Race-Based Medicine Not The Answer

The latest breakthrough in tailoring medicine to an individual's racial background didn't come so recently. The idea of race-based medicine has been around for a long time - in fact Science News did a short series of articles on the matter in 2005. Despite the age of the idea and the progress in the area, it has not become mainstream or standard procedure. It is easy to understand why this is the case when one considers that the subject of race is taboo in the United States. The history of race in the United States is so bloody and hateful that it is no wonder that people see race based medicine as 'racist' medicine.

Before examining the legitimacy of race-based medicine it is important to understand what it is and some examples of its use. The idea behind race-based medicine is that there is variation in disease frequency and effect among different racial group. According to Science News, BilDil is the first medicine approved by the FDA to target a specific racial group. One of the major components in the drug, isosorbide nitrate, donates nitric oxide to tissues and in the process strengthens and widens blood vessels. Studies have shown that nitric oxide levels are low in blacks, implying that BilDil would be an effective drug in this population.

If a medicine works better for one race than another it seems reasonable that this information should be considered by a doctor when writing a prescription. But at a scientific level, the theory behind race based medicine contradicts what is known about racial classifications. The majority of Americans are racialists, meaning that they believe there is a genetic basis for race. Yet, it is generally accepted by the scientific community that race is solely a social construction. With no genetic basis for race, how can race-based medicines actually have an effect?

There may be no scientific foundation for classifying races, but people have done it. The problem with race is that, due to its social construction, it is a reality. What we may attribute to racial differences may actually be the result of environmental variance. At the same time, it is undeniable that there is variance in genetic makeup between individuals. For example, the general public probably would not be surprised if they were told that men react differently to a drug high in estrogen than women do. They probably also would not be surprised if a patient weighing 100 pounds was prescribed a lower dose of a medication than one weighing 200 pounds.

We already have existing stratification in medical care based upon personal profiles. A clear example is pediatrics. Children are given special care unlike that given to adults because their bodies are different. They react to drugs differently than adults do, not only because of body size, but because of physiology as well. The relationships between adults can be classified in the same way. I can say with a high level of certainty that you and I are different from one another.

In terms of genetics even identical twins differ in how they express their genes. A common example is fingerprint patterns; everyone has their own unique print. Why shouldn't it be the same for how people react to medicines? In fact, it makes sense that people respond to medications differently. If you've noticed that your headaches are better treated with Tylenol while your roommate responds to Advil, then you have observed this idea firsthand. There is absolutely no reason to prevent tailoring medical care to individuals.

The more precise our medicines, the more lives we will be able to save. In the end, saving lives and treating people more effectively is more important than any social constructions. Tailoring drugs to different races is the first step in making drugs more personal and precise. Because race is socially constructed, instead of using race to separate people medically, a new standard must be found. Environmental factors such as living conditions and diet can have effects that can seem to be based on race. In terms of the drug BilDil, discussed earlier, an Asian or white person who has both a heart condition and low nitric oxide levels may be an equally suitable candidate for its use as someone who is black. At this point it is an environmental or even a circumstantial issue, not a racial one.

So, what is the balance? How do we tailor medical care to individuals if we can't separate people into discrete groups? The answer: make drugs for different kinds of diseases, not different races. Make a medicine for a combination of heart disease and nitric oxide deficiency, not one for blacks who have heart problems. Provide more potential treatment fits for different diseases, and then find a more specific diagnosis. In the end, a black person who is immediately given a medicine because of his race can be hurt; but so is the person of another racial background who doesn't receive the drug they need solely because they aren't black.

Staff Columnist Pratistha Koirala is a 3rd-semester biology and molecular cell biology double major. She can be contacted at Pratistha.Koirala@UConn.edu.