Dr. Andy

Reflections on medicine and biology among other things

Monday, June 13, 2005

More race and medicine

I made a long post on race and medicine a while back, now BiDil, which seems to be effective for heart failure only in blacks, is under review by the FDA:
The drug's maker, Nitromed Inc., says its decision to test and market BiDil as a drug for African-Americans is based on solid science. But BiDil's application has engendered controversy, with many scientists convinced that race is too broad and ill-defined a category to be relevant in determining a drug's approval, especially since geneticists have failed to identify a biological divide separating one race from another.
As I said in my original post, patients should be treated with whatever medicines will help them the most, without regard for political correctness. That said, I think it is reasonable to be skeptical of claims of race based effectiveness, if for no other reason than the vast majority of drugs work in all races. As one of the cardiologists in the article says:
"I don't believe for a second that this drug combination is only going to prove to be beneficial in African-Americans; it's just not conceivable,"
I wouldn't say it isn't conceivable, but I can see why one would need very strong proof of a racial difference (as opposed to this case, where you have one trial where it didn't work in the general population, and another, later trial, where it did work for blacks--there are many meds for which some trials show benefit and others don't).


At 5:37 PM, Anonymous Steven Harris said...

It looks like BiDil will get its confirmation which can only be a good thing if it will help extend lives. My question though is how will doctors know who is and who is not acceptable for the drug?

From my understanding, the study focused on individuals who were self-described as African-American (no doubt to allow the researchers to avoid being labeled anything noxious). But as you stated in your earlier posting on this topic, at the end of the day, genetics can't really account for the concept of races. So obviously, there is some genetic framework open to the drug that has found itself attached to the general African-American population. I realize that its a myth to imagine one gene = one chracteristic. Thus its likely that the drug works because of a combination of various genes and the synergy of their operation. But I'm curious as how this can play out in the directions given to doctors at the present time as to how to perscribe it.

Is one instructed to judge the worth of the medication as treatment for the patient based upon the patient's pheonotype? Self-described heritage? Etc? I don't know if there are any side-effects that would make mistakes based on this criteria dangerous or not in this case, but how doctors are suppose to decide racial categories seems to not be much of a topic of discussion yet.


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