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Thread: 'Ethnic drug' raises fears over race and genetics

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    Senior Member cosmocreator's Avatar
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    'Ethnic drug' raises fears over race and genetics

    http://www.telegraph.co.uk/news/main...1/ixworld.html

    The development of the first 'ethnic drug' could reignite the race debate and even cause harm without a deeper understanding of the genetic basis behind such medicines, a professor warned yesterday.

    Next month the American Heart Association will be given details of a major trial on black people of the heart failure drug BiDil, which was ended prematurely because the results were so encouraging.

    The company NitroMed hopes to market the drug to African-Americans next year, if it gets regulatory approval, but the collision of race and genetics in medicine is stirring unease.

    Yesterday Prof David Goldstein, of University College London, argued that, while "some medicines do work differently in different racial groups", there was a danger of oversimplifying the situation.

    He was worried that race and ethnicity were "crude simplifying labels" for the genetic differences between people and that misinterpretation could lead to the inappropriate use of such drugs. Differences in the genetic make-up of people within a racial group mean that they could react differently to a drug. "We need to dig deeper to find out what causes these differences and then test for the genes involved, not market drugs on the basis of race," he said.
    .

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  2. #2
    Franz
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    Quote Originally Posted by cosmocreator

    Differences in the genetic make-up of people within a racial group mean that they could react differently to a drug. "We need to dig deeper to find out what causes these differences and then test for the genes involved, not market drugs on the basis of race," he said.
    Which could start a new kind of war - selecting genetic race targets - as someone suggested in another forum.
    So we could make drugs that would attack particular racial features - such as "sickle-cell" - and hasten the good work Aids is doing in Africa.
    How soon can we apply this to the Israelis?

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    Exclamation 'Ethnic drug'

    http://news.bbc.co.uk/1/hi/health/3985653.stm

    Sunday, 7 November, 2004, 01:34 GMT

    A question of genetics?

    By Nick Triggle
    BBC News health reporter



    BiDil has been targeted solely at black people

    On Monday results from clinical trials into a heart failure drug are expected to show it was an amazing success.

    But BiDil will not to be remembered for its effectiveness.

    Instead, it is set to become one of the most controversial drugs ever as it is targeted solely at black Americans.

    The final phase trials, involving more than 1,000 African Americans, were stopped early in July because of the "significant survival benefit", according to the drug's makers, NitroMed.

    The treatment, which is a combination of two existing drugs, isosorbide dinitrate and hydralazine, was initially tested more than 20 years ago on white and black populations but was not thought effective enough to take forward.

    But if the trials prove as compelling as NitroMed has claimed, it seems likely the US Food and Drug Administration (FDA), the country's regulatory body, will grant it a licence next year.

    'Ethnic drug'

    The drug, which is administered orally, has already caused controversy on both sides of the Atlantic as it would become the world's first "ethnic drug".

    But while the marketing and development of the treatment has been branded as crude, experts say it actually represents a step towards genetically-targeted drugs.

    It has been known for some time that certain ethnic groups are more prone to some diseases than others.

    In the US African Americans are twice as likely to develop heart failure than white people.

    A similar pictures emerges in the UK with certain ethnic groups more susceptible to disease than others.

    As a GP I would be angry if I was told you can prescribe this drug to these people but not those, that is just not fair

    Dr Jim Kennedy, of the Royal College of GPs

    The latest government Health Survey for England showed that South Asian men were more at risk of angina and heart attack than other groups.

    Black Caribbean and Indian men were at greater risk of stroke and all ethnic minority groups, apart from the Irish and Chinese, were likely to suffer a higher rate of diabetes.

    Conversely, other evidence has suggested the white population is more prone to cancer.

    Doctors are also realising that certain groups respond better to some treatment.

    For example, black heart patients are known have a poorer response to beta-blockers and Ace inhibitors, both of which are used to treat heart disease.

    In this context, Professor Mark Johnson, a lecturer in diversity in health and social care at De Montfort University in Leicester, welcomed BiDil.

    'Not effective

    "I think it is probably a positive thing to develop treatments to meet specific needs of certain populations.

