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[P]
Pharmaceuticals, Genomics and Race (Politics)

By minerboy
Tue Oct 25th, 2005 at 08:29:57 AM EST

Science

The science of genomics is the study of genes and their function. Recent advances in genomics are bringing about a revolution in our understanding of the molecular mechanisms of disease, and are providing new ways for scientists to develop pharmaceuticals by targeting the specific genes, or the corresponding proteins responsible for the disease. The details of the process are summarized at Decision Resources. They write "Genomics-based drug discovery now offers the improved ability to identify greater numbers of drug targets. Genomics is based on the concept that a gene's function is to generate a certain effect or group of effects in the body. Genes achieve this functionality through the proteins they produce. Although the genes themselves might become therapeutic targets, the pivotal rationale behind this approach is that, by linking public genomic data with proprietary genomic sequence information, pharmaceutical companies can then launch a focused search for proteins expressed from these genes, providing additional therapeutic targets."

The new genomic approach to drug design may have a significant impact on the quality and scope of pharmaceuticals available, it also raises some important questions with regard to social justice, that is, how can you insure that certain groups of people are not disadvantaged with regard to drug development? It is conceivable that the pharmaceutical industry, driven either by profit or prejudice, will avoid developing drugs that will be vital to a minority population.


There are well documented differences in how different racial and ethnic groups react to certain pharmaceuticals.

  • Because African-American patients retain more salt and have a higher incidence of salt-sensitive high blood pressure, the use of diuretics may be more effective in treating high blood pressure among black patients than among white patients.
  • Many East Asians metabolize codeine differently than Caucasians, and the pain relieving effect is often lower.
  • Ashkenazi Jews are significantly more susceptible to a potentially life-threatening blood disorder that can develop as a result of therapy with a particular drug used to treat schizophrenia.
  • Asians and Hispanics with schizophrenia may require lower doses of antipsychotic medications than non- Hispanic whites to achieve the same level of the drug in the bloodstream.

An interesting example of the impact of race on the pharmaceutical industry, is the case of NitoMed, of Lexington, MA. The company specifically targeted efficacy within a racial group to get their drug, BiDil, to market. Previous studies of BiDil in the 1980s failed to show any significant benefit in a general population of heart failure patients, consequently it was not approved for use by the FDA. The results of NitroMed's most recent Phase III African American Heart Failure Trial (A-HeFT) of 1,000 African Americans, which was announced Monday, showed a 43% improvement in survival over standard heart failure therapy. In fact, BiDil is a combination of two generic drugs, isosorbide dinitrate and hydralazine, and is patented to treat heart failure. The targeting of the drug to African Americans has allowed the patent to be extended until 2020, 13 years more than otherwise and has been called the "first African American drug." NitoMed has the support of the Association of Black Cardiologists Committee on Heart Failure, while others are convinced that social inequities, not genetics, account for the differences in response to heart failure drugs between whites and African Americans.

A notable opponent of the use of race in drug development, Jay Kaufman, an associate professor of epidemiology at the University of North Carolina School of Public Health, says

"Undoubtedly, certain alleles are associated with responsiveness to certain drugs; and some of these alleles will be unevenly distributed amongst people of different ancestries. But this implies that drug treatments ought to be based on a person's allele, not on his or her "race." Using "race" as a substitute for "allele" in this case is tantamount to malpractice."
Malpractice ? A perhaps more reasonable view from Borroughs et. al. (PDF)
"race is an imprecise substitute measure of genetic differences among populations. However, the possibility of these differences should alert physicians that an alternate medication or dosage may be warranted for an individual patient."

Regardless of how specific genetic groups are classified, it is clear that the genetics of specific human groups are not evenly distributed. This may provide additional markets for the industry. For example, China is an emerging market, that has a unique genetic distribution.

" The Chinese drug market is expected to be the world's fifth-largest by 2010, with $24 billion in annual sales, according to another report by Burrill & Company, which provides strategic analysis to life science companies interested in expanding into China."
Given the size of the market, it is likely that drug companies will target drugs with greatest efficacy in the Chinese market.

