IBARW: "Race in a Bottle"

[kate_nepveu]

A quick morning link: Scientific American has a story this month entitled "Race in a Bottle." It looks at the history of the approval of the first "ethnic" drug, BiDil, approved to treat congestive heart failure specifically in African-Americans, which is actually a combination of two generic drugs. It concludes that "no firm evidence exists that

Comments

[fledgist]

I am particularly curious as to whether such a drug would be prescribed to a person such as myself who is of mixed ancestry (and by mixed I mean mixed) and who does not identify as 'African-American'.

[kate_nepveu]

I can't answer that question with anything but extrapolation, but heck, I'm a lawyer, extrapolating and drawing inferences is what we _do_. So, some random considerations:

I suspect that would be considered off-label use, which may discourage some doctors. (I'm not very familiar with this area and welcome comments.)

A doctor who was aware that there's no evidence that the drug works better for African-Americans, might prescribe the two generic drugs in the same combination if they were indicated for your condition.

And then there's the common human tendency to like easy categories and flow-charts and the like, which I think would be a factor reducing the likelihood that you would be prescribed BiDil.

I'm sure there are more things I'm not thinking of.

[fledgist]

Hmm. Thanks. That is actually helpful. So my actual genetics wouldn't matter?

[kate_nepveu]

What, for whether BiDil would work for you? There seems to be no evidence that it works better on a genetic basis for anyone.

[dsgood]

I'd be nervous about taking a whites-only drug, because some of my genetic heritage is Asian. (My mother's cousin looks almost as Oriental as his Korean wife.) And the genes relevant to my medical condition might well not be white-only. The same is true of other people of Eastern European ancestry.

As for African-Americans: Many of them are various mixtures of white, black, and American Indian ancestry. (Note: I don't say "Native American" because I believe very few have Inuit or Aleut ancestors.) "One size fits all" isn't going to work.

[kate_nepveu]

Let me quote the paragraph in full that talks about the 29 drugs, because it was buried in page 4 of the article:

In only four of the 29 medicines identified, Tate and Goldstein found evidence that genetic variations between races could possibly be related to the different responses to the drugs. (All four are beta blockers used for treating high blood pressure and other cardiovascular ills; some research indicates that these drugs work better in individuals carrying a gene variant that is more common in people of European ancestry than in African-Americans.) For nine of the medicines, the authors found “a reasonable underlying physiological basis” to explain why blacks and whites may respond differently to the drugs; for example, some scientists have speculated that ACE inhibitors may be more effective in people of European descent than in African-Americans because of variations in enzyme activity. (Other researchers have contested this hypothesis.) For five of the drugs, Tate and Goldstein found no physiological reasons to explain

[cyphomandra]

Thanks for posting this - I'd heard a mention of the drug, and naively assumed it was based on stronger research, possibly tying into the ACE inhibitor data you mention in your above comment, which I'd heard about before (and which now looks like yet another example of subgroup analysis that didn't pan out when specific trials were actually designed to look at differences). Nice - for values of depressingly familiar - to know that it's just another attempt to create and corner a new market.

There are drugs prescribed based on the presence of absence of specific genetic factors (there's an HIV treatment where potentially fatal side effects occur only in patients with a particular genetic marker, so all patients are now screened for that), but using race as a surrogate for these seems like plain bad medicine. Population data is important, but patients are still individuals.

[kate_nepveu]

Thanks. Out of curiosity, do you know if the genetic marker relevant to the HIV treatment you mentioned occurs more in any particular population?