Dispensing of Heart Drug Not ‘Black and White’

  • October 10th, 2005

Historian Joins MIT Group Studying Designer Meds

By Chris Bryant

Some fear designer medicines will lead down a slippery slope to racial medicines. (Photo by Laura Shill)
Some fear designer medicines will lead down a slippery slope to racial medicines. (Photo by Laura Shill)

Think we’ve advanced too far in Civil Rights issues and medical care to resort to making health judgments based on skin color? Don’t be so sure, says Dr. Gregory Dorr, an assistant professor of history at The University of Alabama, who has joined scholars at the Massachusetts Institute of Technology researching so-called “designer medicines” and the possibilities they could lead to racial medicine.

When a recent study of a heart medicine claimed to show the drug reduced the mortality rate of blacks with severe cardiac disease by 43 percent, but had no effect on whites, controversy erupted.

“According to the study, BiDil (the cardiac disease drug) gave a marked increase in lowering the morbidity rates among black patients with end-stage heart disease,” Dorr said. “White people didn’t show any benefit from it. There were problems with the way the study was done that seemed to suggest that it may not be so clear cut.”

Blacks in America are disproportionately affected by cardiac disease, and the Society of Black Cardiologists came out in favor of the drug and the study, Dorr said.

“They said, ‘look, this is a drug that works for our patient population.’ Civil rights organizations came forward and said, ‘no, this is essentially the Nazis again. Sure this looks like a drug that’s going to work for us, but what they are really trying to do is separate black folks from white folks in terms of health care.'”

The ensuing controversy became so heated, discussion of it practically ceased at one point, Dorr said.

The U.S. Food and Drug Administration approves BiDil for the treatment of heart failure in black patients. (Photo by Laura Shill)
The U.S. Food and Drug Administration approves BiDil for the treatment of heart failure in black patients. (Photo by Laura Shill)

“That kind of position is equally dangerous as all the others,” the UA College of Arts and Sciences professor said. “The technologies are still going to emerge, the research is still going to go on, and people are still going to make these claims. And, if everyone is hiding in their shell, nobody is out there talking about what the implications of this are.”

Dorr won a grant to join the team at the Center for the Study of Diversity in Science, Medicine and Technology within MIT’s Program in Science and Technology Studies.

The multidisciplinary group is studying “pharmacogenetics” – the idea that genes control the way the body metabolizes pharmaceuticals, influencing the way drugs affect the body. Some fear efforts to formulate drugs to a person’s genetic make-up could lead to racial medicine, potentially inducing health insurers to refuse coverage to ethnic groups deemed to be medically at-risk because of their genes.

“The issue goes beyond the narrowly pragmatic – how do we apply medicines in the best possible ways,” Dorr said. “It has broader implications for social organizations and social justice. If, instead of using very carefully controlled genetic studies, we start using race or ethnicity as a proxy for the genetic background, we risk not only misapplying medicine but stigmatizing groups as inherently diseased.”

The MIT group is multidisciplinary and includes physicians, pharmacological scientists, sociologists, medical anthropologists and others. Dorr has conducted extensive research between the “Tuskegee Experiment” and the once popular scientific theory of eugenics, the formerly widely held belief that humans could – and should, be improved through selective mating.

Division abounds, as depicted in this photo illustration, over the prescribing of BiDil.(David Jones/Laura Shill)
Division abounds, as depicted in this photo illustration, over the prescribing of BiDil.(David Jones/Laura Shill)

In the “Tuskegee Experiment,” which took place between 1932 and 1972, more than 600 African-American men were part of a secret government study on syphilis. About 400 of the men had syphilis but were not treated for the sexually transmitted disease. Doctors withheld penicillin – giving only placebos instead – so they could study the disease’s progress.

In June the U.S. Food and Drug Administration approved BiDil for the treatment of heart failure in black patients. According to published reports, it’s the first medication approved by the FDA for use in a specific racial group.

BiDil is a combination of generic drugs. Some supporters of the medicine have theorized it might have more impact on blacks because their bodies don’t have enough nitric oxide. One of the drugs comprising BiDil is said to provide nitric oxide while another within the pill helps the body better use the first drug .

Renewing discussions over matters such as the BiDil controversy is a key goal of the MIT group, Dorr said. “Mostly, we want to get it talked about, to get people thinking about it in really rigorous and disciplined ways, without all the heat.

“When you say, ‘we’ve found a drug that works for black people and not for white people,’ people are going to get very uneasy. Race, in that case, is acting as a proxy for genetics. They look at your phenotype – what you look like – and they use it as a marker for your genotype – what your genes really are. But that’s fallacious reasoning. We know that doesn’t work. The human genome project showed us that doesn’t work. But that doesn’t stop people from doing it. There are white people whose genotypes are closer to the people in the black group. There are black people whose genotypes are closer to the white people. Some black folk might be taking that drug and not getting any benefit from it. And some white folk, who might benefit from it, won’t, because the clinician says, ‘this is a black medicine.'”

“In order to understand pharmacogenetics, you have to understand the longer history of race and medicine in America and how they interacted over time,” Dorr said. “I think there is a lot of potential good in genetic medicine. But, when people conflate race and genetics, we get into a very dangerous and murky area.”

The University of Alabama, part of The University of Alabama System, is the state’s flagship university. UA shapes a better world through its teaching, research and service. With a global reputation for excellence, UA provides an inclusive, forward-thinking environment and nearly 200 degree programs on a beautiful, student-centered campus. A leader in cutting-edge research, UA advances discovery, creative inquiry and knowledge through more than 30 research centers. As the state’s largest higher education institution, UA drives economic growth in Alabama and beyond.