Is There Still Too Much Extrapolation From Data on Middle-aged White Men?

A MYOPIC VIEW of confounding factors in clinical research is continuing to confound clinical practice. Efforts to streamline studies by using the most homogeneous population possible have filled medical libraries with data on middle-aged white men. Even female rats are commonly excluded from basic research. In the real world this leaves physicians to guess whether new findings can be extrapolated to the rest of their patients. For instance, no one knows if aspirin has any prophylactic value in coronary artery disease in women because virtually all the current evidence is from studies on men. And for most classes of drugs, no one knows if ethnic variations in drug metabolism exist, or where they have been seen, as with β-blockers and antidepressants, what the full extent of their clinical relevance might be. These gaps remain despite documentation of important differences in drug responses and risk profiles among women, the elderly, and