Fatal Invention by Dorothy Roberts

Author:Dorothy Roberts
Language: eng
Format: epub
Publisher: New Press, The
Published: 2011-05-31T04:00:00+00:00

Back to Genetics

In 2008, the Department of Health & Human Services Advisory Committee on Genetics, Health and Society addressed the controversy over race-specific medicine in a report, “Realizing the Promise of Pharmacogenomics.” Calling race-based prescribing information “suboptimal and medically impractical,” the report recommended that the FDA encourage biomedical investigators to conduct gene-based studies instead of relying on race as a proxy for genetic difference. The latter, the report cautioned, “can result in imprecise prescription guidelines and reinforce a public view of biologically defined races.” 107

The NitroMed research team began searching for the gene that explained BiDil in 2005—after it was approved as a race-specific drug. The Genetic Risk Assessment in Heart Failure Trial, or GRAHF, compared the frequency of aldosterone synthase (CYP11B2) alleles in 354 patients who participated in A-HeFT to the frequency of this same allele in white participants in the Genetic Risk Assessment of Cardiac Events, or GRACE, study conducted at the University of Pittsburgh.108 Activation of aldosterone appears to hasten the progression of heart failure. The GRAHF study found that a specific variant of CYP11B2 influenced clinical outcomes in the African American patients and that it was more common in African American patients than in the white patients who participated in GRACE. The authors observed that these findings “suggest that the genetic variation in aldosterone production may contribute” to differences in heart failure in blacks and whites. “In determining optimal heart failure treatment for an individual, race is likely a surrogate marker for differences in genetic background,” they concluded.109

By comparing genotypes in black and white patients (instead of patients who were helped by BiDil versus those who weren’t), the researchers seemed stuck on finding a biological mechanism based on race. NitroMed’s vice president of corporate affairs stated in 2007 that the company might eventually use the genetic data to develop a diagnostic test for BiDil, though it is not clear what financial incentive it had to invest in genetic screening since it was approved to use race instead.

Finding an underlying genetic reason why BiDil works in black patients does no more to address disparities in cardiovascular disease than does labeling BiDil as a drug for blacks. Neither avenue for developing a pharmaceutical remedy for heart failure will eliminate the social conditions and barriers to medical care that create health inequities in the first place. By turning to a genetic explanation, the researchers foreclosed a potentially more fruitful investigation of the environmental factors that separate white and black health—and that could improve prevention of heart disease for everyone. In fact, conducting genetic research on the heels of BiDil’s approval as a drug for blacks only reinforces the erroneous view that race is a genetic category that causes disparities in disease. It seemed the researchers were looking not for gene variants that predicted who would benefit from the drug, but for gene variants in blacks that explained why it benefited them in particular. In other words, NitroMed sought a post hoc genetic justification for marketing its product based on race.

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