Conversations About Race-Based Medicine: Brian Smedley, PhD
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 BiDil, 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, social scientists and others. Each interview subject provides his or her unique perspective on race-based medicine, which I then publish on this blog. Please click here to read the other interviews in this series.
Interview Subject: Dr. Brian Smedley
About Dr. Smedley: Dr. Smedley is research director and co-founder of the Opportunity Agenda, a communications, research, and advocacy organization dedicated to building the national will to expand opportunity in America. Prior to joining the Opportunity Agenda, Dr. Smedley was senior program officer in the Division of Health Sciences Policy of the Institute of Medicine (IOM), where he was study director for the IOM report, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.
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 one of the key benefits of the debate about race-based medicine include things like this dialogue. This conversation helps to highlight the fact that there are gross inequalities in the health status of people in communities of color relative to whites. It is important to talk about these issues to raise awareness of the disparities in health outcomes among different populations.
There are also drawbacks to focusing on this topic. For example, I’ve been very concerned about how the media has framed this issue. Much of the reporting that I see continues to reify the concept of biological race. In reality, there is no biological basis to the concept of race. People of African, Asian, European, American, and other descent share far more genetically than they differ, and there is more genetic variability within these so-called racial groups than between them.
Of course, there are some population-based differences. For example, we know that there are some group differences in how people metabolize medication. This means that people from certain ancestral backgrounds respond differently to some types of pharmaceuticals.
But these differences in responses to medication do not map well to the common ways we think about race. For example, last year the drug manufacturer NitroMed launched a new drug, BiDil, which is marketed as a medication for self-identified African Americans with congestive heart failure. However, this does not mean that every African American will do equally well on BiDil. Some will respond favorably to the medication and others will not. NitroMed decided to target their efforts to an unfortunately growing market of consumers – African Americans with heart disease. In fact, BiDil is a compound that includes some medications that are known to be quite effective among whites.
So the story here is that there is much more that we need to learn about how medicine should treat different groups. I think there is a real need to look at how different people respond to medications. But we should be careful not to equate race with genetics. For example, we often think of hypertension or high blood pressure as a black disease. However, when we look across the world we see that there is a very low prevalence of hypertension in West African populations. The fact that hypertension is no more prevalent in West Africa than it is in white Americans indicates that we need to look closely at how environmental factors impact the incidence of disease.
Q: In your mind, is there a link between race and disease or is there something else going on?
A: Well, there is certainly a relationship between race and disease in the sense that we know that some racial and ethnic groups are disproportionately suffering from certain types of illnesses. But the underlying causes of these disparities are often the result of social inequality.
For example, there are a number of social scientists, particularly David Williams, who argue that residential segregation – the fact that people of color often live in very different communities from those of whites – is a fundamental determinant of racial and ethnic health disparities. The link is clear – neighborhoods that are predominantly minority tend to have fewer health-enhancing resources, such as major grocery stores to get fresh fruits and vegetables, fewer parks and safe places for exercise, and more health risks, such as environmental degradation and pollutants, poor public transportation, poor schools, and so on. This is true even in relatively high-income minority communities. These communities have suffered from disinvestment, an eroded tax base, and poor access to health care and other necessities. All of these environmental factors can have significant effects on health.
Q: The editorial you published on The Health Care Blog regarding the RAND study on healthcare quality generated a lot of comments. How have your efforts to draw attention to healthcare disparities fared since the editorial was published and a letter on the same topic was sent to the New England Journal of Medicine?
A: The Applied Research Center did a great job circulating the letter. The publication of the letter was a galvanizing event for many groups. They saw it as a prime opportunity to express their opposition to some of the study authors’ conclusions.
My feeling is that the authors of the New England Journal of Medicine study did not look at the indicators that are most important in healthcare. They measured some basic indicators of the quality of primary care, such as whether physicians asked people to wear seatbelts. They did not look at quality indicators associated with specialty treatment or more high-cost services. For patients in need, these types of services can mean the difference between life and death.
What is interesting is that while the authors found that some minorities may receive better care than some white patients, they acknowledge that their research does not refute hundreds of studies indicating that African Americans and other minorities receive lower quality healthcare.
The study authors acknowledge that racial disparities exist. However, they suggest that it is more important to focus on overall quality improvement measures rather than on efforts to reduce healthcare disparities. This is a false choice – both are important, and are synergistic. Efforts to reduce healthcare disparities will likely improve the quality of care for all patients. And because the racial and ethnic diversity of the nation is increasing rapidly, we can’t pretend that problems such as healthcare inequality are issues that can be put off for another day, or are lower priorities.
