Medical oversight, or the lack of it, has exposed a serious health inequity for many in Hawaii’s diverse population.
This is not precisely new — the challenge of gathering health information critical to the ethnic mix of the islands has been well known for decades.
However, Hawaii’s settlement of a longstanding lawsuit against the pharmaceutical industry underscores a catastrophic corporate failure to account for genetic differences in drug effectiveness. And this affected core segments of the state’s population: patients of Asian and Pacific ancestry.
Gov. Josh Green announced on Friday that a landmark $700 million settlement more than a decade in the making was reached between the state and two pharmaceutical companies. The state sued Bristol Myers Squibb and Sanofi over their development of the “blood thinner” most commonly known by the brand name Plavix.
The drug, a platelet inhibitor with the generic name clopidogrel, is among the most widely prescribed medications that prevent the formation of blood clots. Its critical role in managing certain heart conditions and lowering the risk of heart attack or stroke is evident.
However, the companies failed to warn patients that certain populations have genetic factors that limit or completely block the effectiveness of Plavix. Those affected are of Asian, Pacific Islander and Native Hawaiian descent, people who reasonably thought that they were protected when in fact they were vulnerable. And that’s an unconscionable lapse in responsibility by the companies.
The state was originally awarded $834 million in a 2023 nonjury trial. But the Hawaii Supreme Court vacated that judgment because of a legal error. A 2024 retrial increased the award to $916 million, but it could have been appealed. Both a Honolulu firm — Cronin, Fried, Sekiya Kekina & Fairbanks — and the Dallas- based Baron & Budd PC were representing the state.
More details on the dissemination of the settlement fund — how much to the attorneys and how much to the state — are yet to be disclosed. But it is a worthwhile compromise because further delays can be averted.
Green said the state Legislature ultimately will decide how to allocate the funds, but the governor is rightly advocating for the focus to be placed on supporting underfunded health and social service needs.
Inequity in health treatment has a long history here, with significant efforts at course corrections. One example, broadly speaking, is the work being done by the University of Hawaii Cancer Center. This is a National Cancer Institute center, the only one in the Pacific, a designation that powers its research focus on the Asia-Pacific groups.
In another study area, cardiovascular health, the Honolulu Heart Program is a longitudinal study, dating to 1965, that examined the environmental and biological factors affecting the lower rates of coronary disease and higher incidence of stroke among men of Japanese ancestry.
The National Heart, Lung, and Blood Institute website (https://biolincc.nhlbi.nih.gov/studies/hhp/) describes the study history. It now also displays a banner across the top reading: “This repository is under review for potential modification in compliance with Administration directives.” A quick search for that phrase shows it atop other health or science websites as well.
The hope is that the federal reviews underway will correctly conclude that differences in ethnicity do figure in health outcomes, and that valuable research should continue.
And when such realities are established in research, as they were in the Plavix case, the companies must champion patient safety by making those facts clear.
