Genetic Differences Of Race example essay topic

The Dangers of Race-Based Medicine An analysis of new drug therapies specifically targeted towards African American populations with hypertension. Introduction to Contemporary Race-Based Therapeutics On November 11th, 2004, Nitro Med, a Massachusetts based pharmaceutical company published a study on the effects of a new drug called BiDil in treating heart failure among African Americans in the New England Journal of Medicine (Taylor 2049). Since announcing the study, Nitro Med's research has sparked controversy surrounding the ethical implications and scientific evidence of race-based medicine. This study marks a breakthrough in race-based drug treatments as the first pharmaceutical ever researched, endorsed and targeted for a single ethnic group (Pollack 1). The racially-specific pharmaceutical initiative is a product of tremendous government funding allotted by the Clinton administration to the Human Genome Project at the turn of the millennium. Since then, much medical research has focused on understanding the human genome in search of genetic explanations for health problems while funding and interest have decreased in social-related health research and medical programs for poor and under served populations (Braun 162).

Nitro Med's study marks a growing movement that has begun to cite genetic makeup, specifically race-related genetic makeup, rather than environmental or other confounding factors as the source of disease. This shift in presumed cause of health-related problems raises many troubling implications. With race-based therapeutics comes the assumption that there are biological differences between races. The dangers of such implications are vast, the most pressing problem being the ambiguity of race, particularly with regard to genetic composition. Considerable studies have demonstrated the lack of genotypic correlations among members of a given race. Similarly, socioeconomic and other confounding variables have a profound impact on health and thus must be considered in the discussion of race-based therapeutics and research.

This tension between social and biological conceptions of race is now at the forefront of discussion among scientific scholars seeking explanations for the relationship of disease and ethnicity (Foster 844). The ultimate goal of, as stated by Henig, "would be for everyone's genome to be analyzed individually so that doctors could gauge how much of a medication, and which type, is most likely to work for a specific patient" (3). Race-based medications seem highly personalized to the consumer but are simply a short cut to the goal of individually-specific medication. Marketing drugs targeted at particular phenotypes such as race is incredibly lucrative for pharmaceutical companies.

For Nitro Med, this factor will be especially important because African Americans have far higher cases of hypertension than whites while tending to be less responsive to normal treatments than their white counterparts. When the scientific community begins to spread unfounded hypotheses regarding genetic differences between races, particularly differences that attribute poorer health or increased susceptibility to disease among minority groups, a Pandora's Box is opened of potential dangers which can aid proponents of racist doctrines. Historically, scientific studies that sought to prove biological differences among races have led to violently racist movements like slavery, colonialism, and the Holocaust. Hence, as other pharmaceutical companies follow Nitro Med's path and begin marketing drugs targeted for specific racial groups, the dangers of such race-based therapeutics must be acknowledged. Finally, advocates of race-based medicine claim that the scientific underpinnings are irrelevant if a medication is proven to be effective for a particular group. In such a way, race-based medicine is a short-term solution, treating the symptoms of race-related disease without understanding the cause.

BiDil should be available to African Americans, and all races while long-term, continuous research needs to be conducted to determine the actual social causes of hypertension in African Americans. Furthermore, it is important to maintain race-based studies in modern medical research, within the context of understanding that race is a non-scientific, but a social variable. Because inequities exist in health care between races, continuous study is necessary to pinpoint the underlying social and cultural causes of health care disparities. II.

A History of BiDil and African Americans with Heart Failure BiDil is a combination of two generic heart drugs - di nitrate and - first tested together in the early 1980's. In the initial trial, the drug showed so little positive effect that it was rejected from continued study (Arnst 1). Nitro Med, upon purchasing the rights to the drug combination noticed that a small subset of black patients in the original study did in fact show results of the potential efficacy of BiDil. The FDA agreed to approve BiDil if Nitro Med conducted a second trial to confirm the results of the first (Pollack 2). According to Nitro Med, BiDil works by enhancing nitric oxide, which plays a crucial role in controlling blood pressure and is more likely to be deficient in blacks than in whites (Taylor 2054). The eighteenth month examination of 1050 African American men and women showed that those who took BiDil lived significantly longer than those receiving standard hypertension therapies - 43% fewer deaths among BiDil users than the control group as well as 33% fewer hospitalizations (Taylor 2049).