Q: Some have suggested that we should be focusing on outcomes rather than treatment when we discuss healthcare disparities. What is your take on this assertion?
A: This is a very important point. The study published in the New England Journal of Medicine looked at whether people received certain services from their physicians. However, they did not follow up to see how these patients fared in terms of outcomes. This is one of the study’s key weaknesses. In order to identify disparities between patient groups, you have to look at outcomes.
In fact, there are a number of studies looking at outcomes. This research indicates that minority patients that do not receive evidence-based care have poorer outcomes and higher mortality rates. So it is clear that disparities exist in terms of access to care, the quality of care and patient outcomes. These are the truly important measures we should be focusing on.
Q: In your mind, what has been the impact of the publication of Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare on physicians, policymakers, pharmaceutical companies and others?
A: Overall, the impact of the report has been mixed. Some have greeted the report with skepticism while others have supported it. I think a lot of skepticism comes from the fact that some people doubt that inequality exists in healthcare. If you don’t believe that the healthcare playing field is uneven, you have no reason to act.
What has been most disappointing is that the report did not prompt action on the federal level. While there have been a number of bills put forth to address disparities, both on the Republican and Democratic sides, Congress has not passed them.
I’m happy to say that some segments of the business community have stepped up to address disparities in healthcare. For example, Verizon has taken steps to ensure that all health plans they purchase have policies in place to address disparities in healthcare. This is very important, as the company has the potential to greatly influence the quality of care its employees receive.
Q: Dr. Richard Allen Williams has suggested that legislative solutions are required to eliminate racial, ethnic and socioeconomic disparities in healthcare. Do you agree with this assertion?
A: Absolutely. Dr. Williams is quite correct in saying that federal action is required to address healthcare disparities. In the IOM report, we ask for a number of federal responses to this problem. Most importantly:
-We ask that health plans provide statistics regarding the level of care patients receive based on language, race, income and education levels. This data will help us better understand the prevalence of healthcare disparities and how to address them.
-We also ask the federal government to step up civil rights enforcement. We know that the Health and Human Services’ Office for Civil Rights has received a significant number of complaints about healthcare discrimination. Despite this, the agency has not engaged in extensive field investigations and other activities. This office was much more active in the late 1990s.
The federal government needs to clearly communicate the message that disparities in healthcare are unacceptable and will not be tolerated.
Q: Can you provide any general commentary on this issue?
A: You have asked exactly the right questions that get to the heart of the debate surrounding race, medicine and healthcare disparities. I’d like to add that there are a number of encouraging signs that health care disparities are being addressed. For example the state of Massachusetts recently passed legislation to develop a universal access system. Part of this legislation requires that the state assemble and report on disparities in access to and the quality of care that patients receive. So this is an important starting point – certainly not a panacea – but a promising start. (Editor’s note: For more on Massachusetts and other state-based efforts to improve access to healthcare, please see A Healthy Blog, which is produced by Health Care For All, a Massachusetts-based advocacy organization.)
Overall, I’d say that advocates and others must work to expand access and that we insist on mechanisms to guarantee equity. It’s not enough to have a universal access healthcare system in this country, although this would address the most significant problems that we face in terms of containing costs and reducing access disparities. We also need to provide equivalent quality of care regardless of race, gender, language or socioeconomic status. And we need to ensure that as we expand access to care that the healthcare playing field is level for all patients.
June 9th, 2006 at 11:03 am
[…] Commentary: It’s best not to forget that socioeconomic status has a significant impact on access to healthcare and treatment outcomes. See this post for more on this subject. […]
March 5th, 2007 at 1:05 am
The opinions on the issue of race and healthcare will vary widely depending on the community in which a physician works as well as the personal interests of the physician. The disparities in health care will not be as obvious if you are a plastic surgeon in Beverly Hills as compared to a Primary Care Physician in East L.A. Dr. Smedley has raised some good points about the fact that yes some diseases are more prominent in some races but perhaps there is some underlying risk factor due to lack of resources that could otherwise prevent certain diseases. While I realize the stereotype in this thinking, that certain races are likely to live in certain neighborhoods, it does have some truth to it. There are communities as I’m sure we are all aware, that have limited public transportation and those living in the community may not own a vehicle, this may greatly hinder on their ability to see a doctor on a regular basis. This will lead to a health condition necessary of emergency care and only then, on an ambulance, will that person be able to make it to see a doctor. Other factors such as socioeconomic status influence the frequency that people will make to visit a doctor. Not having insurance most likely means regular visits to the doctor are out of the question. Many of these issues can be addressed at the level of the federal government. This also requires action on the parts of physicians and those living in areas they feel are underserved in terms of healthcare and other resources. What can we do as citizens to make these changes happen? For years there has been talk about socialized medicine, will this be the change that needs to happen? It may be a step in the right direction but it might not be the cure that is needed. The best we can do until a more global solution can exist is tackle our own racism and prejudice that might linger in the back of our minds when dealing with patients.
