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Related Article: Perspective, N Engl J Med 2003 :348 ;1081 -1082 .
Race is a thoroughly contentious topic, as one might expect of an idea that intrudes on the everyday life of so many people. The modern concept of race grew out of the experience of Europeans in naming and organizing the populations encountered in the rapid expansion of their empires.1 As a way to categorize humans, race has since come to take on a wide range of meanings, mixing social and biologic ingredients in varied proportions. This plasticity has made it a tool that fits equally well in the hands of demagogues who want to justify genocide and eugenics and of health scientists who want to improve surveillance for disease. It is not surprising, therefore, that diametrically opposing views have been voiced about its scientific and social value.2 ,3 Indeed, few other concepts used in the conduct of ordinary science are the subject of a passionate debate about whether they actually exist.
Into this storm of controversy rides genomics. With the acknowledgment that race is the product of a marriage of social and biologic influences, it has been proposed that genomics now at least offers the opportunity to put its biologic claims to an objective test.4 If those claims are validated, race will become a way to choose drug therapy for patients, categorize persons for genetic research, and understand the causes of disease. Genomics, with its technological innovations and authority as "big science," might thereby solve the conundrum of race and bring peace to the warring factions.
Of the many implications that flow from the claim that race categorizes humans, few have more immediate clinical relevance than the choice of drug therapy. Remarkable progress has been made with drugs for cardiovascular disease, and the rapidly evolving patterns of care now include, for the first time, a candidate for "race-specific" therapy.5 Randomized trials have been interpreted to show that a combination of vasodilators is more effective in treating heart failure in black persons than in white persons6 and that angiotensin-converting-enzyme (ACE) inhibitors have little efficacy in blacks.7 The results of the vasodilator trials were inconsistent, however, and never achieved statistical significance for an interaction between treatment and race, the outcome of interest. Moreover, another analysis...