Race, Genetics, and Personalized Medicine

Kaisernetwork.org, a free multimedia online resource created by the Kaiser Family Foundation to provide “timely and in-depth coverage of health policy news, debates, and discussions,” recently posted another installment of the ongoing “Today’s Topics in Health Disparities” series of webcasts.

The newest webcast, titled “Race and Genetics: The Future of Personalized Medicine,” discusses the “potential of race-based medical solutions for improving healthcare and reducing racial/ethnic health disparities” and “takes a closer look at efforts to study the interaction between race, genetics, and health.”

The hour-long video, moderated by Kaiser Family Foundation Senior Advisor on Race, Ethnicity, and Health Care Marsha Lillie-Blanton, DrPH, features a panel discussion on “the efforts underway to develop medications to treat diseases that disproportionately affect certain racial and ethnic groups, as well as the benefits and drawbacks of using genetic markers for race in medical decisions.” The panelists are Clyde Yancy, MD, FACC, FAHA, FACP, medical director at the Baylor Heart and Vascular Institute; Dorothy Roberts, JD, Kirkland & Ellis Professor at Northwestern University Law School; and Richard Levy, PhD, former Vice President for Scientific Affairs for the National Pharmaceutical Council.

In her opening remarks, Dr. Lillie-Blanton noted that “some scientists and clinicians think this new field of [research that links that links race, genetics, and personalized medicine] has the potential for big payoffs in clinical care. Others are concerned that the risks outweigh the potential benefits.” She framed the issues to be discussed by asking “Should public policy makers or clinicians be concerned about generalizations that describe the benefits of medications for specific racial or ethnic groups? What is the quality of evidence showing differences between racial, ethnic groups in clinical effectiveness of medications?”

Dr. Yancy addressed the issue of how “race,” a contested and charged term, fits into the overall discussion about personalized medicine by noting that “If the entirety of this interest was because race was the end game then this is really for naught because it only polarizes, to use that word again, the environment, but if it allows us to learn something about disease, to understand a unique profile or set of markers that really anticipate or predict disease and then that profile can become a probe for all others in the community, now we have utilized the observation to understand more science to have a greater impact on health.” This began a lively, in-depth discussion on the pros and cons of using “race” as a catchall term when discussing genetic variation among and between groups.

Other topics addressed include the strength of current evidence that drug metabolism differs between some demographic groups and whether the difference in metabolism rates and levels is primarily due to genetics or is a consequence of social and/or environmental factors. Dr. Levy noted there have been a number of studies that have demonstrated differences in metabolic capacity (including the rates at which certain medications are metabolized) across racial and ethnic groups for a variety of these enzymes. And yet, it is important to remember that observable variations and genetic “clusters” within certain groups cannot, as Yancy noted, be extrapolated out and assumed to apply across the board for all members of that group, however it is defined. He stated that “there are no absolutes… you cannot take a group of people that happen to be aligned with a certain demographic and assume that everyone in that group will have the same either limited response or exaggerated response.”

The video may be accessed here.

Readers can also download a podcast of the discussion and read a complete transcript.