Why This Study?
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Ethnic and racial disparities in health care exist
and are prevalent in both the treatment of illness and in the
delivery of health services to minorities in the United States.
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This study, “Racial and Ethnic Differences
in Response to Medicines: Towards Individualized Pharmaceutical
Treatment,” examines the variability in response to medicines
among population groups due to genetic differences and cultural
preferences that should inform prescribing.
Clinical Findings
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Genetic differences among minorities may influence
a drug’s action by altering its absorption, distribution,
metabolism, excretion, or overall effect on the body, which
can help explain why some medicines are more effective in some
patients than others. For example, these differences may increase
or decrease the intensity and duration of the expected drug
effect and substantial dosage adjustments may be necessary.
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There are many significant differences among racial
and ethnic groups in the metabolism, clinical effectiveness,
and side-effect profiles of many clinically important drugs,
for example:
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Medicines used to treat pain, such as codeine,
have been shown to affect Caucasians and East Asians differently.
Because many East Asians metabolize codeine differently than
Caucasians, East Asians often require higher dosages for effective
pain relief.
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There are general differences in the underlying
characteristics of high blood pressure for black and white
patients. For instance, because black patients tend to retain
more salt and have a higher incidence of salt-sensitive high
blood pressure, diuretics used in combination with other blood
pressure medications may be necessary to achieve targeted
blood pressure levels among black patients.
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Ashkenazi Jews are significantly more susceptible
to a potentially life-threatening blood disorder that can
develop as a result of therapy with the drug clozapine used
to treat schizophrenia. The specific set of genes thought
to be associated with this blood disorder is found in 10 to
12 percent of the Jewish population in Israel and the U.S.,
but in less than one percent of the total Caucasian population
of the U.S.
Health Management Implications:
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The goal of individualized pharmaceutical therapy
is to provide the right drug to the right patient for the right
illness in the right dose at the right time.
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Physicians and other health care providers must
be mindful of uncommon responses or side effects from medicines
used by minority patients. Adjustments in treatment may be necessary
in some cases.
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Even cost management policies that allow permission
for exemptions impose administrative barriers that busy health
care providers can seldom overcome.
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Pharmaceutical companies should continue to include
significant numbers of minority patients in drug metabolism
studies and clinical trials.
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As they develop cost management programs, health
care institutions should implement pharmaceutical cost containment
practices that are broad and flexible enough to enable rational
choices of drugs and formulations for all patients, regardless
of race or ethnic origin.
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