Conversations About Race-Based Medicine: NitroMed’s Michael L. Sabolinski, M.D
Over the past several months, I have had the privilege of speaking with a number of well-regarded scientists, physicians, epidemiologists and social scientists about a very contentious issue: race and medicine. I have been pleased that so many distinguished individuals have been willing to speak publicly and candidly about this difficult subject.
Although those I have interviewed have many different perspectives on this subject, a few common themes shone through. Most importantly:
-Race is social construct with biologic and economic consequences: I was speaking about race and medicine with the head of a major medical association the other day. During that conversation he said: “What is the difference between a white horse and a black horse? None. Yet, we make a big deal of differences between whites and blacks. Why do we do this?â€
As many of the people I interviewed observed: At its simplest, race is a social construct, a means of grouping people. Yet, race has many consequences: social, economic and medical. While there are no significant differences between groups of people, race has consequences. Especially on health outcomes and how people metabolize different medications.
-The pharmaceutical industry and government need to do more to address racial disparities: Many of the people I interviewed said that drug companies need to do more to educate ethnic minority patients on risk factors and behaviors that can result in improved health. Some companies, like NitroMed (see the interview below) are making an effort, but more needs to be done. Especially in areas where there is little or no financial incentive to do so. Government can and should play a role in promoting social and health equity.
-Health disparities are real and persistent: A major theme of my interviews was disparities in healthcare. Everyone agreed that disparities are real, persistent and deserve increased attention.
I hope you have enjoyed this interview series and found it informative. While this is my final interview, I will certainly touch on this issue in the future. Click here to read the other interviews I have published on race and medicine over the last few months.
Read on for my interview with Dr. Michael Sabolinski of NitroMed.
About Dr. Sabolinski: Dr. Sabolinski is Chief Medical Officer of NitroMed. He has more than 20 years of experience in clinical research and medical products development. He joined NitroMed in 2002 after completing a distinguished decade long career with Organogenesis, Inc. where he held several positions including President and Chief Executive Officer, Head of Clinical Research, Regulatory Affairs and Corporate Development. During his tenure, he successfully managed the team that secured two FDA approvals of a living skin substitute, pioneering the path for stem cell products and other cell therapies.
Interview
Q: NitroMed’s efforts to develop race-specific treatments for African Americans with heart failure has ignited significant debate about the role of race in treating and diagnosing patients. Given this, I would like to step back a little bit and probe why NitroMed decided – from a philosophical and medical perspective – to focus on this patient population. I have a number of questions along these lines.
Q(a): Why did NitroMed feel it was important to focus attention on the African American patient population, philosophically and medically?
A(a): First, I will preface my statements by saying that as a physician I feel it is most appropriate for me to answer your questions from a medical perspective.
We started studying the BiDil combination (isosorbide dinitrate and hydralazine hydrochloride [I/H]) back in the 1980s with the Vasodilator Heart Failure Trial (V-HeFT I). We studied the combination again in another trial, V-HeFT II, which concluded in 1991. These were groundbreaking studies in heart failure. They were the first trials to examine the effects of balanced vasodilatation.
A Food and Drug Administration (FDA) advisory committee evaluated these trials in 1997. The panel recommended that the FDA not approve BiDil for the management of congestive heart failure. This was because our trials failed to convincingly demonstrate BiDil’s efficacy in the general population. Subsequently the FDA did not approve our New Drug Application for the compound.
In the late 1990s, clinical trials indicated that some high blood pressure medications, including ACE inhibitors and beta-blockers, appeared to work less well in African Americans. These findings, and retrospective analyses of V-HeFT I and V-HeFT II indicating that African Americans taking BiDil had better survival rates than whites, led us to take another look at the medication.
From a clinical development standpoint, we saw that African Americans responded to BiDil. We did not see as strong of a response in other groups. These observations led us to launch the African American Heart Failure Trial (A-HeFT), which was conducted in a population of 1050 self-identified black heart failure patients.
