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Experts debate role of race in medical research

Elizabeth Cohen

ATLANTA (CNN) -- Two studies in the New England Journal of Medicine that compare the effects of drugs between white and black patients have sparked a debate within the publication itself.

The issue is an ethical and scientific one: Should race ever be used as a factor in medical research.

Two editorials in the weekly edition of the journal released Wednesday clashed in their answer.

"Race is a social construct, not a scientific classification," wrote Dr. Robert Schwartz, the deputy editor of the journal.

"I maintain that attributing differences in a biological end point to race is not only imprecise, but also of no proven value in treating an individual patient," he wrote.

But the author of another editorial disagreed.

"The two reports in this issue of the journal that address the effect of race on the response to drugs [will] be of great help to physicians in their attempt to choose the best therapy for heart failure in patients of different races," Dr. Alastair J. Wood, with Vanderbilt University School of Medicine in Nashville, Tennessee.

In one study, researchers found that treatment with the drug enalapril resulted in a significant reduction in the risk of hospitalization for heart failure among white patients with left ventricular dysfunction, a heart ailment, but no such reduction among black patients with the same disorder. The study involved nearly 2,000 patients at medical centers in Dallas, Texas; Minneapolis, Minnesota; and Calgary, Canada.

The other study found that the drug carvedilol worked just as well in black patients with chronic heart failure. The study of nearly 1,000 patients at seven medical centers in the United States measured events such as heart failure, death and hospitalization.

Dr. Lonnie Fuller, an internist and professor emeritus at the Morehouse School of Medicine, said studies that make racial distinctions can be justified and may be valuable.

He and his colleagues are studying the DNA of black study subjects and have discovered that genes that could lead to slow drug metabolism are more common among blacks than whites.

When drugs are metabolized slowly, they stay in the system longer, making them more likely to give patients dangerous side effects, Fuller said.

"About 40 percent of African-Americans would probably fit into the slow metabolism group and maybe about 20 percent of Caucasians would fit into that group," he said.

Fuller said there will always be genetic differences between groups that tend to intermarry. "Like if you come from the African continent, you're much more likely to have sickle cell as a genetic problem," he said.

But Georgia Dunston, a microbiologist and acting director of Howard University's new National Human Genome Center, said she didn't think it was scientifically accurate to group people by race. She said the genome project shows that people of all races share most DNA.

"We share 99 percent. I think that's good evidence that we are pretty much the same," she said. "Genetics show us that humankind is essentially one large family."

New England Journal of Medicine
Howard University College of Medicine

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4:30pm ET, 4/16

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