Here’s the thing: there are lots of drugs to treat high blood pressure. Some work in the renin-angiotensin system, a hormone system used by the kidneys to regular blood pressure. This includes ACE inhibitors and angiotensin-receptor blockers. There are studies showing a racial difference in the response to these drugs — blacks don’t respond as well as whites. This is still under discussion, because there are other studies where the difference disappears with dosage adjustments or combination therapy.

Blacks respond better to other drugs that treat blood pressure, such as diuretics, vasodilators, and calcium channel blockers. There are many well-established drugs used in whites and blacks alike. One is hydralazine; it’s been around for decades. There is also a heart medication (vasodilator) called isosorbide dinitrate… also been around for decades. They’re as “white” as anything. BiDil is simply a combination of hydralazine and isosorbide dinitrate in one pill. Why is it approved for black people? Because its manufacturer did successful clinical trials in (self-identified) African Americans. This is primarily a marketing strategy. It doesn’t mean that the combination wouldn’t work well in whites, or that the same result couldn’t be less expensively achieved in two pills (one hydralazine, one isosorbide dinitrate).

The issue of race/genes is complicated by the fact that in this country there is a lot of mixed heritage. Just because someone is black doesn’t mean that they’ll necessarily be worst off with ACE inhibitor monotherapy and best off with BiDil. When all else is equal, it may be a good starting point, but only time will tell.

In the future we may have far better predictors of how a given patient will respond than superficial race.

Further, the team brought up psittacosis earlier. But they excluded it based on the interview: “he does not have any birds”, nor is he working with birds (they didn’t know about cockfights).

Also, I’m not a doctor but I would expect that falling off a roof might count as “trauma with an increased risk of life-threatening bleed”, another contraindication to its use.

The republican thing was a joke; later on Foreman says the patient himself said House gave him “the white stuff”. But I too think Foreman’s comparison was too much, what was House supposed to do if the man was irreductible? I guess he should have let the idiot die drowned in his own hypocrisis after all, aparently he didn’t want the “black stuff” because he thought that’s what white people wanted to give him to NOT cure him but at the same time he trusted more a white doctor than a black one. The sad thing is that there are people like that.

And I didn’t think the House and Cuddy’s scene at the end was out of character. Stacy had already asked House to cut Cuddy some slack and in the end Stacy gives House a look as for him to say something to make her feel better, and as we have now seen in 4th’s season finale, House Is capable of doing things for people he cares about(especially because there are so few of those).