So overall, I’d say that we decided to focus on African Americans because we were following the science. We saw that African Americans appeared to respond to the I/H combination and decided to find out more.
Another reason we focused on African Americans was healthcare disparities. Blacks tend to have more severe forms of heart failure and are twice as likely to die from the condition than whites. Despite this, there weren’t any heart failure drugs being studied in an African American population.
Q(b): Did NitroMed have any reservations about developing and testing a medication specifically for African Americans – if so, what were they?
A(b): To my knowledge we never had any reservations about developing a drug specifically for African Americans. In fact, after seeing the data from the V-HeFT studies, some thought that it would be discriminatory not to pursue the development of BiDil. We had a responsibility to follow-up on the signal we saw in our clinical trials.
Q(c): How did the African American community react initially when they learned that NitroMed was developing a medication specifically for blacks?
A(c): I think the most important message the company communicated was that we were conducting a well-designed clinical trial (A-HeFT) and that patients were receiving the best of care. People accepted that we were providing patients with excellent treatment, especially after we educated them on the design of the trial.
Q(d): Has NitroMed’s philosophical focus changed since the launch of BiDil?
A(d): We have remained true to what we believed prior to launching BiDil. We have a population that is very much in need of treatment. We are proud to have run a study that showed the best possible outcomes in a self-identified African American population. When we saw that black patients taking BiDil were 43 percent less likely to die and 39 percent less likely to be hospitalized due to heart failure, we knew that were helping a population in desperate need of adequate treatment.
I can tell you that everyone feels great about that.
Q: What is NitroMed’s official position on the benefits and drawbacks of using race as a means of treating and grouping patients in cardiovascular disease and in general?
A: I think our beliefs are consistent with those of most thought leaders in the cardiovascular community. Evidence-based medicine is what we should be practicing and following – especially when the data are remarkable. With BiDil, we have demonstrated that, in a self-identified black patient population, survival and quality of life are significantly improved.
On another note, we are looking at expanding the use of BiDil in other patient populations. We know that skin pigmentation is at best a poor surrogate marker for looking at responses to medication.
The future of personalized medicine is to screen people for genetic markers that will predict the benefits of a particular drug.
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?
A: Overall, I’d give us high marks. I think we deserve an “A†for what we did in the clinic with BiDil and for how we are disseminating messages about the risk factors for heart failure, including high blood pressure, high cholesterol and obesity. We have done a good job of explaining the progression of heart failure and the need for early intervention. We are working very closely with a coalition of African American leaders, including the Association of Black Cardiologists, the Congressional Black Caucus, the International Society on Hypertension in Blacks and the National Medical Association. Education is time consuming, but necessary.
Q: Some physicians and scientists I have interviewed say that the pharmaceutical industry should do more to test medications in different populations. They would like to have more information about side effects and differences in responses to drugs. What is NitroMed’s opinion on this issue and is it doing anything to address these concerns?
A: The FDA is very proactive in this arena. They require that many clinical trials test medications in people from different ethnic and racial backgrounds.
NitroMed is also taking steps to address these concerns. In one study, we are looking at whether specific genetic polymorphisms will help us predict patient responses to certain treatments.
One caveat is that once a marker is found, we’d have to design a trial that will enable us to determine whether the marker was in fact predictive or not. That’s clearly where we are heading and what we believe in.
Q: Dr. Richard Allen Williams, founder of the Association of Black Cardiologists has told me that he disagrees with the term “race-based medicine.†In your opinion, is NitroMed furthering the practice of “race-based†medicine? Does NitroMed view this term positively or negatively?
A: I don’t believe that the term “race-based medicine†has any particular significance. I also don’t feel as strongly as Dr. Williams does about that particular term. In some respects, your question does not quite make sense to me. What I do understand is practicing medicine based on evidence. We had evidence that the I/H combination was effective in an African American population. If we had evidence in a non-black population, we would have pursued a different label.
