Blacks-only medicine highlights drug trends

Mark Jewell:

After services at a predominantly black church in Atlanta, parishioners in their Sunday best roll up their sleeves to get their blood pressure checked at a health screening where they learn about symptoms of heart failure and a new drug approved only for use in blacks.

At another black church in Detroit and a black health fair in Chicago, participants pick up pamphlets about the drug BiDil that are filled with patients' smiling black faces -- not the usual sea of white faces with just a smattering of minorities.

In the nine months since BiDil became the first drug approved for a specific racial group, NitroMed has been sticking with narrowly targeted, homespun-style pitches as it tries to turn around disappointing initial sales that led two top executives to resign last month.

There's no plan to abandon NitroMed's grass-roots marketing in favor of mass-media ad campaigns that accompany many drug launches.

Meanwhile, NitroMed's sales force is focusing only on 144 U.S. metropolitan areas that have large black populations.

Such targeted marketing approaches are expected to become more common as technology continues to advance so treatments are more frequently tailored to individuals' genetic make-ups.

"In a sense, BiDil is a trial balloon for personalized medicine," said B.J. Jones, NitroMed's vice president of marketing.

In the near future, drugmakers could get medications initially approved for a single racial group -- then eventually seek even more narrow clearance for use among people with specific gene types.

"Race is only a surrogate for ultimately looking at one's particular genes and proteins," said Flora Sam, a Boston Medical Center cardiologist who has prescribed BiDil.

That could have big implications for drug marketing in an era of personalized medicine.

"The more specialized the medicine gets, the smaller and smaller the target audience for a drug gets," said Nancy Barlow, president of Xchange, a firm specializing in highly targeted drug marketing.

While mass media campaigns aren't likely to disappear, industry experts say so-called "opt-in" marketing -- in which patients respond to more-direct pitches via e-mail or at seminars -- could become more common with personalized medicine, along with community events like those promoting BiDil.

The researchers who developed BiDil didn't start out looking for a drug that worked better for a particular racial group. After reviewing earlier studies indicating black participants in clinical trials benefited more from taking the drug than those of other races, NitroMed began its own study involving only blacks.

So far, BiDil sales have fallen short of expectations, and NitroMed's chief executive officer and chief financial officer resigned March 21. Nine days later, the Lexington-based company announced plans to cut 30 research and development positions from its 100-person staff.

Initial BiDil sales came in at $4.5 million in last year's final six months from 14,000 prescriptions, behind some analysts' initial projections of around $200 million in annual sales next year.

Analysts and NitroMed officials agree the main problem is difficulty persuading pharmacy benefit plans to approve low patient co-payments for BiDil of around $20 a month, rather than the current $50 a month most plans charge.

To turn sales around, the company is focusing on increasing that insurance reimbursement by trying to convince health plans that BiDil offers easier dosing and greater health benefits than taking two older generic drugs.

NitroMed also has partnerships with the National Association for the Advancement of Colored People and the Association of Black Cardiologists to sponsor health screenings and reach more of the estimated 750,000 American blacks suffering from heart failure.

The first BiDil ads aren't expected until this summer, and those will run only in black media, including radio stations and community newspapers.

The Economist on race-specific medicine

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