In June 2005 the Federal Food and Drug Administration announced it had approved the use of BiDil, a heart failure medication designed exclusively for treating African-Americans. That decision may have been the first step towards an era of "race-based" medicine, treatments targeted at particular races or ethnic groups. But a growing number of legal scholars and bioethicists, including Professor Sharona Hoffman of the Case Western Reserve University School of Law, believe that race-based medicine is an inappropriate and dangerous approach to treating disease.
Writing in the American University Law Review Hoffman, who is co-director of the Law-Medicine Center at Case School of Law and a professor of law and bioethics, notes that race is an elusive concept with no reliable definition in medical science, and therefore is not an appropriate basis for medical treatment. It is also not a genetically valid concept. The map of the human genome has demonstrated that 99.9% of human genes are identical in all individuals and that no genetic variation is found in all members of one race but not in members of other races.
Moreover, Hoffman asserts, "racial profiling" in medicine could potentially be harmful to public health and welfare. "A focus on 'race' can lead to medical mistakes if the doctor misjudges the patient's ancestral identity or fails to recall that a particular condition affects several vulnerable groups and not just one 'race.' The phenomenon can also lead to stigmatization and discrimination if the public perceives certain 'races' as more diseased or more difficult to treat than others," she says. In addition, race-based medicine may also violate a variety of federal and state anti-discrimination laws and regulations.
Rather than focusing on race, Hoffman believes scientists and physicians should devote their attention to "attribute-based" medical research and treatment mechanisms that are objectively definable. Relevant attributes would include specific genetic alterations that might influence the course of a disease or an individual's vulnerability to it, socioeconomic status, diet, exercise, stress level, exposure to toxins, and cultural and religions barriers to treatment. "Ideally, the practice of medicine will become increasingly individualized, with physicians examining patients for multiple variables that will determine which therapy should be prescribed," Hoffman writes.
Hoffman notes that while attribute-based medicine holds promise for improving human health, it too can lead to medical mistakes, stigmatization, and other dangers. Consequently she recommends various measures to guard against the risks of attribute-based medicine. First, according to Hoffman, scientific and institutional review boards must pay special attention to population-specific protocols in order to ensure that selection criteria are justified by scientific data.
In addition, she emphasizes the importance of educating health care providers concerning the variables that actually influence disease vulnerability and treatment response, and of public discussion about the development of attribute-based medicine. "It is only with careful thought and appropriate precautions that attribute-based medicine can become an approach that enhances treatment opportunities for all human beings and contributes significantly to public health and welfare," she concludes.
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