I believe in using medications in patient populations where they work the best.
Q: As briefly as possible, please tell me NitroMed’s response to people who have criticized the company for:
Q(a): Marketing BiDil to African Americans as part of an attempt to “find†a market for a fixed-dose combination of two generic medications.
A(a): We weren’t attempting to “find†anything. The evidence found us. Our retrospective analysis of the V-HeFT trials indicated that (aside from African Americans) no other subgroups responded as well to the I/H combination.
Second, we know that the FDA previously approved BiDil’s individual components. However, the only trials indicating that the I/H combination was effective in heart failure were the V-HeFT and A-HeFT studies. BiDil is not a combination of convenience. It is one of necessity. We need both medications for the drug to work.
We looked at the strength of the data and followed the results.
Q(b): Not working with the African American community enough to market BiDil appropriately.
A(b): As a physician, I can’t speak to that criticism. What I can say is that we have worked with the African American and heart failure communities to develop the medication and to initiate educational programs.
Q(c): Not being sensitive enough to America’s fraught racial history in deciding how and whether to develop a medication for African Americans.
A(c): In A-HeFT we provided the absolute best cardiovascular care for every patient in the trial. I think we demonstrated great sensitivity and caring for patients in the study and for the history of disparities in medical care. We are very proud of the treatment we provided.
Our efforts with A-HeFT are in sharp contrast to what may have taken place over the last 50 years or so in some clinical trials. Overall, I think A-HeFT is a great heart failure study – independent of race.
Q: Does NitroMed have any general commentary on the issue of race and medicine?
A: With BiDil we have a very effective medication that has become the standard of care for the treatment of African American patients with heart failure. We are very comfortable taking the position that BiDil should be used in all African American heart failure patients.
We believe that we are pioneers in this field and look forward to future achievements.
September 2nd, 2006 at 6:58 am
Michael.
I am proud of all the work you have been doing as i have followed it for years. Keep up the vigilence. you are a true caregiver and i wish i had gotten to know you, maybe someday??? jane is an extroidinary young woman and i find comfort in knowing that her parents have set the bar high for her future achievements. please give my sincerest love to Maureen and my apologies that it has taken the www to open the floodgates. I don’t know if you both want to resume communications, but if it is so, reach me at (610) 381-2093. i HOPE THIS REACHES YOU AND THAT YOU ARE ALL WELL. kATHLEEN
September 2nd, 2006 at 6:15 pm
Kathleen:
I’m not sure whether Michael will receive your message so I’ll pass it on to him directly.
Fard
March 4th, 2007 at 10:19 pm
“It is not our differences that divide us. It is our inability to recognize, accept, and celebrate those differences.” -Audre Lorde
The results of the BiDil drug trial should be applauded. Not only is it a potentially life-saving treatment (which should be sufficient), but it also exemplifies the ideals of present-day medicine: to treat each patient as an individual and with the the most current, evidence-based medicine available. If the research on BiDil is sound and it truly is effective only in African Americans, then there should be no qualms with using it only in this population.
Those opposed to BiDil fear that it will introduce racial profiling into medicine. However these critics miss the point. Dr. Sabolinski sites an important point in the interview that the results of clinical trials indicate that this medication is more successful in African-Americans, not a political/social group. Data on race is collected, along with gender, and family and personal medical history, because they appear to affect the efficacy of the drug. I agree with Dr. Sabolinski that medications should only be used in the “patient populations where they work the best.” I also agree with him that race is most likely not the underlying factor determine BiDil’s efficacy, but it is currently the best measure that we have found. It would unethical to restrict access to this medication out of the fear of being considered a bigot.
