Conversations About Race-Based Medicine: George Bakris, MD
Race-based medicine, or the practice of treating people differently based on their racial and ethnic background, has long been a subject of interest to healthcare providers, public health practitioners, communicators and others. Now, with the introduction of Bi-Dil, the first medication approved for the treatment of a condition in a specific race (African Americans), the topic is once again gaining increased attention.
Given the intense interest in this subject, I am conducting a series of periodic interviews with physicians, executives from medical societies, communications experts and others. Each interview subject provides his or her unique perspective on race-based medicine, which I then publish on this blog.
I invite all of you to comment on this issue. If you wish to be interviewed on this subject, please contact me. I can be reached at news at envisionsolutionsnow dot com.
Interview Subject: Dr. George Bakris
About Dr. Bakris: Dr. Bakris is Professor and Vice-Chairman of the Dept. of Preventive Medicine and Director, Hypertension/Clinical Research at the Rush University Medical Center in Chicago. Dr. Bakris has published over 300 articles and book chapters in the areas of kidney disease hypertension and the progression of nephropathy. He has also served on numerous medical guideline development committees, including the JNC-7 national high blood pressure guidelines. He also co-developed the International Society on Hypertension in Blacks’ recommendations on the management of African Americans with high blood pressure.
Interview
Q: There has been a lot of discussion recently about race-based 
medicine. What are the benefits and/or drawbacks to using race as a 
means of treating and grouping patients?
A: I think that in general, there more benefits than drawbacks to doing this. For example, if you look at responses to drugs, there are clear differences between Asians and Caucasians in terms of tolerability and efficacy. It is also clear that African Americans respond differently to certain classes of agents than whites. Overall, there may be subtle differences genetically that may translate to benefits in terms of different drugs.
The drawback is that there are certain conventional wisdoms about treating different races with certain medications. [In the hypertension community there’s been a lot of talk about how] African Americans weren’t being treated with ACE inhibitors for a long time [because of perceptions that they didn’t work as well]. Clearly, ACE inhibitors benefit blacks and you can’t use race to deny a certain group a helpful medication.
What this example shows is that you run the risk of stereotyping races based on certain concepts and fail to look at the whole picture. There are no situations that I know of where race-based medicine helps you in terms of choosing one medication over another. Certain classes of drugs appear to work better in certain races, but that doesn’t mean that you deny it to others for this reason.
What is really important in the field of cardiovascular medicine is achieving targets [high blood pressure, cholesterol, etc]. If we focus on reaching goals, we will have a much better time treating people of all races and backgrounds. I am a firm believer that most people will require a combination of medications to reach established targets.
There is an art to treating patients and you can’t do so based on skin color or background alone, but it can help in certain situations.
Q: In your mind, is there a link between race and disease or is there 
something else going on?
A: I don’t think there is a link between race and disease. But, I do think there is a link between certain genetic profiles and certain races. For example, blacks have a higher risk of end-stage kidney disease. Is this increased risk due to race or is it associated with some genetic factors?
Likewise if you are Asian you have more of a risk of developing IgA nephropathy, but we don’t know why this is. What are the reasons, diet, genetic, etc? We just don’t know.
Race is part of the cultural background that you come from. But diet and genetics also have an impact on disease. It is clear that if you are of a certain race, you have more of a chance of getting certain diseases. But, it might not be race making you more susceptible. It might have to do with history and how you evolved.
The danger is that people will pigeonhole patients based on generalities, because they are used to it. People have to treat based on the whole package, not just race.
Q: Pharmaceutical companies, advocacy organizations and others spend a lot of time and effort attempting to communicate to different groups about diseases that impact them. From what you’ve seen, are these efforts effective? What would you do to improve them?
A: In general, the efforts of pharmaceutical companies have alerted the public to their products. That may be good, because it informs patients about diseases that may not be aware of.
However, companies have spent a lot of money marketing to different ethnic and racial groups with spotty results. [Bluntly speaking] I would grade companies’ efforts to educate patients a D. This is because they are educating on the product rather than a disease.
