Racial medicine: here to stay?

Abstract

Adverse drug reactions are an underestimated but serious problem in medicine, and are the fourth leading cause of death in the USA after cancer, coronary heart disease and stroke (Lazarou et al , 1998). Although any given drug, if prescribed correctly, is beneficial for most patients, it may have unexpected results in a small subset of users. This can range from simply having no effect at all to causing serious, sometimes life‐threatening, side effects. This variation stems—at least in part—from metabolic and genetic differences between patients. It would be a big leap for medicine if physicians could identify these differences and treat patients based on their individual genetic makeup. Now that the human genome sequence is complete, several follow‐up genomic projects, most notably the HapMap initiative to identify and catalogue haplotypes, are focusing on identifying such genetic variants. But it is not yet clear whether this knowledge will lead to personalized medicine. One hindrance is the fact that, for the time being, physicians and scientists have found a comfortable interim solution: racial profiling. Although, at first, this approach could help to use drugs more efficiently, in the long term, it could hinder the exploitation of genetic information in medicine. In fact, physicians increasingly use their patients' skin colour or other physiological features as a first step towards ‘individual’ treatment, under the assumption that specific traits cluster by race. “When I prescribe Prozac to a patient who is African‐American, I start at a lower dose, […] in part because clinical experience and pharmacological research show that blacks metabolize antidepressants more slowly than Caucasians and Asians,” wrote Sally Satel, a psychiatrist and resident scholar at the American Enterprise Institute for Public Policy Research (Washington, DC, USA; Satel, 2002). She is certainly not alone: from 1995 to 1998, the prescription information for 15 new …