    "Some of the favoured medicine, especially for heart disease, is not always effective.

    "Any GP worth their salt will assess a patient and try them on drugs they think will work with their genetic make-up."

    But he said the problem with BiDil is that it "looks like a racialised drug and that raises all sorts of concern".

    "Race is the lazy man's way to get a genetic marker. Genetic markers are not necessarily easily reflected as a visible marker.

    "But the concept of different treatment for different people is not new. After all, men and women are treated differently as are children in comparison to adults."

    There is concern that some populations - the poorer ones - will be neglected in drug development

    Dr Helen Wallace, of GeneWatch

    A NitroMed spokeswoman said if granted a licence the drug, which works by restoring depleted nitric oxide levels, should be welcomed.

    "The trials, and indeed earlier trials, showed it had a significant impact on treating heart failure among African Americans."

    And she defended the decision to only test the drug in these trials on black people, saying that was decided after discussions with the FDA.

    However, Dr Jim Kennedy, prescribing spokesman for the Royal College of GPs, said it would be "totally wrong" if BiDil was licensed solely for black people.

    "As a GP I would be angry if I was told you can prescribe this drug to these people but not those, that is just not fair.

    Genetics

    "All licensed medicine should be available to all people."

    But he said it was only right that doctors try to work out how a person's genetic make-up would affect treatment.

    "We know variations exist and GPs make a reasonable guess at working out a person's genetics using background, exercise, diet, experiences on other medications as well as skin colour.

    "The problem is that at the moment we are no where near good enough."

    But he said that would all change with developments in DNA, which could potentially allow doctors to identify which treatments patients would respond best to.

    The Medical Research Council, funded by the government to promote research, said such developments were extremely promising for patients.


    South Asians in Britain are more susceptible to heart attacks

    A spokeswoman said: "The more specifically we can treat an individual for their particular ailments, theoretically the more effective treatment should be.

    "We are steadily working towards more personalised medicine and recent advances such as mapping the genome, the promise of steam cells and large population studies that combine research into genetics, lifestyle and environment are opening up the potential for a more tailored approach."

    But not everyone is convinced. Dr Helen Wallace, deputy director of GeneWatch, a not-for-profit group that monitors developments in genetic technologies, remains sceptical about the merits and accuracy of genetically-targeted drugs.

    She said BiDil was a "worse than crude" attempt to define humans in genetic groups.

    "Racial differences are not really understood.

    "There are more genetic differences within ethnic groups than between them. It is questionable whether there is a genuine biological difference."

    And she said even more sophisticated approaches to genetics were dubious. "There is concern that some populations - the poorer ones - will be neglected in drug development. "And it is a question of complexity. Environmental factors also play a role in an individual's response treatment and the danger is that too much emphasis can be placed on genes."


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    http://news.bbc.co.uk/1/hi/health/2826719.stm

    Monday, 10 March, 2003, 00:00 GMT

    Ethnic minority health targeted


    Children in London will be asked to take part

    Over 8,000 children are to be asked to take part in a major study to find out why people from ethnic minorities are more likely to become ill.

    People from Britain's black and Asian communities are up to three times more likely to develop diabetes and heart disease compared to white people.

    Doctors believe this is linked to high levels of obesity and poor diet.

    However, there is growing evidence that ill-health starts in childhood and that social conditions may also be to blame.

    Government scientists hope their study will provide a clearer picture and identify ways of improving the health of black and Asian people.

    Social factors

    Experts from the Medical Research Council will examine children's lifestyles, diet and other factors as part of the Determinants of Adolescent Social Wellbeing and Health (DASH) study.

    They will also investigate whether social deprivation or access to education play an important part.

    Pupils from 60 schools in London will be invited to take part. The schools chosen have a high proportion of people from black and other ethnic minority groups.

    Our research aims to find out when ill-health begins


    Professor Sally Macintyre

    The children will be aged between 11 and 13 and will be invited to fill out a questionnaire covering things such as home and school life, their health and how they feel about various aspects of their lives. Their height, weight and blood pressure will also be taken.

    Professor Sally Macintyre, director of social and public health sciences at the MRC, said the study could help the government to develop strategies to prevent ill-health in minority groups.