March 5th, 2007 at 2:52 pm
The Importance of Considering Race in the Practice of Medicine.
It is important to consider race in the practice of medicine. Race is associated with several risk factors. African Americans have a far higher risk of sickle cell anemia.
Caucasian women have a higher rate of osteoporosis. Jews have a much higher rate of Tay-Sachs disease. The list goes on and on. So it would be irresponsible for doctors to ignore these risks. However the introduction of BiDil seems to be a new concept in medicine because it is a medication directed at a particular racial group: African Americans. But is it really a new concept? For many years one of the criticisms of modern medicine is that it was focused on treatments of Caucasian males. An excellent example is the vast increase in breast cancer research in the past 30 years, with significant decreases in mortality and morbidity for women. BiDil is simply one step in equalizing medical care for African Americans in the treatment of heart disease. Dr. KC Ferdinand of Xavier University mentions that “A disproportionate number of African-Americans are affected by [heart disease], with increased morbidity and mortality, yet they are tremendously under-represented in clinical trials.” (1) BiDil has proven to be effective for use: “A-HeFT examined the use of BiDil added to standard HF (heart failure) therapy in blacks with New York Heart Association functional class III and IV HF. BiDil demonstrated a 43% reduction in mortality when compared with placebo. As a result, current evidence-based treatment guidelines recommend that the addition of ISDN and hydralazine in black patients with moderate to severe HF optimized on standard therapy be considered.” (2)
The shown efficacy of BiDil in functional class III and IV heart failure in African Americans makes a strong case for its integration into cardiac health care. As with all drugs, care must be taken not to over-prescribe in areas that it has not shown efficacy for. At this point in time BiDil has not been shown to be beneficial in all heart disease, so it not be uniformly prescribed for all heart disease nor to all African Americans with heart disease, but only to those with class III and IV heart failure.
It would be interesting to see whether BiDil is effective in other ethnic groups, and whether the BiDil ratio of isosorbide dinitrate and hydralazine is the best ratio for all African Americans or whether the ratio is better modified by the physician for each individual patient based on lab value results. In any case, right now BiDil looks like a good therapy for functional class III and IV heart failure in African Americans.
References:
(1) Isosorbide dinitrate and hydralazine hydrochloride: a review of efficacy and safety.
Expert Rev Cardiovasc Ther. 2005 Nov;3(6):993-1001. Review.
(2) BiDil (isosorbide dinitrate and hydralazine): a new fixed-dose combination of two older medications for the treatment of heart failure in black patients.
Cardiol Rev. 2007 Jan-Feb;15(1):46-53. Review.
March 5th, 2007 at 3:27 pm
I agree with Dr. Smedley’s point that socioeconomic status has a significant impact on access to healthcare and treatment outcomes. While we are often taught to treat everyone equally because it is “the right thing to do”, people are so diverse genetically and environmentally, that such differences can be essential to consider when establishing treatment regimens. So often we see the statistics on disease prevalence in one race versus another, and can not ignore that there are some distinct genetic factors responsible. We know income levels and socioeconomic status have a profound impact on a person’s access to healthcare and education about healthcare, but is it possible that ethnicity is an underlying factor for the above? Minorities in the United States have higher mortality rates and poorer outcomes of many chronic diseases, but why? In 2005, LJ Romero et al published the results of the prevalence of depressive symptoms in Albuquerque, New Mexico Hispanic and non-Hispanic white elderly in Ethnicity and Disease. They found the prevalence to be more than doubled in the Hispanic women compared to non-Hispanic white women (19.2% vs 8.7%) and nearly doubled for the Hispanic men compared to non-Hispanic white men (9.5% vs 5.4), concluding that this difference could largely be explained by education and income differences between the two groups. Perhaps these large discrepancies in health between various ethnic groups would be best alleviated by our government. Assuring that people have not only more access to healthcare (via insurance and proximity), but to clean water, healthy food, schools, and are protected from toxins in the environment. I feel that as we try to modify our healthcare system to be more efficient and effective, we should look at the impact we could make on our nation’s health by targeting its education.
