Can pills like BiDil redress social and racial injustice?

Jonathan Kahn is a professor of law and biology at Northeastern, with joint appointments in the College of Science and the School of Law. Photo by Ruby Wallau/Northeastern University

In 2005, the Food and Drug Administration approved a drug that promised to treat heart failure in African Americans, who are disproportionately affected by the disease in the United States. 

The medicine, commonly known as BiDil, became the first race-based prescription drug in the U.S., and it was received with much fanfare and applause. 

Groups such as the Association of Black Cardiologists and the National Medical Association hailed the development of BiDil as a breakthrough for African Americans, and a step toward addressing the health disparities of the African American community, which had been long exploited by the medical system.

But what makes a medication race-based? According to findings published in 2007 by Jonathan Kahn, who was recently appointed professor of law and biology at Northeastern, there was no firm evidence proving that BiDil works better or differently in black people than in anyone else. 

Photo by Ruby Wallau/Northeastern University

“I started asking myself, ‘Well, what’s the story behind this?’” says Kahn, who had been exploring issues around the patenting of human genes. “And I started peeling away the layers of how this drug became racialized.”

In his 2012 book, Race in a Bottle: The Story of BiDil and Racialized Medicine in a Post-Genomic Age, Kahn lays out the complex and fascinating story of how BiDil became racial through legal maneuvering and commercial incentives. The FDA approved the drug primarily on the basis of a clinical trial that enrolled only people who identified themselves as African-Americans, without comparing their health outcomes to those of other ethnic groups.

In other words, BiDil was sold as a drug to treat heart failure in African Americans not because of any solid scientific evidence showing that it was more effective in African Americans, but because it was a way to extend patent protection for the drug, says Kahn. 

“The implication behind this [FDA] approval is that black people are different biologically, and that’s historically an incredibly dangerous thing, and scientifically inaccurate for a number of reasons,” says Kahn. “There is no genetic basis for racial differences. It’s a complexly constructed social and political category that doesn’t map on to biological differences.” 

African Americans have worse health outcomes in the United States, but not because of genetic differences. Researchers have cited prolonged stress from systemic racism, differences in access to care, increased exposure to environmental pollutants, cultural distrust of medical professionals, and other factors.

But marketing a drug as a solution to these social injustices is a lot easier than trying to remedy them through political action, Khan says. And, it’s potentially profitable. 

“You’ve got people promoting it because they can make a buck off of it, and nobody makes a buck off of social justice,” says Kahn.

Kahn’s most recent book, Race on the Brain: What Implicit Bias Gets Wrong About the Struggle for Racial Justice, examines the limitations of unconscious bias, which is the automatic, and often unintentional, associations people have in their minds about groups of people. The concept of implicit bias has emerged in the national discourse around race in the wake of social movements and police scandals.

Race on the Brain asks such probing questions as: What do we risk when we seek the simplicity of a technological diagnosis for racism; and, what do we miss when we locate racism in our biology and our brains rather than in our history and our social practices?

Kahn cautions about the dangers of seeing implicit bias as a panacea for addressing America’s persistent racial problems. While implicit bias is important and real, he worries that when it’s used to explain too much, it can actually undermine efforts to promote racial justice. 

“It distracts us from seeing persistent structural inequalities and ongoing explicit racism,” he says.

He gives as an example the controversial arrest of two black men at a Philadelphia Starbucks. In April of 2018, a store manager called police on the men, who were sitting at a table at the coffee shop, but hadn’t made any purchases. Starbucks apologized for the incident, and the chain’s chief executive officer Kevin Johnson called for changes to its policies, including “training around unconscious bias.” The company later shut down thousands of its stores for one afternoon to do just that. 

Kahn had a different take on the incident.

“That’s racism,” he says. “Implicit bias is something that you’re not aware of. This was all very deliberate. And so the book is built around the problems with using implicit bias to explain things.”

Kahn comes to Northeastern by way of the Mitchell Hamline School of Law in Minnesota. He has also taught at the University of Minnesota, Harvard, and Bard College. His expertise is in a range of subjects, including history, science, bioethics, law, government, and biology.

“What I’ve been working on for a while now, and the heart of a lot of what I do in the law, is looking at intersections between law and science with specific attention to how it impacts issues of racial justice,” he says. 

For his next project, Kahn will examine the advantages and disadvantages of an initiative that was launched in 2015 by the Obama administration to develop targeted therapeutics. Called Precision Medicine Initiative, the program is an attempt to recruit more than a million people to give up genetic information and health data to help propel the next stage of genomic research and breakthroughs. 

Diversity, again, is the prevailing buzzword in discussions about the program. That makes Kahn wary. 

“We are constructing these major databases that could be driving biomedical research for years to come,” he says. “And so I’m looking at how, again, race is getting entangled in all of that, and trying to disentangle it to find out where there are constructive and positive uses of race and where there are potentially negative and harmful uses.”

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