Racist Drug Development.

UPDATE (22 June 2005): Nature has a news item on this drug with some good insights from Francis Collins. Collins suggests, "We should move without delay from blurry and potentially misleading surrogates for drug response, such as race, to the more specific causes."

An important point that needs to be brought up is that race is a somewhat subjective classification. Someone who identifies himself as African-American may be of less than 25% African ancestry. While there is real genetics behind the differences between Africans, Europeans, and Asians, sometimes ethnicity seems to overpower those differences in a cultural setting. Do we prescribe a drug that only seems to work in people of African ancestry to a patient who identifies himself as African-American even if he's mostly of European ancestry?

I know razib will bring this up, so I will point out that the majority of African-Americans are mostly of African ancestry.

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African-Americans are the result of admixture between Africans, Europeans, and Native Americans. Furthermore, Africans are a paraphyletic group containing more genetic diversity than all other human populations combined. That's why this bothers me a bit:

This Thursday, eight years after the drug [BiDil] was rejected for use in the general public, an F.D.A. panel will consider whether BiDil should become the first drug intended for one racial group, in this case, African-Americans.

A study of 1,050 African-American heart failure patients showed that BiDil significantly reduced death and hospitalization, prompting the American Heart Association to call BiDil one of the top developments of 2004. BiDil increases levels of nitric oxide, which widens blood vessels.

The drug's maker, NitroMed Inc., says its decision to test and market BiDil as a drug for African-Americans is based on solid science. But BiDil's application has engendered controversy, with many scientists convinced that race is too broad and ill-defined a category to be relevant in determining a drug's approval, especially since geneticists have failed to identify a biological divide separating one race from another.

. . .

"My criticism of the African-American Heart Failure Study is that they only studied African-Americans," he [Dr. Joshua Hare, a cardiologist at the Johns Hopkins University Medical Center] said. "To really test the hypothesis is to study both populations and then show, aha, the African-Americans did respond better. They didn't do that."

. . .

Jonathan Kahn, a medical ethicist at Hamline University law school in St. Paul, said BiDil's approval as a black-only drug would give an official ring to the discredited idea that race is a biological category.

The scientist in me says that there is very little reason to suspect a drug would work differently in African-Americans than in European-Americans because of genetic difference between the two ethnic groups. There may be some environmental differences, however, that cause the drug to perform differently in the two populations.

The commie pinko bastard in me notes the "historical inequities in medical treatment for African-Americans" and wonders if this is an example of social justice.