Between personalized and racialized precision medicine: A relative resources perspective

Sun, Shirley

doi:10.1177/0268580919885292

Cited by 7 publications

(6 citation statements)

References 53 publications

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“…Dialogue and communication of social workers with vulnerable groups as well as the collaboration of civil society have emerged as some of the most transformative aspects underpinning the findings. In this arena, it is important to highlight the need to further investigate how the crisis has influenced the different cultural groups, taking into account health inequalities [55]. The social work interventions analyzed demonstrate that they have ensured that the most vulnerable groups have had food, housing, medical attention, and moral support, in particular in the cases of the homeless and elderly people.…”

Section: Discussionmentioning

confidence: 99%

Social Work during the COVID-19 Crisis: Responding to Urgent Social Needs

et al. 2020

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Social work during the COVID-19 crisis has faced one of the most challenging times to cover urgent social needs in an uncertain scenario. This study analyzes the immediate responses in social work to vulnerable groups in the first 15 days of the pandemic in Barcelona, one of the most affected areas worldwide by COVID-19. The sample for this qualitative study includes 23 semi-structured interviews with social workers from different fields of intervention, from general approaches (primary care) to specific ones (health, ageing, homeless, and justice). The data analysis followed the communicative methodology, including transformative and exclusionary dimensions, and the analytical categories focused on the impact of the COVID-19 pandemic on social services users, the organizational responses of social workers, and the impact of the interventions to cover urgent social needs of attendees. The interventions have been accompanied by an improvement in communication channels with vulnerable groups, ensuring an understanding of the situation of families and individuals, and covering the most urgent social needs. The study shows the key role of social workers from diverse social attention tools and their contribution to the sustainability of social services with a long-term impact.

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Section: Discussionmentioning

confidence: 99%

Social Work during the COVID-19 Crisis: Responding to Urgent Social Needs

et al. 2020

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“…Research is needed to gather sufficient information so that vulnerable populations are not let aside from benefits. Increase use of personalized medicine in health care will occur when there will be enough resources available at the individual and collective levels, including cost effective results, social and ancestry data, legal protection, and sufficient infrastructure in every context 99 .…”

Section: Discussionmentioning

confidence: 99%

“…However, many clinicians still today use racial or ethnic categories due to the lack of resources for pharmacogenetic testing. Some authors believe that personalized medicine will replace the racial and ethnic identity approach in health care when there will be enough resources available at the individual and collective levels, including financial, informatics, legal protection, and sufficient infrastructure 91 .…”

Section: Equity Concernsmentioning

confidence: 99%

The Application of Bioethical Principles in the Use of Pharmacogenomics in Person-Centered Medicine

Yunta

2022

MRAJ

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This study reviews ethical issues encountered in the literature about the use of pharmacogenomics in personalized medicine. Data gathered from Medline, Scopus, and Scielo were grouped as issues belonging to the application of the four bioethical principles. Autonomy: informed consent with vulnerable populations, consent for biobanks, changes in the physician-patient relationship, safeguarding confidentiality; non-malifecence: risks of stigmatization and discrimination, risks in clinical trials; beneficence: risk/benefit assessment in favor of benefit; and justice: pharmacogenetic tests and public health interests, equity concerns. Issues discussed were: reasons in favor and against returning research results from genomic and pharmacogenetic testing, enhancing the participation of vulnerable populations, and the reconsideration of respect for autonomy from a viewpoint too individualistic to a communal perspective since personal reality is constructed in relation to many significant others.

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“…If genomic and genetic technologies of these kinds were widely available for patients, then race and ethnicity would indeed be rendered irrelevant for therapeutic decision making. However, minority populations continue to be vastly underrepresented in clinical genetics cohorts 46 – 49 and are less likely to have access to genomic medicine technologies 50 , 51 . Until these disparities in research and health care access are rectified, race and ethnicity should continue to serve as a tool for pharmacogenomic patient stratification.…”

Section: Discussionmentioning

confidence: 99%

The Apportionment of Pharmacogenomic Variation: Race, Ethnicity, and Adverse Drug Reactions

Jordan

Sharma

Nagar

et al. 2022

MRAJ

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Fifty years ago, Richard Lewontin found that the vast majority of human genetic variation falls within (~85%) rather than between (~15%) racial groups. This result has been replicated numerous times since and is widely taken to support the notion that genetic differences between racial groups are trivial and thus irrelevant for clinical decision-making. The aim of this study was to consider how the apportionment of pharmacogenomic variation within and between racial and ethnic groups relates to risk disparities for adverse drug reactions. We confirmed that the majority of pharmacogenomic variation falls within (97.3%) rather than between (2.78%) the three largest racial and ethnic groups in the United States: Black, Hispanic, and White. Nevertheless, pharmacogenomic variants showing far greater within than between-group variation can have high predictive value for adverse drug reactions, particularly for minority racial and ethnic groups. We predicted excess adverse drug reactions for minority Black and Hispanic groups, compared to the majority White group, and considered these results in light of the apportionment of genetic variation within and between groups. For 85% within and 15% between group variation, there are 700 excess adverse drug reactions per 1,000 patients predicted for a recessive effect model and 300 for a dominant model. We found high numbers of predicted Black and Hispanic excess adverse drug reactions for widely prescribed platinum chemotherapy compounds, such as cisplatin and oxaliplatin, as well as controlled narcotics, including fentanyl and tramadol. Our results indicate that race and ethnicity, while imprecise proxies for genetic diversity, correlate with patterns of pharmacogenomic variation in a way that is clearly relevant to medical treatment decisions. The effects of this variation is particularly pronounced for Black and Hispanic minority groups, owing to genetic differences from the majority White group. Treatment decisions that are made based on (assumed) White pharmacogenomic variant frequencies can be harmful for minority groups. Ignoring clinically relevant genetic differences among racial and ethnic groups, however well-intentioned, will exacerbate rather than ameliorate health disparities.

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Between personalized and racialized precision medicine: A relative resources perspective

Cited by 7 publications

References 53 publications

Social Work during the COVID-19 Crisis: Responding to Urgent Social Needs

Social Work during the COVID-19 Crisis: Responding to Urgent Social Needs

The Application of Bioethical Principles in the Use of Pharmacogenomics in Person-Centered Medicine

The Apportionment of Pharmacogenomic Variation: Race, Ethnicity, and Adverse Drug Reactions

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