Review of Jonathan Kahn, Race in a Bottle: The Story of BiDil and Racialized Medicine in the Post-Genomic Age

Posted in Articles, Book/Video Reviews, Health/Medicine/Genetics, Media Archive, Politics/Public Policy, United States on 2016-10-28 19:21Z by Steven

Review of Jonathan Kahn, Race in a Bottle: The Story of BiDil and Racialized Medicine in the Post-Genomic Age

The American Journal of Bioethics
Volume 15, 2015 – Issue 10
pages W4-W5
DOI: 10.1080/15265161.2015.1067339

Nathan Nobis, Associate Professor of Philosophy
Morehouse College, Atlanta, Georgia

In 2005 the Food and Drug Administration (FDA) approved the drug BiDil, a combination of two generic vasodilators (hence bi-dil), with specific indication to treat heart failure in black patients. The drug was approved largely on the basis of results from a small clinical trial of only self-identified black patients.

Obviously, however, if a drug works with a particular population, that gives no indication that drug will work only with that population or have unique benefits solely for that population: The drug might work for anyone, of any population, and so works well for a subpopulation. So there is some mystery why BiDil was approved, with this specific indication, on this basis. In Race in a Bottle: The Story of BiDil and Racialized Medicine in the Post-Genomic Age, law professor and historian Jonathan Kahn investigates this mystery.

BiDil’s developers argued that there must be some latent genetic explanation for the drug’s success with black patients—this argument underlies their claim that BiDil uniquely benefits black people. They suggest that race serves as useful surrogate or proxy until further genetic information is revealed.

A major goal of the book is to rebut this explanation. Kahn argues that, according to the best science (and philosophical theorizing about the nature of races), there is no genetic basis for race: There are no unique genes that classify (those who many see as) white people as white and (those who many see as) black people as black, and so on. Race-specific efficacy in drugs is therefore unlikely and dubious, given the lack of race-specific biological mechanisms needed for these drugs to perform as promised.

What role should race play in medicine and public health, then? While Kahn provides positive proposals here, another of his major goals is to argue that race-specific drugs have the (typically unintended) negative consequence of undermining potentially effective projects to address racial health disparities. If we believe that health inequalities are, at root, an unfortunate consequence of genetics and biology—and not a consequence of unfair social, political, and educational opportunities, environmental quality, inequalities in health care access, racism in health care, and other social causes—then there is little reason to focus on these very challenging and demanding issues of justice and the distribution of health-related social, educational, and vocational goods: Just take a pill! But if the pills don’t work, and they lead us to ignore or downplay strategies that will work, then the drugs wrongfully distract—to the detriment of those the drugs were developed to benefit.

In what follows, I briefly summarize the book’s introduction, eight chapters, and very helpful “Conclusions and Recommendations,” and comment on some of the main issues of each chapter…

Read the entire review in HTML or PDF format.

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Interview with Jonathan Xavier Inda on Racial Prescriptions

Posted in Articles, Health/Medicine/Genetics, Interviews, Media Archive, Politics/Public Policy, United States on 2016-09-01 00:40Z by Steven

Interview with Jonathan Xavier Inda on Racial Prescriptions

Theory, Culture & Society

Sibille Merz, Doctoral Researcher
Goldsmiths, University of London

Questioning Racial Prescriptions: An interview with Jonathan Xavier Inda

Sibille Merz: Racial Prescriptions provides a timely, illuminating and theoretically-engaged analysis of the making of BiDil, the first (and only) drug that was marketed exclusively to African Americans. Even though it has proven commercially unsuccessful, the drug has triggered a remarkable discussion, academic as well as activist, about the increasing geneticisation of race, the nature of racial health disparities in the US, and the re-articulation of racial politics under neoliberalism. What motivated you to write the book?

