July 13, 2005

"Is this the future we really want? Different drugs for different races"

"Is this the future we really want? Different drugs for different races" is the headline on a Kenan Malik essay in the Times of London. Personally, as somebody whose life may well have been saved by a new medical breakthrough in 1997 (the Rituxan monoclonal antibody for lymphatic cancer), I think the first priority for patients is seeing that they simply have a future, and if different drugs for different races is a way to achieve that, so be it.

Presumably, though, Malik didn't write the headline. What he does try to do is pretend to be the lone moderate between fulminating extremists:

All this suggests that the question of whether medicine should be colourblind depends on the particular problem we want to address. It is a pragmatic issue, not one rooted in scientific or political principle. Race, however, is such a contentious issue that pragmatism rarely enters the debate. On one side, so-called race realists think that population differences are so important that all medicine should be colour-coded. On the other, many antiracists want to ban race-based research entirely for fear of its social consequences. Both are wrong. It is time everyone calmed down and took a grown-up view of the issue.

Okay, but who, exactly, are these " so-called race realists [who] think that population differences are so important that all medicine should be colour-coded?" The only one he mentions by name is Dr. Sally Satel, author of "I Am a Racial Profiling Doctor" in the NYT Magazine, who certainly has never said that. Nor can I recall that ever being said on www.GNXP.com , www.FuturePundit.com, or my own site.

(I'm sure we are all in favor of "colour-coded" medical research, in the sense that we believe the ancestry of the various patients in a trial should be recorded so that any differences in results by ancestry would be measurable -- if they exist. But that has been standard procedure for decades.)

The reality is that the race realists are the true moderates. What we object to is the absolutist position that "race does not exist biologically," especially among those intellectuals who would prefer that patients die rather than have their dogma undermined.

If I write about race more than I write about, say, the Federal Reserve Board's management of the money supply, it's not because I believe that race is all-important. No, it's just that I've noticed that in the commentary marketplace today, the ratio of intelligent, sensible analysis about race relative to the importance of the topic is much lower than the ratio for the Fed. Back in the inflationary 1970s, I thought about the Fed a lot more than I do now, but, these days, I have a lot more to contribute to human understanding of race than of M3 (or whatever Fed-watchers worry about now). (Of course, from a profit-maximizing point-of-view, the more salient fact is not how little supply there is of sensible analysis of race, but how extraordinarily little demand there is for it, relative to demand for flapdoodle ...)

So, just about everything reasonable that Malik says has long been advocated by race realists. Unfortunately, in his attempts to sound moderate, he ends up pulling a couple of boners. He writes:

One of the dangers of marketing BiDiL as a black drug is that it may be given to African-Americans who don’t respond to it, but denied to non-blacks who could.

Sure, but the only legal alternative is not marketing BiDil to anybody, because it twice failed tests on general populations so badly that the FDA would not have approved it for sale at all. But among black patients within those samples, it proved highly effective. So, a third test on a sufficient sample size of black patients was undertaken, and it reduced the death rate among black heart attack victims by 43 percent, which is such a huge number that the test was stopped early for humanitarian reasons to rush it into the market.

Malik also trots out the tired old sickle-cell-is-not-a-black-disease chestnut:

We all think we know that sickle-cell anaemia is a black disease. Except that it is not. Sickle cell is a disease of populations originating from areas with a high incidence of malaria. Some of these populations are black, some are not. The sickle-cell gene is found in equatorial Africa, parts of southern Europe, southern Turkey, parts of the Middle East and much of central India. Most people, however, only know that African-Americans suffer disproportionately from the trait. And, given popular ideas about race, they automatically assume that what applies to black Americans also applies to all blacks and only to blacks. It is the social imagination, not the biological reality, of race that turns sickle cell into a black disease.

What he leaves out is the huge difference between having the sickle cell gene and having the sickle cell disease. You need two copies of the gene to have the disease, so the chance of getting the disease falls off by the square as the gene becomes less common.

If, to make up some round numbers to illustrate the math, the chance of having one sickle cell gene is an order of magnitude more common in West Africa than in Sicily, the chance of being born in West Africa with two sickle cell genes and thus the sickle cell disease is two orders of magnitude greater.

Sure, it would make a a good episode of House, M.D. for an Italian-American couple to have a child who turns out to be suffering from sickle cell disease, but from the "pragmatic" standpoint that Malik endorses (at least he's in favor of pragmatism in theory), it's not unreasonable for Americans who aren't doctors to think of sickle-cell disease as a black disease.

My published articles are archived at iSteve.com -- Steve Sailer

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