Rebecca Lomas Biology-1090
Diagnosing Racial Profiling
BiDil was a drug that was approved by the FDA and what was considered the first
“ethnic drug.” In both of these articles the writers will present their arguments for and against
whether or not race is a factor in how people respond to pharmaceutical drugs. Overall, BiDil
will be our main subject in both arguments however the arguments are geared towards whether
or not race is a factor.
In the argument that supports racial profiling, Dr. Sally Satel says that she uses racial
profiling as a way to distinguish what patterns, among patients of different ethnicities, are
concise. “We do it because certain diseases and treatment responses cluster by ethnicity,” says
Satel. “When it comes to practicing medicine, stereotyping often works.” Satel will also say that
many of her colleagues use that same method as a way to affectively analyze a patient and then
recommend medications. This, we will learn is what they refer to as “race-based medicine.”
One thing that I found credible about Satel is she is a clinical psychiatrist that has
experience with prescribing drugs to a variety of patients. In this everyday setting, where she
works with the mentally ill, it is easy for her to track the progress of each of her patients while
she prescribes medications as per their diagnosis. Satel is in a position where research, analysis
of her patients, and their response to their recommended treatment, including their prescribed
drugs, is right at her fingertips. This, to me, would present her as a credible source.
An example that Satel gives us to support her claim, that racial profiling is effective, is an
experience that another doctor had. Jerome P. Kassirer is a diagnostician who was able to pin
down a diagnosis of a patient who had come in to his clinic the night before based on a few facts
about age, race and sex of the patient. Dr. kassirer was also given a few symptoms by a resident
doctor who had administered treatment. Remarkably, the diagnosis that Dr. Kassirer concluded
was the correct diagnosis. This, says Satel, is fact that racial profiling does work.
In reference to BiDil, a drug that has proven significant effectiveness in black people
suffering from congestive heart failure, Satel infers that this is a victory against what she calls a
“one–size-fits-all approach to medicine.” In the study that ultimately put BiDil on the market, it
showed that the drug was very effective in the black subjects.
There are some statements that did not resonate with me. Satel admitted in her article that
“race is a rough marker.” She follows this up with “…an imprecise clue is better than no clue at
all.” I find this to be a far reaching opinion and almost admittance that she could be way off in
her main objective, which is that race does play an enormous role in diagnoses.
Also, at one point in the article she states, “Doctors look forward to the day when they
can, in good conscience, be colorblind.” I’m not sure that all doctors feel the need to racially
profile patients. Some doctors may consider other factors above race to help with treatment such
as social and medical background.
A strong persuasion technique that Satel used in her article was stating that there was
some solid support from both the Congressional Black Caucus and the Association of Black
Cardiologists, who also recruited subjects for the study, to prop up her position even though they
referred to the fact that BiDil is a raw estimator of the patients’ response to the drug. Basically
admitting that BiDil works in most cases, there is some concern that it’s not as effective in all
cases.
To sum up Dr. Sally Satels support for “race-based medicine,” she reiterates at the end of
her article that if doctors stay “blind” to the suggestion that “race sometimes provides an
invaluable clue,” then they will be denying the “patients’ best interest” because of “the reality of
differences.”
Dr. Satel has expressed to her readers her strong support for “race-based medicine.” She
calls for more research and development in this area because she strongly believes that race plays
an important role in our society when it comes to treating patients. Her own raw experience
seems like it’s enough to convince her that what she sees in her clinic daily is what the research
and development of BiDil has accomplished.
In the article against “race-based medicine,” Gregory Michael Dorr and David S. Jones
argue that considering race to identify what treatment should be used on a patient is an age old
tale that has been a lingering debate in the medical community for many years. It has spawned
feelings of uneasiness about race with physicians as well as patients which created a byway for
the testing and eventually the approval of BiDil, a drug targeted for black people who suffer
from congestive heart failure, by the FDA.
Some facts about how BiDil became such a hot topic is that when BiDil was first tested,
originally it was only to prove that it was a more effective drug when two separate working pills,
to treat hypertension and angina, were put together to work as one pill. The very first test of
BiDil, known as H/I at the time, was able to prove effectiveness but lacked statistical evidence so
the FDA rejected its approval. Although, some cardiologist suggested that the drug be retested
under more focused research and reapply for approval. It was under this new research that Jay
Cohn and Peter Carson were able to identify, that of all the subjects that were given the drug,
black people showed significant responses to the drug. It was under this conclusion that Cohn
and Carson retested the drug on 1,000 people who identify themselves as black, some were
placebos. During this process, the testing was stopped in advance because BiDil showed
overwhelming results in black patients. The FDA approved the drug and BiDil went on the
market with high expectations.
One fact that seems to be begging the question is: BiDil was only tested among black
people. No other race was included in the study yet “Cohn himself had asserted that BiDil would
work in people regardless of race.” Even under this lack of evidence of race exclusivity, the FDA
still went on to approve this “as a medication specifically indicated for use in self-identified
blacks.”