Jonathan Xavier Inda: One of my main concerns as a scholar has been to explore the exclusionary politics of race in the United States. For example, my first book, Targeting Immigrants: Government, Technology, and Ethics (2006), deals with racial politics of immigration. The major aim of this book is to situate the government of “illegal” immigration within what scholars have called advanced liberal modes of rule. These are forms of governance in which the political apparatus no longer appears obligated to safeguard the well-being of the population through maintaining a sphere of collective security. Instead, it becomes incumbent upon individuals to take upon themselves the primary responsibility for managing their own security and that of their families. Targeting Immigrants notes that while scholars have nicely analysed how advanced liberal governments work through promoting the self-managing capacities of individuals, they have paid scant attention to how such regimes also operate through practices of exclusion…

…Racial Prescriptions continues my examination of the politics of race in the United States. However, instead of dealing with the domain of immigration, it analyses the field of pharmaceutical production and marketing. The book is intended as a contribution to the rethinking of race and biopower in the genomic age. In The History of Sexuality, Michel Foucault remarks that biopower designates “what brought life and its mechanisms into the realm of explicit calculations and made knowledge-power an agent of transformation of human life” (1980: 143). Biopower thus points to how political and other authorities have assigned themselves the duty of administering bodies and managing collective life. Building on Foucault’s work, scholars such as Paul Rabinow and Nikolas Rose (2006) have sought to rethink biopower for the 21st century by taking into account developments in the genetic and biological sciences. They suggest that new knowledges of life have fundamentally altered society’s capacity to engineer human vitality. Specifically, the molecularisation of life—that is, the understanding of life at the level of genes and molecules—has led to the envisioning of biological existence as a collection of intelligible vital elements that can be identified, isolated, controlled, mobilised, and reassembled. As such, life is no longer seen as natural or immutable destiny, but envisioned as inherently manipulable and re-formable. From this perspective, biopower today is about controlling and managing human biological processes in order to prevent disease, enhance health, and optimise the quality of individual and collective existence…

Read the entire interview here.

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Cook: Race and the practice of medicine

Posted in Articles, Health/Medicine/Genetics, Media Archive, Politics/Public Policy, United States on 2015-10-25 20:50Z by Steven

Cook: Race and the practice of medicine

The Casper Star Tribune
Casper, Wyoming

Edith Cook

Edith Cook/Perspective

We now know once and for all that race is not a biological phenomenon but a social construct. The Human Genome Project, completed in 2000, established that, genetically, all of us human beings are more than 99.9 percent the same. When the project was completed, geneticist Greg Venter stated that the accomplishment illustrates that “the concept of race has no genetic or scientific basis.”

Astoundingly, racial and ethnic categories have appeared in the patents of gene-related biomedical patents. Drug firms increasingly target “ethnic niche markets” for drug development, promotion, and sale. That’s partly because the National Institute of Health Revitalization Act of 1993 mandates the use of census racial categories. The Food and Drug Modernization Act of 1997 also strongly encourages these outdated practices. The complexities of patent laws add to the problem.

These facts are thoroughly examined in Jonathan Kahn’sRace in a Bottle.” (He means pill bottle.) Kahn begins with “the story of BiDil.” In the 1980s, BiDil was a drug for everyone; it became racialized “primarily in response to an FDA ruling that placed in jeopardy the value of its owner’s original nonracial patent.”

Soon the commercial aspect of promoting the drug became center stage. Often African Americans are held to white norms, yet health disparities would be more aptly compared to other underserved groups, such as recent immigrants…

Read the entire article here.

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Racial Prescriptions: Pharmaceuticals, Difference, and the Politics of Life

Posted in Books, Health/Medicine/Genetics, Media Archive, Monographs, Politics/Public Policy on 2015-05-10 17:09Z by Steven

Racial Prescriptions: Pharmaceuticals, Difference, and the Politics of Life

September 2014
148 pages
234 x 156 mm
Hardback ISBN: 978-1-4094-4498-5
eBook PDF ISBN: 978-1-4094-4499-2
eBook ePUB ISBN: 978-1-4724-0107-6

Jonathan Xavier Inda, Associate Professor of Latina/Latino Studies
University of Illinois, Urbana-Champaign

In the contemporary United States, matters of life and health have become key political concerns. Important to this politics of life is the desire to overcome racial inequalities in health; from heart disease to diabetes, the populations most afflicted by a range of illnesses are racialized minorities. The solutions generally proposed to the problem of racial health disparities have been social and environmental in nature, but in the wake of the mapping of the human genome, genetic thinking has come to have considerable influence on how such inequalities are problematized. Racial Prescriptions explores the politics of dealing with health inequities through targeting pharmaceuticals at specific racial groups based on the idea that they are genetically different. Drawing on the introduction of BiDil to treat heart failure among African Americans, this book contends that while racialized pharmaceuticals are ostensibly about fostering life, they also raise thorny questions concerning the biologization of race, the reproduction of inequality, and the economic exploitation of the racial body.

