Humans have used taxonomy for hundreds
of years to help make sense of the world. Classifying creatures makes it easier
to analyze their relationships to one another, such as the Linnaean
classification by binomial nomenclature. However, archaic methods of classification
of our own species still influence modern prejudices. Linnaeus himself tried to
group humans into one of four racial groups: Americanus, Europeaus, Asiaticus,
and Africanus (What's Race Got To Do With
It? pg 145). Yes, geological separation, genetic drift, the founder affect,
and other factors have affected the phenotypic appearance of certain
populations, but the genomes of two individuals differ by only about 0.4%
across the board, regardless of "race." There is no scientifically proven
evidence that points to any sort of superiority of one race over another, yet
the struggle to eradicate the antiquated stereotypes of the past continues
today.
We've come a long way since the times
when segregated medical care in America was an acceptable norm. The scientific
and medical world is not the proper place for bigotry (Well, there's no proper
place, but especially not in fields where reason and data show the illegitimacy
of racial classification). When it comes to health care, the betterment of all
people takes forefront importance. But what happens when racial profiling
provides a possible medical advantage?
It sounds crazy in the light of modern
racial thought. In the past few decades, so much progress has been made to
break down racial barriers, and rightfully so. That's why public outrage and
confusion followed the FDA's decision in 2005 to approve BiDil, a drug marketed
to treat congestive heart failure in self-identified African Americans. Early
studies of the drug in the 1970's and 1980's with race-blind clinical trials
suggested that the drug was statistically ineffective. A decade later, NitroMed
(a medical company) reanalyzed the data and found a correlation between
self-identified black patients and effectiveness of the drug. A larger study
was conducted solely on African Americans, and the results were stunning: over
two years, the death rate of treated African Americans was reduced by 43%. The
FDA approved the drug and issued the following label: "BiDil is indicated
for the treatment of heart failure as an adjunct to standard therapy in
self-identified black patients," (What's Race Got To Do With It? pg 161).
If humans of all races are so genetically
similar, then what could have caused BiDil to work well just for African
Americans? Could heritage, not race, better explain similarities between
people? People who descended from populations that developed in isolation from
others may have genetic markers or certain alleles characteristic of the
ancestral population. Though possible, this explanation doesn’t hold water in explaining
the data. This type of ancestral profiling is much more specific than just
saying "I'm African;" Africa has more genetic diversity than any
other region in the world! The most probable explanation lies in the small
sample size of the original study. It should be noted that the original
race-blind study only tested a few hundred individuals. It is possible that a
larger study could provide further insight to its effectiveness in this
scenario. The African American-only study showed that the drug does indeed
benefit African Americans, but does not shed any light on whether the drug
works or doesn't work well for people of other races.
What struck a sour chord with me was the
fact that people in the study categorized their own race…but what constitutes
race? Francis Collins discussed this earlier in the chapter, referencing the
ethnicity of President Barack Obama. Obama's ancestry is half African and half white
European, yet Americans categorize him as black. Conversely, people in Brazil
typically consider only people of strictly African heritage to be black. By
that standard, they consider Obama to be white! How can scientists rely on
self-identification to classify a person by one race or another? The labels are
subjective, with no guidelines that define what constitutes being African
American or not.
The absurdity
of racial profiling by the color of one's skin makes me seriously question the
legitimacy of BiDil's specificity. But does that mean that it shouldn't be used
to treat African Americans? It is proven to be effective for that demographic,
and I see no reason to remove a drug from the market if it can help even just a
select few people. It does concern me, however, that the racial specificity of
BiDil might set a precedent that could set back the progress we've made against
racial prejudice. I'd like to see a study that finds a biological explanation for BiDil's limited application because self-given
labels based on skin tone don't reflect any scientifically sound biological
classification.
2 comments:
During the studies did they analyze DNA of self identified African Americans to that of the larger population? What about other specific descendancies, like self identified Native American or self identified Asian American, etc.? There has to be a reason and until they know I don't think that they should be able to market to only one group.
Jess, the studies did not address the specific genome sequences of the participants. That's why the reasons for the results are so ambiguous. Could there be a genetic attribute to the study that exists in a locus near skin color? If it exists in most ancestral African populations, it could be passed along with the genes for skin color and typically paired with alleles for darker skin. This is tricky though, because many genes control skin color, and as I said in my post, Africa is huge and diverse. The "black" phenotype can be traced back to so many ancestral populations that it seems unlikely to me that this could be the explanation. As for other ethnicities, they were not specifically studied in the test. The data of the second trial supports that the drug helps self-identified blacks, but it provides no evidence as to how it affects people of other races.
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