    "Little is known about how environmental factors affect the health of children from different ethnic populations although there is evidence that some groups experience disproportionate social and economic disadvantage and ill-health.

    "Our research aims to find out when ill-health begins and therefore define the risk factors involved.

    "Knowing the causes of ill-health will enable us to develop preventative strategies."

    Dame Jocelyn Barrow, a founding member and general secretary of the Campaign Against Racial Discrimination, backed the research.

    "This study is an important step forward for the health of London's ethnic minority children.

    "For the first time, we will have a comprehensive picture of the health of 11 to 13 year olds from different backgrounds.

    "Keeping healthy is important for them to make the most of their opportunities now and in the future. "They will benefit from being involved in science, raising awareness about healthy lifestyles and, importantly, from the prevention strategies based on scientific evidence."

  5. #5
    HIEL
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    They're not adapted to the western diet. Alchohol exposure for maybe 200 years?

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    Quote Originally Posted by HIEL
    They're not adapted to the western diet. Alchohol exposure for maybe 200 years?
    It's not that. They are genetically, physically and mentally inferior to Europeans. In their own home countries, with their own ethnic diets, their life expectancy is also as low (or even lower) than here...

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    http://news.bbc.co.uk/1/hi/health/137299.stm

    Wednesday, July 22, 1998 Published at 12:36 GMT 13:36 UK


    Health

    Ethnic risk for disease



    Black and Mexican women in the United States are at greater risk of getting cardiovascular disease (CVD) than white women, even poor ones, according to new research.



    Stanford University researchers were testing the hypothesis that socio-economic status (SES), measured principally by the education level attained, would be the key factor in determining which women developed disease of the cardiovascular system, including the heart.

    They found that status did have an effect, but it did not explain the significant differences between white women and both black and Mexican-American women in determining CVD risk.

    Risk variation

    The study looked at 5,266 women.

    It suggests that ethnic variations in CVD risk - as measured by blood pressure, body mass index, physical inactivity, cholesterol levels, and diabetes rates - may be genetically based.

    The authors say there are large differences in CVD risk factors by SES, a finding they believe illustrates the high-risk status of both ethnic minority women as well as white women with low SES.

    Global problem

    The authors explain: "Our findings are especially relevant in light of the global rise of CVD and other chronic diseases that are influenced by increasing prevalences of hypertension, cigarette smoking, hypercholesterolemia, obesity, physical inactivity and diabetes.

    "The striking differences by both ethnicity and SES underscore the critical need to improve screening, early detection, and treatment of CVD-related conditions for black and Mexican American women, as well as for women of lower SES in all ethnic groups," they say.

    Heart disease accounts for 500,000 deaths among US women annually. The study is published in the Journal of the American Medical Association.

  8. #8
    Senior Member cosmocreator's Avatar
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    I posted about this a week ago but not in so much detail.

    http://www.forums.skadi.net/showthread.php?t=4832
    .

    IHR Revisionist Conference, April 24, 2004, internet broadcast:

    http://www.internationalrevisionistconference.c om/

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    Quote Originally Posted by cosmocreator
    I posted about this a week ago but not in so much detail.

    http://www.forums.skadi.net/showthread.php?t=4832
    Cool, I've merged the threads.

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    Heart drug for blacks to be first pill sold for a specific race

    But but but...race does not exist!... :icon_surp

    Heart drug for blacks to be first pill sold for a specific race

    NEW ORLEANS -- A two-drug combination pill dramatically reduced deaths among blacks with heart failure, a landmark finding that is expected to lead to government approval of the first medication marketed for a specific race.


    Black cardiologists hailed this form of racial profiling after years in which minorities got short shrift in medical studies. Others complained that the drug also might help whites and should have been tested in them, but wasn't for business reasons.

    "At times you can't win," said Dr. Augustus Grant, past president of the Association of Black Cardiologists, which supported the study. "Here we have a wonderful trial that shows a clear result and the issue is raised, `Why was this trial only done in African Americans?'"