References:
Romero, LJ, Ortiz, IE, et al. Prevalence of depressive symptoms in New Mexico Hispanic and non-Hispanic white elderly. Ethn Dis. 2005 Autumn;15(4):691-7.
Kieffer, EC, Sinco, BR, et al. Chronic disease- related behaviors and health among African Americans and Hispanics in the REACH Detroid 2010 communities, Michigan, and the United States. Health Promotion Practice. 2006 Jul; 7 (3 Suppl): 256S-64S.
March 5th, 2007 at 4:12 pm
Title:Other Factors Are More Important
Topic: BiDil
Response to Dr. Smedley’s “Conversations About Race-Based Medicine”
Posted: March 5, 2007 2:10 p.m.
One important point that continues to escape public attention is that patents on pharmacological drugs are extended when the drug targets a specific population. In the “Medicalisation of Race,” Professor Troy Duster notes that “the original BiDil patent, non-race specific, will expire in 2007. By making the drug race-specific, the patent extends another 13 years giving NitroMed exclusive rights to market the drug until 2020.” While, I do not believe that is the entire reason BiDil was marketed for a specific racial group, I do believe that it was a main aspect of focus. By turning the public’s attention on genetic similarities between races, it diverts the attention away from more of the important issues that we face in this country regarding healthcare, such as equal access to high-quality healthcare. By patenting the drug, the drug company can charge higher prices for the medication, making it more difficult for their “target” population to have access to them. What is the point of marketing drugs specific to racial groups if those racial groups such as Hispanics and African-Americans cannot afford them? More focus needs to be placed on the other factors such as access to healthy food choices, cleaner living environments, and better occupational options that people of different racial groups are constantly subjected to. Increasing numbers of data demonstrate that these issues are more pressing and can be used to predict predisposition to hypertension, diabetes, etc. more than genetic factors. As mentioned above by Dr. Smedley, “In reality, there is no biological basis to the concept of race. People of African, Asian, European, American, and other descent share far more genetically than they differ, and there is more genetic variability within these so-called racial groups than between them.”
I’m afraid that if “race-based medicine” becomes widespread, it will give some people an excuse to add to the divisions of racial groups within our country. If we, as medical professionals, need to target “groups”, let us target poverty groups of all colors, by allowing them affordable, good-quality healthcare and education.
References: Troy Duster, Medicalisation of race, The Lancet, Volume 369, Issue 9562, 24 February 2007-2 March 2007, Pages 702-704.
(http://www.sciencedirect.com/science/article/B6T1B-4N3YDMC-18/2/80045c16bc57442019af66d57bbb9168)
March 5th, 2007 at 4:25 pm
Race in Medicine - A Two Edged Sword
Conversations About Race-Based Medicine
In Reply to Interview w/ Brian Smedley, PhD
By: Lee NM
March 5th, 2007
I feel that there are two separately important issues discussed here that deserve separate attention due to the large disparity in thinking when it comes to race-based medicine. Issue one is the probability of populations of individuals to develop certain conditions and/or respond to medications differently. Issue two is the inequality of healthcare services based on patient race.
The first issue is not related to poor health care services or a discrepancy in care based on race. The higher frequency of hypertension in African American populations as compared to Caucasian populations is not a “racist” or stereotypical statement. It is an observation supported by years of un-biased data that the medical professional can use to help better understand the overall picture of a patient’s health both presently and in the future. The epidemiology of a certain condition or the pharmacoepidemiology of a medication allows the health care professional to better prevent or treat medical conditions that their patients are at risk for. (Whether the prevalence rates differ due to actual genetics, ancestry, socioeconomic discrepancies, etc is yet another topic that I’m going to refrain from discussing at this time.) The fact that we are technologically advanced enough to understand population differences and tailor treatments for a given population is an amazing advancement in medicine. I don’t see it as an inequality of healthcare but as a great step toward improved healthcare overall.
