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It took nearly eight years for the new heart drugBiDil to win approval from the Food andDrugAdministration—and it won that approval only after its maker, a small company called NitroMed, repositioned it as a treatment earmarked forAfricanAmericans.But if NitroMed thought gettingBiDil past the FD

A、was hard, wait until it tries marketing the drug to its target group.Even during its clinical trials,BiDil ran into resistance. SaysDr. TheodoreAddai of Nashville’s Meharry MedicalCollege, who had to enlist black patients for a 2001 trial: "We had to try to persuade them that this was not another Tuskegee. "
He’s referring to the infamous Tuskegee experiment, conducted by the U. S. government from the 1930s to the early ’70s, during which doctors denied nearly 400 black men inAlabama treatment for syphilis in order to observe the disease’s long-term effects. The scars left by Tuskegee are slow to heal in theAfrican-American community, and many blacks remain deeply suspicious of anything that approaches the emotionally charged intersection of race and medicine.
TheAIDS epidemic is a prime example.According to theCenters forDiseaseControl, blacks account for 50% of new HIV andAIDS cases in the U. S., although they represent only 13% of the population.African-American women are especially at risk; their annualAIDS case rate is 25 times that of white women.Citing those statistics, significant numbers of blackAmericans subscribe to variousAIDS conspiracy theories.According to a poll conducted for the RandCorp. last January, 53% of blackAmericans surveyed believe there is a cure forAIDS that is being withheld from the poor, and 15% believe the disease was created by the government in order to control the black population. Phil Wilson, director of theBlackAIDS Institute, says such attitudes are hampering his work with antiretroviral drugs, "The most common thing we hear withAIDS drugs is, ’Oh, they’re going to experiment on you,’" he says. "The most cited example is the Tuskegee trials, even though most of us don’t even know what Tuskegee was."
Tuskegee aside, the discrepancies in medical care between blacks and whites in the U. S. are real and persistent and not explained by differences in economic status alone. In March 2002 a study by the Institute of Medicine at the NationalAcademy Of Sciences found that even after controlling for such factors as income and insurance coverage, minorities in the U. S. routinely received lower-quality health care than whites. Matters were not improved in the early ’90s when some Governors and state officials tried to mandate the use of a newly approved five-year birth control device called Norplant as a way of curbing teenage pregnancy and reducing welfare costs, a campaign that instantly acquired racial overtones.
In that context, it’s not surprising that the idea behindBiDil—the first drug approved for a specific race—has been controversial from the start. The drug is actually a combination of two older, generic medicines. When it was first tested on the general population as a treatment for congestive heart failure—a gradual weakening of the heart-the FD
A、ruled that the results were not statistically significant. It was only when the drug was retested on patients who identified themselves asAfricanAmericans that tangible benefits emerged: a 43% reduction in the death rate and a 39% reduction in hospitalizations.
Critics point out that while the trials showed thatBiDil saved lives, they failed to show whether the drug worked better in blacks than in other groups or that it worked only in blacks. "Race is a placeholder for something else," saysDr.Clyde Yancy, a cardiologist at the University of Texas Southwestern MedicalCenter and aBiDil investigator. "And that’s probably a mix of biomarkers, demographics and genes."
NitroMed declined to comment on its marketing strategy, but some doctors voiced concern that the company re