Pharmacogenetics and Race Ethnicity

A number of studies have associated specific ethnic and racial groups with adverse or nonresponses to commonly used drugs because these populations have a greater frequency of a particular genetic allele. For example, Xie et al. (34) claim that "white patients require higher warfarin doses than Asians to attain a comparable anticoagulant effect" because of differences in the distribution of CYP2D6 alleles. Although some claim that racially based prescribing is "better than nothing" (35), there are important social risks involved in linking population groups to particular drug responses. First, it should be pointed out that the differences in the population frequency of deleterious alleles between these socially defined groups may be statistically significant but small in absolute size. Only a minority of a given group may carry these alleles. Problems arising from these claims include the danger of reinforcing discredited biological notions of race, which seek to explain social divisions and inequalities in crude genetic terms. Such ideas have historically formed the basis of discrimination and prejudice. Second, linking ethnic groups to particular diseases, such as Ashkenazi Jews to a higher incidence of hereditary breast cancer, may increase the stigmatization of the group as a whole and lead to discrimination in healthcare. Great care needs to be taken in basing prescription on crude markers of ethnicity, as the benefits of such an approach are still highly contentious.

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