For my reading, I chose Troy Duster’s article on race and the pharmaceutical industry. In this article, he discusses how drug manufacturers in the early 2000’s started marketing drugs to specific ethnic groups. However, this research was not backed by science. The most famous example, isosorbide dinitrate/hydralazine, or BiDil for short, was originally rejected by the Food and Drug Administration by an advisory panel vote of 9-3 after it failed to show efficacy in a multiracial sample. However, when run in a clinical trial with only people who self-identified as African American, the results were significant. This was a problem for multiple reasons. First, the difference between racial groups in the original study was not significant enough to warrant further testing for one group. Second, there was no control group included in the next round of clinical trials, essentially voiding all data collected. When the FDA approved the drug in 2005, it was thus a prime example of race-based medicine, and one that exemplified race essentialism. BiDil was also endorsed by the Association of Black Cardiologists. This demonstrates a lack of understanding even in the medical field. While BiDil has become a token example of race-based medicine, it is still sold today. This clearly suggests that while some progress has been made in recent years, we have a long way to go.
After this example, Duster further counters race-based medicine. Referencing research done by Michael Klag, Duster draws attention to the finding that rates of hypertension increase when skin color is darker. However, this finding is not biological or genetic in origin. Rather, it is a biological effect due to stress-related outcomes of reduced access to social goods like employment, housing, stock, etc. This, to me, highlights one of the most important points of the article: environment and mental health can impact physical health in tangible ways. Clearly this idea makes sense when we think about pollution and the effects that it has on lung function. But the fact that stress can cause physical ailments is less widely appreciated.
When reading this article about pharmaceuticals and race, I was reminded of the Coronavirus pandemic. When vaccines first became available, I remember hearing constantly that people of color were hesitant to get the vaccine. According to the Kaiser Family Foundation, 62% of the White population has received at least one dose of the vaccine compared to 57% of the Black population. This is not a large difference! Further, a study published in JAMA Network Open found that while Black individuals were slightly less intent on getting vaccinated than White individuals when COVID-19 vaccines were first introduced in December 2020, the hesitant Black community was more likely to eventually get vaccinated than the hesitant White community. This highlights the fact that we have, as a society, been convinced that there are vast differences between ethnic groups in all aspects of the medical field, even when these assumptions are not factually supported. Perhaps these differences are due to greater medical access limitations in Black communities. While it would be entirely wrong to dismiss the fact that different ethnic groups have different experiences, we need to realize that these differences are not genetic in origin. It is up to us to further the education of the public, and it is something that I personally plan to make a focal point of my medical career.