At the same time, the pharmaceutical industry is becoming a globalized oligopoly. One of the main goals of the pharmaceutical industry is to standardize drug registration, or as the international conference on harmonization says "achieve greater harmonization in the interpretation and application of technical guidelines and requirements for product registration in order to reduce or obviate the need to duplicate the testing carried out during the research and development of new medicines." But, what if your country or region has a particularly unique genome ? Faced with this uncertainty, it is reasonable for small, isolated populations to look out for its own genetic interests. The Japanese, for instance, have begun their own Japanese genome project. Its objectives are "to determine where SNPs exist in genes influencing pharmacokinetics and how often they occur per 1,000 population in Japan. The expression and function of mutant proteins will also be studied. It is hoped that this will yield the basic data necessary to conduct research on drug responsiveness in the Japanese population."

Faced with global standardization on one hand, and market pressures on the other, it seems almost inevitable that those groups of people with a unique genetic makeup will not be well served by the pharmaceutical industry. The future utopian vision is of individualized medicine, where pharmaceutical teatments will be individualized based on ones' DNA sequence. But that dream belies the current realities of development, testing, and government regulation. Given the desire to standardize approval and patent regulations, it seems unlikely that personalized treatment will be practical for some time, if ever. A more likely scenario is that prevention, through prenatal selection for specific genotypes will be the prefered way to treat disease, with the possibility that individuals will be purposely selected that will have the most positive reaction with the set of pharmaceutical treatments currently available. For example, it is likely that parents will select children that are not allergic to penicillin. The current array of pharmaceuticals might act as a kind of template for the genome of future generations. This raises some interesting questions about the value of genetic distinctiveness among humans. We value genetically distinct animals, amd find it worthwhile to save species from extinction. Will this ethic translate to groups within the human genome? In the near term, it is conceivable that groups with a common genome will band together economically and politically to insure their inclusion in the development of new medicines. Can we count on organizations like the WHO to provide ethical guidelines that serve human genetic diversity ?

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Related Links
o Decision Resources
o well documented differences
o interesting example of the impact of race
o opponent of the use of race in drug development
o Borroughs et. al. (PDF)
o The Chinese drug market
o international conference on harmonization
o Japanese genome project
o More on Science
o Also by minerboy


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Pharmaceuticals, Genomics and Race | 79 comments (65 topical, 14 editorial, 1 hidden)
I never thought I'd see the day... (none / 0) (#77)
by bighappyface on Fri Nov 4th, 2005 at 10:03:42 PM EST

"Undoubtedly, certain alleles are associated with responsiveness to certain drugs; and some of these alleles will be unevenly distributed amongst people of different ancestries. But this implies that drug treatments ought to be based on a person's allele, not on his or her "race." Using "race" as a substitute for "allele" in this case is tantamount to malpractice."

When being politically correct starts fucking with medical treatment.

The short version... (none / 0) (#74)
by MrMikey on Wed Oct 26th, 2005 at 08:37:25 PM EST

The pharmaceutical industry is about making as much money as they possibly can. They don't care about race, except for how it impacts their profitability. If they can make a lot of money curing your disease, they will. If they can't, they won't.

On the bright side, treatments that are tailored to an individual's genetics, rather than that of a group, have the promise of providing us with drugs that are much more effective, and with fewer side effects.

It's simultaneously funny and sad that some people will do anything to divide humanity up into neatly labelled boxes, which, more often than not, result in their own box being "better" in some way than everyone else's.

We walk upright, use tools, can consider the possible future consequences of our actions, but we're still primates, with all those primate instincts towards social hierarchy and the climbing of same. Some humans look at their fellows and see "people", and some humans look and see two groups, "my tribe" (aka "the good ones) and "not my tribe" (aka "the bad ones"). Ah well, let's hope that future generations manage to be more enlightened.

fun ?! (none / 1) (#72)
by rtsvet on Wed Oct 26th, 2005 at 03:21:37 AM EST

Why in USA thema that all people are diferent (including the race) is always perverted and misunderstood? One can see than even on how people are getting hot and emotional talking on that.

