Should the Government Support the Development of Race-based Medicines?Jean Wolph, Kentucky Writing Project RSPDI

 

A Mini-Unit on Teaching Argument: Claims and Text-Based Evidence

2

Writing Reading Argument MINI-UNITEmphasis

# of Lessons

ARGUMENT SKILLS PRODUCT ELEMENTS OF

ARGUMENT CLOSE READING STRATEGIES

RESPONSE TO READINGS TOPICS

Draft, Feedback, Revise, Reflect Close reading strategies

Writing & talking to develop knowledge on

topic or issue

Integrate evidence from multiple sources to support a claim

3 Lessons

Entering Skills:• Annotating text• Identifying

evidence (quotations, facts, and statistics) to support the claim

• Citing sources

Foundational Skills: • Integrate

evidence from several sources to support a claim

Product: Draft with revision to integrate facts

Peer Review

ClaimEvidence

Coding text Partner share

Should Government Support the Development of Race-based Medicines?

1 print text2 video texts

Mini-Unit Overview

Science Writing Standards Emphasized in the Mini-Unit

Write arguments to support claims with clear reasons and relevant evidence.

b.Support claim(s) with…relevant evidence…demonstrating an understanding of the topic or text.

Day 1 Day 2 Day 3

View Nothing to Sneeze At (Science Friday).

Take observational notes.

Viewhttp://abcnews.go.com/WNT/video/best-sneeze-22258478   

Record facts and key words. 

Partner Talk

Read “Do Now” posted athttp://blogs.kqed.org/education/2015/01/20/should-cold-sufferers-wear-medical-masks/. 

Code the article. Mark compelling facts and key words.

Write: Should cold sufferers be encouraged to wear medical masks to help prevent spreading germs?

Peer Review: Where could we add facts from Day 1 videos?

Revise to add additional evidence.

Mini-Unit Sequence

Text #1

View this video: 

VIDEO: Race Based Medication BiDil and African Americans (New York University) / Uploaded on Oct 16, 2009

Ann Morning, Assistant Professor of Sociology, discusses race-based medications

Writing #1

Record what you heard.

We’ll watch it twice, recording facts and key words as we view.

FACTS KEY WORDS

Partner Talk

In pairs, share what you thought was important from the video and from your writing and notes. Add to your notes after sharing.

Then discuss: What is controversial about the notion of race-targeted medicines?

CLAIM

Based on the information you’ve learned so far, form a working claim. Should the government support the development of race-based medicines?

A good claim of policy (should/shouldn’t claims) often has these components:

[WHO] should (or should not] do [WHAT] because [WHY].

Peer Review

Does your partner’s claim meet our criteria?

Compelling, debatable, defensible Takes a stance (position) Clear and specific Avoids “I think” or “I feel” Avoids listing all the evidence

Switch papers and revise as needed.

Text #2

• Read “Race-based medicine? African American heart drug study raises questions about benefits of racially targeted trials” by Kerry Grens | The Scientist. November 19, 2007

Code the article. Mark compelling facts and key words.

Race-based medicine?

African American heart drug study raises questions about benefits of racially targeted trialsBy Kerry Grens | November 19, 2007

A recent study on the effects of a hypertension drug in African Americans has shone the spotlight on the value of single race studies in medicine. While some praise such studies for reaching out to groups disproportionately affected by a disease, others say grouping trial participants by race attributes health disparities to the wrong cause. While clinical trials often look at associations between race and outcomes, it is uncommon for them to be prospectively race-specific. This study compared several different doses of the drug nebivolol - a beta blocker approved in a number of European countries - against placebo, and found the drug significantly lowered blood pressure in African Americans. Beta blockers are thought to be less effective in African American patients than in white Americans. Race-based studies offer "a window of opportunity to understand nuances in medicine," Keith Ferdinand, the chief science officer of the Association of Black Cardiologists, told The Scientist. In addition to a weaker response to beta blockers, African Americans have a higher prevalence and a more severe pathophysiology of heart disease than do white Americans. While medical outcomes might be due to factors such as access to care, economic stress, or diet, they tend to segregate by race, which therefore provides a useful marker for testing the efficacy of drugs, Ferdinand said. In the past, African American-only trials have received considerable attention. The heart disease drug BiDil, for example, which Ferdinand helped to study, was the first drug in the US approved for and marketed to just one race of patients. Jonathan Kahn, a law professor at Hamline University in St. Paul, Minn., who has been an outspoken critic of BiDil's marketing approach, said that "it sends dangerous messages that race is somehow genetic." Which it is not, Charles Rotimi, the director of