Not only is restricting to medications to certain subsets of the population the proper treatment in many cases, but it is also established medical practice because it reduces unnecessary drug use and is an efficient use of limited resources. For instance, the antidepressant Sertraline has been shown to be effective only in women and Imipramine only in men.1 Neither one of these drugs has galvanized this level of debate over introducing sexism into medicine, but rather as In another study, only cocaine-dependent males, and not cocaine-dependent females, responded to treatment with disulfiram.2 In fact, BiDil is not even the first drug to be shown to be more effective in certain racial groups. In a paper published in the New England Journal of Medicine, the researchers indicate that ACE inhibitors are only effective in white patients and not in African American ones.3 ACE inhibitors were never considered racists or attempting to create a market only in the white community. I find it odd that the first drug to show effects only in Africa-Americans is the one to be considered the racist drug.
Rather than illustrate racial tensions in the U.S., BiDil illustrates the poor public image of pharmaceutical companies. Until pharmaceutical companies convince the public that they develop drugs to improve the health of patients and not only their bottom line, the results of drug trials will be viewed with skepticism. Pharmaceutical companies should be cautious when developing drugs whose efficacy depends on the race of the patient because it is obviously still a sensitive subject; it would be detrimental to repeat Tuskegee.
Jacob
March 5th, 2007 at 3:54 pm
The efforts at NitroMed to optimize treatment are significant because they represent a progressive effort towards personalized medicine.
As underlying mechanisms of disease are unraveled, our ability to treat disease is significantly improved. Research into biological processes and genetics factors are unfolding the “why” behind the “what” of disease. Evidence-based medicine is taking the place of relying on serendipitous or even accidental discoveries of drugs as our sources of treatment.
If a drug proves ineffective for the population as a whole, yet is lifesaving for a critical subpopulation, are we justified in discarding the medication and seeking another solution that is equally effective in all subpopulations? Such a medication would be truly remarkable and probably the first of its kind. Variation in response to treatment should be expected and taking note of those variations can help to save lives. Advances in cancer medication with drugs such as Herceptin are targeting subpopulation groups whose treatment plans can be adjusted to maximize benefit. The clinical trials that went into the development of Bidil are similarly helpful in helping us to gain a better understanding of how to tailor drugs to an individual, starting at the level of a subpopulation.
A key point to keep in mind was expressed by Dr. Sabolinski during the interview: “Skin pigmentation is at best a poor surrogate marker for looking at responses to medication.” A host of factors contribute to medication response, each a piece of the puzzle in understanding the underlying biology and mechanisms that are directing us towards individual care. Limiting treatment of Bidil to the African American population is not a racist act, rather, it is an action based on evidence gained from clinical trials that suggests that only a particular subgroup benefits from the treatment. Another drug study might discover similar disparities in different populations based on age, gender, weight, or other factors that are equally as important to evaluate as we optimize treatments to the individual level.
Hopefully studies like these, as Dr. Sabolinski suggests, will help us to determine “whether specific genetic polymorphisms will help us predict patient responses to certain treatments.” Ongoing studies that utilize the evidence-based approach like that of the study that went into developing Bidil give us a better understanding of the mechanisms of disease. They will help us learn not only how to tailor a drug to a particular patient subgroup but ideally to a particular patient whose unique aspects will be understood and taken into account when being treated. This pardigm shift towards “the future of personalized medicine” that Dr. Sabolinski mentions in the interview is a step in the right direction. We should strive for a standard of care that focuses on the patient at the individual level.