K5 used to be a good site... (1.00 / 5) (#68)
by pesachzon on Tue Oct 25th, 2005 at 04:23:41 PM EST

now it's just full of idiots like this miner boy here (is your father a miner?) what's amazing is that these articles actually are voted for, so they appear on the front page... idiot

follow baldrson's home page link under his name (2.33 / 3) (#62)
by circletimessquare on Tue Oct 25th, 2005 at 02:02:41 PM EST
(at gmail dot com)

here is the racist fuck, and boy does he look the part of a white neonazi hillbilly

he even has eugenics-related bullshit under his picture

this man is so obsessed with race, it's incredible

it seems to be the largest source of his sense of self-worth: his genetic make up

how do people get this fucked up and sick?

why and how do people attach so much meaning and sense of value to their race?


He who desires but acts not, breeds pestilence.
- William Blake


Epistemological sabotage of the moon jellyfish (1.50 / 2) (#57)
by Baldrson on Tue Oct 25th, 2005 at 12:33:34 PM EST
(jim_despamagebowery@hotmail.com) http://www.geocities.com/jim_bowery

The anti-racists are like a bunch of moon jellyfish slipping all over the deck of a ship. You can sort of see where their positions are but when you try to nail one of them down they slide over to another position. Then, when you aren't chasing, they slip to random positions again usually biased to the "mere social construct" side of the listing ship.

Here's a first-order stab at the main positions I've observed them to take as they're slipping away from progressive nails being pounded into the deck at their prior positions:

  1. Default position: Race is a mere social construct based on a folk taxonomy, what people commonly think of as "race", that has no correspondence with any scientific taxonomy, any systematic categorization based on observable characteristics, and anyone who thinks otherwise needs psychotherapy. And since, for any given trait or gene, there is "more variation within than between races", as shown by Lewontin, the psychotherapist should preferrably be some cousin of Lewontin's just to be sure you're getting the real deal. Payment is on "sliding scale".
  2. When shown that people can be accurately categorized by what people commonly think of as "race" using genetic or other data they slip over to: Race is a mere social construct based on a folk taxonomy, what people commonly think of as "race", that has no correspondence with any legitimate scientific taxonomy and anyone who thinks otherwise needs psychotherapy. A legitimate scientific taxonomy is one that organizes the data without regard to a pre-existing taxonomy -- by looking for clusters in the data itself. At this point they have abadondoned Lewontin but that's ok. His main usefulness was during the the first decade of the sexual revolution when there was a frenzy feeding on nubile boomer co-eds.
  3. When shown that cluster analysis of DNA markers comes up with the same taxons as the common conception of "race", they slide right over to: Well, sure there are these its not a phylogenetic taxonomy -- these clusters are not the result of shared ancestry but merely the result of things like convergent evolution and genetic drift and anyone who thinks otherwise needs psychotherapy. Yeah -- this is starting to get pretty lame but bear with me they get more lame.
  4. When shown that phylogenetic cluster analysis of DNA markers comes up with the same taxons as the common concept of "race" they slip-slide over to the position (this one starts registering on the chortle-o-meter): Yes of course everyone knew that all along but you are misrepresenting our position! Our position all along has been that there is no correspondence between DNA markers (which are non-functional/selectively neutral) and functional genes and anyone who thinks otherwise needs psychotherapy!
  5. Then when shown that there are drugs that are statistically a lot more likely to be a lot more effective on some races than others, the comedians now moon-walk over to: Well of course you might find a few things that correspond to functional genes that vary enough by race to be noticable during clinical trials, but these are so few and far between that you are engaging in malpractice to actually base medical practice on them -- and of course anyone who thinks otherwise... yada yada....
At this final stage the chortle-o-meter has pegged bt also the danger lights are flashing wildly. We've long departed the days of yore when these little white academic lies were simply a way for professors to get into the pants of nubile boomer co-eds during their first year on birth control pills.

These guys are now actively killing people.

-------- Empty the Cities --------


Physics, Biology and Science (none / 0) (#56)
by cdguru on Tue Oct 25th, 2005 at 10:32:22 AM EST

It was a sad day for racial equality when the "scientific method" was invented. It blinds people to the needs and desires of other races and allows us to do things like have African-American specific drugs when everyone could be benefiting from these.

