Should We Worry About Race-Based Medicine?

In recent months, we have seen the advent of a new medication that is being marketed to address high blood pressure and heart disease in African Americans. The U.S. Food and Drug Administration approved the world’s first “ethnic” medication, BiDil, for ''self-identified African Americans,'' leaving room for interpretation as to who is African American. With the alarmingly high rates of this disease, and its’ debilitating complications, in African Americans, It would seem that this is a godsend.

I have reservations about approving a drug specifically for Blacks; or for that matter any individual race. I believe there should be concern it would provide ammunition for the discredited idea that there are basic biological differences between the races, which historically has been used to justify discrimination.

We are now even seeing that medical identification for Hispanic people as being Hispanic White or Hispanic Black. What if there was a drug developed for Whites only?'' There would be a huge uproar and shouts of racism.

Clearly, the manufacturer, NitroMed Inc., has a financial incentive to market BiDil only to Blacks because its patent was about to run out on the drug in 2007. By repackaging it as a race-specific drug, the company was able to extend its patent to 2020.

The initial clinical trials of BiDil in the 1990s showed no benefit for patients overall.

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. (Remember there are over 36 million African Americans in this country.)

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. The study didn't prove that BiDil works better in one race than another, because only Black patients were studied. It did not study non-Blacks.

NitroMed has begun stocking the shelves of pharmacies and providing doctors' samples. It recently hired 195 new salespeople who are making calls on 10,000 selected doctors in largely Black populated Philadelphia, Atlanta, New York and Washington and other big cities.

Scientists and sociologists continue to argue over whether African Americans’ high rates of hypertension are due to genes or to environment. A classic study found that one thing that correlated most strongly with level of blood pressure was, surprisingly, skin color. Among Black subjects of low socioeconomic status, the darker the skin, the higher the blood pressure. Social scientists’ explanation is that people with darker skin are subject to greater discrimination, and therefore to greater stress.

Many say it is due to diet and stress. As one sociologist said, “If you follow me around Nordstrom’s and put me in jail at nine times the rate of whites and refuse to give me a bank loan, I might get hypertensive.”

Despite the long and ugly social history of race, there is no clear-cut definition for the term. Is a person’s race defined by skin color, that most visible of markers? By language, country of birth, the food they eat or the religion they practice? Not even scientists can agree.

If you have a genetic sample from Nigeria, can you really say that it represents Africans? Afterall, there are over 50 different countries in Africa, and literally hundreds of different tribes. Is that the same as African Americans? In some studies, Jews are White, sometimes they’re not. Sometimes they’re compared to Whites.

But since no one now has the resources to uncover the secrets in every patient’s DNA, both science and medicine are using “race” as an easy, if dangerous, shortcut.

For now, prescriptions for such medications are to be based on little more than physical appearances and questions about a patient’s heritage.

And this could lead to significant risks. Doctors may end up denying a drug to Caucasians who might benefit from it, because it is touted to work only in African Americans. Or they might prescribe a “Black” pill to a black person who actually would benefit from some other treatment. (For example, research has found that as many as 30 per cent of African American men have a white male ancestor, a fact attributed to the sexual politics of slavery.)

Imagine a drug marketed only for Blacks, a simple pain reliever, prescribed in the millions. Now imagine that, like a certain now-notorious pain medication, it turns out to have the horrible side effect of increasing the risk of heart attacks. Result: Tens of thousands of African American die.

What happens if you get a Vioxx situation with one of these drugs? I feel we could be playing with fire. We are all 99.9 percent identical from one person to another; no matter what that person’s race, ethnicity, continent of origin or bank account.

Could this be “Tuskegee” all over again?

Remember, I’m not a doctor. I just sound like one.

Take good care of yourself and live the best life possible.

Glenn Ellis is an NNPA columnist