-Brandon Peterson, First-Year Medical Student
March 5th, 2007 at 10:13 pm
“Following the Science”
Race-Based Medicine
Conversations About Race-Based Medicine: NitroMed’s Michael L. Sabolinski, M.D
March 5, 2007
How would you respond if your physician stated that he could treat you with two drugs, one that is utilized in the general population or another that works better based upon your race, as you have self-identified yourself? In his or her medical opinion, suggesting the one based upon your race’s response to a medication better than another is his or her responsibility to the patient. Isn’t this the application of beneficence by the physician? The utilization of a medication that has a predisposition to work better in a particular race as supported by good, through research should be seen as a great step towards personalized medicine. As Dr. Sabolinski stated, “Evidence-based medicine is what we should be practicing and following, especially when the data are remarkable. With BiDil, we have demonstrated that, in a self-identified black patient population, survival and quality of life are significantly improved.” Epidemiology and etiology have attempted to explain disease in the context of genetic or environmental independently. However, often such is not the case. Although the contribution of each may not be equal, there are components of both that contribute to many diseases that can be seen in certain individuals and populations. If the science, based upon strong evidence, leads medicine toward a genetic variation found among a particular race that results in better outcomes of treatment, it should be pursued. Ignoring the fact that certain races or populations have a genetic variation which could be exposed as targets of treatment for associated diseases would be unjust to the potential health benefits of these individuals. Also, here is a potential opportunity for the pharmaceutical companies to help diminish the dark clouds of criticism held over them by most of the public. It is a chance to show the public their interest in individual health through personalization of treatment rather than advertising and profits. The isolation of individuals within current and future medicine is and should not be for the intention of exclusion or harm, but rather for benefit and the ultimate goal of achieving a better quality of life.
Steven Ogas, First-Year Medical Student
March 6th, 2007 at 12:06 am
Many have criticized NitroMed’s development of the medication BiDil and its use as the standard of care in the African American population with heart failure. I believe however, that Dr. Sabolinski is correct in saying that researchers at NitroMed are pioneers in such treatments. During another interview conducted for this same series, “Conversations about Race-Based Medicine,” Dr. Esteban Gonzalez Burchard states that, “90 percent of research dollars are directed at Caucasians.” Given this information, one could argue that “race-based medicine” is already standard practice, with the primary focus being on the Caucasian race. It seems unfortunate and even unethical that people of any descent other than Caucasian could be prescribed medications derived from such research practices.
Critics of the development and approval of BiDil for African Americans claim that distinctions based on race, rather than pathophysiology, are scientifically unreasonable and should not be grounds for establishing the use of this treatment. While one can certainly see the usefulness of understanding the pathophysiology of different diseases in everyone as an individual, regardless of race or other superficial factors, it is clear that medical research has not progressed to the point that this is yet practical or achievable. The FDA’s perspective on this matter is that, “Understanding pathophysiology is good, of course, but it ranks well behind a documented survival effect in importance.” BiDil has been shown to reduce mortality in a self-identified African American population with heart failure. There is wide agreement that this same population dies from heart failure at rates disproportionate to those among whites. To deny this population an effective treatment such as BiDil, until more details concerning the medication’s enhanced effectiveness based on individual pathophysiology can be elucidated, would be unethical.
Dr. Esteban Gonzalez Burchard also makes the point in his interview that, “We cannot close our eyes to the links between race and disease because of fear or political correctness. Otherwise we will never be able to identify clinically important risk factors and responses to medications caused or impacted by race.” Dr. Sabolinski and the researchers at NitroMed have made ground-breaking headway in developing a medication with a more targeted patient population than previous treatments. This is an encouraging step in the progression toward more individualized medicine. The medication has been found effective in a certain population, approved by the FDA in the face of criticism, and is currently reducing mortality from heart failure in this population while certain polymorphisms allowing us to further understand these results are being investigated.