With very few exceptions, the educational efforts I’ve seen are woefully inadequate. There is [great] potential to do some public service, but in general, things need to be better.
That being said, I think that some companies are doing a good job. For example, there is a public education program [in cardiovascular disease a pharmaceutical company is] conducting currently that is an example of how things could and should be done. The program is very diverse because it is user-friendly and provides people with lots of information.
Q: Are there any ethnic/racial groups that are currently being neglected or overlooked in health promotion efforts?
A: Yes. African Americans are being neglected certainly. Hispanics are also being neglected in terms of messages. For example, the only things I’ve seen on radio and television focusing on Hispanics’ kidney health has been George Lopez’s show. But, I think the only reason we saw anything about this was because he had a kidney transplant.
In general, in terms of cardiovascular disease, these groups haven’t been targeted enough. We should be seeing a lot more public service announcements and [health] promotion on the community-based level. We need a lot more visible efforts to reach these groups and educate them.
Q: Have you been following the Jackson Heart Study? If so, what are 
your thoughts on this effort?
A: I haven’t been following the Jackson Heart Study closely. But, I also haven’t heard anything recently about the effort.
Overall, I think the study is going to have far-reaching implications and will spawn a lot of initiatives. However, I think the study hasn’t received the attention that I think it should have. I’m not sure why this is.
Q: Is there anything going on overseas around race-based medicine 
that disturbs or inspires you?
A: I am not aware of any initiatives going on overseas regarding race-based medicine. So, I’m neither inspired or disturbed.
Q: Can you provide any general commentary on this issue?
A: Overall, I think that race can be useful when you are looking at how different groups respond to drugs. There are clear differences between races when you look at the efficacy and side effects of medications.
However, I think that it is very important not to use race to deny medications to certain groups or overly influence how you practice medicine. Treat the whole patient, not the group.
June 27th, 2006 at 3:17 pm
[…] Q: People have had a generally low opinion of the pharmaceutical industry’s efforts to educate minority populations about healthcare. In fact, one physician I interviewed gave the industry a “D.†How would you grade NitroMed’s efforts to educate African Americans about heart failure and what, if anything, can the company do to improve? […]
October 6th, 2006 at 1:39 am
The idea of race-based medicine and health care is no doubt a new and an interesting thing to me.
March 3rd, 2007 at 4:20 pm
Dr. Bakris’s interview brings to light some important, often overlooked, points about race based medicine. As a first year medical student, I feel that it is necessary to consider a person’s race in order to treat him or her with the care they deserve. It would be a disservice to ignore the physiological impact a patient’s genetic makeup can have on his or her health. Some diseases, such as hypertension or renal disease, require different approaches for different people. Race isn’t necessarily the most critical factor, but it can lead to negative implications on the outcome of treatment if ignored. I agree with Dr. Bakris when he says, “there is an art to treating patients and you can’t do so based on skin color or background alone, but it can help in certain situations.”
What is important to keep in mind, is that each person needs to be treated on an individual basis, but having clues into how they may respond to different therapies will help. Perhaps current research in the field of pharmacogenomics will bring this type of therapy to reality. With the human genome fully mapped and an increasing number of genes being identified, it may be possible to treat each patient based on his or her individual genetic makeup.
I also found Dr. Bakris’s opinion on pharmaceutical advertising interesting. He says that the companies “have spent a lot of money marketing to different ethnic and racial groups with spotty results…This is because they are educating on the product rather than a disease.” The solution would be to inform the communities of different diseases that may impact them personally and then to educate them on therapeutic options. This responsibility would rely on physicians as well as public services.
I find the topic of race based medicine very fascinating and I am interested to see where it goes in the future. Thank you Fard for posting these interviews.
March 5th, 2007 at 9:09 pm
I agree that the topic of race-based medicine is both interesting and potentially a very useful diagnostic tool. There are many diseases that present similarly within certain groups of people, while presenting quite differently across certain races. Many treatments may work better in one race than in another. An example of this is the African American Heart Trial that showed that isosorbide/hydralizine significantly reduced the mortality due to heart failure especially in the African American poplulation because of a mutation involved in nitric oxide synthase production. Since this mutation is more prevalent in the African American population than it is in the White population, people of African American descent are more likely to benefit from this treatment (Should Drug Therapy be Personalized Based on Race? Vivian EM. Ann Pharmacother. 2006 Mar;40(3):550-2).