Engaging the concept of biopower in an examination of race, genetics and pharmaceuticals, Racial Prescriptions will appeal to sociologists, anthropologists and scholars of science and technology studies with interests in medicine, health, bioscience, inequality and racial politics.


  • Acknowledgments
  • 1. Racial politics of life
  • 2. The making of BiDil
  • 3. Biosocial citizenship
  • 4. Enlightened geneticization of race
  • 5. Racial vital value
  • 6. Neoliberalization of life
  • Bibliography
  • Index
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Medicating Race: Heart Disease and Durable Preoccupations with Difference by Anne Pollock (review)

Posted in Articles, Book/Video Reviews, Health/Medicine/Genetics, History, Media Archive on 2014-07-11 06:52Z by Steven

Medicating Race: Heart Disease and Durable Preoccupations with Difference by Anne Pollock (review)

Bulletin of the History of Medicine
Volume 88, Number 2, Summer 2014
pages 393-395
DOI: 10.1353/bhm.2014.0025

Lundy Braun, Professor of Pathology and Laboratory Medicine; Africana Studies
Brown University, Providence, Rhode Island

Anne Pollock, Medicating Race: Heart Disease and Durable Preoccupations with Difference (Durham: Duke University Press, 2012).

Science and technology studies (STS) scholar Anne Pollock’s Medicating Race uses the lens of “durable preoccupations” to explore the racialization of different categories of heart disease from the early twentieth century when cardiology emerged as a medical specialty. The book is a useful reminder that the intense and sometimes vitriolic debate over BiDil, a medication for heart failure and the first race-based drug, is but one moment—though a very public one—in a long history of the mobilization of race in cardiology. Drawing on rich and varied sources, including archival materials, scientific articles, interviews, and professional conferences, Pollock extends prior analyses of BiDil to examine the intersection of race with the numerous epistemological debates that characterize the history of heart disease. Why, Pollock asks, has race proved so resilient in the history of heart disease, despite relentless critique?

This deeply theorized account tracks “epistemologically eclectical” racial preoccupations as they travel among the social worlds of science, the clinic, and the pharmaceutical industry. Weaving together three main themes—the role of heart disease research in constituting Americanness, the persistence of racial categorization throughout this history, and the social and political dimensions of health disparities activism—Pollock argues that the durability of race in theories of heart disease is a dynamic biosocial process enmeshed in ambiguous and changing classifications of both disease and race and the persistence of unequal access to power, resources, and treatment. As Pollock writes, “Preoccupations with racial differences always exceed the data itself” (p. 19).

Beginning with early twentieth-century beliefs about infectious etiologies of heart disease, racial discourses shaped the emergence and professionalization of cardiology in complex ways. So deeply entrenched were ideas of syphilitic heart disease in blacks, for example, that Booker T. Washington’s death from arteriosclerosis in 1915 remained a matter of dispute until the 2000s. For African American physicians committed to providing medical care to their neglected communities, engagement with black heart disease also provided them with access to the modern technologies of scientific medicine, albeit limited. As others have shown with diseases such as tuberculosis and cancer, discourses of modernity, stress, and civilization were central to the whitening of coronary heart disease by midcentury.

Particularly fascinating is Pollock’s detailed examination of the complicated relationship between the famed Framingham Heart Study organized in 1948 and the Jackson Heart Study organized in 2000. Framingham researchers constructed their population as both white and normal through changing coding practices, categorizations, computerization, and data analysis, all of which cohered to produce hypertension as a distinct disease category. Modeled on Framingham, the Jackson Heart Study recruited only self-identified blacks, constructing a population that was simultaneously representative and different. Unlike the Framingham investigators, the Jackson investigators incorporated the social dimensions of health disparities, in addition to lifestyle and genetics, into the study design. In chapter 3, Pollock traces the complexity of social processes that produced African American hypertension as a distinctive disease category—and the consequent emergence of the category of African American itself as a risk factor for heart disease. Moving to “durable preoccupations” in contemporary race science in later chapters, Medicating Race analyzes the debates about the salt-slavery hypothesis of hypertension, thiazide diuretics, and BiDil.

