RAGLANDMYCOOL@AOL.COM wrote:

Raced-Based Medicine Continued....

NICHOLAS WADE
The New York Times, 11/14/2004

RESEARCHERS last week described a new drug, called BiDil, that sharply
reduces death from heart disease among African-Americans. That sounds
like unalloyed good news, especially because African-Americans have
been underrepresented in previous drug trials and because there is
already an important class of heart drug that does not work as well in
blacks as it does in whites.

But not everyone is cheering unreservedly. Many people, including some
African-Americans, have long been uneasy with the concept of race-based
medicine, in part from fear that it may legitimize less benign ideas
about race.

Marketing BiDil as a drug for blacks is ''a classical example of using
race as a surrogate for biology,'' said Dr. Georgia Dunston, a medical
geneticist at Howard University, noting the drug does not work in all
African-Americans and may well be of benefit to other groups. The
emergence of BiDil, described last week in The New England Journal of
Medicine, is a sharp reality test for an academic debate about race and
medicine that has long occupied the pages of medical journals. Is there
a biological basis for race? If there is not, as many social scientists
and others argue, how can a drug like BiDil work so well in one race?
Even if there were a genetic reason for race, why drag race into
medicine when a physician's only concern is with the specific genes
that predispose to disease?

Advances stemming from the human genome project are likely to produce
many new diagnostic tests and treatments tailored to specific
population groups, including races and ethnicities within races. BiDil,
however, had nothing to do with the genome project. It is a combination
of two old drugs, invented some 30 years ago by Dr. Jay N. Cohn, a
physician at the University of Minnesota. On its first trial, in a
general population, it didn't seem particularly effective. But in
reanalyzing the data a few years ago, Dr. Cohn found it had worked well
in a specific group of patients, who happened to be black.

The Food and Drug Administration said it would license the drug if a
second trial confirmed the result. The new trial, conducted with the
help of the Association of Black Cardiologists, had to be stopped when
it became clear the drug was so effective that it would be unethical to
deny it to the control group.

This month, in a special issue on race published by the journal Nature
Genetics, several geneticists wrote that people can generally be
assigned to their continent of origin on the basis of their DNA, and
that these broad geographical regions correspond to self-identified
racial categories, such as African, East Asian, European and Native
American. Race, in other words, does have a genetic basis, in their
view.

But researchers from Howard University, a center of African-American
scholarship, argued in the same journal that there was no biological
basis for race and that any apparent link between genes and disease
should be made directly, without taking race into account.

Most geneticists agree with the Howard researchers that the underlying
genes, not race as such, is what is important for understanding
disease. But many say that race can be a valuable clue. In the case of
BiDil, race was essential to proving the drug's effectiveness. ''It was
the only way we had -- there was no other marker that would tell us how
to select a population that would respond,'' Dr. Cohn said.

Findings based on race can be hard to interpret correctly because many
other factors, from behavior to access to medical care, can track along
with any genetic component. People are often too quick to assume that
any difference found between two races is genetic and immutable, said
Dr. David Altshuler, a medical geneticist at Harvard University. But
race should still be taken into account, he said, even if as a last
resort.

BiDil is designed to increase levels of a chemical signal known as
nitric oxide, which tends to be lower in Africans, possibly because low
levels help retain salt for people living in hot climates. Thus there
may be a genetic basis for African-Americans' positive response to the
drug. Dr. Cohn said he hoped to identify the particular gene, or set of
genes, that is involved. Though that genetic combination is presumably
more common in Africans, it may well exist in people of other races,
who would also stand to benefit from the drug.

Whatever medical benefits geneticists may promise, people may be
disconcerted at being defined genetically, particularly for the purpose
of having a set of diseases associated with them. There has been fear
of stigmatization among Jews following discovery of a number of Jewish
genetic diseases.

Some African-Americans fear that if doctors start to make diagnoses by
race, then some in the public may see that as a basis for imputing
behavioral traits as well. ''If you think in terms of taxonomies of
race, you will make the dangerous conclusion that race will explain
violence,'' says Dr. Troy Duster, a sociologist at New York University.

Of course, every race and ethnic group has its own particular pattern
of disease. The blood disorder hemochromatosis is more common among
Scandinavians, and the predisposing gene is thought to have been spread
elsewhere in Europe by the Vikings. But the danger of stigmatizing a
population by linking its genetics with diseases is probably higher for
groups of lower socioeconomic status.

''Anything that invites the perception of African Americans as
biologically different is a huge worry,'' said Dr. Gregg Bloche, a
Georgetown University physician who studies racial disparities in
health care.