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TR: According to a 2007 report by the Pharmaceutical Research and Manufacturers Association of America, approximately 700 drugs in development are aimed at African Americans. How can we make sure that they are developed and marketed responsibly?
CY: First, we have to understand the impetus to develop a drug for any group and determine that it's driven by a unique unmet need, not by marketing advantages. If there are 700 drugs under investigation, we're talking about 700 different circumstances where someone has presumed they are targeting an unmet need. Frankly, I don't think 700 such circumstances exist.
TR: In a recent review that you wrote on race and medicine, you said that translating differences in disease risk factors into race-based therapeutics has been awkward and ineffective. What do you mean?
CY: The general awkwardness surrounding racial issues in our society bleeds into medicine. There may be unique mechanisms at play in heart failure in some people described as African American. When a practitioner is presented with an African-American patient, they may be hesitant to offer the patient a drug based on their race. And some patients are put off when practitioners emphasize race.
We found in a study that even though there is a drug regimen that is uniquely beneficial to African Americans with heart failure, [prescribing rates are] no better than about 10 percent. And the rate of increase is significantly less than that for other effective therapeutic strategies. That tells me that without being able to articulate all the reasons, there is some hesitancy to proceeding forward with race-based medicine.
TR: Are you referring to Bidil?
CY: Yes, and any iteration of the parent compounds in Bidil have also been poorly prescribed. If the [generic parent compounds] had been prescribed, it would argue that science has been accepted and practitioners found a way to prescribe this to the target population.
TR: How should we move forward?
CY: We need to move away from race quickly. As we mature, we will be able to supplant the notion of race as predictor of response with something more palatable to the scientific community and to patients. Then we don't have to bring the word heft of "race" into how best to care for patients.
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
Reply