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A place for race in medicine?

Drugs for specific races could improve treatment - or endorse prejudice.

By Staff writer of The Christian Science Monitor / March 3, 2005



Ever since the fall of the Nazis, the world has tried to keep the biology of racial disparity under wraps. It has been acceptable to link racial differences to social and cultural factors. One race might underperform another because of upbringing or poverty. But suggesting biology as the cause for those differences - like "The Bell Curve" did a decade ago when it looked at academic achievement - was strictly taboo.

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Now, a new and unexpected force - medicine - is pulling back the covers. By taking a close look at minute differences in people's genetic codes, researchers and drug companies are beginning to create racially based drugs and treatments.

Given the prospect of targeting treatment, some scientists argue that the subject at least ought not to be taboo. Even if race eventually proves to be a crude and insufficient means of understanding genetic differences, it can play an important interim role, they say. Others worry that these voices fail to capture the larger picture: how past claims of "scientific" race and ethnic differences, now debunked, have been used to oppress, even kill, minorities.

"To use the rhetoric of science to sell the idea that historical inequity should be embraced as biological inevitability is an insult to those who value a common humanity," wrote researcher Richard Cooper of the Loyola University medical school in a January article in the American Psychologist. "Race is not a concept that emerged from within modern genetics; rather, it was imposed by history, and its meaning is inseparable from that cultural origin."

Indeed, scholars in recent decades had concluded that racial designations are fuzzy, so hard to pin down that people's self-reporting of their race had become the only useful method of designating race. In the 1990s the work of the Human Genome Project - an international effort to sequence and map all human genes - seemed to add legitimacy to this view. At the genetic level, humans are nearly indistinguishable from one another, 99.9 percent alike.

But as the genome project neared completion in 2003, scientists began to look harder at the 0.1 percent of genes that differ. Their hope: that understanding these differences would open up a new era of medicine based on each patient's genetic makeup.

In recent months, race-based medicine has gained momentum:

• The Food and Drug Administration is expected to approve the drug BiDil in June, making it the first "ethnic drug" on the market. After failing in a broader study, BiDil was shown to be effective in treating heart failure in a clinical study that included only African-Americans.

• The HapMap Project, expected to be completed this year, aims to map haplotypes - sets of closely linked genes that tend to be inherited together. Such a map would be a rich resource, say researchers, in finding genes that affect diseases and individual responses to drugs. The project is studying samples from people in Nigeria, Japan, China, and the United States. Some worry that analyzing differences by country could be used to suggest racial differences.

• African-Americans need higher doses of one medication used to treat asthma than Caucasians, suggesting "an inherent predisposition" in blacks not to absorb the medicine as easily, says a study in the February issue of the journal Chest.

• A study in the American Journal of Human Genetics showed a correlation between the way participants identified themselves by race with groupings of genetic "signposts" among their DNA. "This shows that people's self-identified race/ ethnicity is a nearly perfect indicator of their genetic background," said Neil Risch, who led the study at Stanford University's medical school.

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