The Language of Life: DNA and the Revolution in Personalized Medicine by Collins Francis S

Author:Collins, Francis S. [Collins, Francis S.]
Language: eng
Format: mobi
Published: 0101-01-01T00:00:00+00:00

A few years ago, a practicing physician created an uproar by writing an op-ed in the New York Times titled “I Am a Racially Profiling Doctor.” The author, Dr. Sally Satel, explained how she used the apparent racial background of her patients to make decisions about which drug to give for heart disease, depression, hepatitis infection, or pain relief. In each of those instances, she cited published data to show that as a group African-Americans and Europeans had slightly different responses to those therapeutic interventions. Thus she argued that her kind of medical racial profiling was evidence-based and motivated by a desire to practice the best medicine for the benefit of all of her patients.

There is a certain thread of logic here. After all, no one would have objected if Dr. Satel had indicated that she is much more observant about the possibility of malignant melanoma in her white patients than in her darkest-skinned African-American patients. The problem with her presentation about the other applications of race-based medicine, however, is that these conclusions are based upon relatively small differences between groups, and may therefore be utterly irrelevant to the individual.

Let’s look again at Figure 5.2. Although the existence of health disparities demonstrates a connection between the top of the diagram (self-identified race and ethnicity) and the bottom of the diagram (health outcome), a real desire to help the individual requires focusing on the steps in between, in order to individualize the treatment more effectively. Thus while race may be a proxy for those more significant and proximate factors, it is a lousy proxy, and will often give inadequate information that may actually limit the ability to practice good medicine.

Unfortunately, the intermediate factors, both environmental and genetic, have still not been identified for many health disparities. So for the time being, there will still be instances where we have no better options, and Dr. Satel’s recommendations will need to be considered. However, the medical care system should collectively make the commitment to moving as quickly as possible to get beyond the imperfect and potentially prejudicial proxy of race, and to dissect out the individual causative factors that are really influencing health. Important among those is the family medical history, which is too often ignored, but generally provides much more specific guidance than any generalizations from race or ethnicity.

RACE AND RX

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.