The "facts" that drugs have different effects on different biology is just a smokescreen for the persistance of racial inequality. If we were truely motivated to resolve racial inequality, we would be able to smooth over these differences and just make the drugs work the same.

That this flies in the face of reality doesn't matter one whit to people committed to "racial equality". Why worry about pesky little things like biology and physics when we can solve the great problems of the world?

+1, interesting (none / 0) (#53)
by codejack on Tue Oct 25th, 2005 at 09:00:36 AM EST
http://www.digitalo.com/vrml/cowtip.html

I am particularly fascinated by the concept of prenatal selection for optimal genetics, although suggesting that a given reaction to a drug would be the impetus for such programs is, to me, ridiculous. If you are able to develop drugs according to a genetic makeup, why would you need to select that makeup? I think it is far more likely that, when this technology becomes available, people will use it to select appearance, physique, and mental attributes far more often than for any kind of medical reason.

OTOH, people being morons, they will probably remove any vestige of genetic variation and doom our species to oblivion through some incredible blunder, like accidentally making everyone allergic to hydrogen or something.


Be wary of strong drink. It can make you shoot at tax collectors, and miss.
-- Lazarus Long, "Time Enough for Love"
Pharma = cash whores (none / 1) (#52)
by some nerd on Tue Oct 25th, 2005 at 08:15:08 AM EST

It is conceivable that the pharmaceutical industry, driven either by profit or prejudice, will avoid developing drugs that will be vital to a minority population.

Umm, they do this right now for profit reasons. Trials and so on are expensive. Our Biology teacher at College used to work for a multinational on cancer research, and got involved in working with a new drug that showed considerable promise for one very rare cancer but wasn't much use for anything else. It was shelved because it wouldn't be profitable. She was thoroughly disillusioned by crap like this and left soon after.

Though I don't agree with a lot of this (2.33 / 3) (#51)
by nebbish on Tue Oct 25th, 2005 at 07:55:51 AM EST
(nebbish * gmail dottkom) http://wetfloor.co.uk

You do balance the piece out with the Jay Kaufman quote and make it clear that your disagreement with him is your opinion. Although I'm a bit worried about your agenda (I know how right wing you are), there's no arguing this is a well-researched article about very real scientific developments, even if maybe it isn't as much of an issue as you make out.

Reluctant +1FP.

---------
"Conservatives are not necessarily stupid, but most stupid people are conservatives." - John Stuart Mill

It's good for what ails ya (3.00 / 3) (#38)
by nailgun on Mon Oct 24th, 2005 at 10:50:46 PM EST

Any alert observer of modern society would scarcely fail to notice the increasing prevalence of identity politics in the media, the workplace, and in modern educational systems.

Since it is clear that modern western democracies are in the declining phases of their respective life cycles, it is clear that identity politics, while in the past serving some constructive purpose, is yet another force serving to hasten the breakdown of civilization.

So it can be seen that identifying genetically determined "racial groups" or using already recognized races for the purposes of pharmaceutical research will have negative effect on society. There can be no doubt that the only result would be bloody, violent episodes like the Watts uprising of the 1960s or the Los Angeles riot of the 1990s.

The solution lies in questioning our modern reliance on the pharmaceutical industry.

It is a well-known fact that there are too many people nowadays. They're everywhere. Yet billions continue to be spent prolonging the lives of individuals who mostly just lie around being sick. Most health care serves no useful purpose. If the pharmaceutical industry disappeared tomorrow, society would not fall apart any more than it did in the wake of the Spanish influenza epidemic of 1919.

It follows then that what is needed is a healthy attitude toward death as an unavoidable fact of life. Humane forms of euthanasia need to be introduced so that dollars currently wasted on the sort of "health care" that could be more accurately described as "mollycoddling sick people" can be put into more useful areas such as researching new sources of energy and coping with global warming.

This sensible solution will of course will not be implemented. More proof that everyone is stupid.

If this article gets to FP, (1.16 / 6) (#33)
by a paranoic guy from a shitty country on Mon Oct 24th, 2005 at 09:06:06 PM EST

it will be a great day for all the racist pigs on this site. I do not know how the decent people of k5 voted for this article and not noticed the subtly propaganda aspect. Free speech trumps all, I guess...

