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Cultural and Genetic Diversity in America: The Need for Individualized Pharmaceutical Treatment

Cultural and Genetic Diversity in America: The Need for Individualized Pharmaceutical Treatment

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Pharmacogenetic research in the past few decades has uncovered significant differences among population groups in the metabolism, clinical effectiveness, and side effect profiles of many clinically important drugs. In addition, differences in how various populations view and respond to medicines underscores the need for an individualized approach to pharmaceutical therapy. Historically, the special needs and responses to pharmaceutical treatment of these groups have been undervalued or ignored. According to the authors, all of these factors must be taken into account in the design of cost management policies such as formulary management, therapeutic drug 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 racial or ethnic origin.

Pharmacogenetic research in the past few decades has uncovered significant differences among population groups in the metabolism, clinical effectiveness, and side effect profiles of many clinically important drugs. In addition, differences in how various populations view and respond to medicines underscores the need for an individualized approach to pharmaceutical therapy. Historically, the special needs and responses to pharmaceutical treatment of these groups have been undervalued or ignored. According to the authors, all of these factors must be taken into account in the design of cost management policies such as formulary management, therapeutic drug 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 racial or ethnic origin.

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Categories:Types, Research
Published by: National Pharmaceutical Council on Oct 20, 2008
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byValentine J. Burroughs, MDChair, Health Policy CommitteeBoard of TrusteesNational Medical AssociationRandall W. Maxey, MD, PhDChairman, Board of TrusteesNational Medical AssociationLavera M. Crawley, MDAdvisory Board, Division ofBiomedical Education and ResearchNational Medical AssociationRichard A. Levy, PhDVice President, Scientific AffairsNational Pharmaceutical Council
Cultural and Genetic Diversityin America:The Need for IndividualizedPharmaceutical Treatment
 
About the Authors
Valentine J. Burroughs, MD, is Chair of the Health Policy Committee for the National MedicalAssociation Board of Trustees. Dr. Burroughs is a practicing Board Certified endocrinologist andinternist in New York City. He is Medical Director of Health Care New York IPA, Associate MedicalDirector at Group Health Insurance of New York, and Associate Medical Director and Chairman ofMedicine at North General Hospital in Manhattan. Randall W. Maxey, MD, PhD, is Chairman of the National Medical Association Board of Trusteesand past President of the Golden State Medical Association and the Charles R. Drew MedicalSociety. He has practiced nephrology in the Los Angeles area for over 24 years and holds staffappointments at various hospitals. He has conducted research in cardiovascular pharmacology andhypertension. Dr. Maxey has established several dialysis centers in California, the South Pacific andin Africa.Lavera M. Crawley, MD, is a member of the Advisory Board for the National Medical AssociationDivision of Biomedical Research and Education. She also serves as the Executive Director for theInitiative to Improve Palliative Care for African Americans, as well as a researcher and Lecturer inMedicine at the Stanford University Center for Biomedical Ethics. Dr. Crawley’s publications focuson issues of cultural diversity in serious illnesses, and in race/ethnicity and trust in doctor-patientrelationships. Richard A. Levy, PhD, is Vice President for Scientific Affairs at the National Pharmaceutical Council(NPC). Dr. Levy has spent over thirty years teaching, writing, and conducting research in universitiesand private industry. His current interests include tracking, analyzing, and communicating trendsaffecting pharmaceutical innovation; and developing information on management of medications byindividuals and organizations. Before coming to NPC, he taught and conducted research inneuropharmacology at the University of Illinois College of Medicine.
About the National Medical Association (www.nmanet.org)
The National Medical Association (NMA) is the collective voice of African American physicians and the leading force for parity and justice in medicine and the elimination of disparities in health.The National Medical Association is a 501(c)(3) national professional and scientific organizationrepresenting the interests of more than 25,000 physicians and their patients. Established in 1895,NMA is committed to 1) preventing the diseases, disabilities and adverse health conditions thatdisproportionately or differentially impact African American and underserved populations, 2) supporting efforts that improve the quality and availability of health care to poor and underservedpopulations, and 3) increasing the representation and contribution of African Americans in medicine.
About the National Pharmaceutical Council (www.npcnow.org)
Since 1953, the National Pharmaceutical Council (NPC) has sponsored and conducted scientific,evidence-based analyses of the appropriate use of pharmaceuticals and the clinical and economicvalue of pharmaceutical innovations. NPC provides educational resources to a variety of health carestakeholders, including patients, clinicians, payers and policy makers. More than 20 research-basedpharmaceutical companies are members of the NPC.
© November, 2002. National Pharmaceutical Council and National Medical Association
 
Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2
Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3Toward Individualized Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5
Purposes of This Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Disparities in Health Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8
Disparities in Cultural Competency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10Disparities in Health Literacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10
Interplay of Environmental,Genetic,and Cultural Factors . . . . . . . . . . . . . . . . . . . . . . . . . . .12
Environmental Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12Genetic Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13
Clinical relevance of genetic differences (polymorphisms) 
 . . . . . . . . . . . . . . . . . . . . . .14
Racial differences in response to medication
 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16Cultural Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
Trust and respect 
 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
Health beliefs and practices 
 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18
Family values 
 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .20
Effect of cultural factors on medication compliance 
 . . . . . . . . . . . . . . . . . . . . . . . . . . .21
The Future of Individualized Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22Conclusions and Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25
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