Abstract
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.
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Notes
Definitions of “pharmacogenetics” versus “pharmacogenomics” are difficult to distinguish. In that the distinction is not germane to our argument, we have chosen to use the more established term “pharmacogenetics” throughout this paper (see also footnote #8 in Jones 2011).
The controversial drug BiDil provides a case in point, where presumed racial genetics has been successfully used to gain approval of a drug not shown to be sufficiently effective in the general population Kahn (2004).
This is a class of enzymes involved in drug metabolism.
Angiotensin-converting enzyme (ACE) inhibitors are a class of drugs commonly used to treat high blood pressure.
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Acknowledgments
This research was supported by NIH grant #HG004710-03. We wish to thank the clinicians, clinical staff and patients who participated in this study, whose kind cooperation made this research possible.
Amanda Abramson, Kristan Ewell, Linda Gordon, Heather Howard, Lynette King, Isabel Montemayor, Fredy Rodriguez-Mejia, and Kimme Rovin provided invaluable assistance with a variety of data collection, analysis and literature review tasks.
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Hunt, L.M., Kreiner, M.J. Pharmacogenetics in Primary Care: The Promise of Personalized Medicine and the Reality of Racial Profiling. Cult Med Psychiatry 37, 226–235 (2013). https://doi.org/10.1007/s11013-012-9303-x
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DOI: https://doi.org/10.1007/s11013-012-9303-x