While it would seem appropriate to treat people with a similar genetic backgrounds with drugs targeted to certain genes, proteins, etc, the problem arises in the fact that not all individuals who identify with a certain race carry the targeted gene(s). Treatment of an individual based solely on their race could be risky since not all individuals of a certain race are going to respond to treatments in the same way.
Keeping race in mind when treating a patient can be used as a guide for treatment, but should be considered equally with the patient’s history and presentation of illness. Race can be a risk factor for certain diseases and it can also indicate how a person may respond to certain medications. It is important however not to rule out alternative disease etiologies or medications based solely on race. There are many genetic variances not only across races, but also across gender, and person to person.
March 5th, 2007 at 10:44 pm
This article is my first foray into the topic of race based medicine and I must say it is interesting read. Dr. Barkis has some interesting points especially his views on race, genetics and treatment. Unlike Dr. Barkis, I believe that race and genetics are truly intertwined. Our race is determined by our genes and therefore the two cannot be separated. Granted each individual is unique and therefore their genetic makeup is also unique, the fact is that several diseases/illnesses affect certain races/ethnicities more severely than others. Therefore it would be a disservice to the patient to overlook the importance of race in treatment.
I do agree to an extent with his idea of “treating the whole patient, not the group.” However, I think that any good physician should innately believe this concept. Most respectable physicians would make a global assessment of a patient before initiating any treatment. Accordingly, I don’t think physicians will get nearsighted when practicing race based medicine. I think just knowing that there are certain treatments that are more effective for a specific group of people would eventually only help the patient.
As a Hispanic, I must agree with Dr. Barkis in that I too feel neglected by health care promotion. I have been to many clinics in New Mexico whose sole purpose is to serve predominantly rural populations. At least here in New Mexico, these populations tend to by primarily Hispanic Spanish speaking. It is especially discouraging when information about Diabetes, Hypertension and other diseases which affect the Hispanic population more profoundly are presented in English only. In this regard, I feel that Hispanics are not being targeted effectively. Consequently, since these and other barriers exist and because there are “clear differences between races when you look at the efficacy and side effects of medications,” certain races/ethnicities may unfortunately receive less quality health care.
Ultimately, no treatment or course of action should be based on race/ethnicity alone. Yet race/ethnicity should be strongly considered when assessing treatment options for a patient.
March 5th, 2007 at 11:27 pm
This being my first read on race based medicine, I find myself agreeing on some issues with Dr. Bakris while disagreeing on others. I agree that there are benefits to using race as a means of treatment. Race is important because certain racial groups have a higher chance of getting a certain disease and different racial groups metabolize drugs differently. A competent physician should be cognizant of these differences within racial groups and treat each patient accordingly. Race, though, is just one small component that contributes to an individual’s disease and should be viewed as such. So much more plays a role in disease such as family history, social history, genetic makeup, etc. That being said, I agree with Dr. Bakris that people have to be treated based on the whole package, not just race.
I also agree with Dr. Bakris that pharmaceutical companies have not done enough to educate patients but I also realize that that is not their job. The pharmaceutical industry is like every other industry, a business. They have a product to sell at a price set by the market and their main focus is to market that drug, so they inform the consumer about its uses and side effects. Not many other businesses educate consumers beyond that of their product so why should the burden be laid at the feet of pharmaceutical companies?
The one last issue I’d like to address in the Dr. Bakris interview is his view on Hispanics and African Americans place in health promotion efforts. He clearly believes that these two groups are being neglected. In the general media there is not much health promotion to begin with and most of it is pharmaceutical companies pushing a product. My question to Dr. Bakris is, “who will pay for this targeted health promotion and how can he be certain that the message will reach those who need it most?”
May 7th, 2007 at 7:51 am
[…] know at least one person who would agree. In an interview I conducted with noted researcher Dr. George Bakris, who has done a lot of work with minority populations, […]