In fact, the efficacy became so apparent, that the study was halted several months early because the researchers thought it was unethical to deny the useful new drug to the placebo group (Wade, Race 12). The need for effective cardiovascular medications for African Americans is a pressing issue. Studies show that African Americans respond less well than their European-American counterparts to common drugs for cardiovascular disease such as ACE inhibitors and beta blockers (Tate S 35). Blacks are also diagnosed with heart failure earlier than whites with a greater number of undocumented cases. Hypertension, a leading cause of heart failure is disproportionately greater - three to seven times more - among African Americans (Yancy, Heart 183).

Many scientists believe the higher rate of hypertension among people of African descent is related to underlying biological differences such as salt sensitivity, plasma volume, and levels of nitric oxide. However, not enough research exists to clearly identify which differences are due to genetic factors and which can be attributed to environmental factors that correlate with race (Tate S 35). Though many studies have documented the stark inequities in cardiovascular disease among African Americans, the causes still remain unproven.. Race as Non-Genetic Social Construct With the entire human genome sequenced within the last few years, the knowledge of genetic differences among humans has become better understood by medical researchers.

The genome project demonstrates, in fact, that "humans share 99.9 percent of their genome with one another (Henig 2). The remaining 0.1 percent of variations for such expressions as skin color, hair color, height, and weight are biologically insignificant in comparison to the tremendous majority of similarities among humans. Racial traits such as skin color, eye color, or hair are differences controlled by a relatively few number of genes while intelligence, talents and social skills are determined by thousands (Angier 2). Overall, the human race is only a few thousand generations old, and minimal evolution has occurred that distinguishes the different groups that emigrated out of Africa, and as a result, human beings are genetically quite homogeneous (Angier 3). Thus, race comprises a small, insignificant fraction of 0.1 percent of our genome (Henig 2).

Very little genetic variation exists across races. In fact, more genetic variation exists between individuals within a single racial group than between entire racial groups themselves (Anand 241). This fact disproves any correlation between one's racial identification and genomic makeup. Although genetics and evolutionary theory can be used to sort some people into categories according to their ancestral geographic regions, modern day populations are so diverse as a result of migrations and intermixing that "commonly used racial and ethnic categories" such as African American, Hispanic or Caucasian "are often meaningless when it comes to determining a person's DNA makeup (Racing to Conclusions 1). For example, among self-described African-Americans exists as little as 20% and as much as 100% genetic heritage from Africa (Racing to Conclusions 1). Thus it is impractical and inaccurate to link racial categories to genetic makeup.

Although this fact is commonly accepted among professionals in the medical world, many still seek a genetic explanation for race-specific diseases and / or higher susceptibility for certain inherited health conditions based upon race. When arguing that certain racial inequalities in disease are caused by genetic differences of race, scientists often refer to sickle-cell anemia - a genetic disease that has a higher prevalence among American and West African blacks. While sickle-cell anemia is more common among African Americans, the idea that it is a black disease discounts its prevalence among many other ethnic groups including Latinos, who also have a significantly higher number of sickle-cell cases compared to white Americans. Furthermore, the notion that sickle-cell anemia is a black disease confounds the distinct ideas of racial identity versus racial ancestry (Braun 166).

The distribution of the sickle-cell genetic trait is not related to race; it is coupled with the geographic distribution of malaria (Braun 167). For example, very few scientists consider Orchomenos, a town in Greece that has twice the rate of sickle-cell anemia among African Americans, or the fact that black South Africans rarely possess the sickle-cell anemia (Braun 167). The data on sickle-cell anemia therefore does not support the idea that race and genetic conditions are linked. Since racial groups are not members of distinct gene pools, using genetic explanations for racial inequities in health is a flawed and unfounded approach. Race is not a scientific means of categorization, but a social concept. Classification by race represents "historical / political /social categories based on perceived differences" (Braun 163).

