Posted: Mon 02 Feb 2009 05:30 Post subject: Medical clinical trials based on "race"
Quote:
What’s Race Got to Do With It?
Nine clinical trials around the world are studying treatments in groups defined by race, gender or both.
Jerry Adler
NEWSWEEK
From the magazine issue dated Jan 12, 2009
It is the question that almost never gets raised in polite company, although almost everyone has an opinion about it. Often, in fact, two opinions, one public and one private. There are many ways of asking it, but perhaps the most neutral way is: what, if any, are the significant genetic differences between racial groups, besides the obvious superficial ones, such as skin color, that we use to define "race" in the first place?
That sentence took me a half hour to compose, and I hope I got it right, because this is as touchy a subject as there is in America, or most other countries with populations of mixed ancestry. For decades, it was virtually a closed question in academia, where the reigning scientific paradigm, expressed by Harvard geneticist Richard Lewontin in 1972, held that almost all the variation in the human genome represented differences between individuals. This notion fit well with the social consensus that the question was better not asked, because it could lead toward racial comparisons that almost invariably end badly for one group or another. And there the matter might have rested, but for the march of medical progress, which has been accumulating data on the differential health risks and drug responses of population groups.
The question arose most prominently in the case of a drug called BiDil, which the FDA approved in 2005 to treat heart failure in blacks after a study found that it relieved hypertension in self-identified African-Americans, but not other ethnic groups. If the study findings were correct, then BiDil, made by NitroMed, can prolong the life of many of the 750,000 black Americans with heart failure, but the very idea of marketing a drug that way provoked outrage among people who saw it as a validation of the concept of "race" as a genetic, rather than a social, category. Perhaps because of that controversy, as well as other reasons, including the drug's high cost, it was recently estimated that only 3 percent of the patients who might benefit from BiDil were actually getting it.
But now it turns out that BiDil may only be the first such drug. A recent study in The Pharmacogenomics Journal counted up nine clinical trials around the world studying diseases or treatments in groups defined by race or gender or both, including chronic hepatitis B in blacks and Hispanics and respiratory syncytial virus in Native American infants. A conference recently convened by Timothy Caulfield, a professor of health law at the University of Alberta, drew together medical ethicists, geneticists and legal scholars to debate these issues. The conference report, soon to be published in Genome Medicine, urges researchers to tread carefully in designing, carrying out and reporting studies that involve racial categories. The broad social construct of "race" is, Caulfield points out, biologically not very useful. "Someone whose ancestors came from Nigeria is very different from a descendant of Kenyans, but if the two of them are walking down the sidewalk in New York, they're both 'black'," he says. "You can try to make those distinctions in your research, but once it gets in the hands of drug manufacturers, there's going to be slippage … marketers want to sell to the broadest possible categories."
Fortunately, that very tendency runs counter to another significant trend in medicine. The research that has allowed us to parcel out racial differences by ancestry will eventually outstrip even those categories, and identify specific vulnerabilities and drug reactions in the genomes of individuals. We will no longer be white or Asian or African, or even Northern European, Ashkenazi, Japanese or East African; we will be who we are, each one of us. And the sooner we reach that point, the better.
How are they defining "race"? Do all Hispanics have the same genetic makeup? These medical trials are worthless and dangerous. They are not based on DNA but on political/social definitions.
Joined: 07 Oct 2007 {Posts: 248 } Location: United States
Posted: Mon 02 Feb 2009 09:38 Post subject:
Quote:
The broad social construct of "race" is, Caulfield points out, biologically not very useful. "Someone whose ancestors came from Nigeria is very different from a descendant of Kenyans, but if the two of them are walking down the sidewalk in New York, they're both 'black'," he says.
^ For this reason, obviously it would be more accurate to go more specific than the common social "races" of the U.S. (i.e. black, white, asian). And when it comes to biology, we all know that a "hispanic" label wouldn't help much. Perhaps it would be most accurate to actually test genetic ancestry, should they find many large differences in disease susceptibility, but that would be way expensive...
