"Not only do minorities get asthma at a higher rate, but [UCSF] pulmonologist Dr. Esteban Burchard ... has found that ethnicity is the most important factor in determining if a patient will respond to asthma therapy. Unfortunately, for the most most commonly prescribed asthma medication, Albuterol, 67 percent of Puerto Ricans and 47 percent of African-Americans show no improvement when taking it, yet Albuterol works therapeutically for the vast majority of Caucasian patients."
I did not know that. It's horrifying.
I'm the founder of HDP Health, if you have any questions or want clarifications please ask away!
Part of it is a lack of financial incentives on the part of the drug companies. Most pharmaceutical research is aimed at marketing drugs.
Take the example of hypertension, which is more prevalent among blacks than whites. At the moment, all of the major antihypertensive families are available as generic drugs. The best way to help black people quickly is to do a comparative study of drugs already on the market. No drug company is going to do that because they won't be able to capture the value if the drugs are generic.
Maybe a drug company could try to develop a drug which is particularly good for blacks, but it will take a decade, may not work, won't sell as well (fewer people), and then it will be an expensive new drug and people will complain about the cost.
At least on the commercial side the FDA requires that your approval population (“treatment group”) be “representative” of the population who will receive the drug if it’s approved. So you can’t get away with, say, doing your study solely in Chad or Norway as their population distribution (except perhaps by sex) won’t match that of the USA.
I did find the line at the top "With more than 50 percent of the population estimated to be a minority by 2044..." funny - doesn't that make them a majority?
Suppose this wasn't the case. The news headlines would of course be "Experimental drugs being tested on minorities". That would be a PR disaster. It's safer to steer clear of minorities.
Essentially, the drug companies can't win. People will find something to complain about. Either minorities are getting neglected, or they are being abused as lab subjects.
Great post, Brian, keep being awesome!
This is a longer article on the subject of poorer health outcomes for minorities, covering the situation for black women and one family's experience, which is very much worth reading, but here are the key points:
* A black woman is 22% more likely to die from heart disease than a white woman
* ...71 percent more likely to perish from cervical cancer
* ...243 percent more likely to die from pregnancy- or childbirth-related causes
* Black women are more likely to be uninsured outside of pregnancy, when Medicaid kicks in, and thus more likely to start prenatal care later and to lose coverage in the postpartum period.
* The hospitals where they give birth are often the products of historical segregation, lower in quality than those where white mothers deliver, with significantly higher rates of life-threatening complications.
* [Black women] are more likely to have chronic conditions such as obesity, diabetes, and hypertension that make having a baby more dangerous.
* Black expectant and new mothers frequently told us that doctors and nurses didn’t take their pain seriously [...] numerous studies that show pain is often undertreated in black patients for conditions from appendicitis to cancer.
* An expanding field of research shows that the stress of being a black woman in American society can take a significant physical toll during pregnancy and childbirth.
* Black women are 49 percent more likely than whites to deliver prematurely (and, closely related, black infants are twice as likely as white babies to die before their first birthday).
Good luck defending this as long as it's deemed political wrongthink to say there are any biological differences between races.
If everyone is the same, why bother with diverse studies?
> With more than 50 percent of the population estimated to be a minority by 2044
"Hi, I'm Brian Clark and I don't know what 'minority' means"
It's weird to frame this as 'neglect'. Some minority groups are uniquely distrusting of medical professionals (I'll cite this later when I'm not on a work network) - that's going to impair testing participation.
In the past, medical researchers went out of their way to use minority test subjects and that's been understood to be more problematic than our volunteer-based system.
The vast majority of medicine was developed in white and asian countries, it's not surprising that medicine is optimized for people in those clusters. And it's only unethical that it winds up this way if you think it's unethical for people to advance their self-interest. Personally, I think that motivates most of the research so I'd rather have medicine that isn't tailored for me than no medicine.
I'm sure we can make things better, but to act as though any disparity is conclusive evidence of neglect/racism/prejudice/structural barriers isn't helpful and isn't going to get us any closer to improving medicine.