Vol 435|23 June 2005 NEWS Drug targeting: is race enough?

WASHINGTON DC which lowers blood pressure. It is made by differences in drug response. Even if blacks The expected approval in the NitroMed of Lexington, Massachusetts. The respond better on average to BiDil than whites, of the first drug targeted to a specific racial drug was initially tested in a population that he points out, the drug will still be ineffective group is sparking debate about the future of was about two-thirds white and one-third for those who don’t possess a particular ‘personalized’ medicine. black by another company. The results weren’t cardiac physiology or combination of genes. Enthusiasts predict a future in which people persuasive, and the FDA turned down a There may also be a minority of whites who are given genetic tests to help choose the drug request for marketing approval in 1997. would benefit from taking BiDil. to which they will respond best. But some But Jay Cohn, a cardiologist at the University Collins contrasts BiDil with Iressa (gefi- experts worry about the precedent of accept- of Minnesota, reanalysed the data and found tinib), the AstraZeneca drug whose effective- ing race as a crude marker for underlying bio- that the black patients had responded much ness at treating advanced lung cancer was so logical differences — which could still leave better to the drug. disappointing that the FDA last many individuals being treated with drugs that Cohn and NitroMed were “We should move week restricted its use to don’t work well for them. granted a precedent-setting without delay from current users and patients in Last week, an advisory committee to the patent on BiDil as a racially tar- blurry surrogates for clinical trials. Nevertheless, in Food and Drug Administration (FDA) recom- geted drug, and the company about 10% of patients on mended that BiDil, a drug for congestive heart launched a new trial in 1,050 drug response to more Iressa, lung tumours shrink failure, should be approved for sale with a label black patients. BiDil reduced specific causes.” rapidly. Japanese patients are designating African Americans as the target deaths by 43%, proving so suc- three times as likely as whites population. The FDA usually follows the cessful that the trial was stopped early, in 2004. to fall into this group. But the underlying advice of its experts and is expected to make its The drug’s anticipated approval has been difference is that patients who respond well decision by 23 June. greeted with enthusiasm by both cardiologists have specific mutations in the receptor for , director of the National and the drugs industry. “This is the most epidermal growth factor. Human Genome Research Institute in important advance in the care of black people This opens up the possibility of using Iressa Bethesda, Maryland, says that the drug’s effec- that we’ve seen in my lifetime,” Charles Curry, to treat people whose tumours have these tiveness in blacks is “something to celebrate”. president of the International Society on mutations. “Wouldn’t it be unfortunate if at Even so, he argues: “We should move without Hypertension in Blacks, told the FDA. this point all we knew is that there is a better delay from blurry and potentially misleading But Collins is wary of using the “biologically chance of responding if you are Japanese?” surrogates for drug response, such as race, to inaccurate and socially dangerous” surrogate says Collins. the more specific causes.” of race, rather than pushing researchers and But will drug companies have sufficient BiDil is a combination of isosorbide di- companies to investigate the genetic and envi- incentive to go beyond using race or other nitrate, used to treat angina, and hydralazine, ronmental factors that determine individual crude surrogates, when to do so would entail Trouble brews over contested trend in hurricanes

The debate over whether global warming is Open season: the making hurricanes worse has been nothing if latest hurricane not stormy. analysis will wind The issue came to a head in January, when up those who say leading US meteorologist Chris Landsea that worsening resigned from the Intergovernmental Panel on storms are not , complaining that a colleague related to global on the panel, Kevin Trenberth, had supported warming. a link between warming and storms in a press conference. Now, just in time for the 2005 hur- ricane season, Trenberth has clarified his views in print (Science308,1753–1754; 2005). He extremely cautious about connecting hurri- section of the National Center for Atmos- argues that the intensity, if not the frequency, of cane activity and global warming. Since satel- pheric Research in Boulder, Colorado, argues hurricanes and typhoons will increase as the lite detection started 35 years ago, there has that because the number of hurricanes is rela- oceans warm. been no detectable trend in hurricane fre- tively small, and fluctuates in cycles of various The hurricane seasons from 1995 to 2004 quency, points out modeller Kerry Emanuel lengths, proving the existence of a trend from have been far above the long-term average in of the Massachusetts Institute of Technology weather records is extremely difficult. terms of the number of storms and accompany- in Cambridge, Massachusetts. He has looked instead at how hurricanes ing rainfall. However, most scientists are still But Trenberth, head of the climate analysis form. “Trends in human-influenced environ-

