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The Practitioner's Dilemma: Can We Use a Patient's Race To Predict Genetics, Ancestry, and the Expected Outcomes of Treatment?

Donald A. Barr, MD, PhD
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From Stanford University, Stanford, California.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Donald A. Barr, MD, PhD, Department of Sociology, Stanford University, Building 120, MC 2047, Stanford, CA 94305-2047; e-mail, barr@stanford.edu.

Ann Intern Med. 2005;143(11):809-815. doi:10.7326/0003-4819-143-11-200512060-00009
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Recent research has identified genetic traits that can be used in a laboratory setting to distinguish among global population groups. In some genetic analyses, the population groups identified resemble groups that are historically categorized as “races.” On the basis of these associations, some researchers have argued that a patient's race can be used to predict underlying genetic traits and from these traits, the expected outcomes of treatment. Others have questioned the use of race in this way, arguing that racially defined groups are so heterogeneous that predictions of individual characteristics derived from group averages are bound to be problematic.Practitioners today face the dilemma of translating this scientific debate into clinical decisions made 1 patient at a time. Is it or is it not appropriate to use a patient's self-identified “race” to help decide treatment?In contrast to the global population groups identified by genetic studies, the U.S. population has experienced substantial genetic admixture over time, weakening our ability to distinguish groups on the basis of meaningful genetic differences. Nonetheless, many researchers have suggested that these differences are still sufficient to identify racially specific uses for pharmaceutical and other treatments. A review of recent research on the treatment of hypertension and congestive heart failure finds that race-specific treatments of this type carry a substantial risk for treating patients—black or white—inappropriately, either by withholding a treatment that may be effective or by using a treatment that may be ineffective. Only by moving beyond historical concepts of “race” to examining a patient's individual socioeconomic, cultural, behavioral, and ancestral circumstances can a practitioner select the treatment that is most likely to be effective and in doing so, can best serve that patient's needs.





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