The colour of medicine

A US government advisory panel recommended (last) week that a drug which helps to treat congestive heart failure should be granted a licence...

A US government advisory panel recommended (last) week that a drug which helps to treat congestive heart failure should be granted a licence. Its decision is controversial because BiDiL will be the first racially-targeted drug. When tested on the general population it proved ineffective, but when given to African-Americans, to whom it will be marketed, it appeared to cut death rates from heart failure by 43 per cent.

The BiDiL debate gets to the heart of one of the most explosive issues in medicine. Does race matter in medicine? Or should it be colour-blind? The New England Journal of Medicine has argued that “race is biologically meaningless” and that doctors should be taught about “the dangers inherent in practising race-based medicine”. Others disagree. The psychiatrist, Sally Satel, believes that in medicine “stereotyping often works”. In her Washington drug clinic, Satel prescribes different amounts of Prozac to black and white patients because, she says, the two groups seem to meta bolise antidepressants at different rates.

So who is right? As with much else in debates about race, the answer is both sides and neither. Different populations do show different patterns of disease and disorder. Northern Europeans, for instance, are more likely to suffer from cystic fibrosis than other groups. Tay-Sachs, a fatal disease of the central nervous system, particularly affects Ashkenazi Jews. Beta-blockers appear to work less effectively for African-Americans than those of European descent.

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Yet race is not necessarily a good guide to disease. We all think we know that sickle-cell anaemia is a black disease. Except that it is not. Sickle cell is a disease of populations originating from areas with a high incidence of malaria. Some of these populations are black, some are not. The sickle-cell gene is found in equatorial Africa, parts of southern Europe, southern Turkey, parts of the Middle East and much of central India. Most people, however, only know that African-Americans suffer disproportionately from the trait. And, given popular ideas about race, they automatically assume that what applies to black Americans also applies to all blacks and only to blacks. It is the social imagination, not the biological reality, of race that turns sickle cell into a black disease.

Genetic studies show that human beings comprise a relatively homogenous species and that most of our genetic variation is at individual, not group, level… About 85 per cent of human variation occurs between individuals within local populations. A further 10 per cent or so differentiates populations within a race. Only about 5 per cent of total variation distinguishes the major races. This is why many scientists reject the idea of race.

Excerpted from an article by Kenan Malik in the London ‘Times’, June 18