On Race and Medicine |
The Scientist: Exploring Lie, Inspiring Innovation
Volume 28, Issue 2 (Febuary 2014)
Keith Norris, M.D., Ph.D., Professor, College of Medicine and Science
David Geffen School of Medicine
University of California, Los Angeles
Until health care becomes truly personalized, race and ethnicity will continue to be important clues guiding medical treatments.
Clinical trials were traditionally conducted using predominately white male subjects. However, the 1993 National Institutes of Health (NIH) Revitalization Act required that all NIH-funded research involving human subjects, including clinical trials, have as diverse a participant cohort as possible, unless there were strongly justifiable reasons to do otherwise (e.g., limiting the study of uterine cancer to female subjects). One of the most significant advantages to the inclusion of diversity in clinical studies is that it enables the early detection of differences in the safety and efficacy of interventions among heterogeneous patient subgroups.
Most clinical trials, as well as large observational studies, now perform an elaborate set of statistical adjustments to account for the impact of key cohort characteristics such as age, gender, and race/ethnicity on study outcomes. Despite these sophisticated analyses, it is still uncertain whether these characteristics can accurately predict treatment response in an individual patient. While age and gender are strongly associated with biological differences that may have a significant impact on disease susceptibility and treatment response—and are thus carefully controlled for, sometimes by excluding certain groups such as children and/or elderly from trials—the role of race/ethnicity is far less clear. Indeed, unlike the case with age or gender, race has no consensus criteria for definition…
…At the same time, we must be mindful that generalizations filtered through the lens of race/ethnicity and other sociodemographic factors should not be used indiscriminately. In the setting of increasing admixture within and across racial/ethnic groups in a diversifying United States, there is a lack of concordance between today’s patients and traditional racial stereotypes. Fortunately, genomic data are already beginning to predict disease risk and treatment response, and advances will no doubt continue to improve their accuracy. The ultimate goal is to arrive at a point where medicine becomes so personalized that it is driven from a “fingerprint” of one’s biologic makeup, not from racial typecasting…
Read the entire article here.
Tags: Keith Norris, The Scientist