--
Welcome to k5, sorry you're here - some nerd
nazi propaganda, -1. (1.07 / 13) (#27)
by a paranoic guy from a shitty country on Mon Oct 24th, 2005 at 07:15:30 PM EST

you people, are disgusting.

--
Welcome to k5, sorry you're here - some nerd
Perhaps race is imaginary, but... (3.00 / 2) (#26)
by alexboko on Mon Oct 24th, 2005 at 06:48:52 PM EST
http://keepthelightson.net/

...mitochondrial families and Y-chromosomal lineages are not. So use that instead of race in an adequately diverse or adequately specific pool of volunteers for drug trials. Isolate some mtDNA from each volunteer and get an RFLP fingerprint. Problem solved.


Godwin's Law of video games: if a company is out of ideas for a long enough period, they will eventually publish another World War II shooter.
I don't normally respond to Nazis, (1.00 / 3) (#24)
by razumiking on Mon Oct 24th, 2005 at 06:08:06 PM EST

But this one might have a point.

If phrenology tells us nothing else, it's that certain psychological traits can be determined by the morphology of the caranium. Therefore it only makes sense that other more holistic measures, such as region of ancestors (or race as it were) would be a useful predictor of physiological traits, like responsiveness to drugs. Indeed, phrenology was able to use such corellations to make important conclusions about psychological traits such as criminality and imbecility -- these scientific ideas are still with us today and in fact constituted much of the impetus for the development of automatic locks for upscale vehicles, so that owners of such vehicles could lock their cars from the inside without making an obvious show of it when potential criminals or terrorists approach.

In any event, the internet is full of people who will jump up and down at the mention of racial profiling and the reaction to this (relatively moderate) article is typical in that respect. Even so, I hope that in spite of whatever criticism we may have for minerboy's views on race, we keep an open mind with respect to the scientific and pharmacological content of his article.

you forgot economic concerns wrt trials (none / 1) (#21)
by nietsch on Mon Oct 24th, 2005 at 03:42:08 PM EST
http://www.lassche-anwalt-in-holland.de

You need volunters to test your drugs on to get them approved. Some of these are people that have the intended disease, but for a lot other tests you need healthy people. These people are paid, but not a lot.
Whealth/poverty is not equally distributed, so the race distribution in your test sample does not match the race distribution of the 'target' population either. Your drug are unintentionally optimized to the population that volunteers for drug trails.
(in my country those are mostly white male students, but could differ per country)

Using drugs is bad. (none / 1) (#20)
by Egil Skallagrimson on Mon Oct 24th, 2005 at 02:20:04 PM EST
http://keyofachkin.blogspot.com/

Instead, as an emotional response to a logical problem, what we should do is to use the 'natural' ingredients that drugs are derived from, though they come in a far weaker form, and get only a few of the benefits of drugs through the use of said inadequate substances.

Then, we should tell everyone in our drumming circle how great our herbs and roots are and that they should learn some obscure, non-mainstream form of yoga, since we were into almost a year before everyone else got into it.

----------------

the underground motto of K5 is "I am not Egil." - superdiva

Your sig is retarded, Egil - creativedissonance

Drugs are bad (1.33 / 3) (#17)
by AlwaysAnonyminated on Mon Oct 24th, 2005 at 01:25:29 PM EST

and also illegal.
---------------------------------------------
Give your girlfriend a rimjob for the holidays.
Race and genetics (3.00 / 3) (#16)
by Sgt York on Mon Oct 24th, 2005 at 12:24:51 PM EST
(sgt_york@hotmail.com)

Yes, the ideal way to deal with this is genetics directed treatment. But, as Burroughs said, use of race would be imprecise. Race is an indicator, a risk factor. It is not a measure; the polymorphisms are not just between the races, but also between individuals. Actually, you missed one: gender differences.

