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Thursday, November 20, 2008

"House" the television medical drama and race specific drugs

Did anyone see the recent episode of the television medical drama, House, in which the black doctor on Dr. House's team assigned a high blood pressure medicine to an older black male patient after telling the patient something along the lines that the drug works really well on "us" meaning blacks?  The patient was skeptical and refused to take the drug.  He made a new appointment, this time to see Dr. House who, after chastising the patient essentially for being stupid, prescribed him the same drug.  Of course, anyone familiar with the show would not be surprised to know that Dr. House, in order to get the patient to fill the prescription, misrepresented what he was prescribing and told the patient that he was prescribing the same medicine that he would give to his white patients when, in fact, he wrote the prescription for the same drug the black doctor had prescribed.  The unsuspecting patient went away happy as a lark.

This episode caught my attention because of Dorothy Roberts' work on race-specific pharmaceuticals, specifically BiDil, which is advertised as a drug designed to treat heart failure in blacks.  It was really interesting to see the concept of race specific medicine presented on prime time.  There was never any discussion amongst the characters about whether there is any real genetic basis for targeting drugs to patients based on race.  I am interested in how IP is driving this new demand / trend?

Carol N. Brown

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Comments

Dear Dr. Brown,
The intersection of pharmacology, genetics, and race certainly is very stimulating. Prior to entering law school, I served, from 2000-2003, as the Director of Public Health Genetics for an association that represents the heads of US state health departments. I do not believe that IP is spurring the research trend in pharmacogenomics and race. Rather, I think it stems from a drive to explain why epidemiological studies in certain health areas show racial disparaties despite efforts to control SES variables and other variables that may possibly create study bias.

Asthma is an area of public health that comes to mind when I think of pharmacogenomics and race. There have been several studies documenting that certain "races/ethnicities" respond differently to (metabolize) bronchiodilators. While genetic research goes beyond race and to some extent tries to stratify individuals by genotype (e.g., ADRB2 genotype), that sort of stratisfication gets lost in translation. Thus, these studies are often explained and reported in terms of phenotypic expression (e.g., race/ethnicity). The use of "race" in genetic research and its implications is complex.

If you are interested in pharmacogenomics reseach, I suggest visiting the Centers for Disease Control and Prevention's HuGe site:
http://www.hugenavigator.net/HuGENavigator/startPagePubLit.do

Other sites that discuss implications of race and genetic research include:
-The SSRC's Race and Genomics site: www.raceandgenomics.ssrc.org
and the National Human Genome Research Institute's Ethical, Legal, and Social Issue's site: http://www.genome.gov/10001618.

Best regards,
Amy E. Klein, MPH

Posted by: Amy Klein | Nov 20, 2008 9:13:42 PM

To the extent that particular races suffer disproportionately from certain problems, the genetic basis is indirect. For instance, blacks suffer from as we know, sickle-cell anemia in numbers other races do not. But does a medicine know that that gene or cell carrying the problem, also codes for black pigmentation...who knows? To me it doesn't make a difference. If I'm American Indian, and it's known that American Indians suffer from American Indianitis to the near exclusion of any other race, and there's a drug that is smart enough to target the problem based on my American Indian genes, hey, hoorah! Just get me better. I don't really care what the implications are.

If you want the characters to discuss some highly volatile racial issue or medical issue related to race or any of a thousand politically and socially polarizing other issues...the show to watch is Boston Legal. Of course what appears there isn't so much a discussion, as a lecture from the writers, but that's another story for another day.

As far as the IP side of it goes, I'm sure that if pharma sniffs a demand for a particular drug, regardless of who it's targeted at or why, they'll get their scientists cracking.

Posted by: sam gompers | Nov 21, 2008 8:12:11 AM

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