The concept of race is a socially constructed classification that relies upon phenotype, not genotype, to "govern the distribution of risks and opportunities" such as disease susceptibility in our highly race-dominated country (Jones 300). African Americans are "an extremely heterogeneous, admixed population" whose genetic differences are too vast to allow their racial categorization to serve as an explanation for their higher rates of heart disease (Denberg 1744). By falsely linking genetic factors to the higher expression of hypertension in African Americans without any tangible evidence, researchers are ignoring environmental and socioeconomic factors related to race that contribute to the expression of many diseases such as heart failure. IV.

Environmental and Socio-economic Determinants of Disease Researchers are often quick to identify differences in risk factors and disease rates between racial groups as evidence that genetic differences between races exist. However, determinants such as socioeconomic status are often overlooked because such variables are "notoriously difficult to measure, and hence difficult to control for in analyses" (Anand 243). Because of new findings in the human genome, interest in biological differences between racial groups has strengthened while environmental differences are ignored as health contributors (Foster 845). The greater the scientific emphasis on genetic factors, the more governmental funding agencies may discount the impact of social factors in disease differences between races "on the basis that these differences are pre-determined, and are not determined at a societal level" (Anand 243). This further perpetuates the belief that genetic differences exist between ethnic groups while true social problems such as inequities in the delivery and quality of healthcare are overlooked. The social problems that are associated with race rather than the biological composition of race itself determine susceptibility to disease.

As stated by Professor Lundy Braun: "Racism, not race, influences pattern of disease" (160). Minority racial groups are plagued with inequities of power, wealth, and privilege, which all have an influence on one's health (Braun 168). Diet, occupation, housing, job availability, discrimination, and political representation are all race-related social factors that, although difficult to measure, have profound effects on health. A qualitative study conducted by Krieger and Sydney, confirms that "physiological effects of racism contribute to the high rate of hypertension in African Americans" (Braun 164). African Americans experience greater discrimination than whites and therefore are faced with more stress, which is a definite contributor to hypertension. As put by sociology professor Troy Duster: "If you follow me around Nordstrom's, and put me in jail at nine times the rate of whites, and refuse to give me a bank loan, I might get hypertensive...

What's generating my increased blood pressure are the social forces at play, not my DNA" (Henig 3). The three main forms of racism each play a role in contributing to disparities in health outcomes among different ethnic groups (Jones 300). Internalized racism, in which discriminated races accept negative stereotypes about themselves, leads to negative health behaviors among minority groups. Furthermore, institutionalized racism, the structural inequities and level of access among groups, contributes to lower socio-economic status and consequently, poorer access to health care among minorities.

Personally-mediated racism, individual prejudice and discrimination, results in stress and disparities in health care, all of which have negative outcomes on the health of minority groups (Jones 301). Unfortunately, few studies are able to provide concrete, quantitative evidence of environmental influence on disease. As a result, genetic and environmental interpretations both appear as potential causes of the differences in disease among races. Many anthropologists, sociologists and other social scientists fear that genetic explanations will completely overshadow the true social and economic causes of disease if the scientific community continues to emphasize the genomic differences between humans (Henig 3). V. Social Dangers of Race-Based Therapeutics The Nitro Med study and marketing of BiDil raises an "explosive issue" surrounding the assumption that blacks are intrinsically different than whites (Wade, Articles 13). Furthermore, Nitro Med is making the assumption that these differences are so vast that based on race, one can know whether a drug will work better for one person than another (Beware 14). Studies like Nitro Med's, which assume races are biologically different present a significant concern by suggesting that African Americans, a group of lower socioeconomic status and already stigmatized by our nation's history, are fundamentally different than whites (Wade, Race 12).