But honestly, I don't think it's possible to do that, certainly not in the forseeable future. The most likely scenario is that we will continue to see multiple drugs that treat the same disorder. The polymorphism will start to be recognized, and companies will try to make more universal drugs, and try to widen the biochemical variance between them. More importantly, MD's will take notice of this and stop telling women that it's all in their head just because the Paxil isn't working. They might start to realize that different people metabolize drugs differently, and they will switch drugs, preferably to one with many chemical differences.

It's not just the companies, it's the public research field as well. You don't get funding to research a gene that is found in 0.01% of the population and plays a role in a disease that impacts 1 out of every 10000.

Also, there are a few spelling errors. Did this sit in the edit queue at all?

There is a reason for everything. Sometimes, that reason just sucks.

Look further into it... (2.50 / 2) (#14)
by bighappyface on Mon Oct 24th, 2005 at 12:06:33 PM EST

...the politics involved in the pharmaceutical industry, an industry supposedly dedicated to helping people and benefiting their health, is FUCKING DISGUSTING.

But what can you do about it?

Drug approval is a joke anyway (3.00 / 4) (#10)
by Hung Fu on Mon Oct 24th, 2005 at 07:01:09 AM EST

It's more about business than science. Bringing a new drug to market is a large investment, taking at least 8 years to get through clinical trials. The pharmaceutical company must not only prove that it's drug is efficacious but that it's potential benefit and need outweighs the risk. In the case of BiDil, the African-American-specific angle was probably just a cunning way to get approval for a "new" drug in an already crowded field.

And most "new" drugs are simply close analogues of existing drugs designed to work around patent expiration or existing substances marketed for a different purpose or, as in this case, combined in different ways.

For example, the multiple reuptake inhibitor buproprion is marketed as the anti-depressant Wellbutrin in the US. It's also marketed, in lower doses, as the smoking cessation drug Zyban in UK/Australia. At the same time, you can't get Wellbutrin here because of the risk of seizures. It's crazy.

race is just a social construct* (2.40 / 5) (#3)
by Wenceslaus of Bohemia on Mon Oct 24th, 2005 at 02:57:06 AM EST
(wenceslaus@email.bh)

clearly these drug companies have discovered nothing more than a complex action of the placebo effect

*kuro5hin.org diary section, 2005

imagine you're hunting a rabbit (1.50 / 14) (#2)
by circletimessquare on Mon Oct 24th, 2005 at 12:44:30 AM EST
(at gmail dot com)

someone told you the rabbit always hangs out by the river, and you notice that most of the river goes through the valley (but not all of it)

so you decide to dynamite the dam above the valley, flooding the whole valley, and sure enough, you kill the rabbit

what the hell am i talking about?

rabbit=disease

valley=race

river=genetics

see, genetics DOES effect how well a drug works

and there is overlap between race and genetics, but it is very macroscopic: it's all generalizations, fuzzy: 55% of blacks this, 75% of asians that, 35% of caucasians that

in other words, you want to pinpoint the river, where the rabbit is at, and you say "well, 70% of the river is in the valley, so if i pinpoint the valley, i can probably get the rabbit"

but what you really want is to be able to pinpoint the river, and only the river, and achieve 100% accuracy

this is drugs tailored to your genetic makeup, rather than your race

and that's the real future of pharmaceuticals and genomics

race is just a very rough approximation, a quick rule of thumb, a stop gap measure, until we get better at pinpointing genetics quickly and easily and cheaply

for example, if you wanted to treat lactose intolerance, race is a good rough approximation of making generalizations about that

but it's all very rough and imprecise: caucasians are generally not lactose intolerant, southeast asians generally are

wouldn't it be better to just test for the presence of the lactase gene being turned on in the gut?

and in fact, it is

it's just expensive and time consuming and difficult to do that in today's world

and that's the real lesson here


He who desires but acts not, breeds pestilence.
- William Blake


FP (none / 1) (#1)
by Witchey on Sun Oct 23rd, 2005 at 10:38:11 PM EST

Very topical, gets a little bogged down with details, but this is the science section.

Editorial suggestion: there are many commas in this piece in places where one isn't necessary and onlly serves to confuse.

Pharmaceuticals, Genomics and Race | 79 comments (65 topical, 14 editorial, 1 hidden)
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