However, the second issue of inequality of healthcare based on race is related to a breakdown in the healthcare system. It is unfortunate that even in the 21st century here in the United States that health care professionals let personal antagonism towards those of a different race affect their professional duty to provide the best quality healthcare possible in any and all cases. I would love to see an increase in federal or state involvement to make sure everyone has equal access to healthcare as well as equal quality.
March 5th, 2007 at 8:45 pm
As a medical student I have been confronted with issues that I had never considered before entering school. Included in these new and interesting topics is the issue of race based medicine. I feel like the term itself can conjure up ill feelings from both lay persons as well as those in the medical field. Anytime one attempts to classify any group based on race they are walking a narrow line, on which someone from either side of that line may be offended. However, in medicine I believe it is best to step back and consider that the role of any health professional is to provide the best possible care for any individual; based not upon their race, occupation, or religion, but their medical needs. From the New England Journal of Medicine, the authors of The Importance of Race and Ethnic Background in Biomedical Research and Clinical Practice concluded that “although there are potential social costs associated with linking race or ethnic background with genetics, we believe that these potential costs are outweighed by the benefits in terms of diagnosis and research.” In this endeavor it is important to realize that the evidence shows that certain ethnic groups are more susceptible to certain illnesses, and may react in different ways to certain medications. For example a mutant allele is known to cause hemochromatosis, and this allele is found in 8-10% of European populations while it is nearly nonexistent in nonwhite groups. This is important to keep in mind when considering a differential diagnosis in a patient who presents with the signs and symptoms, but should not affect the treatment for hemochromatosis whether the patient is European or nonwhite. In short it is vital that any knowledge about how a certain population responds to medication or what illnesses befall that population should be used to provide the best possible care, not to discriminate against that population or others.
March 6th, 2007 at 2:10 am
Race-Based-Medicine Commentary
Health care in the US today stands as yet another strong symbol of institutionalized racism which continues to marginalize and oppress people of color. It is commonly thought of as a “subtle” form of racism, often going unnoticed were it not for its very real impact on life quality and even life span of those most affected by it. In the realm of medicine, institutionalized racism may have its gravest impact yet, with some studies revealing major differences in health outcome between African Americans and White Americans suffering from hypertension, diabetes, or end-stage renal disease. It may be easy to toss this up as evidence of some inherent difference of “race” that should be explored by the medical and scientific community. This could lead to the development of separate treatment protocols, perhaps different treatment facilities, etc. Could it be the basis of a new form of medically- sanctioned segregation? I don’t doubt that there is genetic variability in disease susceptibility or responsiveness to therapies that should be explored. However, using the concept of race as a springboard for this research is not the same as highlighting polymorphisms encountered in the human population. Clive O. Callender and Patrice V. Miles from the National Minority Organ Tissue Transplant Education Program at Howard University, show that “this race concept (superior versus inferior), is a sociopolitical construct and is destructive. The federal government and the Office of Management and Budget (OMB) are equally guilty of perpetrating this farce as they continue to categorize human beings into different races
when only one race exists. Human beings should be categorized according to ethnicities and cultures and even languages, but never as different races.” The continuous categorization of human beings on the basis of “race” only fuels the institutional practices which perpetuate social injustices in legal, economic, and now health care realms. Dr. Smedley very accurately cited the various sociopolitical contributions to health disparities in communities of color, including the lack of a stable tax-base and government interest, leading to disadvantaged schools, fewer economy-building businesses, and the absence of public safe places for community growth. Education, economic stability and growth, and a safe environment are all necessary components of a healthy community. Health disparities and institutionalized racism should not and cannot be tolerated. Not only is the US Health care system the most expensive in the world with possibly the least to show for it, but it may be responsible for the inexcusable alienation of patients, human beings, based solely on the concept of race. A concept which may have no real meaning or medical justification; a concept that continues to plague this country and endangers the health of its citizens. The time calls for community organizing centered around a goal valued across all cultures, in all languages, in all parts of the world: the attainment of health and a humane quality of life.
Sources:
Cozier, Y, Palmer, J, Horton, N, Fredman, L, Wise, L, Rosenberg, L.
Racial Discrimination and the Incidence of Hypertension in US Black Women.
Annals of Epidemiology Volume 16, Issue 9 , September 2006, Pages 681-687
Callender, C., Miles, P. Institutionalized Racism and End-Stage Renal Disease:
Is Its Impact Real or Illusionary? Ethical Issues in Dialysis. Aaron Spital, Series Editor. Seminars in Diaiysis—Vol 17, 3 (May-June) 2004
pp. 177-180.
