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Study Shows that Genetic Differences in Minorities
May Cause Varied Reactions to Medicines
Study Underscores Need for Individualized Care
WASHINGTON, DC (September 25, 2002) — Genetic differences
among minorities may explain why some medicines are more effective
in some patients than others, a new study finds. The study advises
physicians and managed care plans to be aware of the need to tailor
drug regimens for individuals considering their ethnic or racial
group, and to be on alert for uncommon responses or side effects
from medicines used by minority patients.
The study, to be published as a supplement to the October Journal
of the National Medical Association, shows that responses to
medications among minority patients can vary based on genetic, cultural
and environmental factors. The researchers advise that such factors
must be considered by health plans and providers in order to ensure
access by minority patients to clinically appropriate prescription
drugs and to prevent further widening of disparities in the healthcare
that minority populations receive.
“A ‘one-drug-fits-all’ approach to therapy does
not take into account individual patient responses to medicines,”
said L. Natalie Carroll, M.D., president of the National Medical
Association. “New science is helping to identify differences
in the ways individuals react to drug therapy. Any attempt to control
spending should take such differences into account.”
The study, Racial
and Ethnic Differences in Response to Medicines: Towards Individualized
Treatment, was co-authored by the National Medical Association
(NMA) and the National Pharmaceutical Council (NPC). It shows that
genetic variations can affect how the body processes a drug and
its overall effect on the body, and that certain genetic variations
are more prevalent among specific population groups. Although race
and ethnicity are imprecise indicators of genetic differences, they
can be helpful in anticipating variations in response to a medicine.
For example:
- There are general differences in the underlying characteristics
of high blood pressure for black and Caucasian 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.
- 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.
- 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 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.
In addition to genetic factors, cultural factors (such as attitudes
towards medicines, health beliefs, and family influence) common
to members of different ethnic groups, and environmental factors
(such as pollutants, smoking and climate) can affect how patients
respond to drugs and compliance with prescribed treatments.
Varying cultural beliefs lead to actions that may increase health
risk; for example, self-treatment with herbal and folk remedies
may not effectively treat the disease or may interact with other
treatments. Communication barriers are also common obstacles to
optimum care.
“Multiple factors affect a patient’s response to a given
drug and thus the effectiveness of therapy,” said Dr. Carroll.
“Physicians, who work in a clinical setting, know this. Problems
can arise if clinical decisions, which must be based on the individual’s
specific health needs, are constrained by techniques designed to
control costs.”
The authors make several recommendations:
- Patients from diverse racial and ethnic groups must receive
care tailored to their specific needs so that disparities in health
care do not become even greater than those identified by the IOM
report.
- Health plans should not restrict access to specific drugs based
on cost alone or impose drug preferences that preclude individual
patients from accessing medicines that are safe and effective
for them.
- When treating minority patients, physicians and other health
care providers must be mindful of uncommon responses or unexpected
side effects from medicines. Dosage adjustments may also be necessary.
- Efforts to include greater numbers of diverse populations in
clinical trials and outcomes studies should be strongly encouraged
in order to further understand the clinical implications of drug
therapies among racial and ethnic groups.
- Health care providers should stay abreast of developments in
pharmacogenomics, the growing field that studies the genetic basis
of differences in patients’ response to drugs. Such studies
will increasingly enable physicians to customize care for patients
and should be used by health plans to refine strategies that manage
drug spending.
About the National Medical Association
The National Medical Association (NMA) is the collective voice of
African American physicians and the leading force for parity and
justice in medicine and the elimination of disparities in health.
The National Medical Association is a 501(c)(3) national professional
and scientific organization representing the interests of more than
25,000 physicians and their patients. Established in 1895, NMA is
committed to 1) preventing the diseases, disabilities and adverse
health conditions that disproportionately or differentially impact
African American and underserved populations, 2) supporting efforts
that improve the quality and availability of health care to poor
and underserved populations, and 3) increasing the representation
and contribution of African Americans in medicine.
About the National Pharmaceutical Council
Since 1953, the National Pharmaceutical Council (NPC) has
sponsored and conducted scientific, evidence-based analyses of the
appropriate use of pharmaceuticals and the clinical and economic
value of pharmaceutical innovations. NPC provides educational resources
to a variety of health care stakeholders, including patients, clinicians,
payers and policy makers. More than 20 research-based pharmaceutical
companies are members of the NPC.
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Please direct all media inquiries to Pat Adams, phone
(703) 620-6390.
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