ARCHIVES OF EDITORIALS

 

June 30, 2005

Necessary inquiries

There is a substantial disparity in Boston between the health status of African Americans and other racial groups. According to a recent study of the problem, it appears that a college education and higher income does not cure the disparity.

Blacks in Boston are twice as likely as whites to die from diabetes and are four times more likely to perish from HIV. Black men in Boston are likely to die five years younger than white men.

An easy explanation for this disparity is racial discrimination. Those who assert this point of view might rely on the report which found that blacks in Boston are four times more likely than whites to believe that they have been discriminated against by the health care industry.

However, that does not explain why black women with bachelor’s degrees have the highest infant mortality rate in the city – 12.4 per 100,000 births compared with only 3.4 per 100,000 births for college educated whites.

The accessibility of healthcare is also not a primary issue. While 11 percent of black adults lack health insurance compared with only 5.6 percent of whites, the Boston Medical Center provides quality care for everyone, whether or not they are able to pay. That is its mission.

Mayor Thomas Menino understands that the racial differences in health status have complex causes. He has launched a $1 million effort to determine the reasons for the differences, and then eliminate them. Menino deserves accolades from the Greater Boston community for focusing on such a critical issue.

An appropriate ruling

For the first time ever, the federal Food and Drug Administration has authorized the sale and distribution of a drug to a specific racial group. BiDil, a heart drug, has been approved for the treatment of African Americans.

The FDA approval process tests primarily for toxicity and efficacy. The first step is to assure that a proposed drug has no harmful side effects. The next step is to establish that the drug is sufficiently effective in healing the targeted illness.

Early tests of BiDil did not establish sufficient improvement among white patients. However, African Americans in the test responded well to the treatment. Another study of 1,050 African Americans with overtaxed hearts showed a 43 percent improvement in the survival of those in the BiDil group.

Idealists object to a remedy for one so-called racial group because they believe such a policy might vitiate the notion that we are all members of one race – the human race. This view ignores the fact that some genetic medical conditions have developed among certain ethnic groups. African Americans are the primary victims of sickle cell anemia and Ashkenazi Jews suffer from Tay-Sachs disease.

Some have objected that there is no genetic test to determine who is an African American. It is enough for a patient to declare “I am black” in order to receive BiDil treatments. However, since BiDil has passed the toxicity tests, the drug will do no harm, and a wise patient will reconsider his ethnicity if the drug provides no improvement in his condition.

With so much attention on gene therapy, which is quite specific, it is timely for drugs to be specially targeted when appropriate.

Home Page