What Race and Ethnicity Measure in Pharmacologic Research

Abstract

Advances in genomic technology have put the utility of collecting racial and ethnic data into question. Some researchers are optimistic about the potential of moving toward "personalized medicine" by using a person's genome to administer medications. Genetics will not erase the importance of race and ethnicity because race and ethnicity do not measure genetic composition. Unlike genes, race and ethnicity are social constructs; 2 persons with identical genetic makeup may self-identify as being of different race or ethnic origin. Race and ethnic categories have been subject to change over time; a person's self-identification may vary according to the context, wording, and format of the question asked. Despite the fluid nature of the concept, self-identified race and ethnicity can capture something that genes cannot, namely, aspects of culture, behavior, diet, environment, and features of social status that commonly used measures of socioeconomic status, such as income, education, and occupation, cannot measure.

Genetics and Genomics

“…Moving forward, a key concern is that randomized clinical trials cannot account for genomic variability across study participants or clearly delineate patient groups per genetic responses to pharmaceutical agents. Common approaches to address the issue involve patient stratification according to race or ethnicity, but question of appropriateness is necessary as genetics research identifi es serious fl aws in these categories (Bamshad, Wooding, Salisbury, & Stephens, 2004;Doyle, 2006;Foster & Sharp, 2002;Lee, 2007). To better account for biotechnologic advancement, many proposals call for overhauled federal regulatory networks allowing improved focus on pharmacogenomic clinical research including synchronized payment systems, genetic/genomic education for patients and health care providers, and clinical care focusing on an individual' s dynamic probability for disease development (Califf, 2004).…”

How cranial shapes led to contemporary ethnic classification: a historical view

“…Knowing the origin of patients may also be important in the management of the disease. For example, Glucose-6-phosphate dehydrogenase deficiency, which is frequently seen in the Middle East and South Asia, may be complicated by the use of anti-malaria drugs or sulphonamides (7,8). Because all of these considerations, some authors express the ethnic origin of patients who present with unique syndromes.…”

Systematic reviews reveal unrepresentative evidence for the development of drug formularies for poor and nonwhite populations

“…There is substantial controversy associated with racial profiling for heath care [41,45e51], with competing ideas of social and biological causes of differences in disease rates and response to treatment, and theories of multiple, interconnected health determinants [34,42,52e54]. While racial categories may not represent meaningful genetic differences, health outcomes vary by race and ethnicity, and self-identified race can capture living experience in ways that genetics cannot [53,55,56]. Poverty, income inequality, and SES are well-known factors in health inequities, and poor and socially disadvantaged populations, such as those served by Medicaid programs, have higher rates of morbidity, chronic disease, and excess death, [57,58].…”