Tópico: A medicina racial nem era racial mesmo

[Buckaroo Banzai]

A close inspection of BiDil’s history, however, shows that the drug is ethnic in name only. First, BiDil is not a new medicine—it is merely a combination into a single pill of two generic drugs, hydralazine and isosorbide dinitrate, both of which have been used for more than a decade to treat heart failure in people of all races. Second, BiDil is not a pharmacogenomic drug. Although studies have shown that the hydralazine/isosorbide dinitrate (H/I) combination can delay hospitalization and death for patients suffering from heart failure, the underlying mechanism for the drug’s efficacy is not fully understood and has not been directly connected to any specific genes. Third, and most important, no firm evidence exists that BiDil actually works better or differently in African-Americans than in anyone else. The FDA’s approval of BiDil was based primarily on a clinical trial that enrolled only self-identified African-Americans and did not compare their health outcomes with those of other ethnic or racial groups.

Resumo em português: um medicamento lançado há uns dois anos foi promovido como tendo sido projetado especificamente para africanos ou afro-descendentes americanos. Mas na verdade, seus componentes são os mesmos de  medicamentos utilizados para pessoas de todas raças, sem qualquer estudo que diga que seja melhor para afro-americanos. É meio como se lançassem "aspirina para canhotos".


Scientific American: Race in a bottle

[Stéfano]

Só esclarecendo de mod simples, foi lançado para afro-descendentes pois diversos estudos sugerem que os mesmos são mais susceptíveis ao tratamento da hipertensão arterial com diuréticos.

[Buckaroo Banzai]

Agora eu já nem lembro da matéria toda (que é de 2007), mas lembro que por exemplo, a "hipertensão negra", não é necessariamente "negra", não tem nada de diferente da hipertensão de brancos, índios e asiáticos, e nem haveria uma maior propensão biológica real para ela, mas poderia estar associado a discriminação racial.

Não que seja um tipo de racismo achar que os negros tem mais hipertensão, mas que a hipertensão pode ser mais freqüentemente catalisada por efeitos psicológicos do racismo, e daí os negros seriam aparentemente mais "propensos". Talvez essa catálise psicológica da coisa seja o que crie essa diferença racial que há na resposta ao tipo de tratamento; e assim grupos brancos/asiáticos/índios discriminados de algum jeito razoavelmente comparável, talvez gays por exemplo (nem tanto porque tendem a ser mais ricos, algo na mesma faixa sócio-econômica seria preferível), tenham igualmente hipertensão, e também respondessem ao mesmo tratamento que se supõe ser mais eficaz para negros.

Algo mais ou menos relacionado: "sick  of poverty", Robert Sapolsky, Scientific American (PDF)

[Stereotype threat,] Physiological responses

Stereotype threat can result in physiological responses since the pressure and fear caused by negative stereotypes is so great. For example, a study by Blascovich J, Spencer SJ, Quinn D and Steele C. found that African Americans under stereotype threat exhibited larger increases in arterial blood pressure during an academic test, and performed more poorly on difficult test items. Some researchers feel this may explain the higher death rates from hypertension related disorders among African Americans.[6]

http://en.wikipedia.org/wiki/Stereotype_threat

[Buckaroo Banzai]

Talvez tenha relevância:

[Hypertension,]Role of renin

Renin is a hormone secreted by the juxtaglomerular cells of the kidney and linked with aldosterone in a negative feedback loop. The range of renin activity observed in hypertensive subjects tends to be broader than in normotensive individuals. In consequence, some hypertensive patients have been defined as having low-renin and others as having essential hypertension. Low-renin hypertension is more common in African Americans than Caucasians and may explain why they tend to respond better to diuretic therapy than drugs that interfere with the renin-angiotensin system.

