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Table of contents
Even if some but not all BiDil proponents simply slide the drug into a genetic frame, why should critique of BiDil do so? Finally, because of the explicitness of its racialization, BiDil has become an obvious icon of racialized medicine, but it is actually not clear that BiDil is…. Dorothy E. Roberts , George A. In June , the Food and Drug Administration FDA announced a historic decision: it approved the first pharmaceutical indicated for a specific race.
BiDil , a combination drug that relaxes the blood vessels, was authorized to treat heart failure in self-identified black patients. A-HeFT enrolled 1, subjects suffering from advanced heart failure, all self-identified African Americans. A-HeFT showed that BiDil worked; in fact, it worked so spectacularly that the trial was stopped ahead of schedule. BiDil in-creased survival by an astonishing 43 percent.
Hospitalizations were reduced by 39 percent. It was a momentous accomplishment for Jay Cohn , the University of Minnesota cardiologist who invented BiDil and had pioneered vasodilators as an important treatment for heart failure. Instead, the FDA put race at the center of its decision, sparking controversy and paving the way for a new generation of racial medicines.
No one is complaining that BiDil is available to people who will benefit from it. The problem is that BiDil was made available on the basis of race.
Its racial label elicited three types of criticism: scientific, commercial, and political. I will discuss the first two controversies en route to what I consider the main problem with race-based medicine, its political implications. By claiming that race, a political grouping, is important to the marketing of drugs and that race-based drugs can reduce health disparities, which are caused primarily by social inequality, those who promote racialized medicine have made it a political issue.
Yet, having made these political claims, these very advocates answer criticism by saying that we must put aside social justice concerns in order to improve minority health. This article explains why marketing pharmaceuticals on the basis of race is more likely to worsen racial inequities than cure them…. Eddie L. There have been many examples of events in the past 70 years to suggest that achievements by ethnic peoples are not genetically determined and that race and ethnicity are merely terms to describe external features, language, culture, social mores and folklore.
Thus arose the question of the efficacy of doing race-based research in humans. This makes for far greater similarities among U. Scientists involved with the first mapping of the human genome have noted that there is no basis in the genetic code for race. That being the case, there appears to be no justification for race-based research among human beings. To be sure, disparities in healthcare, like anything else, are a function of a variety of factors, including education, environment, income and culture, among others. Race and ethnicity are important determinants of some of these functions, thus raising the question as to whether these parameters may, in fact, be determinants of outcome in some of these disease processes based upon genetics as well as the aforementioned risk factors.
Modern-day science has amassed enough evidence to suggest that there is very little biological difference between the various races. Some racial and ethnic groups have a very heterogeneous gene pool, such as whites and Hispanics. This would make for far greater similarities in the U. This would obviously include race-based pharmaceutical research that resulted in the drug BiDil. This is not to be confused with the fact that race indeed affects both access and outcomes in our healthcare system, as it most certainly does.
Even black medical professionals do not enjoy the same access to highly specialized services as their white counterparts, such as coronary artery bypass grafting, but the basis is not biological and by extension, not genetically determined…. Black and White Medicine.
Mixed Race Studies » BiDil
What is your race? In another time and place, these may have been the available choices. Obviously these categories are not anthropologically or scientifically based. Currently the United States uses the definition of racial categories as published by the Office of Management and Budget in its Revised Directive Directive 15 stems from the civil rights movement; it aims to provide consistent data and a uniform language in order to increase fairness in society. All federally funded research with human participants is required to address issues of race, although the OMB explicitly states that its categories are not anthropologically or scientifically based.
There are two categories for data on ethnicity: a Hispanic or Latino and b not Hispanic or Latino Office of Management and Budget, The human genome project, completed in June , concluded that all human beings, regardless of race, have pretty much the same genes. Race is an ideology that changes according to time and place. However, at the same time that the human genome project has unequivocally demonstrated that race is a construct with no biological validity, the idea of race as a genetically based population variant is becoming more and more entrenched in biomedical research and practice.
How is it possible? Read the entire review here. Comments Off on Black and White Medicine. Racial profiling in medicine. The field of human genetics is moving beyond using genomics as a tool for deeper understanding of human disease pathophysiology to the possibility of translating this knowledge for efficient treatment. This ideal vision, however, can cause unease when our notions of genetic individuality intersect with those of ancestry and race.
In it, he skillfully uses the story of the drug BiDil , a therapeutic for heart failure marketed specifically for African Americans but whose use has declined markedly because it provides no unique benefit in comparison to similar drugs , as the backdrop for examining the expanding role of race in medical genomics, even when the same science has called the existence of race into serious doubt. As Kahn highlights in the book, the innocuous birth of BiDil in was no predictor of its contorted history. BiDil is a combination of two vasodilators , hydralazine and isosorbide dinitrate H-I , which are presumed to act through the nitric oxide pathway to provide benefit to patients with congestive heart failure.
They were combined into one pill for easier administration, although each was already available in generic form. Between and , two major clinical trials in the United States, involving patients of both European and African ancestries, clearly established that angiotensin-converting-enzyme inhibitors should be the preferred drug for patients with heart failure and that the H-1 combination should be used in individuals who did not benefit from this frontline therapy.
The FDA refused, arguing that clinical trials showing the utility of H-1 for heart failure did not meet the stiff criteria for such approval. There was a suspicion that the nitric oxide response, and heart failure, was somehow different in blacks than in whites.
So Jay Cohn, a respected cardiologist and owner of the original BiDil patent, reanalyzed the original clinical trial data to demonstrate that H-1 did work better in blacks than whites, a contention described and contested in the book. This finding not only led to a new patent but prompted its new owner, NitroMed, to conduct a fresh clinical trial in , involving only African-American patients with heart failure, to demonstrate BiDils utility in this group. None of these facts are in doubt. What is doubted, however, is the implicit assumption that BiDil is not useful for white patients, the chronology of key events and the motivations of various actors in medicine, industry and government—factors that morphed an otherwise convenient drug formulation into a race-specific drug.
Any classification of biological races within our species is arbitrary because there are no major discontinuities in our diversity across the globe. Importantly, genetic data show that currently populous groups are not necessarily reflected by their past abundance, and human history is one of repeated admixture, not maintenance of purity. It is this genetic admixture that has left an imprint on every human disease with a genetic component, including common chronic ones.
Thus, it is quite unlikely that the genetic variations underlying our diseases, which represent only a small fraction of our genetic diversity, will vary markedly across humanity….
How Race Made the Opioid Crisis
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Targeting Immigrants notes that while scholars have nicely analysed how advanced liberal governments work through promoting the self-managing capacities of individuals, they have paid scant attention to how such regimes also operate through practices of exclusion… …Racial Prescriptions continues my examination of the politics of race in the United States. From this perspective, biopower today is about controlling and managing human biological processes in order to prevent disease, enhance health, and optimise the quality of individual and collective existence… Read the entire interview here.
Often African Americans are held to white norms, yet health disparities would be more aptly compared to other underserved groups, such as recent immigrants… Read the entire article here.