Saturday, August 11, 2007
ras en gevoeligheid medicijnen
zie artikel voor meer EMBO reports 7, 3, 246–249 (2006) doi:10.1038/sj.embor.7400654 Racial medicine: here to stay? The success of the International HapMap Project and other initiatives may help to overcome racial profiling in medicine, but old habits die hard Katrin Weigmann | |
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| Adverse drug reactions are an underestimated but serious problem in medicine, and are the fourth leading cause of death in the USA after cancer, coronary heart disease and stroke (Lazarou et al, 1998). Although any given drug, if prescribed correctly, is beneficial for most patients, it may have unexpected results in a small subset of users. This can range from simply having no effect at all to causing serious, sometimes life-threatening, side effects. This variation stems—at least in part—from metabolic and genetic differences between patients. It would be a big leap for medicine if physicians could identify these differences and treat patients based on their individual genetic makeup. Now that the human genome sequence is complete, several follow-up genomic projects, most notably the HapMap initiative to identify and catalogue haplotypes, are focusing on identifying such genetic variants. But it is not yet clear whether this knowledge will lead to personalized medicine. One hindrance is the fact that, for the time being, physicians and scientists have found a comfortable interim solution: racial profiling. Although, at first, this approach could help to use drugs more efficiently, in the long term, it could hinder the exploitation of genetic information in medicine. In fact, physicians increasingly use their patients' skin colour or other physiological features as a first step towards 'individual' treatment, under the assumption that specific traits cluster by race. "When I prescribe Prozac to a patient who is African-American, I start at a lower dose, [...] in part because clinical experience and pharmacological research show that blacks metabolize antidepressants more slowly than Caucasians and Asians," wrote Sally Satel, a psychiatrist and resident scholar at the American Enterprise Institute for Public Policy Research (Washington, DC, USA; Satel, 2002). She is certainly not alone: from 1995 to 1998, the prescription information for 15 new drug products contained a statement about their differing effectiveness depending on race (Tate & Goldstein, 2004). Claims have been made in peer-reviewed journals that at least 29 medications have racial or ethnic differences in safety or efficacy, although most of these claims are controversial (Tate & Goldstein, 2004). In June 2005, the US Food and Drug Administration (FDA; Rockville, MD) approved the first drug labelled for a racially identified population: BiDil® (NitroMed; Lexington, MA, USA) for the treatment of chronic heart failure in African-Americans. And in July 2005, the European Patent Office (Munich, Germany) renewed a patent for the BRCA2 gene test "for diagnosing a predisposition to breast cancer in Ashkenazi-Jewish women", because mutations of this gene are frequently found in that population. Race has been a dominant concept in our society for centuries and has concerned scientists as much as anyone else. However, most scientists agree that race makes a bad scientific concept (Rotimi, 2004; Tishkoff & Kidd, 2004; Wilson et al, 2001). Not only do humans share 99.9% of their genetic makeup, regardless of race, but most of the variants that occur in the remaining 0.01% of the genome—although they vary between individuals—are shared between whole populations. Moreover, a social or physiological concept of race is not the best strategy to identify underlying genetic differences. Relying on a few obvious characteristics, such as skin colour or eye shape, tells something, but not everything, about a person's ancestry. "It doesn't mean that if we look at these various groups as we define them now, that some of these genetic variants are not going to be more frequent in some groups, but there is overlap," said Charles Rotimi, a biochemist and genetic epidemiologist at the National Human Genome Center at Howard University (Washington, DC, USA). "What is important to recognize however, is that genetic variants cut across social demographic groups in ways that make it difficult for us to consistently say who is black or Hispanic, for example."
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# posted by roodbont @ 3:30 PM 