Another interesting fact surrounding this new drug was the expectation that hit wall street
at the time that they believed the FDA would approve BiDil. Analysts forecasted that NitroMed,
the pharmaceutical producer of BiDil, would net higher earnings. Within the six months leading
up to its release into the marketplace, “NitroMed stock quadrupled.” BiDil failed in the
marketplace and the company reported a loss of $108 million.
This article could have convinced me on facts alone that this drug clearly worked in
African-Americans but because they lacked evidence in other races it could not be considered
almost exclusive to blacks. Gregory Dorr and David Jones threw in some unnecessary opinions
that spoiled this convincing piece of work. They claim that “much of the controversy…has been
motivated by BiDil…” and yet just a few sentences away they will also state, “The idea that
different races…..should be treated differently is an ancient one in medicine.” Reading this I’m
certain that the controversy had already existed long before BiDil. Dorr and Jones even give a
brief history of the arguments associated with “race-specific therapeutics,” as they refer to it, but
yet they use the controversy of BiDil to fuel their argument.
The heading, “BiDil’s Complicated Course,” is also a statement that is loaded. Referring
to the course of BiDil as “complicated” is opinionated in that many drugs that have to face the
FDA probably have complicated courses as well. I highly doubt that researchers looking to get
their drug approved by the FDA have it easy. One known fact that would illustrate this point is
how many people in the United States travel overseas to obtain drugs that have proven efficacy
yet the FDA will not allow them here in the United States?
Also, the use of propaganda in this article ruins its potential of being solely reliable on
facts alone. Dorr and Jones state that NitroMed made a donation to the NAACP of $1.5 million
dollars. In this same paragraph they describe how a chapter of the NAACP was pressuring
Medicaid to reimburse patients who were prescribed BiDil. Medicaid was holding out on these
reimbursements because the other two drugs that were prescribed to people suffering from
congestive heart failure before BiDil were still available in the market place at a lower price.
Another form of fear that Dorr and Jones incorporate in their article is suggesting that
there will be “copycats” who will try to do as BiDil has done. Develop a drug that merges two
drugs together and market it as an original. They claim that pharmaceutical companies will see
this as a way to increase their bottom line.
An example of this type of bottom-line increase was discussed in this article referring to
BiDil’s second experiment when it was stopped early because of the overwhelming results it had
in the test subjects. The FDA seemed eager to give it the stamp of approval because of these
results. This alerted Wall Street as a sign of innovation, and as we mentioned earlier, the reaction
was NitroMed’s stock had a sharp increase.
To wrap up this argument against race-based medicine and BiDil, Dorr and Jones have
offered evidence of how BiDil is less of an innovative drug and perhaps more of a catapult for
higher earnings seen by pharmaceutical companies. These companies may present to the
American public a picture of ground-breaking exploration in the name racial equality within the
medical community.
Sally Satel’s experience would make her more empirical than biased in this argument
simply because she does have exposure to working with raw data while treating her patients. Dr.
Satel works with the mentally ill and drug addicted so perhaps in her field of treatment some
forms of racial profiling probably do exist in the environment of social medicine. Hopefully she
also uses other methods to properly diagnose her patients. Questioning facts surrounding each
case, using medical and social background should also be a focal point when treating individuals.
Gregory Dorr and David Jones presented an argument that was more biased because they
lacked the experience that Dr. Satel is exposed to. Dorr and Jones relied on the research others
had done to represent their opposing views. In all the research they had done to prove their point,
they could have also done some counter-research and presented it as well. Where these biases
stem from, I don’t know? Maybe they feel that unequal health care treatment among the races
doesn’t exist in this country? I will differ with them. Whatever the case may be, my belief in this
matter is that they had the option of presenting all the facts for both sides of this argument and
they failed to do that.
There are obviously many questions surrounding racially profiling patients as they walk
through the door of a clinic. There also might be a missed opportunity of we don’t research and
look farther into how race plays a part in medicine, if it even does. Dr. Satel believes that race is
critical when treating a patient because she believes that patients react to medicine differently
based on their ethnicity. Dorr and Jones believe there is high risk involved with racially profiling
patients and they also somewhat imply that pharmaceutical companies will take advantage of this
opportunity to convert race-based medicine into profits.
My view of racially profiling in medicine has opened. I do believe there could be some
truth to what Sally Satel has said, “Recognizing these patterns can help us diagnose disease more
efficiently.” I know when I walk into a clinic it has been customary, in my experience, that there
is a notation made about my race. If that will help in my diagnosis and treatment, by all means,
note it. The only hope that I can have is that the FDA will be truthful in which drug is genuine.
Let’s not let capitalism, in these cases, take advantage of the American public once again, this
time in the name of medicine.