BiDil, "Race", and Constructive Discourse
Hope those on the list have kept pace with the news this past week on the
breakthrough drug, BiDil, a heart pill that has shown amazing efficacy in
those of African ancestry but apparently does little for whites and other
population groups.
Last Friday, I organized and presented at a conference on "Race and
Medicine" in Washington, DC that was broadcast live on CSPAN (and repeated
over the weekend..and apparently is still being repeated).
The key note speaker, Keith Ferdinand, a renowned cardiologist, former head
of the Association of Black Cardiologists, and co-author of the BiDil study
that demonstrated the drug's efficacy on blacks, made it very clear that
with lives on the line, particularly of minority populations, it's high time
we get beyond the ideological trap of trying to deny population-based
differences.
You might find his talk illuminating. Other speakers included William
Lawson, a renowned Howard University psychiatrist who discussed metabolic
differences between blacks and whites in handling psychotropic drugs, Dr.
Sally Satel, who explained why she 'racially profiles her patients,' Dr.
Pamela Shankar of the University of Pennsylvania, who expressed concerns
about 're-biologizing race,' molecular geneticist Vincent Sarich, and me,
who talked about "Jewish Genetic" disorders, one aspect of my upcoming book,
"Abraham's Children," on the shared genetics of Jews and Christians.
An internal, one camera, video of the event should be posted today at:
http://www.aei.org/events/eventID.937,filter.all,type.past/event_detail.asp#
At this stage, anyone who continues to insist, in defiance of overwhelming
evidence that 'race has no biological significance' is frankly endangering
the health of various population groups, particularly minorities, for purely
ideological reasons. As a result of evolution, there are measurable
differences between populations in SOME characteristics, such as response to
drugs, body type, physiology, etc. This has huge implications for science
and medicine...and of course for those studying sports, where these patterns
have been clear for many years, and are now being linked to specific aspects
of the human genome.
Let's hope those studying sports can quickly and thoughtfully integrate this
bio-cultural reality into our scholarship, instead of being slaves to
outdate, polemical, ideological paradigms.
There have been numerous press reports on this issue. The editorial
reproduced below was written by Michael Crane of USA Today, who attended the
Friday forum, and quoted from it liberally in his article (alas, without
attribution).
--
Jon Entine
Miami University
(513) 527-4385 FAX: 527-4386
http://www.jonentine.com
--
Jon Entine
Miami University
(513) 527-4385 FAX: 527-4386
http://www.jonentine.com
****
USA Today
November 15, 2004
Editorial/Opinion
Our view: Racial diversity in drug trials can produce breakthroughs.
More than a decade ago, a howl went up about the way new drugs were tested.
Virtually all trials were limited to white males, even though some medical
differences based on race are widely acknowledged. The Food and Drug
Administration (FDA) ended that bias in 1997, when it required drugmakers to
test more ethnic groups and women.
The fruits of the change surfaced last week. A study published in The New
England Journal of Medicine found that a heart medication, BiDil, reduced
death rates among black heart-failure patients almost in half. Previous
research had shown blacks benefited from the drug, while whites didn't. But
too few blacks were included in the study to draw firm conclusions. So the
Association of Black Cardiologists helped set up a trial of 1,050 black
patients.
Now some ethicists are raising a new worry: Such race-specific testing could
open the door to discrimination in medical treatments and dangerous notions
of genetic differences based on race, conjuring up the eugenic experiments
of Nazi doctor Josef Mengele.
That's a danger requiring vigilance. But in today's reality of medical
research, the fear is no reason to turn back the clock to the days of
all-white-male testing.
Though research has found that 99.9% of human genetic composition is the
same in everyone regardless of race, stark differences among ancestral
groups exist. Ignoring them doesn't benefit patients. Consider:
€ At least 29 drugs are known to work differently in blacks than in whites,
according to a recent report in Nature Genetics. Blood pressure medicines
that are standard for whites have decreased responsiveness in blacks. The
FDA requires that information to be included in drug labeling.
€ Some genetic diseases seem to target ethnic groups. Various breast cancer
mutations are most common in Jews; cystic fibrosis disproportionately
affects whites, and sickle cell anemia is more prevalent in blacks.
Spotting medical trends among ethnic groups and targeting appropriate
treatments make sense, whether the differences among groups are due to
genetic makeup, environment or socioeconomic factors such as poverty and
lack of access to health care.
Mistrust about race-based medicine is understandable in light of past
outrages, especially the U.S. Public Health Services' notorious Tuskegee,
Ala., study. Beginning in 1932, hundreds of black men with syphilis were
treated as guinea pigs for decades and denied penicillin in the name of
scientific research.
By contrast, the results of the new heart-drug study were so dramatic that
the trial was halted abruptly in July so that patients getting the placebo
could join those getting the medication.
Denying scientifically determined racial differences in medical therapies
because of ethical concerns only puts patients at risk. Blacks are twice as
likely to die from heart failure as whites, according to the American Heart
Association. Widespread use of the new drug by the 375,000 blacks with heart
failure could save 15,000 lives a year, researchers say.
When all segments of society are included in clinical research, the result
can be medical benefits too big to ignore.
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