Beware of Race-Based Cures
RICHARD S. COOPER
USA Today, 11/15/2004
Today's debate: Race and medicine;
Opposing view: Treatments should focus on all patients, not specific racial groups.
Any improvement in medical treatment is welcome news. And black Americans, who are so maltreated by our health care system, deserve an extra share of good news. But ill health is our common enemy, and medical research should define those who benefit as broadly as possible. Studies of "race-based" treatments may not be the best way.
A recently released study on heart failure required two assumptions. First, that black patients are intrinsically different from white patients. Second, that the differences are so extreme that one can predict, based on race,
whether the drug will work for a given patient. Neither of those assumptions is justified. It is more likely that medical factors found among all races, such as the cause of the heart failure and the length of the illness, determine who will respond. Unfortunately, we will never learn what those
factors are from studies like this one.
Could it be genetic? Population genetics shows that common DNA variants are usually shared by all human subpopulations. If drug responsiveness has a genetic basis, it will almost certainly be found in all other groups to
varying degrees. The assumption that "race-based medicine" relies on the new knowledge of genetics is therefore false. In fact, the path to testing and marketing this drug was driven by economic and patent considerations, not the science of genetics.
Perhaps genetics is not the story. If one chooses to argue that the blacks in this study share some environmental or risk characteristics, it would be important not to confuse that medical question with the issue of race.
This trial creates several dilemmas. What do we tell patients? It was tested only in blacks, but should we withhold it from whites? Is it ethical to do a new study and put patients -- of whatever race -- on placebos when we already know that this drug works? Should "race- based medicine" be a general strategy?
Good clinical science should define the medical characteristics of patients who might respond to a given treatment and not rely on mistaken assumptions about race. Once we have identified important genetic factors and we can measure them, then targeted therapy becomes appropriate. The last thing we need is greater acceptance of race in the name of "science" when there is no scientific evidence.
Richard S. Cooper is chairman of the Department of Preventive Medicine at
Loyola Medical School in Chicago.