Duke University, Medical Xpress, May 27, 2016
Prescribing certain medications on the basis of a patient’s race has long come under fire from those uneasy with using race as a surrogate for biology when treating disease.
But there are multiple challenges to overcome before we can move beyond race-based treatment decisions, writes Duke University geneticist and bioethicist Charmaine Royal in a perspective piece published May 25 in the New England Journal of Medicine.
In “Will Precision Medicine Move Us beyond Race?” Royal and colleagues Vence Bonham of the National Institutes of Health and Shawneequa Callier of The George Washington University describe some of the thorny issues raised by race-based drugs.
“What we even mean by race has always been murky and is becoming even more so given changing demographics,” said Royal, an associate professor of African and African American Studies and director of the Center on Genomics, Race, Identity, Difference at Duke’s Social Science Research Institute. Someone who self-identifies as black, such as President Obama, likely has ancestors from multiple so-called races.
Given the genetic diversity that exists within racial groups, and the similarities between different groups, it is likely that a drug labeled for use in African Americans will not work for all African Americans, and that some non-African Americans would also benefit from the drug.
“Prescribing medications on the basis of race oversimplifies the complexities and interplay of ancestry, health, disease, and drug response,” the authors write.
Eventually, optimizing drug treatments to a patient’s unique genetic makeup, lifestyle, environment and other factors, rather than race, could help ensure that patients receive the right drug at the right dose–an approach called precision medicine.
“There are many hurdles to overcome if a precision medicine approach to health care is to replace the use of race in treatment decisions,” the authors say.
One barrier to understanding the complex interplay between genes, environment and lifestyle is the lack of participant diversity in biomedical research and clinical trials. Addressing the problem will require recruiting more participants from minority groups to better reflect the diversity of the U.S. population.