1008 © 2005Nature PublishingGroup |Vol 435|23 June 2005 NEWS

NEUTRINO RIPPLES SPOTTED IN SPACE Universal lumpiness is imprinted in mysterious particles. www.nature.com/news China's chicken

farmers under fireUNIV. TROTTA/MELCHIORRI/OXFORD for antiviral abuse TOKYO The much-feared H5N1 strain of bird flu has become resistant to one of the most effective antiviral drugs against it — and it seems that Chinese farmers’ use of the compound in chickens is to blame. This week the accusation was formally made — and formally denied. But at some point after 1997 the H5N1 strain became resistant to the amantadine family of anti- viral drugs, and Chinese officials have now pledged to investigate the claim. On 18 June, The Washington Post reported that Chinese farmers, encouraged by government officials, had been routinely using amantadine drugs in chickens. The United Nations Food and Agriculture Organization (FAO) and the World Health Organization (WHO) then questioned the Chinese government, which denied the reports, although officials did not comment Positive discrimination: BiDil, a drug to prevent heart failure, will be targeted at black patients. on whether farmers were using the drugs. The FAO’s avian-flu surveillance network costly research and might narrow their target addition to finding out about what works, I coordinator in China, Fusheng Guo, told markets? Experts agree that they might not. might be able to find out what causes prob- Naturethat the drugs have been widely used But some point out that further studies could lems, and save myself some liability,” says to combat the H9 family of viruses in in some cases expand the potential market, Arthur Caplan, director of the Center for chickens. Guo, who was a private consultant and pinpoint the markers predisposing some Bioethics at the University of Pennsylvania in for Chinese farmers throughout the 1990s, S. HUFFAKER/KRT/NEWSCOM S. people to dangerous side-effects. Philadelphia. ■ says that he warned farmers not to use “If I were a drug company executive, in Meredith Wadman amantadine, because residues in the meat could make human viruses resistant. But, at the time, he did not worry about it in relation to H5N1. “Now I believe it’s a mental changes are expected to affect hurri- cane behaviour. They point out that even if serious problem,” he says. cane intensity and rainfall,” he concludes. there were a trend that had been missed in According to Guo, the agriculture ministry One simulation that Trenberth reviewed sug- weather records, the change would have to be was probably not aware of the use. “The men gests that warming tropical oceans will stretch quite small relative to the year-to-year vari- selling it knew it was illegal,” he adds. the upper limit of ’ potential strength. ability that already exists. China’s health ministry told the WHO on “Most storms may actually not reach the Trenberth counters that sceptics are ignor- 21 June that the problem is “worth following limit,” says Tom Knutson, a co-author of the ing the evidence. “I am trying to get people to up in the closest way possible”, according to simulation based at the US National Oceanic think about things in a different fashion,” he Roy Wadia, the WHO spokesman in Beijing. and Atmospheric Administration in Prince- says. “The point is that all meteorological Surveillance and testing will now be ton, New Jersey. “But in principle, Trenberth’s events around the world are influenced in required to find out how widespread the use conclusions are consistent with our studies.” some way by global warming.” has been and how common resistance to Trenberth also argues that higher sea sur- In any case, everyone is hoping that there amantadine has become. face temperatures in the Atlantic Ocean and will be fewer severe storms this summer than The first H5N1 strain that infected increased water vapour in the lower atmos- last — when four strong hurricanes struck humans, in Hong Kong in 1997, was sensitive phere — caused by global warming — are to Florida, and Japan was hit by a record ten to the amantadines. But resistance to them, blame for the past decade’s intense storms. typhoons. They also hope that the storm that discovered in 2003, has left another — more His conclusions will not please some in the came ashore unexpectedly in Brazil on expensive — family of antivirals, including community. In an upcoming 28 March 2004 will not be a harbinger of oseltamivir (sold as Tamiflu) and zanamivir paper in the Bulletin of the American Meteoro- things to come: Catarina, as it was christened, (Relenza), as the only line of defence against logical Society, Landsea, Emanuel and col- was the first ever recorded hurricane to the virus. This leaves the poor countries of leagues argue that there is no proven link develop in the southern Atlantic Ocean. ■ southeast Asia without a low-cost option. ■ between greenhouse-gas emissions and hurri- Quirin Schiermeier David Cyranoski

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