References:
1.Conversations About Race-Based Medicine: Esteban Gonzalez Burchard, MD
2.Temple R, Stockbridge N. BiDil for Heart Failure in Black Patients: The U.S. Food and Drug Administration Perspective. Annals of Internal Medicine 2007;146:57-62
March 6th, 2007 at 1:38 am
“Pure Science”
Race-Based Medicine
Conversations About Race-Based Medicine: NitroMed’s Michael L. Sabolinski, M.D
Evan Baldwin, MSI
03/05/07
To begin, I must say that this has been one of the most interesting interviews I have read in a long time. Before reading this I had no idea that the BiDil medication existed, let alone the incredible history behind its inception. Given that, I have not only been impressed by the ingenuity of the individuals involved with the study, but also the candor with which Dr. Sabolinski graciously perried the interviewer’s near-insistence that the creation of BiDil has anything to do with race-based medicine. I agree whole-heartedly and feel that rather than fodder for what could be seen as a political issue, BiDil is best viewed as a sterling example of evidence-based medicine and science at its purest. However, it is also my opinion that any debate as to whether or not BiDil suffices involvement of discussion around race-based medicine is nearly irrelevant when compared to the life-saving benefit of the drug; the FDA corroborates Dr. Sabolinski’s claims in the June 2005 press release:
“The approval of BiDil was based in part on the results of the African-American Heart Failure Trial (A-HeFT). The study, which involved 1,050 self-identified black patients with severe heart failure who had already been treated with the best available therapy, was conducted because two previous trials in the general population of severe heart failure patients found no benefit, but suggested a benefit of BiDil in black patients. Patients on BiDil experienced a 43% reduction in death and a 39% decrease in hospitalization for heart failure compared to placebo, and a decrease of their symptoms of heart failure.”
If the purpose of medicine is to better life, then I think the actions of NitroMed in the creation and application of BiDil to be undeniably true to that principle. Furthermore, it is my hope that this case will help to pave the way for future pharmaceuticals that have greater efficacy and specificity for individuals/races/religious groups/social classes/ etc. because as long as people are being taken better care of, I cannot possibly entertain the idea that they would be disappointed to hear their treatment hinges on one of those contructs.
1) FDA News: http://www.fda.gov/bbs/topics/NEWS/2005/NEW01190.html
March 6th, 2007 at 9:20 am
There is no way around the fact that there are race based health disparities in this country and this is a problem that must be addressed from several different angles, including that of the drug companies. Especially in the area of cardiology there is strong evidence that African Americans receive sub-standard care when compared to whites. (“Racial/Ethnic Differences in Cardiac Care: The Weight of the Evidence,” The Henry J. Kaiser Family Foundation and American College of Cardiology Foundation, 2002.) If there is a medication that is superior to what African Americans are currently being offered then I think it would be unethical not to go ahead with the trials.
My concern is that there is so much distrust of medicine by African Americans, a study like this has the potential to have a very positive or negative impact. After the Tuskegee Syphilis Study African Americans tend to be more skeptical of not only the government, but healthcare in general. Unfortunately, there are documented studies that have been carried out since then that have been unethical and have taken advantage of impoverished minorities. (Strauss RP, Sengupta S, Quinn SC, Goeppinger J, Spaulding C et al. The role of community advisory boards: involving communities in the informed consent process. American Journal of Public Health 2001; 91(12): 1938-1943) Just that fact that BiDil is a combination of two generic drugs I can imagine could be interpreted as an attempt to make money. On the other hand this could be a great opportunity to provide a better more convenient medication. This could be a step in the right direction to bridge the gap in health disparities and begin to establish trust.
March 6th, 2007 at 5:16 pm
I had heard nothing of BiDil until now, and I applaud Dr. Sabolinski for his commitment to the treatment of individuals with CHF and for his response to the interviewer’s insistence that the use of this medication had something to do with anything other than improving patient treatment through evidence-based medicine. From a medical student’s point of view, it is extremely exciting to get a glance of the possibility of what may very well be the future of medical practice, where treatments may be tailored to every patient, to help meet that individual’s need. Although illnesses may present with identical symptoms in every patient, due to distinct genetic pathways found in diverse ethnicities the treatment may not necessarily be identical. There may actually be a group of diseases that have a higher incidence in a certain population, the severity of a disease may also present as a more severe form in certain racial groups and as such require a different form of treatment in those individuals.
