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Race, Money and Medicines

Published online by Cambridge University Press:  01 January 2021

M. Gregg Bloche
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Extract

Taking notice of race is both risky and inevitable, in medicine no less than in other endeavors. The literature on race as a classifying tool in clinical research poses this core dilemma: On the one hand, race can be a useful stand-in for unstudied genetic and environmental factors that yield differences in disease expression and therapeutic response. On the other hand, racial distinctions have social meanings that are often pejorative or worse, especially when these distinctions are cast as culturally or biologically fixed. Our country's troubled past in this regard and the persistence of race-related disadvantage should keep us on notice about this hazard. Yet paying attention to race in order to ameliorate past wrongs sometimes supports the quest for social justice, as Dorothy Roberts points out in this issue. And at times, as Jay Cohn and Raj Bhopal note, attention to race can make a therapeutic difference, to the point of saving lives.

Type
Symposium
Information
Journal of Law, Medicine & Ethics , Volume 34 , Issue 3 , Fall 2006 , pp. 555 - 558
Copyright
Copyright © American Society of Law, Medicine and Ethics 2006

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References

Roberts, D. E., “Legal Constraints on the Use of Race in Biomedical Research: Toward a Social Justice Framework,” Journal of Law, Medicine & Ethics 34, no. 3 (2006): 526–534.CrossRefGoogle Scholar
Cohn, J. N., “The Use of Race and Ethnicity in Medicine: Lessons from the African-American Heart Failure Trial,” Journal of Law, Medicine & Ethics 34, no. 3 (2006): 552–554.CrossRefGoogle Scholar
Bhopal, R., “Race and Ethnicity, “Responsible Use from Epidemiological and Public Health Perspectives,” Journal of Law, Medicine & Ethics 34, no. 3 (2006): 500–507.CrossRefGoogle Scholar
This, of course, isn't necessarily true in a quantitative sense: what has happened is not an indicator of the probability of the thing happening again, absent a sufficient number of similar past scenarios to make prior occurance statistically meaningful.Google Scholar
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Kahn, J., “How a Drug Becomes ‘Ethnic’: Law, Commerce, and the Production of Racial Categories in Medicine,” Yale Journal of Health Policy, Law & Ethics 4 (2004): 1–46.Google Scholar
Indeed, it once was, with disappointing results, achieved years before the current, state-of-the-art drug treatment for heart failure (an angiotensin converting enzyme (ACE) inhibitor) became standard. BiDil in conjunction with an ACE inhibitor has never been studied in a multi-ethnic population.Google Scholar
From a patent law perspective, BiDil's developers could have chosen a racial or ethnic group other than African-Americans. In this issue, the BiDil patent holder, Jay Cohn (who licensed his intellectual property rights to NitroMed, the drug combination's developer), summarizes the BiDil investigators' scientific rationale for selecting African-Americans. Cohn, , supra note 2.Google Scholar
Bloche, M. G., “Race-Based Therapeutics,” New England Journal of Medicine 351 (2004): 2035–2037.CrossRefGoogle Scholar
See generally, Avorn, J., Powerful Medicines: The Benefits, Risks, & Costs of Prescription Drugs (New York, N.Y.: Knopf, 2004) (reviewing the pharmaceutical industry's responses to market and regulatory incentives).Google Scholar
Reichman, J., unpublished manuscript on file with author.Google Scholar
Conflicts-of-interest arising from relationships with pharmaceutical and biotechnology companies have become a matter of controversy for NIH-employed scientists as well as for researchers who receive regular funding from NIH's extramural grant programs. See Kassirer, J., On the Take: How Medicine's Complicity with Big Business Can Endanger Your Health (New York, N.Y.: Oxford University Press, 2004). These conflicts present serious problems, but the problems would be even greater absent a large, dependable flow of funding allocated in non-commercial fashion by NIH's peer review system.Google Scholar
This approach would fit well with more robust FDA efforts to induce drug makers to track prescription-related adverse events after the agency approves new medicines.Google Scholar