While arguing throughout the book for careful attention to biology in any constructivist analysis, for this reader Pollock underestimates the consequences of genetic essentialism and market imperatives in medicine. Yet, in making explicit the tensions in democracy embedded in the historical debates over black heart disease, this book provides fresh insight into a key aspect of the dilemma of difference: when and how to use race in contemporary research. Despite at least a decade of careful social and scientific scrutiny, the academic and public debate about race and race science is not, nor can it be, settled as long as race remains such a salient marker of inequality in U.S. society.

This theoretically sophisticated book does an excellent job of making many familiar STS concepts relevant to medical history. Placing current arguments over race and heart disease in a broad historical context, Pollock adds valuable nuance to the historiography of race and heart disease and their material-semiotic natures. For all its semiotic ambiguity, heart…

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Race in a Bottle: The Story of BiDil and Racialized Medicine in a Post-Genomic Age by Jonathan Kahn (review)

Posted in Articles, Book/Video Reviews, Health/Medicine/Genetics, Media Archive, United States on 2013-12-23 17:34Z by Steven

Race in a Bottle: The Story of BiDil and Racialized Medicine in a Post-Genomic Age by Jonathan Kahn (review)

Bulletin of the History of Medicine
Volume 87, Number 4, Winter 2013
pages 708-709
DOI: 10.1353/bhm.2013.0067

Anne Pollock, Assistant Professor of Science, Technology and Culture
Georgia Institute of Technology, Atlanta, Georgia

Jonatha Kahn, Race in a Bottle: The Story of BiDil and Racialized Medicine in a Post-Genomic Age. New York: Columbia University Press, 2013. xi + 311 pp. Ill. (978-0-231-16298-2).

When BiDil was approved by the U.S. Food and Drug Administration in 2005 for heart failure in black patients, it became the first ever drug to receive a racial indication. Race in a Bottle is likely to be the most in-depth book that will ever be written about BiDil’s controversial regulatory approval. Its author, Jonathan Kahn, has followed the case of BiDil’s approval at least as closely as anyone else, probably including those most directly involved (the clinicians, the pharmaceutical company, the FDA). Ever since he first heard about BiDil in 2002 (p. 4), Kahn has pursued the story doggedly. He became part of BiDil’s story through the articles he wrote about it, starting with a 2003 piece in Perspectives in Biology and Medicine, which debunked the statistic that blacks were twice as likely as whites to die of heart failure. These articles were read by regulators, among others, and in 2005 Kahn testified against BiDil’s race-specific indication at the FDA hearings on the drug (p. 94). Kahn notes that material in this book has previously been published in sixteen different journal articles and book chapters (pp. ix–x); Race in a Bottle is the definitive compilation of that body of work.

Regulatory processes are at the center of Kahn’s account. According to Kahn, “Race enters biomedicine through many pathways. Foremost among these are federal initiatives that shape the production and use of racial categories in biomedical research” (p. 25). Kahn carefully traces the ways in which the terrain of BiDil was laid by mandates at the FDA and NIH to use OMB categories and, especially, by patent law. This regulatory focus is not inevitable as a way to approach how race enters biomedicine: we might start with lived experience in a structurally racist society, or with clinical encounters, or with social movements mobilized against health disparities, or elsewhere. But Kahn’s passion is for regulation, and this is where his expertise is on display.

Race in a Bottle is at its most effective in debunking two things: BiDil’s racialized indication and racialized medicine as a path toward pharmacogenomics. As Kahn fastidiously shows, the vasodilating drug combination that would become BiDil (isosorbide dinitrate and hydralazine) was originally conceived of as a treatment for anyone with heart failure, not just blacks, and it was commercial imperatives—specifically circumventing the fact that the patent on the drug without the racial indication was about to expire—rather than persuasive scientific evidence that led the pharmaceutical company to seek approval for it as a drug for blacks. Kahn also persuasively debunks the notion that racialized medicine is a step toward pharmacogenomics. Although many BiDil proponents argued that race was a “crude surrogate” but nevertheless useful “in the meantime” until more was known about the genetics of drug response (p. 157), Kahn shows that even when there are genetic tests available to indicate drug response (as in warfarin, the “poster child for pharmacogenomics” [p. 165]), “far from withering away, race is persisting and even proliferating as genetic information increases” (p. 168).

