Re: Race Based Medicine Arrives

Re: message below...

While a broad category called "race" can be divvied up into groups for
purposes of determining what ON AVERAGE is good for MOST in this or that
research population, the ultimate way to fit treatment to individuals is to
treat individuals as individuals.

Again and again and again, some of us seem to need to be reminded that
drawing genetic racial lines results in such fuzziness of defining that all
but the most die-hard stereotypers among us discern any clear parameters.

The idea of clear and present demarcations of race-basing for any research
study has to be analyzed very carefully for the simple and blatant reason
that there is so awfully much admixture among genetic pools that few (if
any) of us is a pure "anything."

The ultimate need in medical research, and in medical practice, is for
taking heed of the uniqueness of individuals.
Even among SIBLINGS there can be genetic differences and acquired
differences.

Granted, there are some group characteristics of, say, American blacks who
have chosen to be so categorized and/or have certain stereotypic
characteristics which would lead others to call them blacks. As for me, I
am a bit
English, a bit Irish, a bit Scotch, with a healthy dab of bourbon, Bach and
Coors Light. But, seriously... aside from the EXPENSE involved, the only
absolute categorization for designer pharmaceuticals and treatment protocols
is THE INDIVIDUAL.

To say that (all) American blacks, as a distinguishable category, are
preponderantly inclined to, develop, say, hypertension or late-onset
diabetes is equivalent to saying that (all) the graduates of Harvard live to
be whatever the average is at which they kick the bucket.

In oncology, it has clearly been demonstrated that INDIVIDUALIZED designer
oncological treatment is the ideal. So it is not for social ideals, nor
political expediency, that race-based distinctions have some validity and
some
real value. It is only for ECONOMIC reasons -- vis a vis, it would cost a
hell of a lot of money to do a full physiological and genetic evaluation on
each individual (and each specific kind of mutagenic pathology within that
individual, where applicable) pursuant to arriving at the optimal medical
protocol, procedure, choice of pharmaceuticals or dosages are best fitting.

Needed research, has by no means been exhausted, to evaluate just what
medical tools and supplies and procedures actually DO serve best with what
genetic mixes. Happily research to that end is on-going, and progressing on
a daily basis.

If I were a member of a stereotypic category of which most members are dead
by the time they are eighty, and I were ninety-one, and healthy... I would
resent being treated by physicians and morticians as though the only proper
way to treat members of my "research population" indicated I was long
overdue for, and therefore in immediate need of being embalmed.

g

P. S. I note that John has posted a message attempting to treat the
applicable issues formulaically. I do not happen to concur on that as
suggestive of approaches to solutions to the actual issues -- at least not
to the actual issues important to me and my family, and our health.



<RAGLANDMYCOOL@xxxxxxx> wrote in message
news:em6rln$2ek1$1@xxxxxxxxxxxxxxxxxxxxxx




Pharmaceuticals
Race-Based Medicine Arrives
Matthew Herper, 05.10.05, 6:00 AM ET


Click here for a slide show of race- and gender-based medical
differences.

By This Author

Matthew Herper
· Dangerous Ignorance
· Merck Stands Tall
· Pfizer's Warning Signs
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NEW YORK - In November, a tiny company called NitroMed unveiled results
showing that its drug combo, BiDil, reduced deaths due to heart failure
by half.

The results were astounding, but there was a catch. The drug was only
tested on African-Americans and had previously failed to show a benefit
in a broader population. An editorial in The New England Journal of
Medicine by M. Gregg Bloche, a Georgetown University medical ethicist,
warned of the need to manage the downside of "race-based
therapeutics"--and predicted that it was only a matter of time before
race was linked to the effects of other drugs.

Only six months later, Bloche seems prescient. A flood of studies has
emerged showing racial differences in how patients suffer from
disease--or benefit from drugs--in ailments ranging from osteoporosis
to cancer. And several more have looked at the effects of drugs on
particular racial groups. Many of the doctors conducting the studies
are African-American.


Click here for a slide show of race- and gender-based medical
differences.
There is even evidence that some drugs work differently in women than
in men. For instance, aspirin seems to prevent heart attacks and cause
strokes in low-risk medicine, but a controversial study showed it did
the opposite in women. "There is nothing in evolutionary biology more
based on genetics than whether the embryo develops into a man or into
woman. But people generally haven't studied drugs this way," says
Harvard researcher Paul Ridker.

Part of the problem is that clinical trials have too often focused on
white men. Over the years African-Americans, in particular, have been
absent from many trials.

"Much of the data we have on medicines in general have been in white
populations," says Keith C. Ferdinand, a pharmacology professor at
Xavier University. "How do we know that any of this is true across the
board?" asks Gary Butts, an associate dean at Mount Sinai School of
Medicine.

For many drugs, just doing a study looking at the effects of medicines
on African-Americans might be useful. Ferdinand conducted such a trial
with Crestor, a cholesterol drug from AstraZeneca (nyse: AZN - news -
people ). Patrick Griffith, a neurologist at the Morehose School of
Medicine, conducted a trial of Aricept, the Pfizer (nyse: PFE - news -
people ) and Eisai Alzheimer's medicine, in African-Americans. Both
studies, funded by the manufacturers, found the drugs to be effective
in those populations.

But issues emerged from cases where racial groups are compared, and
differences are found. The labeling for AstraZeneca's cholesterol drug
Crestor suggests starting the drug at a lower dose in Asians. Another
AstraZeneca drug, the lung cancer pill Iressa, failed to extend life in
a clinical trial but seems to have worked in Asians.

Perhaps the best-studied example is African-Americans with heart
disease. Just as BiDil may have been more effective in
African-Americans than others, a widely-used class of heart medicines
does not work as well in black patients.

Medicines called ACE inhibitors are cornerstones of cardiology. But for
reasons that are still unclear, they seem not to work as well in
African-Americans. This outcome was confirmed in a recent analysis of a
government-funded 33,000-patient study of blood pressure medicines. For
all patients, old-fashioned diuretics, or water pills, are the
preferred first treatment. But blacks do less well with ACE inhibitors.


Jackson T. Wright, a cardiologist at Case Western Reserve University
who co-authored the study, says that as firms like Novartis (nyse: NVS
- news - people ) and Merck (nyse: MRK - news - people ) develop new
blood pressure medicines, they should be careful to look at racial
subgroups.

"I have yet to see a downside to doing studies that might point out
differences in populations," Wright says. "One could always envision
potential harm, but thus far that has not been a major concern."

Many hope that this brief fling with differences that correlate to race
and gender is just a short step on the path to using genetic tests to
match a drug to a patient. Race and ethnicity may act as surrogates,
either for slight genetic differences based on ancestry, or physical
differences based on upbringing or environment. In the U.S., it may be
a marker not only for differences in ancestry but also for differences
in environment, diet, exposure to pollution and other factors.

Mount Sinai's Butts says he worries that using race to match medicine
to patient is too crude a measure. Genetically speaking, race is
actually a rather bad marker for genetic difference, he says. "Proceed
cautiously," he warns. "It may not be race--it may be something else."

But until those tests emerge, doctors and drug companies may be eager
to find something to fall back on--especially if it means they can save
lives. "All I want is to pick the right drug for the right patient,"
says Susan Desmond-Hellmann, head of product development at Genentech
(nyse: DNA - news - people ). "If that's a PET scan, or if that's
gender...I would caution all of us not to get too focused on a genetic
test."





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