I hadn’t seen this discussed anywhere on the board so I decided to make a thread about it. This article tells of a two-drug combination pill which dramatically reduced deaths among blacks with heart failure, and is expected to lead to government approval of the first medication marketed for a specific race. Athough, this case seems legit, it seems to me like such a policy (race-based meds) could have undesired and damaging consequences. Do you think this is ethical or necessary? Or does our increasing understanding of the physiology naturally lead to more specialized and targeted treatment?
What’s wrong with it, if it’s based on scientific fact? I mean, if it was used as a justification for unfair practices that would obviously be wrong, but if something works better on black people, I don’t see a problem with making it for black people. Some diseases are well-known to occur more in certain populations, and you never hear anybody say anything about, say, sickle cell anemia drug trials being predominately done with African Americans, obviously. And it’s not like there aren’t a lot of medications and treatments for women and not men - because there are differences between groups of people, whether they’re ethnic, gender-based, diet-related, or whatever.
We did have a question on the topic over in GQ a couple of weeks ago:
Does this mean there is a scientific basis for race?
I don’t have any problem with trying to find medicines to help people. I would hope that future trials would be open to peoples with more varied backgrounds to see whether they, too, could benefit. I would also hope that people pay attention to what was and what was not learned from this study and the earlier study that prompted it. I would hope that a desire for a “quick fix” would not be used to begin broadcasting false correlations in the minds o the public.
Disease does not know swat about Political Correctness. It is the great Equilizer. Sickle Cell, Breast Cancer, Tay-Sachs, ect . . .Why wouldn’t we want to address these on there own merits and cures? What is there to debate about?
You have to remember that we’re still talking statistics. No one is going to come out and say: This drug works for all Blacks but is worthless for all Whites. It comes down to certain drugs have a higher probability of success for certain ethnic groups than others.
The ultimate goal is to tailor drugs to the specific gentic makeup of the individual, or at least to understand that drug A work for people with genetic sequences BCD and drug E works for people with sequence FGH. It might turn out that 70% of Blacks have BCD sequence and 70% of Whites have FGH. That still means that 30% of Blacks need drug E and 30% of Whites need drug A. (Numbers obviously made up for illustrative purposes only.)
Strictly speaking, black Americans aren’t a race, they’re a population group, with genes from (primarily) West African, North American, and European populations. A race, by contrast, is a continent-wide grouping of people based on phenotypic characteristics. In order to make the case for race-based medicine, you’d have to demonstrate that the drug combo in question was markedly more effective for Somalis, Xhosas, Akan, Wolof, Dinkas, Kalenjin, et al, and markedly less effective for Sicilians, Irish, Latvians, Croats, et al.
Very few objections are raised towards defining population groups. It’s when someone tries to take the definition continent wide, lumping together diverse, heterogenous peoples, that conventional notions of race come under attack.
As Si amigos indicates, we can define the groups most prone to particular illnesses quite separately from sociological or political definitions of race. There’s diseases that disproportionately affect white people, such as cystic fibrosis - yet should we refuse to identify a ‘white population’ as more likely to suffer CF?
The definition of race strikes me as singularly worthless and (probably) simply a holdover from pseudo-scientific attempts to divide up the world’s people into groups that could each be assigned a destiny to make sure Europe stayed on top of the colonies, and the right people stayed on top of Europe. I see very little useful in a priori groupings based on political and broad geographic boundaries.
All that being said, phenotype obviously mirrors genotype and it shouldn’t be surprising that people who share physical characteristics also share predispositions to genetic disorders and even reactions to certain drugs. But it should be kept in mind that the genes that code for the effectiveness of a given drug aren’t necessarily linked to any genes that code for visible physical characteristics, and as humans from all regions continue to filter through the world via international travel genotypes will be scattered to the four proverbial winds.
But in most cases, we don’t - we define them on societal grounds, ones which shift and change over time.