Race in a Bottle is less convincing as a window into “racialized medicine in a post-genomic age.” Situating BiDil in a “post-genomic age” is misleading. In Kahn’s own account, BiDil emerged from statistical signals in clinical trial data, not from genetic research. Related claims of racial differences in heart failure foregrounded pathophysiology, not genetics. BiDil’s FDA indication is for “self-identified black patients,” an explicitly social category rather than a genetic one. Yet the book opens by describing the White House ceremony on the occasion of the completion of the Human Genome Project (p. 1). This narrative choice is emblematic of a preoccupation with genetics in the account as a whole, and shows the intractable appeal of analyzing race in terms of genetics, even for those explicitly critiquing genetic understandings of race. Even if some (but not all) BiDil proponents simply slide the drug into a genetic frame, why should critique of BiDil do so?

Finally, because of the explicitness of its racialization, BiDil has become an obvious icon of racialized medicine, but it is actually not clear that BiDil is…

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What’s Wrong with Race-Based Medicine?: Genes, Drugs, and Health Disparities

Posted in Articles, Health/Medicine/Genetics, Media Archive, Politics/Public Policy, United States on 2013-09-30 21:31Z by Steven

What’s Wrong with Race-Based Medicine?: Genes, Drugs, and Health Disparities

Minnesota Journal of Law, Science & Technology
Volume 12, Issue 1 (Winter 2011)
pages 1-21

Dorothy E. Roberts, George A. Weiss University Professor of Law and Sociology; Raymond Pace and Sadie Tanner Mossell Alexander Professor of Civil Rights
University of Pennsylvania

In June 2005, the Food and Drug Administration (FDA) announced a historic decision: it approved the first pharmaceutical indicated for a specific race. BiDil, a combination drug that relaxes the blood vessels, was authorized to treat heart failure in self-identified black patients. BiDil had been tested in the African-American Heart Failure Trial (A-HeFT) launched in 2001. A-HeFT enrolled 1,050 subjects suffering from advanced heart failure, all self-identified African Americans. A-HeFT showed that BiDil worked; in fact, it worked so spectacularly that the trial was stopped ahead of schedule. BiDil in-creased survival by an astonishing 43 percent. Hospitalizations were reduced by 39 percent. It was a momentous accomplishment for Jay Cohn, the University of Minnesota cardiologist who invented BiDil and had pioneered vasodilators as an important treatment for heart failure.

Given evidence of BiDil’s efficacy, but little evidence that race mattered to its efficacy, the FDA should have made one of two decisions: reject the request for race-specific approval or approve BiDil for all heart failure patients, regardless of race. Instead, the FDA put race at the center of its decision, sparking controversy and paving the way for a new generation of racial medicines.

No one is complaining that BiDil is available to people who will benefit from it. The problem is that BiDil was made available on the basis of race. Its racial label elicited three types of criticism: scientific, commercial, and political. I will discuss the first two controversies en route to what I consider the main problem with race-based medicine, its political implications. By claiming that race, a political grouping, is important to the marketing of drugs and that race-based drugs can reduce health disparities, which are caused primarily by social inequality, those who promote racialized medicine have made it a political issue. Yet, having made these political claims, these very advocates answer criticism by saying that we must put aside social justice concerns in order to improve minority health. This article explains why marketing pharmaceuticals on the basis of race is more likely to worsen racial inequities than cure them…

Read the entire article here.

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There Is No Scientific Rationale for Race-Based Research

Posted in Articles, Health/Medicine/Genetics, Media Archive, Politics/Public Policy, United States on 2013-08-19 20:37Z by Steven

There Is No Scientific Rationale for Race-Based Research

Journal of the National Medical Association
Volume 99, Number 6 (June 2007)
pages 690-692

Eddie L. Hoover, Professor of Surgery
State University of New York, Buffalo

For centuries, the colonial governments used a combination of race and ethnic characteristics to subjugate and control people of color, and scientists of the day provided evidence of the “natural order of things” to support national policies of domination, segregation and control. There have been many examples of events in the past 70 years to suggest that achievements by ethnic peoples are not genetically determined and that race and ethnicity are merely terms to describe external features, language, culture, social mores and folklore. BiDil was the first drug in this country approved by the FDA for use in a single “race” after a clinical trial that enrolled only members of that race. Thus arose the question of the efficacy of doing race-based research in humans. In order for this kind of research to have any scientific basis, each individually defined or self-declared race would have to have a 100% pure gene pool, and the data show that the gene pool among whites, blacks and Hispanics in America is very heterogeneous. This makes for far greater similarities among U.S. citizens than any perceived differences, and genomic science has failed to support the concept of racial categories in medicine.Scientists involved with the first mapping of the human genome have noted that there is no basis in the genetic code for race. That being the case, there appears to be no justification for race-based research among human beings.