The popularization of the notion that disease can be attributed to race is likely to extend far beyond the realm of the medical world. The danger of the claim that races are genetically different is the slippery slope that will follow. Drug developers and scientists will continue to explore the ways in which blacks, whites, Asians, and Hispanics are biologically different. Claiming some diseases are more common in one group or another because of genetics allows conjecture regarding what else is more common or varies among groups, such as behavioral differences (Wade Articles 13). The potential exists for stereotypes such as black males being more violent, to be attributed to genetic differences. The results of such assumptions can only lead to racially charged rhetoric and its adverse consequences.

Attempts to scientifically prove that races are inherently different are rooted in negative, racist, and destructive political movements in history. In the past, biological classification of race has led to disastrous social injustices such as hierarchical ranking of races, justification of genocide, colonialism, slavery, and eugenic theory (Tishkoff S 21). The belief that blacks and whites are biologically different hardens back to the antebellum era in American history. In defense of slavery, anti-abolitionists and Southern scientists presented "detailed anatomical studies" that supposedly proved blacks were inferior to whites, inherently diseased and underdeveloped, and simply members of a different species (Braun 161). The idea of genetic differences based on race is also reminiscent of the Eugenic experiments of Nazi doctor Josef Menge le (Racial Diversity 14). The early 20th century scientific Eugenics movement was developed to prove the biological differences between races in order to promote the success of a more evolutionary "fit" species of humans.

This movement, founded on genetic differences between groups was the foundation of Nazi policies of "ethnic cleansing and racial extermination" (Henig 5). Although race-based therapeutics are intended for medical aid of certain groups, emphasizing the notion that racial differences are rooted in genetics only "plays into the hands of racists" (Henig 1). The social implications of race-related therapeutics are a dangerous mix of racism and abuse of science that may likely have negative effects on our society. VI. Profitability of race-based therapeutics Nitro Med's new drug therapy BiDil, once approved by the FDA, is likely to gross nearly $1 billion in its first year alone, according to Dr. Michel Loberg, CEO of Nitro Med. Only a few days after the results of the Nitro Med study were released in the New England Journal of Medicine, Nitro Med's stock went up 73%.

BiDil is not being presented as a competitor against other hypertension drugs, but a complementary drug to be taken with other therapies. The lack of competition gives BiDil the opportunity to be a tremendously profitable drug (Pollack 1). However the largest profits are likely to result from Nitro Med's race-specific strategy. Nitro Med possesses a patent on the first pre-existing drug (BiDil is a combination of two older generic drugs) with "a new race-specific use" (Braun 176). Market entry by generic sellers will be pushed back to 2020.

With 750,000 black Americans suffering from hypertension, the business prospects for BiDil look promising (Pollack 1). Many analysts consider the testing and marketing of BiDil to be driven by "economic and patent considerations, not the science of genetics" (USA Beware 14). Because race can be used as a "crude marker for clinically relevant biological differences", it is a very profitable basis for selling pharmaceuticals (Braun 166). In other words, because race can be portrayed as scientific genetic material without actual evidence, it is easily marketed. Furthermore, drug companies will attempt to convey that their drugs are "fine-tuned for the individual" (Henig 3).

Drugs crafted for specific individuals are scientifically far more advanced than our technologies currently allow, thus tailoring drugs to smaller groups is one step closer to "personalized" drugs. In the US, where "skin color seems to count for so much" creating drugs specifically for racial groups is a tremendously profitable way to market drugs as scientifically individualized (Henig 3). Using race as a marketing tool is a short-cut, money-making strategy for drug companies in a long-term effort to personalize drugs for individuals based on genetics. Finally, once companies like Nitro Med have patent protection for race-specific drugs and a profitable market targeted at a single race group, they have no reason to fund research that explains the actual genetic variations that cause diseases (Braun 163). Nitro Med's published study itself concedes that the ultimate goal of pharmaceutical research would be to "identify genotypic and phenotypic characteristics that would transcend racial or ethnic categories" thereby finding the true, non-race specific population who would benefit most from BiDil therapy (Taylor 2055). Once genetic factors themselves are identified, there is no longer a need to use race as "a loose proxy for predicting drug response" (Tate S 37).

