RESPONSE TO MEDICINES: TOWARDS
INDIVIDUALIZED PHARMACEUTICAL
TREATMENT
Valentine J. Burroughs, MD, Randall W. Maxey, MD, PhD, and Richard A. Levy, PhD
Washington, DC and Reston, Virginia
It is now well documented that substantial disparities exist in the quality and quantity of
medical care received by minority Americans, especially those of African, Asian and Hispanic
heritage. In addition, the special needs and responses to pharmaceutical treatment of these
groups have been undervalued or ignored. This article reviews the genetic factors that underlie
varying responses to medicines observed among different ethnic and racial groups. Pharmacogenetic
research in the past few decades has uncovered significant differences among racial and
ethnic groups in the metabolism, clinical effectiveness, and side-effect profiles of many clinically
important drugs. These differences must be taken into account in the design of cost management
policies such as formulary implementation, therapeutic substitution and step-care protocols.
These programs should be broad and flexible enough to enable rational choices and individualized
treatment for all patients, regardless of race or ethnic origin. (J Natl Med Assoc. 2002;
94:1–26.)
Key words: race l ethnicity l
pharmaceuticals l
pharmacogenomics
The recent report of the Institute of Medicine
(IOM), “Unequal Treatment: Confronting
Racial and Ethnic Disparities in Healthcare,”
illustrates in eloquent scientific detail that racial
and ethnic disparities in health care do
exist and are prevalent in both the treatment of
medical illness and in the delivery of health
care services to minorities in the United States.1
Of greater significance is the finding that these
disparities still exist even after adjustment for
differences in socioeconomic status, insurance
coverage, income, age, comorbid conditions,
expression of symptoms, and access-related factors.
These disparities are not confined to any
one aspect of the health care setting, and can
even be found in the delivery of pharmaceutical
services, which are under increasing cost
control measures.
Implicit in this transaction is the ultimate
outcome of increased morbidity and mortality
for African Americans and other minorities.
This is mostly due to a diminished quality of
medical care and health services, but also due
to a predilection to avoid using better quality
© 2002. From the Health Policy Committee, Board of Trustees, National
Medical Association, Washington, DC; and Scientific Affairs,
National Pharmaceutical Council, Reston, Virginia. Requests for reprints
should be addressed to Dr Richard Levy, National Pharmaceutical
Council, 1894 Preston White Drive, Reston, VA 20191.
JOURNAL OF THE NATIONAL MEDICAL ASSOCIATION VOL. 94
NAMI has a plan in place to "treat" Natives - and people in other nations of non-white ethnicity.
"Chapter Four Evaluating Your Outreach Efforts 127 Materials adapted from Outreach to African Americans and Hispanic Families: A Manual for NAMI Affiliates. Currently, Mental Health and Social Services......"Link
NAMI's "Eliminating Disparities" pdfs - various ethnic groups targeted
Shouldn't any plan which mentions "eliminating" and "Natives" be immediately suspect?
If "losing your mind" is a normal response to having your culture, community and country destroyed, what then?
Has much really changed since the days of the Hiawatha Asylum?
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