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Related Article: Original Article, N Engl J Med 2001 :344 ;1358 -1365 .
Related Article: Original Article, N Engl J Med 2001 :344 ;1351 -1357 .
Two articles in this issue of the Journal deal with the treatment of heart failure in white and black patients. One, concerning carvedilol, reports that the benefit of this beta-blocker is similar in nonblacks and blacks with chronic heart failure.1 The other contends that enalapril, an angiotensin-converting-enzyme inhibitor, is more effective in whites than in blacks with left ventricular dysfunction.2 The authors of both articles refer to "race," "racial groups," "racial differences," and "ethnic background" but offer no plausible biologic justification for making such distinctions. In a nod to the quandary faced by anyone who tries to explain the complex therapeutic effect of a drug along racial lines, the authors of the enalapril study acknowledge "the difficulty in ascertaining whether racial differences in outcomes are attributable to race or to other factors" and concede that "racial categorization [may be] only a surrogate marker for genetic or other factors." I maintain that attributing differences in a biologic end point to race is not only imprecise but also of no proven value in treating an individual patient.
Race is a social construct, not a scientific classification. In a 1999 position paper, the American Anthropological Association stated the following:
" It has become clear that human populations are not unambiguous, clearly demarcated, biologically distinct groups. . . . Throughout history whenever different groups have come into contact, they have interbred. The continued sharing of genetic materials has maintained humankind as a single species. . . . Any attempt to establish lines of division among biological populations is both arbitrary and subjective.3 "
Racial identification does have importance in the formulation of just and impartial public policies. However, recently released data from the 2000 U.S. Census show that even self-identification of race can be problematic. Following the decision by the Office of Management and Budget to allow multiple responses to a question on racial identification in the 2000 Census, almost 7 million people identified themselves as members of more than one race; about 800,000 respondents said they were both white and black.4 This degree of multiracial identification underscores the heterogeneity of the...