March 7th, 2007 at 12:14 am
In response to Dr. Brian Smedley’s interview concerning Bidil:
While it is noble to attempt to treat minorities (or anyone one else for that matter) with the most appropriately targeted medication available many important other obstacles remain when it comes to effectively treating patients based on race. To begin with, the vast majority of genetic differences that exist between people are actually between those of the same ethnic group, as opposed to those differences that exist between races. This alone should warrant a closer look at the benefits of racially targeted drugs as opposed to the irrefutable need for better access for minorities and underserved populations to the drugs that are already in existence, and may be available for a fraction of the cost of a new patented with questionable benefits for even the intended or targeted population. It is truly unfortunate that minorities and the poor are some of the hardest hit in an era of rising health care costs and shrinking coverage. However this argues even more strongly for the fact that difficult decisions often need to be made that weigh the benefit to cost ratio of any new treatment.
There is also reason to at least consider the possibility that the drug company may have a cynical interest in finding a way to extend their patent on an existing drug, simply by claiming that it can be used specifically for a particular racial population. The question that immediately arises in my mind is this: if the drug was being presented for the purpose of providing the best care to an overwhelmingly poor population, why not simply encourage its use as a generic drug for the “off –label” purpose for use for in a specific minority population? While it is possible that someday there will be effective drugs that arises that do indeed warrant specific application to certain populations over others,
targeting an expensive drug to an already underserved population seems to make little sense indeed.
March 7th, 2007 at 12:16 am
In response to Dr. Brian Smedley’s interview concerning Bidil:
While it is noble to attempt to treat minorities (or anyone one else for that matter) with the most appropriately targeted medication available many important other obstacles remain when it comes to effectively treating patients based on race. To begin with, the vast majority of genetic differences that exist between people are actually between those of the same ethnic group, as opposed to those differences that exist between races. This alone should warrant a closer look at the benefits of racially targeted drugs as opposed to the irrefutable need for better access for minorities and underserved populations to the drugs that are already in existence, and may be available for a fraction of the cost of a new patented with questionable benefits for even the intended or targeted population. It is truly unfortunate that minorities and the poor are some of the hardest hit in an era of rising health care costs and shrinking coverage. However this argues even more strongly for the fact that difficult decisions often need to be made that weigh the benefit to cost ratio of any new treatment.
There is also reason to at least consider the possibility that the drug company may have a cynical interest in finding a way to extend their patent on an existing drug, simply by claiming that it can be used specifically for a particular racial population. The question that immediately arises in my mind is this: if the drug was being presented for the purpose of providing the best care to an overwhelmingly poor population, why not simply encourage its use as a generic drug for the “off –label†purpose for use for in a specific minority population? While it is possible that someday there will be effective drugs that arises that do indeed warrant specific application to certain populations over others,
targeting an expensive drug to an already underserved population seems to make little sense indeed.
March 7th, 2007 at 12:24 am
March 6th, 2007
In response to Dr. Brian Smedley’s interview concerning Bidil:
While it is noble to attempt to treat minorities (or anyone one else for that matter) with the most appropriately targeted medication available many important other obstacles remain when it comes to effectively treating patients based on race. To begin with, the vast majority of genetic differences that exist between people are actually between those of the same ethnic group, as opposed to those differences that exist between races. This alone should warrant a closer look at the benefits of racially targeted drugs as opposed to the irrefutable need for better access for minorities and underserved populations to the drugs that are already in existence, and may be available for a fraction of the cost of a new patented with questionable benefits for even the intended or targeted population. It is truly unfortunate that minorities and the poor are some of the hardest hit in an era of rising health care costs and shrinking coverage. However this argues even more strongly for the fact that difficult decisions often need to be made that weigh the benefit to cost ratio of any new treatment.
There is also reason to at least consider the possibility that the drug company may have a cynical interest in finding a way to extend their patent on an existing drug, simply by claiming that it can be used specifically for a particular racial population. The question that immediately arises in my mind is this: if the drug was being presented for the purpose of providing the best care to an overwhelmingly poor population, why not simply encourage its use as a generic drug for the “off –label” purpose for use for in a specific minority population? While it is possible that someday there will be effective drugs that arises that do indeed warrant specific application to certain populations over others,
targeting an expensive drug to an already underserved population seems to make little sense indeed.