What you’re ‘seeing’ is discomfort in lazy medicine and/or thinking, especially when it comes to ‘race’.
Describe an African-American. Who counts? What measurement do you use? Brown paper bag or one drop? How does a ‘race’ drug work? Does it measure the amount of African genetic material vs European vs Native American and becomes a 1/3 effective? Would it work on Brazillian, on Hatian on Cubans or does it only work on West Africans, with European and Native American influences? Does it’s effectiveness vary with the amount melanin in the skin or the width of the nose?
How do you invision a ‘race’ drug working, when the race it’s supposed to benefit only exists has a historical, cultural event?
As has been noted, you’re better off looking at geography as opposed to skin color.
I have friend who just had a baby, who found out AFTER the baby was born, that she is a carrier for sickle cell. When she asked why her and her husband weren’t tested, the doctor said, " You should have told me you were black…" She and her husband are East Indian…what did think, they were passing?
That’s (for me) the cause of the discomfort you’re seeing.
I hear you, holmes, but consider the doctor’s POV. There are a million conditions any given patient could be suffering from, limited funds to test for them, and only the doctor’s professional judgment to guess what the problem might be.
I was sick a few years ago. Given my age and marital status, Hepatitis seemed like a good guess and failed gallbladder an unlikely one, and a doctor spent the better part of six months testing my blood for any sign of Hepatitis. It turned out to be gallbladder. The doctor was wrong, for most of that time, but not wrong in a lazy or incompetent way.
Remember, we’re only 140 years out of the “Leeches and Four Bodily Humours” approach to medical treatment. It ain’t foolproof.
In this case, it would appear that the doctor is an idiot (barring some truly mitigating circumstances). India is the major geographical locus for one strain of sickle cell. (It varies slightly from the African/Mediterranean variety, but no M.D. in a land with Indian immigrants should be unaware of that strain–and particularly should not jump to a conclusion that the couple is of African origin when their baby tests positive for sickle cell.)
This is one of my objections to “race based” medicine at any level beyond triage: it allows doctors to slide on their obligations based on what “everyone knows” rather than holding them to the standard that they should actually study their field.
It wasn’t just that he assumed they were African, but that they were hiding it from him and if they had been straight with him about their “blackness”, he would have checked them for it.
Which is why “race” based thinking doesn’t work. Most African people do not carry the sickle cell gene. Only certain groups of Africans ( a minority) do. Population group based thinking, by contrast, can work. For sickle cell anemia, you can make a list of population groups that are likely be at risk for the condition. Some of these groups are “black” (and this is the largest group susceptible to sickle cell in the US), and some are clearly not “black”.
Wonder what would happen if a Sicilian-American couple found out they were sickle cell carriers, and their doctor accused them of hiding their “blackness”?
If you recall, last year the results from a trial of an experimental AIDS vaccine came in. Overall, it showed little efficacy, but when the results were broken down by patient’s race, it showed roughly 80% effectivness for blacks, 60-70% for asians, and much lower for whites. Would there be anything wrong with producing this vaccine and providing it to blacks? Think of sub-saharan Africa and the amount of good such a vaccine could do.
I have no problem with providing people with anything that will help them, just as I have no problem with administering the drug combination in the OP to blacks in the U.S., although I think it is important to determine whether the same drugs would help others and whether the drugs are interacting with diet and lifestyle rather than ancestry.
What I would be interested in seeing, however, would be the actual trials and controls of the AIDS vaccine. Was the study a world-wide study? Or was it limited to the U.S.? How much did diet and lifestyle affect the results? IF the results were truly related to biological populations, then we should distribute it accordingly. However, my concern with shipping it in bulk to Africa without further trials is that it might be no more efficacious in Africa than among the white U.S. population.
This is not an idle concern. Nigerians have a much higher occurrence of the gene that actually promotes high blood pressure than do blacks in the U.S., with their more mixed ancestry. Yet in examinations of blood pressure comparing (I think) the populations of Lagos against the black population of Chicago, the Chicagoans had hypertension at rates two to three times that of the Nigerians. Straight genetics argues in the opposite direction. This, again, is one of the problems with pharmacological analysis by “race”: there are no pure races and we have not yet identified all the aspects of the body that affect drug actions.
Why would you think that a ‘black’ drug that works on thisblack man would work on this black man. If this was tested on African-Americans, and didn’t work as well on whites, why would it work on Africans?
As Tomdebb pointed out African-Americans and Africans react differently to similar events, this is most likely due to the additional genetic material. It would be sloppy medicine to start shipping drugs tested on African-Americans to Africans on the basis that they are the same race or color. They’re not, not even close, not anymore.
Now if the drug was tested in sub-saharan Africa on acutal sub-saharans and worked. Cool, great news…anything else is sloppy, lazy and misleading.
