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.
Baylor Heart and Vascular Institute
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.
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.
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.
Charles Rotimi explains why a more complete snapshot of genetic variation is important.
Are drugs that seek to serve a specific population changing our concept of race?
Population genomics is expanding our knowledge of human diversity. What role should race have in drug development?
Self-identifying as "black" in America is a highly-suspect way to classify people for anything, much less medical treatment. "Black" basically means only that one of your ancestors had dark skin and (probably) came from Africa. That ancestor could have come from anywhere in Africa and might not have even been Negro -- just a darker-skinned version of Caucasian. Or the ancestor might even have been a dark-skinned person from South Asia -- India, say, or Pakistan. (That is supposed to be cheating, but nobody checks.) Really, a person doesn't even need to be dark-skinned. If he/she self-identifies as "black," then he/she is "black." It's a crazy system: sort of a self-imposed reverse-apartheid.
First off, I thought DMM's comments seem to be germane. Self identification may be the most troubling aspect. Another aspect of the US, is that especially in the last 50 years, intermingling has been increasing, if not out and out "rampant" (just to be clear, this is good). To really make a difference, we are going to have to learn to identify gene pools and then find a way to early on identify people's membership in a given gene pool. My family on my father's side has been in country since about 1760. Based on my father's work on geneology, the best guess for me is 1/4 Polish, 1/4 English, 1/4 Irish, part Cherokee, Blackfoot, Austrian, Danish, Welsh and Scottish. And that is assuming that the first generation was 100% English. Heck, just on the English side - there is Norman, Saxon, Celt and Pict. What "gene pool" am I part of? Too make matters more confusing, "saidak" comes from the Polish side of the family. In Polish, "sajdak" has no meaning as a word. We have been only able to identify two words that MIGHT explain it's origin - the Hebrew siddaka or the Ukranian word for quiver (as in full of arrows). So is that part of my family pure Polish? Or part Ukranian, or part Jewish? On my mother's side, no one has done a geneology. As that side of the family came through the south, could I have Creole and/or African as unnamed parts of my genetic heritage? Ignoring that "race" is genetically meaningless in respect to humans, gene pool seems to be the best approach, and as others have pointed out, individual membership in any given gene pool is open to question.
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devassocx
111 Comments
Race-Based Medicine
Seems to me this is a race baiting article.
Genetic differences between people, races and
race subsets is a well known I believe.
Decode Genetics is a firm in Iceland with its business based on the genetic differences of Iceland's population. It investigates and find drugs for various disorders.
And I believe it is not uncommon to find that within a clinical trial a subset of the population will be found to benefit from the drug under investigation.
Of course, it is up to the FDA to ultimately approve any drugs and define who might benefit from them. So it is important that they operate
properly (and efficiently) to maximize the outcome. This appears to not always be done but that is a different problem.
In summary, I find this article to be unnecessary
and suspect in it's content. Too bad.
Reply
rvandell
22 Comments
Re: Race-Based Medicine
Globally funded medical research is the only viable solution for all peoples of planet earth.
For-profit medical research only produces conjecture.
IMHO
Reply
Emily Singer
26 Comments
Re: Race-Based Medicine
Previous research suggest greater genetic diversity exists within race-based populations than between them. Specific genetic variations likely underlie some of the observed differences in disease rates and drug response. Scientists have used use race as an proxy for genetics because extensive genetic analysis has been too expensive. But that is changing. Dr. Yancy’s point is that understanding the specific genetic variations linked to these differences will provide a much more accurate (and less socially charged) way to assess and treat different diseases
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