The Genome in Black and White (and Gray)

The implications of race-based medication.

  1. Imagine that you have heart failure. What can medicine do for you? It depends: are you white or black? If you're white, your doctor may prescribe one of the drugs that seem to ease the symptoms, maybe a beta-blocker or an ACE inhibitor. And if you're black, your doctor may still prescribe those drugs, but they might not really help.

    That's about to change. In the not-too-distant future, if you're black and have heart failure, drug-company researchers predict you'll be able to go to the doctor and walk out with a prescription tailor-made for you. Well, not tailor-made, exactly, but something that seems to work in people a lot like you. Well, not a lot like you, exactly, except that they're black, too. In this not-too-distant future, if you're black, your doctor will be able to prescribe BiDil, the first drug in America that's being niche-marketed to people of a particular race—our first ethnic medicine.

    BiDil, expected to be approved early next year by the Food and Drug Administration, is on the leading edge of the emerging field of race-based pharmacogenomics. It signals a shift in perception, a new approach to medicine that has at its core an idea at once familiar and incendiary: the assumption that there are biological differences among the races.

    BiDil is also a feat of creative repackaging. Five years ago, the F.D.A. rejected it for use in the general population because it was found to be ineffective in the treatment of heart failure, a common complication of cardiovas...