Race and Personalized Medicine

Are drugs that seek to serve a specific population changing our concept of race?

Last year, the U.S. Food and Drug Administration made the landmark decision to approve the first race-based drug. Clinical trials showed that Bidil, a combination drug treatment for heart failure, significantly improved survival rates in a group of self-reported black patients. While some applauded the move for focusing on an underserved population, others countered that race is a poor proxy for the genetic variation that likely underlies response to the drug. Sandra Soo-Jin Lee, a medical anthropologist at Stanford University, says the Bidil approval is just one example of how genetic research is shaping society's perception of race. She explains the trend in a paper appearing in the January issue of Clinical Pharmacology & Therapeutics and spoke this week with Technology Review.

Technology Review: Has genomic research changed our conception of race?

Sandra Soo-Jin Lee: We've been witnessing a pendulum switch. Previously, social and life scientists agreed race is best understood as a product of socioeconomic circumstances--who is included in one category as opposed to another is largely tied to the political history of groups over time. While there was a great deal of concurrence of race as a societal construction, now, with genomic technologies, there seems to be a rethinking of race as a biological phenomenon. In scientific research, researchers use race as a way of characterizing differences between groups.

TR: What role does race play in pharmacogenomics?

SL: Pharmacogenomics has really promised this idea of tailoring medicines to individuals, but we're not quite there yet. It's not cost-effective to sequence the genome of all individuals. In lieu of that, race becomes an easy proxy. It becomes a way of filtering individuals into populations that might have certain genetic variants.

Race also becomes an easy method for marketing a product. It is easily recognizable in terms of a specific market segment. It becomes attractive for companies to use that to segment the market and tailor products to specific markets.

TR: Previous research has shown that more genetic variation exists within race-based populations than between populations. Given that finding, is it ever appropriate to do race-based medical studies?

SL: That finding is very powerful--it does speak to the idea that race is not a good proxy for genetics. But I think race can be a valuable variable when looking at racism or inequalities in health care. I don't want to say that race doesn't exist. It does exist on a very visceral level for many people. But the point of this research is to disavow the idea that race is embedded in the genome and to get us away from thinking about racial biology.