Although the United States has experienced enormous improvements in its healthcare system over the past half-century, there are still widening disparities in most disease processes between whites and blacks/Hispanics.’ There has been much debate as to how these disparities can be eliminated, but simple, logical programs that could be tailored to specific minority communities in different geographical locations have not proven to be practical for a variety of reasons. To be sure, disparities in healthcare, like anything else, are a function of a variety of factors, including education, environment, income and culture, among others. Race and ethnicity are important determinants of some of these functions, thus raising the question as to whether these parameters may, in fact, be determinants of outcome in some of these disease processes based upon genetics as well as the aforementioned risk factors.

Modern-day science has amassed enough evidence to suggest that there is very little biological difference between the various races. In order for race-based research to have any scientific basis, each individually defined or self-declared race would have to have a 100% pure and homogeneous gene pool. Some racial and ethnic groups have a very heterogeneous gene pool, such as whites and Hispanics. The same scientific data show that approximately 80% of American blacks have some degree of white ancestry, and although not so nearly well publicized is the fact that many whites also have black and Hispanic ancestry. This would make for far greater similarities in the U.S. black/white gene pool than any perceived differences, and genomic science has failed to support the concept of racial categories in medicine and further purports that there is more genetic diversity within a “racial cohort” than any differences between two such cohorts.” Craig Venter, who helped produce the first map of the human genome, noted that there is no basis in the genetic code for race.’ That being the case, race then becomes rather meaningless in scientific research. This would obviously include race-based pharmaceutical research that resulted in the drug BiDil. This is not to be confused with the fact that race indeed affects both access and outcomes in our healthcare system, as it most certainly does. Even black medical professionals do not enjoy the same access to highly specialized services as their white counterparts, such as coronary artery bypass grafting, but the basis is not biological and by extension, not genetically determined…

Read the entire article here.

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Black and White Medicine

Posted in Book/Video Reviews, Health/Medicine/Genetics, Media Archive, United States on 2013-08-09 03:07Z by Steven

Black and White Medicine

Volume 58, Number 32 (August 2013)
5 pages

Alejandra Suarez, Professor of Psychology
Antioch University, Seattle

A review of Race in a Bottle: The Story of BiDil and Racialized Medicine in a Post-Genomic Age by Jonathan Kahn New York, NY: Columbia University Press, 2013. 311 pp. ISBN 978-0-231-16298-2 (hardcover); ISBN 978-0-231-53127-6 (e-book), hardcover.

What is your race? (a) Mestizo, (b) Greek, (c) Creole, (d) Peninsular, (e) Mulatto, (f) Quadroon, (g) Octoroon, (h) Indian, (i) Chinese, (j) Japanese, (k) Moor, (l) Syrian, or (m) Nubian? In another time and place, these may have been the available choices. Obviously these categories are not anthropologically or scientifically based.

Currently the United States uses the definition of racial categories as published by the Office of Management and Budget (1997) in its Revised Directive 15. Directive 15 stems from the civil rights movement; it aims to provide consistent data and a uniform language in order to increase fairness in society. All federally funded research with human participants is required to address issues of race, although the OMB explicitly states that its categories are not anthropologically or scientifically based.

The current racial choices in the United States are (a) American Indian or Alaska Native, (b) Asian, (c) Black or African American, (d) Native Hawaiian or other PacificIslander, and (e) White. There are two categories for data on ethnicity: (a) Hispanic or Latino and (b) not Hispanic or Latino (Office of Management and Budget, 1997). Many people objected that it is difficult to fit into these categories, so in the 2000 census, one could also self-select multiple categories of race/ethnicity. Selecting one’s race is complicated: It is about identities; it is not about genetic differences.

The human genome project, completed in June 2000, concluded that all human beings, regardless of race, have pretty much the same genes. In fact, the American Anthropological Association has asserted that race is “a worldview, a body of prejudgments that distorts our ideas about human differences and group behavior” and that “racial beliefs constitute myths about the diversity in the human species and about the abilities and behavior of people homogenized into ‘racial’ categories” (American Anthropological Association, 1998, para. 8, and cited in book under review, p. 40).

