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    Medical Response Not All Black and White


    "This is the first time we have demonstrated that a specific therapy is effective in African-Americans," Yancy tells WebMD. "We know there is a disproportionate incidence of heart failure in African-Americans and a growing concern that traditional therapies may not work as well. We have emphatically demonstrated that in this cohort of patients treated with [Coreg], there was a similar benefit in blacks and whites."

    He is associate professor of medicine and cardiology at the University of Texas Southwestern Medical Center, in Dallas.

    The observation of racial differences in response to treatment raises uneasy questions: Can the difference in response truly be related to skin color?

    Study authors and other experts are unanimous that the explanation lies in genetic differences -- still to be unveiled -- in the way individual patients process individual drugs. In the era of the Human Genome Project, skin color will disappear entirely as an explanation for why people respond to differently to treatment, argues Robert S. Schwartz, MD, an NEJM editor .

    "The publication of the first draft of the sequence of the human genome should force an end to medical research that is arbitrarily based on race," Schwartz writes in an accompanying editorial. "The Human Genome Project now gives us the power to uncover the true origins of genetic variations; linking them to race has become passe."

    Yet until science has determined the specific genetic variations that cause one individual to respond differently to a drug than another, researchers are left with studying populations according to the only readily apparent distinguishing factor -- skin color.

    Cohn, for instance, acknowledges that the difference in response to Vasotec may have nothing to do with skin color, but instead with fine variations in genetics between individuals. In the study, "the only distinguishing feature is their skin color," Cohn says. "But we recognize that there will be many responders among African-Americans, and many nonresponders among whites."

    And he agrees that the human genome project will take researchers beyond skin color in understanding differences in treatment response. Soon, the science of tailoring drugs to specific genetic differences will dissolve the apparent differences between blacks and whites until they are seen for what they are: variations among individual people.

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