Race-based vitamins: no, it's not The Onion (Updated)

[Posted originally on 19 July but updated to include more information on BiDil]

DrugMonkey alerted me to this gem at Light-skinned-ed Girl on a company called GenSpec Labs who are marketing, African American-, Hispanic-, and Caucasian-focused vitamin supplements.

Seriously. I thought this was a link to The Onion.

The GenSpec promotion is a completely asinine and repulsive marketing exploitation of a concept that, surprisingly, often has some pretty good science behind it. But it's also very typical of the dietary supplement industry to take a little science and come up with some snake oil. I loved LSG's note that being biracial will require her to be taking a whole heap o' vitamins.

This concept is indeed interesting to think about in the context of BiDil, the combination of two old vasodilators that remarkably and selectively improved survival and functional impairment in self-identified "black" patients, but not "white" patients, with moderate to severe heart failure. (BiDil prescribing info and clinical trials results in PDF here).

In fact, there are three genetic polymorphisms between self-identified black and white patients that may theoretically contribute for the differential clinical effect of BiDil (in the aldosterone synthase gene promoter, the endothelial nitric oxide synthase 3 coding region, and the β₁-adrenergic receptor coding region), although the polymorphisms did not segregate in an absolute manner. The manufacturer of BiDil, NitroMed, has not been particularly successful in marketing the drug and laid off some of it sales force in January. In 2007, the NAACP mounted a grassroots campaign against Medicare for not covering BiDil giving rise to much rancor, pro and con, in the nation's OpEd pages.

I now realize that I could've written a whole blogpost just on BiDil.

But back to GenSpec and race-based vitamins.

Let's first introduce you to the GenSpec management team that includes - and I've never heard of this before - a "naprapath." No, not a naturopath - a naprapath. I think it's a chiropractor with alleged natural products/nutrition expertise - paging Orac and Stephen Barrett. We'll have to get back to this one later.

Turns out that I've done part of my research in cancer health disparities and I've found that the biggest issue is defining what is meant by these inaccurate terms we often use to categorize tens of millions of people at a time. I'm still really careful, and still learning, about how to go about this work in a scientifically-valid and culturally-sensitive manner. Few disparities studies (even by the epidemiologists, who should know better) really drill down into geographic origin and race (which I've learned is a term no longer used by anthropologists but still thrown around by biomedical types) plus skin darkness (plenty of 100% "African Americans" from North Africa who are about as light tan as me; "Hispanics" vary based on indigenous or Spanish ancestry, etc.) plus regional diets (Southern US "African Americans" eat a hell of a lot more foods that give rise to pro-carcinogenic heterocyclic amines than Yankee "African Americans"; mid-America "whites" eat far more pickled foods and cured meats than northeastern "whites").

That's not even mentioning access to health care - I had the good fortune of participating in a fabulous health disparities meeting about three years ago featuring Dr Otis Brawley from Emory, now with the American Cancer Society, and Dr Funmi Olopade, the Chicago breast cancer physician-scientist who received a MacArthur genius award last year. An introduction from Dr Brawley:

Race is a sociopolitical way of categorizing a population. It is not a biological categorization. The US Office of Management and Budget defines the racial and ethnic categories used in the decennial census. These categories are then used by cancer registries to generate the published data. These population categories are not based on biological science or taxonomy. Indeed, these categories are extremely political. Over the past 30 years, native Hawaiians have been considered first Asian/Pacific Islanders, then Native Americans, and are now placed in a category separate from Asians called "Pacific Islanders or Hawaiians."

While race is a sociopolitical categorization, it can be a surrogate for extrinsic causes of cancer. It is somewhat ironic that this sociopolitical construct is often used in a sort of medical racial profiling for risk of disease. Other more scientific ways of categorizing populations include ethnicity, socioeconomic status, and area of geographic origin.

Brawley noted historic prostate cancer rates between "white" and "black" men as being two- to three-fold different but then said that the US military has already done the experiment for us to take out the contribution of access to health care that often divides health outcomes across groups. Prostate cancer rates among "black" military men were similar to that of "white" military men - meaning that the military solved 50% of the disparity just by normalizing access to uniform health care.

Dr Gary Schwartz at Wake Forest Comprehensive University Medical Center and Cancer Center has been one of the leaders in the vitamin D/prostate cancer link and has strong data to support the link between skin color, vitamin D levels, vitamin D receptor genetic polymorphisms and prostate cancer risk. It is a real difference but is based on skin color (measured with a reflectometer in the sun-protected upper underarm area vs. "facultative" skin color on the sun-exposed forehead) and not necessarily the geographic origin that gives rise to that skin color. While the cited study was done with a population in San Francisco, Dr Schartz's research environment of North Carolina is particularly dense with various shades of white and black folk (some colleagues like to use the word "tan").

Heck, I just learned I am of Ethiopian descent thanks to the National Geographic Genographic mapping kit that PharmSis got me. How many dang vitamins do I have to take?

The field of "personalized medicine" is laden with mines.