Those who will likely die without it...will very likely find a way to wrap their brains around a bent-paperclip logic so that they can live.
I find the whole "once we go down that road" argument about differentiation in races and ethnicities re diseases and treatments absurd. Especially since we are way the hell down that road already. Sickle cell anemia? Taysack's disease? The list goes on.
If you're black and a pill that science has developed can not only improve your life but save it, shut up and take the pill. If you're black or any other color and you want to hold cures and medicines up because you fear for the "impact" they will have on society, etc....just shut up.
bump
I guess this Doctor doesnt believe in Sickle Cell either.
"But not everyone is cheering unreservedly. Many people, including some African-Americans, have long been uneasy with the concept of race-based medicine, in part from fear that it may legitimize less benign ideas about race. "
Talk about cutting off your nose to spite your face!!!
This is PC raised to a Criminal level.
Race is determined genetically. Predisposition to certain diseases is determined genetically. It is inevitable that linkages exist.
It's all Bush's fault, anyway.
Unless I missed it, I don't think anyone said that at all.
The actual fact is that the black aspect is pure marketing -- nothing at all to do with the mechanism of the drug.
It is marketing.
African americans need higher dosages of some Lupus drugs too. They usually get lower doses and suffer greatly.
Medicine is medicine. If it helps you, is there a color to it?
...but this also begs the question...how will researchers define and qualify the term "Black"?
Welcome to the brave new wonderful world of PC medicine.
bump for later
BTTT
So the PC crowd would rather let blacks die than allow them access to this medicine-which helps thembecause they happen to be black?
And we're the ones who are supposed to be racist?
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