No. You are making the mistake of thinking that whether or not a drug “works” is a binary result. Generally, it’s a statistical outcome, with the drug working in x% of cases tried. American Blacks do indeed have a more mixed heritage than African Blacks of the same region where most American Blacks can trace their ancestry, but you are postualting that they have ratained essentially no genetic heritage from that region. That is simply incorrect.
If a hypothetical drug had a 40% effective rate on “pure” Europeans and an 80% effective rate on “pure” west Africans, one would still expect there to be a higher effective rate on American Blacks than on American Whites.
Now, I certainly agree that one trial showing increased effectiveness for a drug on American Blacks is not cause to ship the drug in bulk to Africa and subscribe it willy-nilly there. But you are trying to impose a black and white situation (pardon the pun) on a sitation that is by its very nature statistical.
I know it seems that way, so I’ll try to clarify. My point is that drugs don’t know how to filter out the genetic material. The genes that cause skin color, aren’t the same ones that influence hypertension using tomdebb’s example.
So saying that a drug that has 80% rate on Africans with Hypertension will have a better range on African Americans, than whites without a way of knowing what part of the African’s genetic code it’s effecting is wishful thinking. Because there’s no way to tell what percentage of African-Americans are still African. We’re not talking about smart bullets here.
We already know that African-Americans respond different to hypertension than native born Africans, simple logic tells me then that a drug that has 80% effectiveness on Africans may well have no little effect at all on African-Americans, as they are already reacting differently.
I’m not looking for a black and white answer, just trying to point out the shades of grey…
I’m not saying they do. I’m not using the term “Black” to mean “someone with very dark skin”, but to mean “someone who traces MOST of their genetic ancestry to Africa”.
But the drug being discussed here, per to OP, was tested on African-American Blacks, not on Africans. Your argument, while true , does not cover the case we’re discussing.
And while there is no way to tell for sure what % of a given African-American’s genetic heritage is from Africa, unless that person knows he has a specific ancestor of European ancestry, it’s probably a better bet that most of it IS from Africa. And given that the drug in question was tested on African-Americans, it would be a safe bet that most of those tested had SOME genetic ancestry from Europe, too.
Let’s look at a hypothetical. Suppose we have two drugs, A and B. A is shown to be pretty effective on “White” Amerivcans, but not too effective on “Black” Americans. The opposite is true of B. Lets also assume that a doctor cannot prescibe both drugs. Now, let’s say you are an “African-American”. You know that, like most American Blacks, you probably have some Europen genetic heritage. But your parents and their parents all self-identified as Black-- ie, you don’t know of any specific “White” ancestor you have. The doctor gives you a choice of which drug to take. What is your choice?
Fine John, but this thread is littered with people doing just that. A few posters asked/suggested whether or not a drug tested on African-Americans means that it can be transferred to Africans; as if they were the same ‘race’ of people…based on skin color. People have claimed that Sickle Cell is primary a “black” disease, based on skin color; not Geography. I have no problem using Geography, the problem most people don’t do that; they use skin color to mean ‘race’.
Still, what does that mean, “traces most of their ancestry to Africa?” Africans are not interchangable, an East African is not a West African. Further due to America’s caste system, any one with one drop of African blood was considered ‘black’, regardless of their appearance. Which means you have whole pockets of people who look white, yet consider themselves black and feel that they have most of their genetic material from Africa. Good luck convincing them that they don’t.
How do reach that conclusion that most of it is? We have no idea how genes are going to merge and in what variation. We have no idea how much European and Native American, as well as Latin American and other African genes are in the African-American gene pool and to a lesser degree Euro-Americans.
Tiger Woods is prime example of this, according to him, most of his genes are Asian, not African, we know this. However, if he was John Doe and walked in off the street, with no history; according to you I would have to assume that most of his genes are African…based on what? His apperance?
C’mon, let’s make it interesting…
You tell me which variation of the drug you would give this family assuming they were all alive. Remember you can only give them one and they all self-identify as “black”.
Well, Europeans arene’t interchangeable either. It’s a statistical issue. You pick the solution that is most likely to give the most benefit. You seem to be saying that because we don’t have perfect knowledge that we shouldn’t act on having partial knowledge. Granted there are many people who don’t easily fit into a given “racial” category, but the current situation is that most people do.
The point is, we don’t know. Again, this is a statistical matter.
You, as a patient, make the best informed consent you can. I’m not advocating that doctors make this decision based on how someone looks. I’m just saying that doctors should inform patients of their options and let them choose.
See above. And Tiger is a bad example. He KNOWS his mother is Thai and that his father is only partly of African descent. If I were he, and I had a choice of “racially specific drugs”, I’d probably go with the one that worked best for Asians.
I wouldn’t pick anything for them-- I’d let them pick. If I was one of those folks and had absolutely no idea where the majority of ancestry was from, I might just flip a coin.
