Medical Response Not All Black and White
"We are entering a new era," he tells WebMD. "Although there may be great reluctance to take these studies on, the time has come to explore these things."
"When we see racial or ethic differences in response to a drug, that may be a clue that there is an underlying genetic difference and may point us in a direction to look for those differences," Alastair Wood, MD, tells WebMD. Wood, who is vice chancellor and professor of medicine at Vanderbilt University School of Medicine, in Nashville, wrote a second editorial accompanying the reports.
Wood says refinement of genetic research will likely show that the genetic differences affecting response to treatment are not specific to one race or another, but occur randomly across races. Some races and ethnic groups may be more likely to carry the genetic variation, but not all members of that group will carry it.
He likens it to fitting a suit for an entire population: A suit tailored to fit a population of American men would be unlikely to fit many typically smaller Chinese men -- but it may well fit some, and would be just as unlikely to fit some Americans.
"One size does not fit all," Wood says, when it comes to fitting the proper dose of a drug to any one person, regardless of race.
In the meantime, doctors tailor their drugs and doses the best way they know -- by trial and error. And whether a specific drug and dose will prevent hospitalization or death -- the kinds of things measured by the NEJM study -- is all but impossible to determine at the time a patient is being treated in the doctor's office, Wood says.
"One day we will be able to do better," Wood tells WebMD. "In the meantime, ethnic differences in response to treatment can point the way to understanding genetic differences."
Yancy argues that the disproportionate effects of certain diseases in certain populations make further research on racial differences unavoidable. He notes that in the U.S. heart failure affects 3.5% of black men and 3% of black women, compared to 2% of white men and 1.5% of white women.Black Americans develop symptoms at an earlier age, and heart failure progresses at a faster rate than in any other ethnicity, he says.