Pharmacogenetics in Primary Care: The Promise of Personalized Medicine and the Reality of Racial Profiling
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Many anticipate that expanding knowledge of genetic variations associated with disease risk and medication response will revolutionize clinical medicine, making possible genetically based Personalized Medicine where health care can be tailored to individuals, based on their genome scans. Pharmacogenetics has received especially strong interest, with many pharmaceutical developers avidly working to identify genetic variations associated with individual differences in drug response. While clinical applications of emerging genetic knowledge are becoming increasingly available, genetic tests for drug selection are not as yet widely accessible, and many primary care clinicians are unprepared to interpret genetic information. We conducted interviews with 58 primary care clinicians, exploring how they integrate emerging pharmacogenetic concepts into their practices. We found that in their current practices, pharmacogenetic innovations have not led to individually tailored treatment, but instead have encouraged use of essentialized racial/ethnic identity as a proxy for genetic heritage. Current manifestations of Personalized Medicine appear to be reinforcing entrenched notions of inherent biological differences between racial groups, and promoting the belief that racial profiling in health care is supported by cutting-edge scientific authority. Our findings raise concern for how pharmacogenetic innovations will actually affect diverse populations, and how unbiased treatment can be assured.
- AMA (American Medical Association) 2011 Pharmacogenomics: Increasing the Safety and Effectiveness of Drug Therapy. http://www.ama-assn.org/resources/doc/genetics/pgx-brochure-2011.pdf.
- Chan, I. S., & Ginsburg, G. S. 2011 Personalized medicine: progress and promise. Annu Rev Genomics Hum Genet 12:217-244. CrossRef
- Cheng, Y. J., Kahn, H. S., Gregg, E. W., Imperatore, G., & Geiss, L. S. 2010 Recent Population Changes in HbA1c and Fasting Insulin Concentrations Among US Adults with Preserved Glucose Homeostasis. Diabetologia 53:1890-1893. CrossRef
- Chobanian, A. V., Bakris, G. L., Black, H. R., Cushman, W. C., Green, L. A., Izzo, J. L., Jr., et al. 2003 Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 42(6):1206-1252. CrossRef
- Conrad, Peter 2005 The shifting engines of medicalization. Journal of Health and Social Behavior 46(1):3-14. CrossRef
- Cooper, R. S., Kaufman, J. S., & Ward, R. 2003 Race and genomics. New England Journal of Medicine 348(12):1166-1170. CrossRef
- DHHS (Department of Health and Human Services) 2006 Coverage and Reimbursement of Genetic Tests and Services. Report of the Secretary’s Advisory Committee on Genetics, Health and Society. http://oba.od.nih.gov/oba/sacghs/reports/CR_report.pdf.
- Duster, Troy 2005 Medicine. Race and reification in science. Science 307(5712):1050-1051. CrossRef
- Ellison, George T. H., & Jones, Ian Rees 2002 Social identities and the ‘new genetics’: scientific and social consequences. Critical Public Health 12(3):265-282. CrossRef
- FDA, (Food and Drug Administration) 2010 Drug Safety Newsletter: EQUETRO® (Carbamazepine) Extended-Release Capsules Prescribing Information. http://www.accessdata.fda.gov/drugsatfda_docs/label/2010/021710s008lbl.pdf.
- Feero, W. Gregory, & Green, Eric D. 2011 Genomics Educations for Health Care Professionals in the 21st Century. American Medical Association 306(9):989-990. CrossRef
- Fine, M. J., Ibrahim, S. A., & Thomas, S. B. 2005 The role of race and genetics in health disparities research. American Journal of Public Health 95(12):2125-2128. CrossRef
- Fiscella, K. 2011 Health care reform and equity: promise, pitfalls, and prescriptions. Annals of Family Medicine 9(1):78-84. CrossRef
- Fullwiley, Duana 2011 The Enculturated Gene: Sickle Cell Health Politics and Biological Difference in West Africa. Princeton: Princeton University Press.
- Gaines, Atwood D 1998 Culture and Values at the Intersection of Science and Suffering: Encountering Ethics, Genetics and Alzheimer Disease. In Encountering Ethics, Genetics and Alzheimer Disease. In Genetic Testing for Alzheimer Disease: Ethical and Clinical Issues. S. G. Post, and P. J. Whitehouse, eds., pp. 256–274. Baltimore: Johns Hopkins University Press.
- Gaines, Atwood D. (2005). Race: Local Biology and Culture in Mind. In C. Casey & R. Edgerton (Eds.), Companion to Psychological Anthropology: Modernity and Psychocultural Change (pp. 255-278). Oxford: Blackwell.