http://en.wikipedia.org/wiki/Hypertension

Renin-angiotensin-aldosterone system in rats with neurogenic stress

Abstract 

In adult male rats moderate neurogenic stress was induced by crowding for periods of 1 and 7 days. The angiotensin I concentration and renin activity in the blood plasma and the aldosterone concentration in the peripheral blood and adrenal tissues were determined radioimmunologically. Crowding the rats for 1 day led to a considerably marked increase in the adrenal aldosterone concentration in the plasma. The aldosterone concentration in the blood and adrenals of the rats was lowered 7 days after the beginning of neurogenic stress but the renin activity and angiotensin I concentration in the peripheral blood plasma were raised. The causes of the dissociation observed in the renin-angiotensin-aldosterone system in response to neurogenic stress of varied duration are discussed.

http://www.springerlink.com/content/w464100457466428/



Com humanos:

[...]Physiological increments of circulating Epi* do not affect renal blood flow but enhance renin release markedly without apparent activation of the renal nerves in humans.

*Epinefrina, relacionada ao estresse.


http://ajprenal.physiology.org/cgi/content/abstract/257/4/F682

[Buckaroo Banzai]

Achei algo interessante sobre diferenças médicas resultando diretamente de diferentes graus de pigmentação, uma delas sendo relativa à hipertensão:



Vitamin D malnutrition may also be linked to an increased susceptibility to several chronic diseases such as high blood pressure, tuberculosis, cancer, periodontal disease, multiple sclerosis, chronic pain, depression, schizophrenia, seasonal affective disorder, and several autoimmune diseases including type 1 diabetes (see role in immunomodulation).[10][16]

http://en.wikipedia.org/wiki/Vitamin_D#Deficiency


A pigmentação da pele dificulta em diversos graus a síntese de vitamina D que em parte tem a ver com os raios solares. Em contrapartida, a falta de pigmentação/proteção solar resulta em problemas com ácido fólico, destruído pela mesma luz solar.

Só não sei se esse tipo de causa de hipertensão tem benefício com o tratamento por esses "micro-diuréticos".

[Buckaroo Banzai]

Só esclarecendo de mod simples, foi lançado para afro-descendentes pois diversos estudos sugerem que os mesmos são mais susceptíveis ao tratamento da hipertensão arterial com diuréticos.

Acho que no artigo (não lembro) tem qualquer coisa sobre esse rótulo racial ser um tipo de truque burocrático para conseguir aprovação da FDA. No Point of Inquiry (ótima indicação!) tem um episódio interessante que talvez tenha alguma relevância sobre esse tipo de coisa, "the sins of the big pharma ^[mp3]", por Barry Beyerstein:

Barry Beyerstein is Professor of Psychology and a member of the Brain Behaviour Laboratory at Simon Fraser University. His research has involved many areas related to his primary scholarly interests: brain mechanisms of perception and consciousness and the effects of drugs on the brain and mind. His work in these areas and his interest in the philosophy and history of science have also led him to be skeptical of many occult and New Age claims. This has prompted him to investigate the scientific status of many questionable products in the areas of medical and psychological treatment, as well as a number of dubious self-improvement techniques.

Dr. Beyerstein serves as chair of the Society of B. C. Skeptics and he is a Fellow and a member of the Executive Council of CSICOP and serves on the editorial board of CSICOP's journal, The Skeptical Inquirer.  He was also elected to the Council for Scientific Medicine, another organization headquartered at the Center for Inquiry; it provides critiques of unscientific and fraudulent health products.  He is a founding member of Canadians for Rational Health policy and a Contributing Editor of the journal, The Scientific Review of Alternative Medicine.  He has published in these areas himself and is a frequent commentator on such topics on TV and Radio and in the print media.

In this interview with DJ Grothe, Dr. Beyerstein discusses what he calls "the sins of Big Pharma," elaborating on what he considers the negative implications of the profit motive in the pharmaceutical industry and the development of new and unnecessary drugs due to possibly biased research.





Tem um episódio sobre "quackery" que eu não lembro se já ouvi, mas também parece muito interessante.