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Race and Medicine

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BiDil was the first drug approved by the FDA for a specific racial group. We want to know what the ramifications are for using skin color as a diagnostic tool for diseases and disorders that can't be seen. Producer Soren Wheeler talks to Dr. Jay Cohn, developer of BiDil and cardiac specialist. Sociologist Troy Duster and epidemiologist Richard Cooper discuss race, medicine, slippery slopes, and the dangers of false stereotypes.

Journalist Malcolm Gladwell has thought about stereotypes. Growing up in Ontario to an English father and Jamaican mother, he became one of the top sprinters in his age-group and he noticed that a surprising number of the most successful runners in Canada were from Jamaica. It got him wondering about the relationship between race and athletic success, and he's pretty sure his initial ideas were wrong.

Produced by:

Soren Wheeler

Comments [14]

Dani from LA

I am a pre-med student in my junior year and I believe this interview is timely and pertinent to me. The interview provided a comprehensive view of specific cases in race-based medicine and aptly detailed both perspectives of the argument. I would like to add a voice to this discussion and further clarify why I believe the practice of racially filtered diagnoses are unjustified.
Of grave concern in medicine is the inequality among races when it comes to healthcare and health outcomes. Although science has proven that race is a construct without a basis in biology, the biology of race continues to be distorted to maintain racial inequality. Even well-intentioned scientists can easily fall prey to the incipient way that biological determinism and racial essentialism impact our society and our policies. Prior to listening to this interview, I came across a New York Times article from 2002, where the physician-author stated that she uses race to diagnose and treat diseases more effectively. The article cites examples from intubation to prescribing Prozac differently for African American patients and argues that these race-based techniques are more effective or even life-saving to her patients. How could someone disagree that when it is lifesaving to discriminate on the basis of race it legitimates the means? However, a seemingly innocent practice can establish a dangerous pattern of ignoring the science of race that keeps biological determinism and racial essentialism alive. Although science has definitively determined that race/ethnicity has no genetic markers, in our society, we continue to act as though they do. A current television commercial marketing ancestral information has a man after a DNA test discovering that “50 % of my DNA comes from Ireland,” and trades his lederhosen for a kilt . And in 2014, a novel asserting that certain traits, such as intelligence, literacy and math skills, have a genetic basis through race/ethnicity, made the New York Times Best Seller list.
Racial medicine has the potential to market to specific groups and could profit from customizing drugs. Largely discussed in the interview, in 2005, BiDil was approved by the Food and Drug Administration. Khan used BiDil as a model to demonstrate how pharmaceutical companies can profit from race-based medicines. Racializing medicine is a potential way of monetizing adherence to racial differences and should, therefore, be viewed with the highest scrutiny.
Racial classifications are, at best, arbitrary and imprecise. Therefore, logically, no reliable data should start from this premise. If physicians assume that race is a social construct, as science elucidates, they are challenged to understand other causes of differences within a population that may account for varied health outcomes. Physicians simply cannot account for racial differences in terms of genetics and through your articles I have come to understand this more thoroughly.

Feb. 05 2016 06:26 PM
Robert Thomas from Santa Clara

I just heard a re-broadcast of this program. It's an interesting and thought-provoking edition.

Malcolm Gladwell is an interesting guy. I've enjoyed his writing

Malcolm Gladwell is not a scientist. He doesn't possess the tools of a scientist, he doesn't exhibit the sensibilities of a scientist, he doesn't have the education of a scientist, he hasn't had the training of a scientist and doesn't have the knowledge of a scientist.

Other journalists treat Gladwell as though he were a scientist. It is an error to do this. It's a grievous error.

Apr. 19 2014 05:00 PM
lylc from Philadelphia, PA

As a pharmacologist, I am most interested in the effectiveness of the medication(s) used for treatment of diseases, regardless of the race of the patient. It is unfortunate that the political implications get in the way of using BiDil in patients who can potentially benefit from it.

As we learn more about genetics of drug responses, a race may have a higher or lower % of people having certain biological factors, which contribute to differential responses to some drugs. A case in point is the use of tyrosine kinase inhibitors (TKIs) for the treatment of lung cancer (Stage IIIB/IV adenosarcoma). TKIs are useful for treating patients having active mutations in the epidermal growth factor receptor (EGFR) in cancer cells. In East Asian (Korea, Japan, Taiwan) adenocarcinoma patients, 30-40% have EGFR mutations, whereas in Caucasian patients only 5-15% do. Therefore, these drugs are more widely used in East Asian countries than in the US. The reasons why higher % of East Asian patients harbor EGFR mutations than Caucasian patients are not known at the present time.

