Ethics in Medicine

Now, a new and unexpected force in medicine is pulling back the covers. By taking a close look at small differences in people's genetic codes, researchers and drug companies are beginning to create racially based drugs and treatments.

Given the prospect of targeting treatment, some scientists argue that the subject at least ought not to be taboo. Even if race eventually proves to be a crude and insufficient means of understanding genetic differences, it can play an important interim role, they say. Others worry that these voices fail to capture the larger picture: how past claims of "scientific" race and ethnic differences, have been used to oppress, even kill, minorities.( Ben Harder, 2005)

According to Robin Marantz Hening:

BiDil, the first drug in America that's being niche-marketed to people of a particular race, our first ethnic medicine. BiDil, is on the leading edge of the emerging field of race-based pharmacogenomics. It signals a shift in perception, a new approach to medicine that has at its core an idea at once familiar and incendiary: the assumption that there are biological differences among the races.

BiDil is also a feat of creative repackaging. Five years ago, the F.D.A. rejected it for use in the general population because it was found to be ineffective in the treatment of heart failure, a common complication of cardiovascular disease that affects some five million Americans and leads to 300,000 deaths a year. But in 2001, the manufacturer, NitroMed, asked permission to test BiDil exclusively in blacks, whose heart failure tends to be more severe and harder to treat. The company reasoned that the drug's effect on nitric-oxide deficiency, more common in black heart-failure patients than in non-black, might make it especially suited to them. With the collaboration of the Association of Black Cardiologists, NitroMed embarked on a large clinical trial involving more than 400 black women and 600 black men, all of whom had heart failure. Last summer, investigators called an early end to the study because they thought BiDil was so effective that it would be unethical to continue to deny it to people in the control group. Thus, a drug that had been deemed ineffective in the population at large seemed to work so well in one racial subgroup that the scientists thought everyone in that subgroup should get it

In November, NitroMed unveiled results showing that its drug combo, BiDil, reduced deaths due to heart failure by half. The Food and Drug Administration is expected to approve the drug BiDil in June, making it the first "ethnic drug" on the market. After failing in a broader study, BiDil was shown to be effective in treating heart failure in a clinical study that included only African-Americans.

Geneticists agree that the medically important issue is not race itself but the genes that predispose a person to disease. But it may often be useful for physicians to take race into account because the predisposing genes for many

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