However, because the market for one racial group is so profitable, it is unlikely that Nitro Med or any other groups will invest in research to discover the true genetic or environmental causes of heart failure. VII. Justification and Long-Term Goals of Race-Based Research and Therapeutics Despite the lack of scientific evidence that justifies race as a biological determinant and the dangers of race-based science, many scientists advocate the inclusion of race in both medical treatment and research studies (Jorde S 28). Nitro Med uses this stance in defense of their development of BiDil. CEO of Nitro Med, Michael Loberg said that "heart failure presents itself differently in African-Americans... not all drugs are for all people" (Rosenberg 1). To deny the scientific evidence that shows blacks benefit from BiDil because of ethical concerns of race only puts African Americans at higher risk of heart failure.

Researchers believe widespread use of BiDil could save 15,000 lives a year (Beware 1). Thus, there exists a short-term value for BiDil and other race-based medicine. Whether or not the treatment is based on inaccurate scientific pretenses, it is still an effective treatment. BiDil helps African Americans with heart failure and should thus be available for this population. Many extremists suggest that to avoid inaccurate scientific assumptions of race, medical experiments should discontinue the collection of race-related data. In October, 2003, a California ballot initiative called the Racial Privacy Initiative or Proposition 54 proposed to ban state and local governments from collecting any data on race.

Although the proposition may seem to go hand in hand with the notion that race is non-biological, the Racial Privacy Initiative would make it impossible to track race-based health disparities or collect useful data to support the need for money and research for minorities The initiative was defeated by over 60%, allowing race-related medical research to continue freely in California but nonetheless stirring up controversy about the role of race-based medical practices and research ( (Newman-Wagner 34). Because health care inequities are so vast in the U.S., therapeutics such as BiDil that are proven to benefit a racial group should not be denied to that racial group. However, marketing towards a particular racial group is problematic because profits are too lucrative to encourage any company to continue research for long-term solutions to race-related disease inequities. Similarly, scientific research on race should not be terminated because of the notion that race is not scientific information. Instead, recognizing that race is a social construct and continuing to collect data on race and medicine is the first step towards achieving a more equitable healthcare system in the US (Moore 90). Data on race gives clues to the inequalities in health care access and delivery.

However, once these race-associated differences are documented, the "basis of those differences" must be continually explored so that preventive medicine strategies can be developed (Collins 14). V. Concluding Remarks Nitro Med's new product - Bidil is likely the first of many race-based therapeutics to appear in the pharmaceutical market. The development and marketing of race-specific drugs, however, is too scientifically ambiguous and socially dangerous to become the new wave of pharmaceuticals. Despite the new knowledge pouring into the medical world of the 21st Century, the genome age has negatively influenced scientific theory on race, translating race from a social construct into falsely assumed genetic differences between humans. The notion that races are biologically different is incredibly dangerous as evidenced by the history of eugenics theory and justification for slavery in our nation's history.

Furthermore, though race-targeted drugs have the potential to be tremendously profitable, research must continue to find the true factors that contribute to disease, whether they be specific genetic patterns or environmental influences. Race must remain in the conversation involving medicine, disease, drug-development, and other treatments because the healthcare inequities between races are stark and must be researched. The short-term solution of race-based medicine may seem effective, but the strongest way to addre racial medical differences is to investigate and treat the social symptoms in the spirit of preventive medicine because the majority of heart failure among African Americans is preventable (Yancy, Heart 186). By testing various risk factors in large-scale studies among different races, cultures, and population, more effective therapies for heart failure and other diseases among African Americans will be developed. Even Nitro Med officials say they hope to find "a better diagnostic" than race to target their therapies (Marshall 1). If governmental and medical focus shifts back towards preventive strategies and sociological contributors to disease, continuous race-related research that includes far more anthropological, social, and psychological studies will slowly begin to uncover the true scientific underpinnings of race-related disease.

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