BMJ  2005;330 (7 May), doi:10.1136/bmj.330.7499.0-g

Editor's choice

Triumph of the white male

The winner of the United Kingdom's election will come as a surprise to the nation's 9-13 year olds. A survey of these future voters revealed that footballer Wayne Rooney would make the best prime minister. Second to Rooney in this most perceptive of pre-election polls was schoolboy wizard Harry Potter. Failing that Charlie from "Busted," a defunct teen pop band, was best equipped to lead the country in any future wars or fiscal negotiations. Tony Blair, who has a taste for many of the attributes desired by his country's children—a love of football, music, and, his critics will say, a recently acquired taste for fiction—came in a respectable fourth.

By all accounts this has been the most negative and personalised election campaign in the history of British politics. Researchers from Loughborough University calculated that 43% of television and press coverage showed politicians attacking rivals. Voters turned their backs on this mudslinging and the tabloid press devoted more space—some by a factor of 10—to the marital strife of England's football captain than to publication of the attorney general's advice on going to war in Iraq. Health, which invariably tops the list of issues that matter to voters, received 3.5% of media coverage. Education fared little better at 3.7%. The subject that was most likely to topple Mr Blair was the issue of trust, something that is also a fundamental challenge for modern healthcare systems: trust between doctors and patients, doctors and managers, and doctors and politicians.

The children's poll also confirmed the durability of the stereotype of a white male as head of state—a stereotype that presents problems for research and clinical practice. With the white male overrepresented as a participant in research, the question arises as to the applicability of those research findings to other groups. What meaning do the reams of evidence based guidance have for a black woman? These are difficult and potentially incendiary issues, but developments in pharmacogenetics have reopened the debate on whether response to drug treatment is determined by genetic differences.

Pharmacogenetics, say Taslin Rahemtulla and Raj Bhopal, will refine our understanding of these issues, and doctors should adopt an open minded but critical stance (p 1036). A new drug called BiDil, a polypill combining isosorbide dinitrate and hydralazine, will soon be approved by the US Food and Drug Administration to treat heart failure in African-American patients only. Yet claims of a biological basis to racial and ethnic variations in therapeutics have proved to be overstated, warn Rahemtulla and Bhopal. Racial and ethnic variations continue to confuse and perplex researchers, clinicians, policy makers, and journal editors, with a possible breakdown of trust with non-white consumers of health care. Solutions are essential, preferably before Wayne Rooney becomes prime minister.