Race and Pharmacogenomics—Personalized Medicine or Misguided Practice?

Goodman, Christopher W; Brett, Allan S.

doi:10.1001/jama.2020.25473

Cited by 54 publications

(39 citation statements)

References 10 publications

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“…Utilizing reported racial and ethnic backgrounds in healthcare decision-making is challenging for a variety of reasons. A recent study suggests that ethnicity-based PGx decision-making is limited by intrapopulation genetic variation and fluidity ( Goodman and Brett, 2021 ). Additionally, concerns have been expressed regarding medical decision tools incorporating ethnicity having bias that causes sub-optimal therapeutic outcomes for patients of different ethnic backgrounds ( Vyas et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Clinical Implications of Combinatorial Pharmacogenomic Tests Based on Cytochrome P450 Variant Selection

et al. 2021

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Despite the potential to improve patient outcomes, the application of pharmacogenomics (PGx) is yet to be routine. A growing number of PGx implementers are leaning toward using combinatorial PGx (CPGx) tests (i.e., multigene tests) that are reusable over patients’ lifetimes. However, selecting a single best available CPGx test is challenging owing to many patient- and population-specific factors, including variant frequency differences across ethnic groups. The primary objective of this study was to evaluate the detection rate of currently available CPGx tests based on the cytochrome P450 (CYP) gene variants they target. The detection rate was defined as the percentage of a given population with an “altered metabolizer” genotype predicted phenotype, where a CPGx test targeted both gene variants a prospective diplotypes. A potential genotype predicted phenotype was considered an altered metabolizer when it resulted in medication therapy modification based on Clinical Pharmacogenetics Implementation Consortium (CPIC) guidelines. Targeted variant CPGx tests found in the Genetic Testing Registry (GTR), gene selection information, and diplotype frequency data from the Pharmacogenomics Knowledge Base (PharmGKB) were used to determine the detection rate of each CPGx test. Our results indicated that the detection rate of CPGx tests covering CYP2C19, CYP2C9, CYP2D6, and CYP2B6 show significant variation across ethnic groups. Specifically, the Sub-Saharan Africans have 63.9% and 77.9% average detection rates for CYP2B6 and CYP2C19 assays analyzed, respectively. In addition, East Asians (EAs) have an average detection rate of 55.1% for CYP2C9 assays. Therefore, the patient’s ethnic background should be carefully considered in selecting CPGx tests.

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Section: Discussionmentioning

confidence: 99%

Clinical Implications of Combinatorial Pharmacogenomic Tests Based on Cytochrome P450 Variant Selection

et al. 2021

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“…That this racist implication was not noted at the time may be an indicator of how entrenched the notion of biological differences between "races" had become by the 1930s-and foreshadows ongoing problems in medicine of using the social construct of race as though it has significant biological or genetic meaning. 14…”

Section: Nationalization Of Racial Stigmamentioning

confidence: 99%

Living Histories of Structural Racism and Organized Medicine

2021

AMA Journal of Ethics

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This article reassesses and recontextualizes findings of an independent writing group commissioned in 2005 by what was then known as the Institute for Ethics of the American Medical Association (AMA). The authors were members of this group, which uncovered a paradigm case of structural racism that has perpetuated health inequity since the issue of admitting African Americans was first raised at the AMA's national meetings immediately after the Civil War ended, in 1868. Upon publication of the writing group's findings, the AMA publicly apologized for its social, cultural, and political roles in the racist history of organized medicine. Now, in 2021, the authors of this article seek to situate this aspect of the AMA's history as it prepares itself for antiracist leadership in the health care sector. Historical RecordIt is tempting to believe that since the medical profession is dedicated to employing the biomedical sciences to prevent and heal illnesses, the inherently benevolent goals of the profession would serve to insulate it from bigotry and racism. Sadly, the historical record suggests otherwise. Recognizing this, in 2005, the Institute of Ethics of the American Medical Association (AMA)-then led by the second author-commissioned an independent panel, the Writing Group on the History of African Americans and Organized Medicine, to analyze the AMA's history on issues of race. 1 In this article, the authorsboth of whom identify as White men who participated in the original study-reassess and recontextualize these research findings, 1 recognizing them as describing a paradigm case of structural or systemic racism-terms not widely used at the time. (Stokely Carmichael and Charles V. Hamilton first coined the term institutional racism in their 1967 book, Black Power, and this term is largely synonymous with systemic racism. 2 ) In short, the Writing Group's research clearly documented the AMA's role in creating structural racism, defined as "a system in which public policies, institutional practices, cultural representations, and other norms work in various, often reinforcing ways to perpetuate racial group inequity." 3 After the research group reported back to AMA's Board of Trustees, in July 2008, immediate past President Ronald Davis issued a formal public apology to the National

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“…The ultimate goal would be to sequence a patient's entire genome, but as that is not yet practical, race has been asked to serve as a proxy for genetic differences. So far, that approach has not been fruitful, 61 and is felt to be problematic for a number or reasons 62 . This does not eliminate the possibility that factoring race into medical decision making will have net clinical benefit in some cases.…”

Section: Race In Medicinementioning

confidence: 99%

Should Estimated Glomerular Filtration Rate Be Adjusted for Race?

Cohen

2021

Clinical Pharm in Drug Dev

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Race and Pharmacogenomics—Personalized Medicine or Misguided Practice?

Cited by 54 publications

References 10 publications

Clinical Implications of Combinatorial Pharmacogenomic Tests Based on Cytochrome P450 Variant Selection

Clinical Implications of Combinatorial Pharmacogenomic Tests Based on Cytochrome P450 Variant Selection

Living Histories of Structural Racism and Organized Medicine

Should Estimated Glomerular Filtration Rate Be Adjusted for Race?

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