Like was mentioned in the earlier blogs, this is not the first time a medication has been used on a specific race. Like BiDil the British pharmaceutical company AstraZeneca came out to the market with the drug Iressa in the treatment of advanced lung cancer. In the original study, the difference between patients that received placebo and those taking Iressa was insignificant. However, once the data was re-assessed by race and ethnicity, scientists found that Asians had a 9 month prolongation of life on the medication, compared to 5 month average for the general population. With these results AstraZeneca decided to market the medication to Asian countries. In this instance and in others, the marketing of drugs to specific races did not develop into a racial discrimination controversy, and truly why should it be? This simply is a way to practice better evidence-based medicine?
March 6th, 2007 at 5:33 pm
There are probably more than one misconception leading to miscommunication and misunderstanding in this discussion about race, genetically tailored drugs and the impacts on social justice and healthcare. “Race is a social construct”, it does NOT have a biological basis. In popular culture, debate often takes the form of race versus ethnicity. The concept of race was born from a failed attempt of the western scientific community to identify groups of people and their characteristics. (The Mismeasure of Man, by Gould provides an excellent history.) Current thought amongst biologist and anthropologists is that there is no biological basis for race and terms are often applied to one group by another group-not always with the best intention. Conversely, ethnicity is a term that a group applies to themselves. This is evident in the terms applied to different ‘races’/ethnicities: Mexican-American (both political entities), Latino (geography- many Brazilians consider themselves Latino/a), Hispanic (derived from Spain- a political entity), White (skin color), African-American (geographic and political). There is no consistency in these as terms for races. Dr. Sabolinsky illustrates his own confusion stating, ”We had evidence that the I/H combination was effective in an African American population. If we had evidence in a non-black population, we would have pursued a different label [than race-based medicine].” A Nigerian who recently moved to the US would likely not refer to themselves as African-American because they have the combination of dark skin and happen to be residing here. His comment, “We know that skin pigmentation is at best a poor surrogate marker for looking at responses to medication.” further illustrates the ambiguity of the term/concept of race. Ethnicity then is a very fuzzy and messy concept, particularly in a pluralistic multicultural society like the US where many now consider themselves multiethnic.
Although these issues are useful and inform our understanding of racism and social justice in America, including healthcare, they are not very useful concepts for determining the efficacy of a drug. Genetically tailored drugs seem to be the way pharmaceutical development is going (though many would argue money would be better spent providing basic health care to the uninsured/uncovered). Ancestry does have a genetic basis would be a useful tool in drug therapy and development. A theory from Critical Medical Anthropology holds that people with ancestry from the American slave trade have higher rates for hypertension because only a very small percentage whose kidneys hoarded sodium were able to survive the trip and reproduce. This is supported by research comparing hypertension rates in African-Americans to people in countries where most people were enslaved, especially Nigeria. Here, ancestry is useful for medicine, whereas race is not.
Useful for drug development and useful for shareholder profit are two different often oppositional methods to often different goals. Dr. Sabolinski recognizes this when he states, “it is most appropriate for me to answer your questions from a medical perspective,” which avoids a fully critical approach in absence of economic and social justice issues. I seriously doubt there were, or are now, a bunch of board members sitting around a table discussing, “How can we better serve the African-American population?” in fact the findings were from a “retrospective analysis” and confirmed in Dr. Sabolinski’s comment, “the evidence found us.” It is discomforting, although marketable, to then use the idea that the drug was developed to help the underserved.
The “politically correct” touchy “why can’t we all just get along approach” does not address the historical events that have lead to the structural inequities that should inform the complexities of race, social justice, and healthcare. (It also probably comes from a person from society’s privileged class.) I am in support of development health care modalities and structures that help the underserved and not further aid for capital gain. I do applaud Dr. Sabolinski for, “[focusing] on African Americans was healthcare disparities. Blacks tend to have more severe forms of heart failure and are twice as likely to die from the condition than whites.” However, I do question the motivations of NitroMed for doing so. The end result is better care for African-Americans. Way to go! But, don’t take credit where credit is not due.