The idea is that the traits we use to classify “race” can serve as a reasonably good proxies for whatever is going on under the hood, so to speak, at least in some circumstances. That’s nothing new to public health, and it’s not terribly surprising that an ethnic group with a higher risk for a particular disease might benefit more from a certain drug or coctail of drugs.
As John Mace pointed out, this is one of the initial steps toward the ultimate goal of being able to give individuals customized treatments; but we must also consider that such a level of customization may not be needed in all cases. If it’s helpful in certain circumstances to paint with broad strokes, so be it. If tailor-made individuality is needed, that’s the way to go.
I get uncomfortable with people loading these issues with politics, as if the deseased care. If the science says A works better than B for population X, while visa versa for population Y, it’s pretty obvious to me we ought to use A for X and B for Y. It can’t be helped if some people don’t like the mere existence of X or Y. If certain correlates work for you, there’s no good reason not to use them. There’s also no good reason to always use the proxy of “race” when it makes no difference to the outcome. Ethnic background can be used judicously if people just listen to the science, and, just as importantly, are devoted to doing good science to begin with.
that should have been “as if the diseases care”. I sure the diseased care a lot, but those s and d keys are right next to each other, durn it.
One size doesn’t fit all. Medicine can and should recognize this, even if white liberals find it philosophically inconvenient.
“Strictly speaking”, there is no such thing as race, so saying African-Americans aren’t a race is pretty meaningless-- no group is **really **a race. But there really is not a better word to use in talking about this subject, so the not-so-scientific term “race” will have to do. We could say “ethnic group”, but that is commonly used to distinguish nationalities (like Polish, French, or Italian) which is not what this research is about.
Of course, it would help if we knew that there actually was a population X or a population Y.
For example, prior to the trials for the drug under consideration in the OP, there was a study (written up in the New England Journal of Medicine) that noted that a rather new drug with a really good track record had a record that was not nearly as good if one separated out black men. I would not be surprised to discover that that analysis prompted the testing of this newer drug.
Unfortunately, the identity of the men who were not helped as often in the earlier trials may or may not have had anything to do with perceived race. A later re-examination of the first study where race was removed from the data points showed a better correlation based on age, diet, and general health of the subjects prior to the study. It seems that the older black men who happened to have been recruited for the study happened to be disproportionately represented among the number of older, overweight, smoking subjects who were not helped by the drug. So now we get a second trial for a different drug and the testing is limited to black men (based, possibly, on the faulty assumption that they are less likely to be helped by the first drug), meanwhile, older, overweight, smoking whites seem to have been excluded from the current study on the (possibly erroneous) assumption that they will be fine using the older drug.
I’m not sure what point is being attempted in this statement.
Consider that these drugs would be perscribed in the U.S. by drugs approved by the FDA.Their ability to keep dangerous drugs out of the hands of Americans is considered by some to be lacking. Also consider that these drugs will be supplied by your friendly neighborhood pharmaceutical corporation. These corporations benchmark their successes by margins of profit and not our well-being.
Now imagine if a product like Phen-fen or Vioxx (or maybe even more harmful) were perscribed to, say, black people? Imagine Rev. Jackson, Al Sharpton, and the Black muslims reacting to such an incident?
I think we shouldn’t persue this line of medicine, or at least wait until we neutralize the political and commercial aspects of the whole endeavor.
The party line is, there’s no such thing as race and the physical differences between different ethnicities are purely cosmetic. There is some evidence to the contrary, though. Some diseases are appalingly undemocratic. We’re all subject to colds and flu, but white people seldom get Sickle Cell Anemia and gentiles typically don’t fear Tay-Sacs disease.
My doctor–whom I’ve known since we were both undergrads at UVA–mentioned to me that black men are statistically a lot more likely to get prostate cancer than white men. I asked if that was due to environmental or hereditary factors. He said that as far as he knew, it was nothing environmental. I found this very upsetting to my worldview; surely, racism was the culprit! But, there’s no evidence to support this.
