NitroMed's BiDil recently received FDA approval as the first drug targeted exclusively for a racial group -- African Americans with heart failure. Although this condition affects Americans by the hundreds of thousands, BiDil's label will effectively read that Whites, Latinos, East and South Asians and folks from the Middle East need not buy; only those whom society considers "black" -- a concept as slippery as pinpointing the race of Michael Jackson, Soledad O'Brien or Mariah Carey -- should take this drug.
Does this make sense? Is this good science? BiDil has been met with both celebration and admonition. Many scientists see this as the pharmaceutical man landing on the genomic moon -- a bold first step to a future where medications are developed specifically for individuals' biochemical predispositions. A number of black physicians are joining NitroMed shareholders' jubilations. Charles L. Curry, president of the International Society on Hypertension in Blacks, told the Washington Post that BiDil is "the most significant advance in the treatment of black people that [he had] seen in [his] lifetime." So much for penicillin.
At the same time, accusations of racial opportunism are flying left and right. Much has been made of BiDil's 1997 rejection by the FDA for its poor trial design and inefficacy among the general population, as well as the millions of dollars stood to be made by repatenting BiDil as a different drug -- a black drug.
A bit of clear thinking is desperately needed. To be sure, African Americans do have a unique relationship with heart failure: More than 700,000 blacks suffer from it, many of whom are sure to benefit from BiDil if its trial success is seen in the real world. But, this relationship need not be a racial one. Race may not be as reliable an indicator as, say, poverty: Twice as many blacks suffer from heart failure than whites, yet three times as many blacks live below the poverty line.
Could BiDil's supporters be making the one faux pas no scientist should make -- confusing the correlation of race and heart failure as a causal relationship? The jury is still out. One thing is certain: Racial profiling in medicine is as problematic as it is in law enforcement. "Driving while black" and "Having heart failure while black" both work from the presumptions that race is real; genes producing an abundance of melanin in blacks' skin also produce a predictable set of social pathologies and health conditions; and unfortunate outcomes such as increased heart failure or "heightened criminality" are natural, not attributable to other structural or environmental forces, and can only be resolved through a politics of containment. It follows that all we can do to help the disproportionately high number of blacks with heart failure is to contain the disease with a pill. And all we can do to keep blacks from committing crimes is to contain them through police profiling. After all, it's in their genes.
There is a fine line between eugenics and taking black health care seriously; one looks to "improve" society by weeding out the "weak," the other tries to remedy the conditions undergirding inequitable health outcomes. Race is certainly at the heart of both.
How to distinguish between the two? Perhaps the FDA should develop a "strict scrutiny" standard akin to the federal courts. And perhaps the black community should become as skeptical of pharmaceutical profiling as it is of its policing counterpart. Until these or other precautions are in place, it looks like a whole lot of black folk need to drive extra slowly and use their turn signals on their way to the pharmacy to pick up their BiDil.
Osagie Obasogie, J.D., is project director with the Center for Genetics and Society's Project on Race, Disability and Eugenics.
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