Beyond Race-Based Medicine

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TR: According to a 2007 report by the Pharmaceutical Research and Manufacturers Association of America, approximately 700 drugs in development are aimed at African Americans. How can we make sure that they are developed and marketed responsibly?

CY: First, we have to understand the impetus to develop a drug for any group and determine that it's driven by a unique unmet need, not by marketing advantages. If there are 700 drugs under investigation, we're talking about 700 different circumstances where someone has presumed they are targeting an unmet need. Frankly, I don't think 700 such circumstances exist.

TR: In a recent review that you wrote on race and medicine, you said that translating differences in disease risk factors into race-based therapeutics has been awkward and ineffective. What do you mean?

CY: The general awkwardness surrounding racial issues in our society bleeds into medicine. There may be unique mechanisms at play in heart failure in some people described as African American. When a practitioner is presented with an African-American patient, they may be hesitant to offer the patient a drug based on their race. And some patients are put off when practitioners emphasize race.

We found in a study that even though there is a drug regimen that is uniquely beneficial to African Americans with heart failure, [prescribing rates are] no better than about 10 percent. And the rate of increase is significantly less than that for other effective therapeutic strategies. That tells me that without being able to articulate all the reasons, there is some hesitancy to proceeding forward with race-based medicine.

TR: Are you referring to Bidil?

CY: Yes, and any iteration of the parent compounds in Bidil have also been poorly prescribed. If the [generic parent compounds] had been prescribed, it would argue that science has been accepted and practitioners found a way to prescribe this to the target population.

TR: How should we move forward?

CY: We need to move away from race quickly. As we mature, we will be able to supplant the notion of race as predictor of response with something more palatable to the scientific community and to patients. Then we don't have to bring the word heft of "race" into how best to care for patients.