Hope I’ve cleared that up.
As I understand it this drug combination was only tested on African-Americans, and because of that, the FDA was only going to approve it for African Americans. The treatment previously We don’t know the drugs efficacy in whites, because it was not tested thoroughly on whites. Previous studies seem to have indicated that the drug was more effetive in blacks than whites, so they did aanother study on black African-Americans only. The numbers then showed that the drug had benefit. So, what about whites who have black ancestors? Would the drug benefit them, or is it treating a condition that is closely linked to skin color?
Drug companies have excluded groups from drug trials for reasons of questionable validity, like the asprin against heart attack study, where the researchers said they did not have a good test pool of women whom they thought would understand the importance of taking medicine on schedule, so they tested it only on male doctors. At the time there may have been more men than women doctors, but there were plenty of women who were nurses who quite grasp the importance of taking drugs on schedule.
What is to prevent them from excluding women and blacks from their next study and ae drug being only approved for white males? Will insurance companies pay for treatments that don’t have FDA approval for your demographic?
In the U.S., few whites get Sickle Cell because the overwhelming number of white immigrants did not come from those regions surrounding the Mediterranean where Sickle Cell is endemic. Blacks whose ancestors are from the regions south of Zimbabwe and Angola have almost no susceptibility to Sickle Cell (although in the U.S., we can get away with associating blacks and Sickle Cell because the overwhelming majority of people imported to the U.S. happened to be from Sickle Cell endemic regions–unlike Brazil where a large number of slaves were also imported from non-Sickle Cell areas). Similarly, Jews have little to fear from Tay-Sachs, provided their ancestry is Sephardim or Mizrahim, rather than Ashkenazim, while French Canadians and Louisiana Cajuns are nearly as susceptible as the Ashkenazim. Since the very large number of Jewish immigrants to the U.S. happened to arrive from Russia and Poland, then, in the U.S., we tend to associate Tay-Sachs with “Jews” rather than with Ashkenazim.
Now, there is always the possibility that there is a population of people who are susceptible to an illness that happens to be coincident with our socially defined labels of race, but if the Tay-Sachs and Crohn’s diseases and Sickle Cell syndrome are any indication, we would be much better off discovering a test based on blood or tissue sample to discover actual susceptibility rather than casually looking at an issue based on perceived race and ignoring all the people who might really be susceptible (or who might really benefit from treatment) because they do not happen to “look” like they belong to some ill-defined category.
If a doctor ignored symptoms for Sickle Cell because I was not “black” or ordered invasive tests because I was “Jewish” (even though I had no Northeastern European ancestors), I would consider him an idiot. As a good quick test on where to look first, the association of ancestry with frequently occurring diseases is fine. I have trouble with the idea that we should limit our tests or our treatment based on false impressions presented by socially determined information.
It is entirely possible that there is a trait common to men from the region of Africa extending from Senegal to Gabon who have a susceptibility to prostate cancer. If this is true, then we should set up tests on both sides of the Atlantic to determine that factor. I would also say that it is a statistically prudent thing for a U.S. doctor to warn his or her black, male patients to get periodic prostate checkups. However, until studies are done that discover a cause, we have nothing more than an apparent statistical correlation that should provoke further study, but on which we should not be basing current medical decisions.
Do you know for a fact if it did or did not?
Are you sure? I’ve always thought of African-Americans (as in, the population group in the USA that is largely descended from West African slaves and white settlers) as more of an ethnic group than anything else. They have a common history, distinct folkways, a broadly similar genetic makeup, etc., much like the Polish-Americans, Italian-Americans, et al. Certain diseases are more common among them, much like Tay-Sachs is among Ashkenazi Jews or dwarfism and polydactylism is among Amish. While your average African-American and your average Eritrean or !Kung may be classed as the same “race”, they obviously have little in common either culturally or genetically.