Pharmacogentics will advance our understanding on biological factors contributing to differences in drug responses. We can then screen for differences in such biological factors for choice of drugs and/or drug doses, regardless of race.

Aug. 19 2012 11:23 PM

While I do think that there are social choice and environmental issues that are important, to use Malcolm Gladwell as the example of Jamaicans and running is really kind of misleading. Apparently, he was quite good at the 1500m as a youth. Jamaicans are not at all known for the body type excelling in this event. I cannot think of one Jamaican who has medalled at a distance greater than 400m. And this should be the better metric - all world class athletes have made the decision that they care a lot about athletic success. Gladwell's athletic success is probably his English side. If he was half Kenyan or Ethiopian the argument would hold more water. And that is also an interesting cut on this...

Aug. 19 2012 03:59 PM
Greg from Bend, OR

As we consider racial identities, we should be cautious in the jungle. We cop or deny race for many reasons and the result is a disturbing failure to hold to any logical pattern that might shine a light for medical purposes and much more.

A blazing example arose on this program as a comment was made about a Lebanese cast member possibly "passing for a Jew". As Abraham and Sarah were natives of Mesopotamia (Iraq), they were 100% Arab. Yet, thru the magic of identity theft and identity death, the claim of Abraham's lineage is almost exclusively held by the followers of his Old Time Religion (Judaism), no matter what % of the bloodline.

A genetic study has been made of the earliest bodily remains of the ancient inhabitants of the "Holy Lands", with altars to the God of Abraham. By a preponderance of the exclusive genetic markers, The present day Lebanese population is of most direct descendancy from these Hebrews, as compared to other identifiable possible descendancy communities.

Why shouldn't your Lebanese colleague pass for "Jewish"? Despite the attempt by the Nazis to further segregate their victims, Jews were no more than a religious sub-group of a number of regional and religious groupings of the earlier period Arabic population. That identity has been confused by inter-marriage in Europe, sociological forces and plain xenophobia.

There is much more information available, now, than even 10 years ago. These claims of identity have clear application to aboriginal claims to land and ancestry. But we seem to be moving away from the facts, perhaps for obvious reasons. Please look for the definition of Semite and make note of its regular misusage. It is of no small consequence and usage is quickly changing the definition/ identity. I don't see "winners".

Jul. 18 2009 08:01 PM

I think you have the wrong link for the Facing History School. Yours takes me to some strange Amazon page for books on derivatives...eek! I did find the Facing History School page by googling it and that is wicked cool... yeah, I live in Vermont.

Mar. 25 2009 09:13 PM
Nathan from Pacific Northwest

Is Malcom Gladwell saying that West Indians are genetically faster, but as a whole simply "want it" more? Did he really address the fact that Jamaicans are winning on such a greater margin?

Dec. 22 2008 12:09 PM
Brandie from East Coast

First, I <3 RadioLab.

Second, I was waiting and waiting and waiting for someone to clarify what definition of "race" doctors were using in the context of the Bidil trials. I remember when the drug came out, then, too, I kept waiting for an explanation of the categories.
It seems like such a fundamental flaw: the groups are self reported. We heard, in one of the other segments, how wrong we can be when we assume someone's genetic history based on appearances, so what groups, exactly, are these studies monitoring? In the Bidil study, the conclusion is that the drug yields better results in people who consider themselves Black. What does that mean? Dark skinned? Kinky haired? We all know how mixed up people -- especially black people in America -- can be without even knowing it.
The most disheartening aspect, in my opinion, is that maybe there really is a genetic basis for certain treatments, but the actual group is ignored in favor of what is, in effect, a social construct. Not to say that anyone knows how much genes play in "race," but to lump together in some kind of assumed biological category myself, Barack Obama, and the gentleman from the earlier segment who found out he had NO African markers in his DNA, is misinformed, to say the least.

Third, I <3 RadioLab.

Dec. 19 2008 11:24 PM
Annette Miller from Fort Collins CO

Can't the drugs be tested with a broad sample and then evaluated using the empirical genetic data highlighted in the first segment? This seems a much more objective way to group physiologically different human populations for the purpose of determining if these populations show real differences in drug efficacy.

