title: Race, money and medicines.
abstract: Taking notice of race is both risky and inevitable, in medicine no less than in other endeavors. On the one hand, race can be a useful stand-in for unstudied genetic and environmental factors that yield differences in disease expression and therapeutic response. Attention to race can make a therapeutic difference, to the point of saving lives. On the other hand, racial distinctions have social meanings that are often pejorative or worse, especially when these distinctions are cast as culturally or biologically fixed. I argue in this essay that we should start with a presumption against racial categories in medicine, but permit their use when it might prolong lives or meaningfully improve health. Use of racial categories should be understood as an interim step; follow-up inquiry into the factors that underlie race-correlated clinical differences is important both to improve the efficacy of clinical care and to prevent race in itself from being misunderstood as a biological determinant. If we pursue such inquiry with vigor, the pernicious effects of racial categories on public understanding can be managed. But perverse market and regulatory incentives create the danger that use of race will be "locked-in," once drugs or other therapies are approved. These incentives should be revisited.
authors.affiliation: Georgetown University, USA.
authors.forename: M Gregg
authors.initials: MG
authors.lastname: Bloche
mesh_terms: D035843:Biomedical Research / Q000191:economics / Q000941:ethics*; D002961:Civil Rights; D017277:Drug Approval / Q000191:economics*; D004338:Drug Combinations; D004345:Drug Industry / Q000191:economics*; D026689:Ethical Analysis; D005006:Ethnicity / Q000145:classification / Q000235:genetics; D017048:Health Care Costs; D006333:Heart Failure / Q000188:drug therapy; D006801:Humans; D006830:Hydralazine; D007548:Isosorbide Dinitrate; D018579:Patient Selection / Q000941:ethics*; D011287:Prejudice; D044469:Racial Groups / Q000145:classification / Q000235:genetics; D016032:Randomized Controlled Trials as Topic; D012962:Sociology, Medical / Q000191:economics / Q000941:ethics*; D014481:United States; D014486:United States Food and Drug Administration; D014665:Vasodilator Agents
chemical_list: D004338:Drug Combinations; D014665:Vasodilator Agents; C431665:isosorbide-hydralazine combination; D006830:Hydralazine; D007548:Isosorbide Dinitrate