Race-Based Medicine Arrives

Matthew Herper, Forbes, May 10

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

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.

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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.

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Medical News Today, May 11

African-American and Caucasian adolescent girls handle sodium and calcium differently, which may help explain why the races have different rates of hypertension and osteoporosis, according to research at Purdue University.

In a study published in the April edition of the Journal of Clinical Endocrinology and Metabolism, nutrition researchers discovered Caucasian girls lose more calcium in their urine than African-American girls, but both races lose calcium at an accelerated rate when they consume a high-salt diet.

“While we found a racial difference in calcium retention in adolescents, we also confirmed that blacks retain more sodium on a high-salt diet than whites,” said Connie Weaver, distinguished professor and head of Purdue’s Department of Foods and Nutrition. “This proves that salt is processed differently in the races, but too much salt in the diet reduces bone density in both races.”

One out of four Caucasians will be diagnosed with osteoporosis, a bone-loss disease that costs Americans $14 billion a year in health care. The disease strikes one out of 10 African-Americans, but studies show they are more susceptible to hypertension, Weaver said.

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