    The nationwide study is the largest ever done solely on blacks with heart failure. The findings were reported Monday at an American Heart Association meeting in New Orleans and will be published Thursday in the New England Journal of Medicine. The drug's maker plans to seek Food and Drug Administration approval by the end of the year.

    Heart failure affects 5 million Americans, but blacks are 2 1/2 times more likely to develop it. It happens when the heart is too weak to pump effectively, causing fluid to back up in the lungs and leaving people weak and short of breath. Half die within five years of diagnosis.

    Earlier research suggested that standard heart failure drugs called ACE inhibitors do not work as well in blacks, and that blacks may have lower amounts of nitric oxide, which plays many roles in heart health, in their blood.

    Two chemicals _ isosorbide dinitrate and hydralazine _ boost this substance, but administering the right dose is complicated when they are prescribed separately. A Massachusetts biotechnology company, NitroMed, developed a combination pill, BiDil, that gets around this problem, but the FDA refused to license it as a new drug because earlier studies involving mostly white patients who got the chemicals separately showed no benefit.

    But there were tantalizing signs that BiDil helped the few blacks in the studies, and NitroMed won a patent to use it just in that minority group.

    The company then launched a study of 1,050 blacks. Half of them got standard heart failure drugs; the other half got those drugs plus BiDil. The study was stopped ahead of schedule last year when doctors saw BiDil clearly was better.

    After roughly two years' use, only 6.2 percent of the patients who took BiDil had died versus 10.2 percent who got only standard heart failure drugs. That translates to a 43 percent reduction in deaths, said Dr. Anne Taylor of the University of Minnesota, one of the study's leaders.

    Only 16.4 percent on BiDil required hospitalization for heart failure, versus 24.4 percent of the rest.

    BiDil had substantial side effects _ 47.5 percent on it had headaches, compared with 19.2 of the others. Dizziness occurred in 29.3 percent on the drug and 12.3 percent on fake pills.

    But the favorable overall result "virtually ensures FDA approval," because the agency previously told the company that a successful study in blacks would merit it, Dr. M. Gregg Bloche, a Georgetown University lawyer and Johns Hopkins University physician, said in a commentary in the medical journal.

    That is "cause for celebration" for blacks, but the company now will have no financial incentive to do a larger trial in whites because its "black-only" patent allows it to sell it that way and keep generic versions from coming the market until 2020, he said.

    Others worried that the drug might not be the best choice for every black but that they will automatically be prescribed "the black pill" solely on the basis of skin color.

    Being black is not a black-and-white distinction, said Dr. Timothy Gardner of the University of Pennsylvania in Philadelphia, who had no role in the study. "Physiologically, it's a sort of continuous variable," including people of mixed races, he said.

    Dr. Shamir Mehta, a heart expert from McMaster University in Ontario who has done much research on ethnic differences, said the genetic differences among ethnic groups are so small that the drug should probably help whites, too.

    The early studies in the 1980s that found no benefit from the two chemicals in whites were done before modern heart failure drugs were available, and that could warrant a new study involving all races, experts noted.

    "We don't know how the broad population treated with appropriate background therapy would respond to this compound," said Dr. Clyde W. Yancy, a heart specialist at UT Southwestern Medical Center in Dallas who participated in the study.

    The FDA could choose to approve the drug generally for heart failure with a statement saying it had been tested only on blacks, he said.

    NitroMed's vice president for marketing, B.J. Jones, said the company would submit all results to the FDA and let the agency decide.

    Meanwhile, experts say it is a watershed event in efforts to develop race-based medicine.

    "In 2001 it was almost a fringe concept" that was highly controversial, Yancy said. "The idea was that all this would do would be further polarize medicine and have practitioners make decisions based on race: What does this person look like? There has been a relaxing of the animosity about doing this kind of study."

    Dr. Raymond Gibbons, a Mayo Clinic cardiologist who had no role in the research, said: "To these investigators' credit, they didn't give up on the idea," and pursued testing the drug for blacks. "It's an admirable attempt to focus therapy on the group they thought would most benefit."

    ___

    On the Net:

    New England Journal: www.nejm.org

    http://www.katc.com/Global/story.asp?S=2537237

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