The Dangers of Race Based Medicine

The Dangers of Race-Based Medicine

An analysis of new drug therapies specifically targeted towards African American populations with hypertension

I. Introduction to Contemporary Race-Based Therapeutics

On November 11th, 2004, NitroMed, a Massachusetts based pharmaceutical company published a study on the effects of a new drug called BiDil in treating heart failure among African Americans in the New England Journal of Medicine (Taylor 2049). Since announcing the study, NitroMed's research has sparked controversy surrounding the ethical implications and scientific evidence of race-based medicine. This study marks a breakthrough in race-based drug treatments as the first pharmaceutical ever researched, endorsed and targeted for a single ethnic group (Pollack 1). The racially-specific pharmaceutical initiative is a product of tremendous government funding allotted by the Clinton administration to the Human Genome Project at the turn of the millennium. Since then, much medical research has focused on understanding the human genome in search of genetic explanations for health problems while funding and interest have decreased in social-related health research and medical programs for poor and underserved populations (Braun 162).

NitroMed's study marks a growing movement that has begun to cite genetic makeup, specifically race-related genetic makeup, rather than environmental or other confounding factors as the source of disease. This shift in presumed cause of health-related problems raises many troubling implications. With race-based therapeutics comes the assumption that there are biological differences between races. The dangers of such implications are vast, the most pressing problem being the ambiguity of race, particularly with regard to genetic composition. Considerable studies have demonstrated the lack of genotypic correlations among members of a given race. Similarly, socioeconomic and other confounding variables have a profound impact on health and thus must be considered in the discussion of race-based therapeutics and research. This tension between social and biological conceptions of race is now at the forefront of discussion among scientific scholars seeking explanations for the relationship of disease and ethnicity (Foster 844).

The ultimate goal of pharmacogenomics, as stated by Henig, "would be for everyone's genome to be analyzed individually so that doctors could gauge how much of a medication, and which type, is most likely to work for a specific patient" (3). Race-based medications seem highly personalized to the consumer but are simply a short cut to the goal of individually-specific medication. Marketing drugs targeted at particular phenotypes such as race is incredibly lucrative for pharmaceutical companies. For NitroMed, this factor will be especially important because African Americans have far higher cases of hypertension than whites while tending to be less responsive to normal treatments than their white counterparts.

When the scientific community begins to spread unfounded hypotheses regarding genetic differences between races, particularly differences that attribute poorer health or increased susceptibility to disease among minority groups, a Pandora's Box is opened of potential dangers which can aid proponents of racist doctrines. Historically, scientific studies that sought to prove biological differences among races have led to violently racist movements like slavery, colonialism, and the Holocaust. Hence, as other pharmaceutical companies follow NitroMed's path and begin marketing drugs targeted for specific racial groups, the dangers of such race-based therapeutics must be acknowledged.

Finally, advocates of race-based medicine claim that the scientific underpinnings are irrelevant if a medication is proven to be effective for a particular group. In such a way, race-based medicine is a short-term solution, treating the symptoms of race-related disease without understanding the cause. BiDil should be available to African Americans, and all races while long-term, continuous research needs to be conducted to determine the actual social causes of hypertension in African Americans. Furthermore, it is important to maintain race-based studies in modern medical research, within the context of understanding that race is a non-scientific, but a social variable. Because inequities exist in health care between races, continuous study is necessary to pinpoint the underlying social and cultural causes of health care disparities.

II. A History of BiDil and African Americans with Heart Failure

BiDil is a combination of two generic heart drugs - isosorbide dinitrate and hydralazine- first tested together in the early 1980's. In the initial trial, the drug showed so little positive effect that it was rejected from continued study (Arnst 1). NitroMed, upon purchasing the rights to the drug combination noticed that a small subset of black patients in the original study did in fact show results of the potential efficacy of BiDil. The FDA agreed to approve BiDil if NitroMed conducted a second trial to confirm the results of the first (Pollack 2).

According to NitroMed, BiDil works by enhancing nitric oxide, which plays a crucial role in controlling blood pressure and is more likely to be deficient in blacks than in whites (Taylor 2054). The eighteenth month examination of 1050 African American men and women showed that those who took BiDil lived significantly longer than those receiving standard hypertension therapies - 43% fewer deaths among BiDil users than the control group as well as 33% fewer hospitalizations (Taylor 2049). In fact, the efficacy became so apparent, that the study was halted several months early because the researchers thought it was unethical to deny the useful new drug to the placebo group (Wade, Race 12).

The need for effective cardiovascular medications for African Americans is a pressing issue. Studies show that African Americans respond less well than their European-American counterparts to common drugs for cardiovascular disease such as ACE inhibitors and beta blockers (Tate S35). Blacks are also diagnosed with heart failure earlier than whites with a greater number of undocumented cases. Hypertension, a leading cause of heart failure is disproportionately greater - three to seven times more - among African Americans (Yancy, Heart 183).

Many scientists believe the higher rate of hypertension among people of African descent is related to underlying biological differences such as salt sensitivity, plasma volume, and levels of nitric oxide. However, not enough research exists to clearly identify which differences are due to genetic

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