Race-based medicine? --continued

the National Human Genome Center at Howard University in Washington, DC, told The Scientist. While race can be useful to understand how diseases manifest in certain groups, hinging studies on race distracts from the underlying causes of health disparities, Kahn said. But Frank Douglas, the former director of MIT's Center for Biomedical Innovation, said that regardless of the underlying causes of health disparities, testing a drug's efficacy by racial identification can benefit patients. In the case of nebivolol, Douglas told The Scientist, "If you find a beta blocker that works in a patient subset that traditionally hasn't responded well to others, why would you...lose focus on patients who need the drug and get involved in a social discussion? That I don't understand." Unlike BiDil, nebivolol will not be marketed as a beta blocker specifically for African Americans, said Charles Triano, the vice president of investor relations at Forest Laboratories, nebivolol's manufacturer. "Nebivolol, we think, is a product that will demonstrate blood pressure reduction in a very broad population," he told The Scientist. (The US Food and Drug Administration is currently reviewing the drug for approval; Triano said he expects a decision at the end of this month, and prescriptions to become available in January 2008.) Instead, the study, commissioned by Mylan Pharmaceuticals, was conducted in order to demonstrate that nebivolol works well in African American patients, despite the fact that it is a beta blocker, said lead author Elijah Saunders of the University of Maryland School of Medicine. He examined the drugs efficacy exclusively in African American patients, and found that nebivolol "basically did a wonderful job to lower blood pressure," he told The Scientist. The study did not compare nebivolol to other beta blockers. Nor did it compare the efficacy of nebivolol in white versus African American patients, although previous trials have shown a

Race-based medicine? --continuedcomparable benefit for both groups taking the drug, the authors wrote. While beta blockers work significantly better in white patients than African American patients, the overall difference in efficacy is still quite small - only about 10 percent, said Jay Kaufman of the University of North Carolina School of Public Health. One study found the beta blocker atenolol was effective in about half of hypertensive African American patients. "So if you deny Black patients these drugs, a big chunk of patients aren't getting drugs that would work for them," Kaufman said. But the problem Rotimi sees with using race as a marker is that any one self-identified group is never homogeneous - there are always more variations genetically within a racial group than between them, he said. "Human variations do not overlap with our notions of race," Rotimi said. The nebivolol study included patients who self-identified as African Americans, which Rotimi noted is a very heterogeneous group. "That is the key message. It is not for us to ignore differences, but understand differences and interpret them correctly."

By Kerry Grens mail@the-scientist.com Links within this article: Saunders E. et al., "The efficacy and tolerability of nebivolol in hypertensive African American patients," J Clin Hypertens, 9:866-75, 2007. http://www.lejacq.com/Search_articleDetail.cfm Diversity, The Scientist, supplement, 2007. http://www.the-scientist.com/supplement/2006-11-1/ Keith Ferdinand http://www.controlhypertension.org/about/bios/item.php?bio_id=135 S. Pincock et al., "The year that was," The Scientist, December 5, 2005. http://www.the-scientist.com/article/display/15896 Jonathan Kahn http://www.the-scientist.com/article/display/15896 Charles Rotimi http://www.genomecenter.howard.edu/unitsFrank Douglas http://mitsloan.mit.edu/newsroom/newsbriefs-0605-douglas.php F. Douglas, "Discrimination in academia," The Scientist, October, 2007. http://www.the-scientist.com/article/display/53636/ Elijah Saunders http://www.ishib.org/AI_board_esaunders.asp T. Toma, "Benefits from beta-blockers after heart attacks," The Scientist, December 7, 2000. http://www.the-scientist.com/article/display/19316 Jay Kaufman http://www.sph.unc.edu/research/spotlight_on_jay_kaufmanCushman W.C. et al., "Regional and racial differences in response to antihypertensive medication use in a randomized controlled trial of men with hypertension in the United States," Arch Intern Med, 160:825-31, 2000. http://www.the-scientist.com/pubmed/10737282 A.M. Leroi, "On human diversity," The Scientist, October 24, 2005. http://www.the-scientist.com/article/display/15791

Writing #3

What do you think? Should the government support—monetarily or otherwise—the development of race-based medicines? Why or why not?

Use evidence from the article to support your claim. Remember to cite the source.

• According to Ann Morning, Assistant Professor of Sociology, _________• In the article, “Race Based Medicine?” by Kerry Grens, _____________

Skip a line between each row as you write because we’ll be adding to our writing.

Integrating Research

Should government support the development of race-based medicines?

• Re-read your writing. Underline your claim.• Re-read your notes from the video. • What evidence from the videos is RELEVANT (applicable) to

your claim? Find 2-3 places in your writing to add specific facts and key words from these texts as evidence to support the reasons you have given.

• OR add new reasons/evidence from the videos that you did not use in your first draft.

• OR add evidence from our textbook (see pages ___-____).• Remember to cite the source of the information.

Peer Review/Revision

• Read your partner’s draft.

• Put a star each time they used evidence from the article to support their ideas.

• Put a question mark each time you recognize a fact from the article or video that does not include the source.

• Suggest 1-2 additional relevant facts that they could add.

• Trade papers back and use your partner’s feedback to improve your draft.