6 ms·

But this seems to be different situation from what the article is talking about which is the inadequate involvement of minorities in drug trials. You are highli

by pkaye 9y ago

But this seems to be different situation from what the article is talking about which is the inadequate involvement of minorities in drug trials. You are highlighting the lack of adequate health coverage which is a different issue in the US. But this bring up a question if blacks and other minorities have the poorer health outcomes in other countries? Japan, China, South Korea for example does their own drug testing and development so would they find that a particular drug doesn't work on their population at all? What about the black population in UK or France? Do they also have poorer health outcomes?

blaurenceclark 9y ago
We haven't done extensive research in populations outside of the United States, but for the last 50-100 years the US (and Europe) has been leading the charge, but in both these locations, Minorities have been a low percentage participation in research. As well, many of these outcomes he mentioned are the indirect result of years of research. Think of diabetes, 100 years of research was 99% spent on a white population and that contains prevention, diagnosis, and treatment. Populations that aren't white begin to see detrimental effects that add up over time.
- pkaye 9y ago
  So none of the asian countries (for example SK or Japan) retest the drugs on their own population before approval for use?
  - blaurenceclark 9y ago
    There is a much longer answer to that question. SK and Japan only make up 5% of the asian population, many parts of asia are not well tested for these drugs. We're actually in the process of working with a large pharmaceutical company on a multi-country diabetes prevention trial in Asia because traditionally they have not been tested on as much as necessary. As well the companies there will run many of their trials in the US as well as Asia but our larger population (as well as running the trials in mostly white continents such as Australia and Europe) still causes quite a large discrepancy. We could do a whole other article on this topic.
  - hrktb 9y ago
    Japan retests, and interestingly recreates the same problems in a local way. Taking medical checks for foreigners or minorities in japan means the guidance numbers are mostly irrelevant. Doctors might not know very well how to deal with you, a lot of advice for common but non critical illness can be summed up to “you do you”
- Alex3917 9y ago
  > We haven't done extensive research in populations outside of the United States, but for the last 50-100 years the US (and Europe) has been leading the charge I'm confused, I thought that over the last ten years a lot of the medical research formerly conducted by U.S. pharma companies has been outsourced to SROs, who in turn test their drugs on poor people in India or whatever. Is that not actually the case?
  - blaurenceclark 9y ago
    That only happens for certain drugs, typically treatment naive diabetes, IBD and other chronic disease patients where in the US there’s a standard treatment the patients receive right away so they have to go overseas to find untreated patients. That being said often those treatments will still have to come back to the US to run trials later on for approval on the population here.
- ekianjo 9y ago
  > Minorities have been a low percentage participation in research. That's not true at all if you consider PMS (Post Marketing Studies) which are an integral part of clinical development post launch.
charlescearl 9y ago
Or generally if historically oppressed minorities get poorer health outcomes. It seems a complex question that has many facets. Two tickets that come to mind: 1. When US sociologists and political scientists talk about “systemic and structural racism” this is one of the manifestations. That in general the well being of Native peoples in the US, of African Americans is devalued. It is witnessed in the exclusion in drug trials, in the diseases that pharma considers worthwhile to address, in the staffing of hospitals, in the access to healthcare,etc. 2. The unique inefficiency of the US healthcare system among those of wealthy countries has been documented in depth so I don’t know if is possible to do an adequate comparison of progressive health systems (e.g. Japan, UK, Finland) against that of the US. It might be worthwhile to pull in progressive health systems that focus primarily upon Black people —- Botswana comes to mind —- as a point of comparison.
- Banthum 9y ago
  >That in general the well being of Native peoples in the US, of African Americans is devalued. It is witnessed in the exclusion in drug trials, in the diseases that pharma considers worthwhile to address... Speaking about medical research specifically: You seem to say these outcomes are because of white racists "devaluing" black and native peoples' well-being in an evil act of collective racism. A simpler explanation would be: There are far fewer blacks and natives than whites in America, which means fewer sick people to help and fewer customers, which means their unique illnesses get less research focus. The same effect happens between common diseases and rare diseases irrespective of race. Common diseases get studied first, because that's where the most good can be done. This isn't because the well-being of people with rare diseases is "devalued". Frankly I'm concerned you jump so quickly to a mass accusation of collective racial evil (which echoes historic hatred against other high-performing ethnic groups) when a simpler explanation is so obvious.
  - arionhardison 9y ago
    > Frankly I'm concerned you jump so quickly to a mass accusation of collective racial evil (which echoes historic hatred against other high-performing ethnic groups) when a simpler explanation is so obvious. Do you live in America? Are you familiar with US history? If both of these are true then I dont understand why its so hard for you to grasp the fact that much of this was done out of malice. https://en.wikipedia.org/wiki/Tuskegee_syphilis_experiment https://en.wikipedia.org/wiki/Tuskegee_syphilis_experiment - I guess you think this was a "mistake" too?
ekianjo 9y ago
> Japan, China, South Korea for example does their own drug testing and development so would they find that a particular drug doesn't work on their population at all? Yes, it happens sometimes that certains drugs approved in the US fail to make it in Japanese clinical trials. Recent one I can think of is Prozac: https://clinicaltrials.gov/ct2/show/NCT01808612 https://clinicaltrials.gov/ct2/show/NCT01808612 It did not show to be better than Placebo in the Phase3 Japan trial. (https://clinicaltrials.gov/ct2/show/results/NCT01808612?sect=X70156#outcome1 https://clinicaltrials.gov/ct2/show/results/NCT01808612?sect...) There could be multiple reasons for that, but in the end the drug is not approved in Japan.

