Beyond Race-Based Medicine

Let's move beyond race when exploring disease, says Clyde Yancy.

While racial disparities are rampant in medicine, some evidence suggests that physicians and the public have little appetite for race-based drugs.

Race-based medicine: Clyde Yancy, medical director of the Baylor Heart and Vascular Institute and president-elect of the American Heart Association, says that the public may have little appetite for race-based drugs. Credit: Baylor Heart and Vascular Institute

Bidil, a drug for heart failure, was approved by the U.S. Food and Drug Administration in 2005 after clinical trials showed that it significantly improved survival rates in a group of patients that described themselves as black. Some applauded Bidil's approval for focusing on an underserved population, but others countered that race is a poor proxy for the genetic variation that likely underlies drug response. And because Bidil is a combination of two generic compounds that are individually available much more cheaply, some critics suggested that racially targeted prescribing was mainly a marketing tool.

The drug has since suffered poor sales. Nitromed, the company that developed Bidil, suspended marketing for it last year and announced yesterday that it is considering a buyout offer. A general reluctance to delve into race-specific medicine may partly explain its failure. According to Clyde Yancy, medical director of the Baylor Heart and Vascular Institute and president-elect of the American Heart Association, prescribing rates for both Bidil and its generic equivalents have been low. Yancy, who was involved in clinical trials of Bidil, talks with Technology Review about the best ways to approach racial disparities in medicine, and the need to move beyond race-based medicine.

Technology Review: Why is the issue of race so important in medicine?

Clyde Yancy: The demographics of our population are changing much faster than we thought. Within the practice lifetime of many health-care providers, we will be dealing with a much more diverse population than ever before. So it's critical to understand the nuanced differences in disease presentation in different groups.

TR: How can we make sure that doctors are more sensitive to differences?

CY: Awareness. I don't believe practitioners willfully overlook disease. But if they are not aware that diseases can present differently, change won't come about.

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TR: How much of a factor is genetic variability in explaining racial health disparities?

CY: Even with the most robust understanding of genetics, we may be able to explain only a small percentage of disparities in health care. More blacks have high blood pressure than whites. That's a difference, not a disparity. But when we look at the percentage of blacks who have achieved blood-pressure goals, it's very small. That may be a disparity; it may be due to lack of access to health care or lack of understanding of how malignant blood pressure can be in blacks. If we don't address those issues, the difference has resulted in disparity.