文章基本信息

标题：Racializing Drug Design: Implications of Pharmacogenomics for Health Disparities
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作者：Sandra Soo-Jin Lee
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2005
卷号：95
期号：12
页码：2133-2138
DOI：10.2105/AJPH.2005.068676
语种：English
出版社：American Public Health Association
摘要：Current practices of using “race” in pharmacogenomics research demands consideration of the ethical and social implications for understandings of group difference and for efforts to eliminate health disparities. This discussion focuses on an “infrastructure of racialization” created by current trajectories of research on genetic differences among racially identified groups, the use of race as a proxy for risk in clinical practice, and increasing interest in new market niches by the pharmaceutical industry. The confluence of these factors has resulted in the conflation of genes, disease, and race. I argue that public investment in pharmacogenomics requires careful consideration of current inequities in health status and social and ethical concerns over reifying race and issues of distributive justice. THE COMPLETION OF THE Human Genome Project has heightened public anticipation of the potential fruits of genomic medicine. The era of “personalized medicine” and the development of differentiated strategies for the prevention of disease at the molecular level 1 has fueled expectations of improved health through targeted therapeutics. These technological developments have fostered the burgeoning field of pharmacogenomics in the study of gene-to-gene interactions using high-throughput technologies. 2 One goal of pharmacogenomics is to identify drug response for molecular subgroups using differential diagnosis 3 during the early stages of drug development to create “tailored” drugs of greater efficacy. How such molecular subgroups are characterized reveals the continued salience of “race,” despite the widely publicized conclusion of the Human Genome Project that humans share 99.9% of their genetic makeup. A review of the pharmacogenomics literature indicates a particular emphasis on stratifying patient populations by race or ethnicity. In the absence of cost-effective methods of sequencing individual genomes in clinical settings, research on human genetic variation is increasingly conducted among racially identified populations. This approach mimics the longstanding practice in clinical medicine of identifying patients by race and ethnicity. Clinical care, including disease risk analysis, has often incorporated perceptions of race in clinical judgment and decisionmaking. Building on these practices, pharmaceutical companies may easily adopt conventional notions of race in marketing pharmacogenomic products. 4 The use of race as a proxy for genetic relatedness has been widely criticized. 5 ^– 7 The conflation of race with genetics opens the door to prejudice, racial stereotyping, and overly simplistic conceptualizations of pharmacogenomic interactions, which could ultimately lead to poor health care. 8 ^– 10 I discuss an “infrastructure for racialization” in biomedicine and drug development and its implications for public health. This infrastructure includes research on human genetic variation that maps genes to social categories of race as used in the United States, the pervasive use of race as a proxy for risk in clinical medicine, and the search for new “racially inscribed” market niches by the pharmaceutical industry. Although it has been predicted that pharmacogenomics will usher in an era of personalized medicine, population—rather than individual—differences continue to be the focus of much of current research. In research design, race and ethnicity remain important factors in identifying study populations. Numerous studies in the pharmacogenomics literature conclude that racial and ethnic differences exist among drug-related enzymes. 11 ^– 13 Most of these studies categorize research participants by self-identified race or ethnicity and compare frequencies of candidate alleles. Although several studies have suggested that race will be rendered obsolete once underlying genetic mechanisms are identified and that the use of race in genomic research is merely an interim solution, much evidence suggests that the current infrastructure built up around racialization may stymie efforts to use genetics to counter notions of a racial biology. This debate over the relationship between race and genes is more than merely academic: at stake are struggles over equity, access, and resources for public health.