Ethnic Medicine – Beyond Bidil

Drugs_Clinical_Trials2.jpgWhile Bidil’s patent for general use runs out in 2007, its FDA approval for “selective” use on people of African origin runs out in 2020. Despite being hailed by the US Food and Drug Administration in 2005 as a step towards the “promise of personalized medicine,” the question why two established anti-hypertensive drugs (hydralazine and isosorbide dinitrate have been around for many decades) in combination is promoted as a major medical breakthrough remains unanswered.

The clinical practice of medicine is in itself a process of “personalization” — physicians often select the best form of therapy for an individual patient by a process of trial and error, and often by incorporating latest medical evidence. In the treatment of hypertension combinations of multiple agents are the usual norm, and if research suggests that the two above drugs are particularly efficacious in African Americans, why not simply prescribe the two generic drugs, instead of combine them in a more expensive single “patented” pill?

To brand it as an “ethnic” designer drug is basically unethical — the logical equivalent of this is describing a suntan cream as “specially designed for whites.” Not because of the fact that Bidil is not effective, but because it is not at all a medical advance in any way. On scientific grounds, human genomes are identical by more than 99.9% amongst races, and most drug action (as a result of binding to specific receptors) is bound to be fundamentally the same, except for the few odd, rare interactions. More importantly, no one has yet proved that Bidil is not highly effective in other races too — the question of “how much” can only be answered by many more controlled trials, which are thoroughly unnecessary.

The controversy surrounding Bidil is fundamentally this: is it necessary to racially segregate medical treatment? In my view it isn’t, not on any touchy-feely moral grounds, but scientific ones. There is simply not much evidence that racially tailored medicine exists. Bidil is an example of poorly concocted race marketing.

Sudip Ghosh, MD

Sudip Ghosh, MD, is a surgeon at the University of Manchester, UK and a medical writer.
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