I don't understand why this would be so useless for Hispanics. West Coast Hispanics tend to be prodominetly Indian or Indian/White. While the East Coast Hispanics have a tendency to be prodominetly White or Black/White mixed. They also do not run into the trouble that African Americans do being prodominetly African and trying to figure out their racial origins from a place as big as sub-saharan Africa. Hispanics are very aware of their Spanish (European origins) and in the case of West Coast Hispanics many are aware of their Native American origins as well. I've met quite a few Mexicans who still spoke the "the dialect" of Indians as well as Spanish! The same goes with the more Mulatto East Coast Hispanics. Cuba, for example, is famous for its Yuroba culture and its still present day influence on the culture! Hispanics are much better off knowing at least one piece of their ancestry than African-American people who know next to nothing, when asked by a doctor. In many cases, Hispanics can not only name the nationality of ancestors they can give you tribes. You can't get anymore specific than that for genetic studies! I know for Hispanic politicians its better to include every Spanish speaking person in the world as Hispanic for political clout. And for Multiracial activist its much easier to make every Hispanic "so mixed" (to prove race doesn't exist) and the present of a ODR in America, but everyone has racial origins (even Hispanics).
I don't understand why this would be so useless for Hispanics. West Coast Hispanics tend to be prodominetly Indian or Indian/White. While the East Coast Hispanics have a tendency to be prodominetly White or Black/White mixed. They also do not run into the trouble that African Americans do being prodominetly African and trying to figure out their racial origins from a place as big as sub-saharan Africa. Hispanics are very aware of their Spanish (European origins) and in the case of West Coast Hispanics many are aware of their Native American origins as well. I've met quite a few Mexicans who still spoke the "the dialect" of Indians as well as Spanish! The same goes with the more Mulatto East Coast Hispanics. Cuba, for example, is famous for its Yuroba culture and its still present day influence on the culture! Hispanics are much better off knowing at least one piece of their ancestry than African-American people who know next to nothing, when asked by a doctor. In many cases, Hispanics can not only name the nationality of ancestors they can give you tribes. You can't get anymore specific than that for genetic studies! I know for Hispanic politicians its better to include every Spanish speaking person in the world as Hispanic for political clout. And for Multiracial activist its much easier to make every Hispanic "so mixed" (to prove race doesn't exist) and the present of a ODR in America, but everyone has racial origins (even Hispanics).
The problem is that the categorization breeds intellectual laziness and becomes political. Take your examples of the broad differences one might see between Central American Hispanics (mestizo norm) and Carribean Hispanics (mulatto or trigeño norm). What about the smaller, but quite real population of Mexicans with SSA ancestry? What about the mestizos that exist in the Carribean, without one iota of SSA ancestry? What about the Hispanics in both regions with little to no SSA or Asian genes? Making these broad assumptions about what medicines a population of ethnically identified people will respond to, without consideration of each individual's genetic makeup is downright irresponsible and extremely dangerous.
For example: Has anyone considered that the typical southern AA diet, lack of exercise and access to medical care is an exacerbating factor in hypertension and diabetes rates? Nah, it seems easier (or more profitable for pharmaceutical companies) to medicate the problem away, thereby proving that a social construct is "real." It's easier to give the brown people who check a certain box a pill without consideration of the actual genes present, let alone their behaviors/lifestyles. Has anyone tested the drug on, say, poor Southern Whites who have much the same diet and lifestyle?
Relying on social "race" can lead to dangerous outcomes for people in a self-identified population who don't fit the mold. Even for Hispanics, who are the obvious but not only mixed population. Picking on Mexicans again, imagine what might happen if a Mexican who is proud of his Euro and Amerindian ancestry but in the habit of denying his African ancestry (or perhaps his family is simply unaware of their complete ancestry, which is quite common) takes one of these "mestizo" drugs and has an adverse effect?
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