Race is an ideology that changes according to time and place. However, at the same time that the human genome project has unequivocally demonstrated that race is a construct with no biological validity, the idea of race as a genetically based population variant is becoming more and more entrenched in biomedical research and practice. How is it possible?…

Read the entire review here.

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Racial profiling in medicine

Posted in Articles, Book/Video Reviews, Health/Medicine/Genetics, Media Archive, United States on 2013-07-16 05:17Z by Steven

Racial profiling in medicine

Nature Medicine
Volume 19, Number 7 (July 2013)
page 808
DOI: 10.1038/nm.3254

Aravinda Chakravarti, Professor of Medicine
McKusick-Nathans Institute of Genetic Medicine
Johns Hopkins University

Jonathan Kahn, Race in a Bottle: The Story of BiDil and Racialized Medicine in a Post-Genomic Age, Columbia University Press, 2012. 28 pp., ISBN: 0231162987

The field of human genetics is moving beyond using genomics as a tool for deeper understanding of human disease pathophysiology to the possibility of translating this knowledge for efficient treatment. A particular emphasis is being placed on Individualized medicine’, promising to tailor treatment based on each of our genomes. This ideal vision, however, can cause unease when our notions of genetic individuality intersect with those of ancestry and race. Jonathan Kahn’s book, Race in a Bottle, is a contemporary medical story born of this nexus. In it, he skillfully uses the story of the drug BiDil, a therapeutic for heart failure marketed specifically for African Americans (but whose use has declined markedly because it provides no unique benefit in comparison to similar drugs), as the backdrop for examining the expanding role of race in medical genomics, even when the same science has called the existence of race into serious doubt.

As Kahn highlights in the book, the innocuous birth of BiDil in 1992 was no predictor of its contorted history. BiDil is a combination of two vasodilators, hydralazine and isosorbide dinitrate (H-I), which are presumed to act through the nitric oxide pathway to provide benefit to patients with congestive heart failure. They were combined into one pill for easier administration, although each was already available in generic form. Between 1980 and 1991, two major clinical trials in the United States, involving patients of both European and African ancestries, clearly established that angiotensin-converting-enzyme inhibitors should be the preferred drug for patients with heart failure and that the H-1 combination should be used in individuals who did not benefit from this frontline therapy. Sensing a market opportunity, Medco Research obtained the intellectual property rights to BiDil, demonstrated its bioequivalence to the H-1 formulation and approached the US Food and Drug Administration(FDA) in 1996 for approval to market this ‘new’ drug. The FDA refused, arguing that clinical trials showing the utility of H-1 for heart failure did not meet the stiff criteria for such approval.

There was a suspicion that the nitric oxide response, and heart failure, was somehow different in blacks than in whites. So Jay Cohn, a respected cardiologist and owner of the original BiDil patent, reanalyzed the original clinical trial data to demonstrate that H-1 did work better in blacks than whites, a contention described and contested in the book. This finding not only led to a new patent but prompted its new owner, NitroMed, to conduct a fresh clinical trial in 2001, involving only African-American patients with heart failure, to demonstrate BiDils utility in this group. None of these facts are in doubt. What is doubted, however, is the implicit assumption that BiDil is not useful for white patients, the chronology of key events and the motivations of various actors in medicine, industry and government—factors that morphed an otherwise convenient drug formulation into a race-specific drug. Kahn makes the charge that “BiDil was not about personalizing medicine; it was about exploiting race to obtain cheaper, quicker FDA approval for a drug.”…

…Genetic analysis strongly suggests that early humans first arose in Africa and emerged out of Africa only ~100,000 years ago, a fairly recent development, evolutionarily speaking, which explains why we are all closely related. Any classification of biological races within our species is arbitrary because there are no major discontinuities in our diversity across the globe. Importantly, genetic data show that currently populous groups are not necessarily reflected by their past abundance, and human history is one of repeated admixture, not maintenance of purity. It is this genetic admixture that has left an imprint on every human disease with a genetic component, including common chronic ones. Thus, it is quite unlikely that the genetic variations underlying our diseases, which represent only a small fraction of our genetic diversity, will vary markedly across humanity…

Read or purchase the article here.

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