Race and CHF

9 Nov
2004

This study is all “the buzz” – Heart drug for blacks to be first pill sold for a specific race

A two-drug combination pill dramatically reduced deaths among blacks with heart failure, a landmark finding that is expected to lead to government approval of the first medication marketed for a specific race.

Black cardiologists hailed this form of racial profiling after years in which minorities got short shrift in medical studies. Others complained that the drug also might help whites and should have been tested in them, but wasn’t for business reasons.

“At times you can’t win,” said Dr. Augustus Grant, past president of the Association of Black Cardiologists, which supported the study. “Here we have a wonderful trial that shows a clear result and the issue is raised, `Why was this trial only done in African Americans?’”

Here is the good news and the problem. First, the good news: this study provides some data supporting an old treatment for CHF – hydralazine and isordil. The benefit while modest does seem real.

However, I have a problem with racial designation in this type of trial.

Others worried that the drug might not be the best choice for every black but that they will automatically be prescribed “the black pill” solely on the basis of skin color.

Being black is not a black-and-white distinction, said Dr. Timothy Gardner of the University of Pennsylvania in Philadelphia, who had no role in the study. “Physiologically, it’s a sort of continuous variable,” including people of mixed races, he said.

Dr. Shamir Mehta, a heart expert from McMaster University in Ontario who has done much research on ethnic differences, said the genetic differences among ethnic groups are so small that the drug should probably help whites, too.

We really need to better understand the underlying genetic predispositions that identify patients who benefit from this combination pill. Self-designated race gives only a modest clue to a patient’s genetics.

I applaud investigators, but caution all scientists to invest the effort to better understand the genetics and physiology suggested by these results.

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4 Responses to Race and CHF

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JournalClub » A new patent for an old drug in a new population

November 10th, 2004 at 4:57 am

[...] rnalClub 11/10/2004 A new patent for an old drug in a new population In a much discussed study presented at the AHA meetings in New Orleans and just being published [...]

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DB's Medical Rants » Grand Rounds 8

November 16th, 2004 at 12:15 pm

[...] blacks with congestive heart failure (CHF): db (yours truly) also blogged on this issue – Race and CHF We really need to better understand the underlying genetic predispositions th [...]

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RGL

November 9th, 2004 at 9:50 am

I, too, don’t understand why this study was limited to African-Americans. All past studies on a number of drugs covered the mosaic of Americans – black, white, brown, and yellow. Which is why we target drugs for particular clinical entities, not for certain ethnic groups.

Some are speculating that this drug combination may be just as effective for other non-black Americans. Why not duplicate the study using other ethnic groups to make that point?

If that study does not duplicate the effectiveness on African-Americans, there may indeed by reason to pursue why this is so. But if
the drug combination proves to be just as effective, there is no reason to pursue future research based on race and ethnic origins.

I understand studies of this sort are not similar to racial profiling, but I hate to see the day when drugs have to be tested separately on browns, whites, blacks, and yellows. Outside of body builds, weights, and few physical traits, most of us are not physiologically not that much different.

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James McMurry

November 20th, 2004 at 4:51 am

I am disappointed in RGL’s comment about studies aimed at “clinical entities,” as I believe we could classify many people for pharmacological interventions that would work in some, while not working in others–all with hte same clinical entity.
I am old enough to have done some “BSP” tests (bromosulphothalein) in medical school. It suggested that a sick liver would fail to extract the IV-administered BSP. While that was true, it was replaced with many other tests that did not involve an IV drug.
Modern pharmaceuticals cost too much to give them to the 15% who will not respond. We need some testing, some may be done on the basis of race, that will pick the “responders” and leave the “nonresponders” to other drugs.

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