- Ginsburg, G. S., & Willard, H. F. 2009 Genomic and personalized medicine: foundations and applications. Transl Res 154(6):277-287. CrossRef
- Hunt, Linda M., & Megyesi, Mary S. 2008a The ambiguous meanings of the racial/ethnic categories routinely used in human genetics research. Social Science & Medicine 66(2):349-361. CrossRef
- Hunt, Linda M., & Megyesi, Mary S. 2008b Genes, race and research ethics: who’s minding the store? Journal of Medical Ethics 34(6):495-500. CrossRef
- Hunt, Linda M., Truesdell, Nicole, & Kreiner, Meta J In Press Race, Genes and Culture in Primary Care: Racial Profiling in the Management of Chronic Illness. Medical Anthropology Quarterly.
- Jones, D. S. 2011 How Personalized Medicine Became Genetic, and Racial: Werner Kalow and the Formations of Pharmacogenetics. http://www.ncbi.nlm.nih.gov/pubmed/21908852.
- Kahn, Jonathan 2003 Getting the numbers right: statistical mischief and racial profiling in heart failure research. Perspectives in Biology and Medicine 46(4):473-483. CrossRef
- Kahn, Jonathan 2004 How a Drug Becomes “Ethnic”: Law, Commerce, and the Production of Racial Categories in Medicine. Yale Journal of Health Policy, Law, and Ethics 4(1):1–46.
- Kahn, Jonathan 2009 Beyond Bidil: The Expanding Embrace Of Race In Biomedical Research And Product Development. Saint Louis University Journal Of Health Law & Policy 3(61):61-92.
- Lee, Sandra Soo-Jin 2007 The ethical implications of stratifying by race in pharmacogenomics. Clinical Pharmacology and Therapeutics 81(1):122-125. CrossRef
- Nguyen, T. T., Kaufman, J. S., Whitsel, E. A., & Cooper, R. S. 2009 Racial differences in blood pressure response to calcium channel blocker monotherapy: a meta-analysis. American journal of hypertension 22(8):911-917. CrossRef
- Ninnemann, K. M. 2012 Variability in the efficacy of psychopharmaceuticals: contributions from pharmacogenomics, ethnopsychopharmacology, and psychological and psychiatric anthropologies. Culture, medicine and psychiatry 36(1):10-25. CrossRef
- Shields, A. E., Fortun, M., Hammonds, E. M., King, P. A., Lerman, C., Rapp, R., et al. 2005 The use of race variables in genetic studies of complex traits and the goal of reducing health disparities: a transdisciplinary perspective. American Psychologist 60(1):77-103. CrossRef
- Shields, A. E., Burke, W., & Levy, D. E. 2008 Differential use of available genetic tests among primary care physicians in the United States: results of a national survey. Genet Med 10(6):404-414. CrossRef
- Tate, S. K., & Goldstein, D. B. 2004 Will tomorrow’s medicines work for everyone? Nature Genetics 36(11 Suppl):S34-42. CrossRef
- Thayer, Z. M., & Kuzawa, C. W. 2011 Biological memories of past environments: epigenetic pathways to health disparities. Epigenetics : official journal of the DNA Methylation Society 6(7):798-803. CrossRef
- Thorlby, R., Jorgensen, S., Siegel, B., & Ayanian, J. Z. 2011 How health care organizations are using data on patients’ race and ethnicity to improve quality of care. The Milbank Quarterly 89(2):226-255. CrossRef
- Timmermans, S., & Oh, H. 2010 The Continued Social Transformation of the Medical Profession. Journal of Health and Social Behavior 51 Suppl:S94-106. CrossRef
- Torres, J. B., & Kittles, R. A. 2007 The relationship between “race” and genetics in biomedical research. Current hypertension reports 9(3):196-201. CrossRef
- UpToDate 2012 Evidence-Based Clinical Decision Support Resource. http://www.uptodate.com/index.
- Wolf, A. M., Wender, R. C., Etzioni, R. B., Thompson, I. M., D’Amico, A. V., Volk, R. J., et al. 2010 American Cancer Society guideline for the early detection of prostate cancer: update 2010. CA Cancer J Clin 60(2):70-98. CrossRef
- Pharmacogenetics in Primary Care: The Promise of Personalized Medicine and the Reality of Racial Profiling
Culture, Medicine, and Psychiatry
Volume 37, Issue 1 , pp 226-235
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
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- Personalized medicine
- Race and ethnicity
- Racial profiling