by pkaye 9y ago

blaurenceclark 9y ago

We haven't done extensive research in populations outside of the United States, but for the last 50-100 years the US (and Europe) has been leading the charge, but in both these locations, Minorities have been a low percentage participation in research. As well, many of these outcomes he mentioned are the indirect result of years of research. Think of diabetes, 100 years of research was 99% spent on a white population and that contains prevention, diagnosis, and treatment. Populations that aren't white begin to see detrimental effects that add up over time.

pkaye 9y ago
So none of the asian countries (for example SK or Japan) retest the drugs on their own population before approval for use?
- blaurenceclark 9y ago
  There is a much longer answer to that question. SK and Japan only make up 5% of the asian population, many parts of asia are not well tested for these drugs. We're actually in the process of working with a large pharmaceutical company on a multi-country diabetes prevention trial in Asia because traditionally they have not been tested on as much as necessary. As well the companies there will run many of their trials in the US as well as Asia but our larger population (as well as running the trials in mostly white continents such as Australia and Europe) still causes quite a large discrepancy. We could do a whole other article on this topic.
- hrktb 9y ago
  Japan retests, and interestingly recreates the same problems in a local way. Taking medical checks for foreigners or minorities in japan means the guidance numbers are mostly irrelevant. Doctors might not know very well how to deal with you, a lot of advice for common but non critical illness can be summed up to “you do you”
Alex3917 9y ago
> We haven't done extensive research in populations outside of the United States, but for the last 50-100 years the US (and Europe) has been leading the charge I'm confused, I thought that over the last ten years a lot of the medical research formerly conducted by U.S. pharma companies has been outsourced to SROs, who in turn test their drugs on poor people in India or whatever. Is that not actually the case?
- blaurenceclark 9y ago
  That only happens for certain drugs, typically treatment naive diabetes, IBD and other chronic disease patients where in the US there’s a standard treatment the patients receive right away so they have to go overseas to find untreated patients. That being said often those treatments will still have to come back to the US to run trials later on for approval on the population here.
ekianjo 9y ago
> Minorities have been a low percentage participation in research. That's not true at all if you consider PMS (Post Marketing Studies) which are an integral part of clinical development post launch.

charlescearl 9y ago

Or generally if historically oppressed minorities get poorer health outcomes. It seems a complex question that has many facets. Two tickets that come to mind: 1. When US sociologists and political scientists talk about “systemic and structural racism” this is one of the manifestations. That in general the well being of Native peoples in the US, of African Americans is devalued. It is witnessed in the exclusion in drug trials, in the diseases that pharma considers worthwhile to address, in the staffing of hospitals, in the access to healthcare,etc. 2. The unique inefficiency of the US healthcare system among those of wealthy countries has been documented in depth so I don’t know if is possible to do an adequate comparison of progressive health systems (e.g. Japan, UK, Finland) against that of the US. It might be worthwhile to pull in progressive health systems that focus primarily upon Black people —- Botswana comes to mind —- as a point of comparison.

Banthum 9y ago
>That in general the well being of Native peoples in the US, of African Americans is devalued. It is witnessed in the exclusion in drug trials, in the diseases that pharma considers worthwhile to address... Speaking about medical research specifically: You seem to say these outcomes are because of white racists "devaluing" black and native peoples' well-being in an evil act of collective racism. A simpler explanation would be: There are far fewer blacks and natives than whites in America, which means fewer sick people to help and fewer customers, which means their unique illnesses get less research focus. The same effect happens between common diseases and rare diseases irrespective of race. Common diseases get studied first, because that's where the most good can be done. This isn't because the well-being of people with rare diseases is "devalued". Frankly I'm concerned you jump so quickly to a mass accusation of collective racial evil (which echoes historic hatred against other high-performing ethnic groups) when a simpler explanation is so obvious.
- arionhardison 9y ago
  > Frankly I'm concerned you jump so quickly to a mass accusation of collective racial evil (which echoes historic hatred against other high-performing ethnic groups) when a simpler explanation is so obvious. Do you live in America? Are you familiar with US history? If both of these are true then I dont understand why its so hard for you to grasp the fact that much of this was done out of malice. https://en.wikipedia.org/wiki/Tuskegee_syphilis_experiment https://en.wikipedia.org/wiki/Tuskegee_syphilis_experiment - I guess you think this was a "mistake" too?

ekianjo 9y ago

> Japan, China, South Korea for example does their own drug testing and development so would they find that a particular drug doesn't work on their population at all? Yes, it happens sometimes that certains drugs approved in the US fail to make it in Japanese clinical trials. Recent one I can think of is Prozac: https://clinicaltrials.gov/ct2/show/NCT01808612 https://clinicaltrials.gov/ct2/show/NCT01808612 It did not show to be better than Placebo in the Phase3 Japan trial. (https://clinicaltrials.gov/ct2/show/results/NCT01808612?sect=X70156#outcome1 https://clinicaltrials.gov/ct2/show/results/NCT01808612?sect...) There could be multiple reasons for that, but in the end the drug is not approved in Japan.