Blacks die from heart failure at twice the rate of whites. So a medication that is tested and efficacious for blacks that cuts those deaths by over forty percent would seem to be a great thing, right?
Although many cardiologists Monday hailed the findings because blacks die from heart failure at twice the rate of whites, some geneticists were concerned, arguing that racial categories were an inappropriate way to guide medical treatment.
“It’s great that this is showing such promise to treat heart failure,” said ethicist Jonathan Kahn of Hamline University School of Law in Minnesota. “But it is extremely unfortunate that the packaging has been associated with race. All you can tell from the data is that [the drug] works against heart failure. The patients happened to be black, but you can’t make any claims based on the data.”
[…] Kahn, the ethicist, said the label sent the wrong message in a society where blacks often received inadequate medical treatment. “It lends credence to the idea that blacks and whites are genetically different,” he said. “And it’s a short step from saying blacks are genetically different to saying they are genetically inferior.”
Crikey.
Okay, race, as some sort of monolithic “You are X, You are Y,” is an arbitrary and goofy concept. That said, across the continua of bloodlines tangled through the human species, one can identify trends and predispositions and biochemical processes and reactions that associated, generally, with racial labels.
[P]hysicians are aware that many drugs have different effects in whites and blacks. The ACE inhibitors, for example, are generally agreed to be less effective in blacks. A recent report in the journal Nature Genetics listed 29 drugs that were known to have different efficacies in the two races.
Certain diseeases and conditions seem to be more prevalent among folks of certain ethnic and “racial” backgrounds than in others. To make that observation is not to be racist, it is to be realistic. Can you find a “white” person and a “black” person who react more similarly to certain meds than two “black” people do? Probably. But either you completely discard effective groupings, or you pay attention to them. As was the case in the development of this new drug therapy, a combination of two other meds. It was originally tested on a broad cross-section of individuals.
The combination of isosorbide dinitrate and hydralazine provided some benefit, but not enough to justify approval, according to the Food and Drug Administration.
When Cohn reanalyzed the data and stratified the results by race, however, it appeared that the drug provided greater benefits for blacks. That was an intriguing finding because, even though heart failure affects 5 million Americans, blacks are 2 1/2 times more likely to suffer from it. […]
Spurred by these findings, Cohn and his colleagues organized a new study of the two drugs in 1,050 patients self-identified as black. Half received the drugs in conjunction with normal therapy for heart failure, and half received only conventional therapy. In both cases, subjects were given an ACE inhibitor.
The results were so striking that the study was terminated prematurely in July. Over the two years of the study, 6.2% of the patients given BiDil died, compared with 10.2% of those given the standard treatment. First hospitalizations for heart failure were observed in 16.4% of those receiving BiDil, compared with 24.4% of those receiving conventional therapy.
The difference seems to be statistically very real. To object to recognizing it as such because some folks might say, “See, they really are different,” is horribly self-defeating — pro-active political correctness of a lethal sort.
Why is the drug company, NitroMed, not simply asking the FDA to approve the drug for all patients, with the footnote that it appears more effective for blacks? Two reasons. First off, the FDA the drug did not show as being sufficiently effective among the general population in the initial studies.
The second reason is a bit more sinister. The drug, BiDil, is, as indicated above, actually a combination of two medications. That combination, as a treatment for the general population, loses its patent protection (can be made generically) in 2007. But a new patent application, using the drug for just blacks, is good until 2020. Ch-ching. Physicians could prescribe the two meds for anyone, of course — and, at $0.44/dose (for the generic constituents), even if insurance companies don’t cover it, it’s not a deal breaker.
We are all different. We are all the same. If someone came out with a drug that corrected a condition more prevalent in whites, but only in whites, I wouldn’t feel like it was a tacit admission that whites were somehow inferior, or that I might be discriminated against in my next job interview. Of course, granted, I’m probably less likely to be discriminated against due to my race anyway, but the only folks who are going to think that a medication that specifically treats a condition only effectively in blacks — and, in fact, is a condition that affects blacks more commonly — is proof that blacks are therefore somehow “inferior” — almost certainly already beleves that without any additional evidence.
(via Kevin Drum)