But the real controversy comes when you look at "standard" diseases like hypertension and heart failure and perhaps prostate cancer. For some reason there you get a visceral response when the suggestion is made that the very different prevalence, disease course and response to treatment may be the result of genetic differences corresponding to race rather than other factors.
Interesting justoposition of articles. A long time ago there was a study done of people's attempt to state color-blindness. Somewhat counter-intuitively the people making the most statements of color-blindness were those who, when hooked to machines, had the strongest differential reaction.
BTW - Someone on this thread brought up the fact that Africans are the most genetically diverse group of people in the world and therefore it makes no sense to partition medicine by race. This is fallacious for a variety of reasons:
a) genetic diversity doesn't get rid of genetic drift - the centers of the European diversity and of the African diversity are undoubtedly different just due to chance. Yes, Africans would be more spread out around this drifted center, but ... .
b) The diversity often talked about is typically random mutations as discussed in human family trees. The geneticists try, in general, to measure things not driven by selection because their purpose is to put together a family tree based on stochastics. But the reality is that there are large numbers of differences driven by local environments. For instance, sickle cell anemia prevalence is driven by the fact that being heterozygotic for the sickle cell gene gives some resistance to malaria, which is much more common in Africa than in Europe. And it now looks like a lot of the genetic diseases, like Cystic Fibrosis, are the local solution to a particular disease or other environmental factor (e.g. Typhoid is a possibility in the case of CF). The drift is not random, and it is highly probable that many differences which appear trivial/random are actually utilitarian. And thus would result in different drug efficacy.
I personally would prefer that less inflamatory biomarkers were used, but realistically if the drug shows 40% efficacy in self identified Afro-Americans and less than 10% efficacy in self identified 'whites' then it is what it is.
Clark |
