The Social Consequences of Disease Stratification

Inherent in a number of applications of pharmacogenetics is the "stratification" of patient populations based on the subclassification of disease. For example, common conditions, such as asthma, diabetes, schizophrenia, and heart disease, are starting to be subdivided into different diagnostic categories according to their response to particular medicines. The profiling and stratification of patients based on the creation of new disease categories has many potential benefits. Diagnosis could be more precise and treatment more specific. However, one consequence may be that some individuals become categorized and are labeled as "good responders" and others as "non-responders" or "difficult to treat" (15). This might have a number of implications for patients:

The social consequences that arise from new disease labels and their legitimisation would obviously involve interpersonal stigmatisation or identity issues. In addition, a wider range of possible societal concerns, such as those related to access to insurance, employment and health-care resources, will probably emerge (17).

If common diseases are increasingly "geneticized" in this way, family members related to affected individuals may also feel at increased risk of becoming ill and having fewer therapeutic options, even when the inherited risk has not been scientifically quantified.

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