Dec. 16 2008 01:33 PM
Alexandra from Montclair, NJ

Let me preface my comments with the fact that I truly love Radiolab!

But, I have to say I was disappointed in the segment on BiDil. First off, there is no reason why a drug should ever be approved for a specific race since there are no diseases that occur solely in certain genetic populations of humanity.

Yes, certain genetic populations have higher prevalence, but even white people can have sickle cell anemia. Thus, until a disease or condition is identified that afflicts only a certain genetic group (and it definitely isn't heart failure!) all drugs should be approved for all of humanity.

I know you touched on this in the debate but you really failed to drive this home. Also, you failed to note that heart failure is the end product of obesity, a disorder which occurs in higher rates of minorities, including African-Americans, which has a lot more to do with diet, nutritional education, access to open space, and income disparity than race. I think Radiolab should have at least acknowledged this fact.

Dec. 10 2008 01:33 AM
Amy from San Francisco, CA

Who is the "well known" female lawyer in the BiDil symposium clip? Is this Sandra Soo-Jin Lee? The only woman in the story is not identified!?!

Also, I think a good biomarker debate would have been a little less off beat than the stories you chose. If women are more likely to die from a type of cancer if they are asian vs white, and we know they respond to particular drugs differently if they have a given marker that is predominant in asian communities, why not screen for the marker? In this light, "race" becomes just one of the many factors that could pop up in a personalized medicine profile (and personalized medicine is the "wave of the future," right)? Biomarkers with "racial" distributions would be only one of many things screened for. They may or may not be present in any given individual with an asian lineage (or what have you), and may not be any more important than a wide number of personal markers. In this light, many of the "continuum" theories of gender might apply to race. You can't take a person and make a decision about their biochemistry based on race, but there might still be different distributions of markers within a racial group (and of course whether or not the marker predicts disease outcomes is another question, and whether the tumor is even there to present markers in the first place may have just as much to do with environmental exposures that carry racial and socioeconomic implications, and possibly other stress and lifestyle issues that stem from the positioning of one racial group within a given culture). This is a very different type of debate than the one you carried out during the BiDil story.

Dec. 09 2008 02:50 AM
Jim Labbe from Portland, Oregon

Wait a minute Philip. Are you saying we are not here to try to understand the bioloigical and health related differences attributable to genetic ancestry and attributable to historic and contemporary racism?

Dec. 03 2008 11:48 PM
Phiip Margolis from Brooklyn

We will never get to the depths of “race” and the role it plays in our society if we continue along non-scientific, politically correct, and ideologically driven paths. “Health inequity” is serious and so is “Income and access to healthy foods”. However, to get at the truth, or at least to a deeper version of it than we have now, the first thing we need to do is stop passing the buck. Hypertension in blacks is related to access to healthy food, is related to income, is related to racism, is related to white people, is related to … STOP!! We are not here to free associate and do cosmic poetry, nor are we here to figure out why there is an economic disparity between whites and blacks, or to apologize for slavery. We are here to acknowledge only that “racial” differences between people exist, as a matter of empirical reality. All we need to do is ‘recognize’ facts, not interpret them. This is ‘science’, not sociology or liberal arts.

Nov. 29 2008 08:05 AM
Anna Geer from Oakland, CA

When I turned on the radio and heard a discussion about racial health disparities, I was intrigued. However, as I listened further, I was disappointed to hear such a cursory and dichotomizing treatment of an issue as serious as health inequity. I would have liked to hear a more nuanced analysis and synthesis of Dr. Cohn and Dr. Cooper's research. While they draw distinct conclusions and employ distinct methods, it seems to me that both ultimately are concerned with ways to explain and therefore reduce racial health disparities. I would submit that tracking the disproportinality of cases of hypertension among African Americans is critical, but equally critical is the assertion that race is not the sole explanation for this. This should not mean that we wipe our hands clean of the allegation that race was the primary determinant. This means that more questions should be asked because we still need to understand why African Americans are impacted so disproportionately by hypertension and nearly all other chronic diseases. If, as Dr. Cooper suggests, diet is the factor most predictive of hypertension, shouldn't the next questions consider the various factors that impact diet, such as income and access to healthy foods.
I appreciate that this discussion may have extended beyond the scope of today's theme of "race," but because racial health inequities are so prevalent in our country, I believe it is an issue that deserves a more thorough treatment.

Nov. 22 2008 06:27 PM

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