In May, a collection of academics, physicians, scientists, and activists were convened by the Novartis Institutes for Biomedical
Research to discuss the current state of global health equity, or why certain populations continue to suffer from illness
and disease at a rate disproportionate to other populations.
Many of the presentations focused on socioeconomic disparities as a barrier to access: lack of transportation, lack of quality
education, the high price of a healthy diet, and clean air. (One slide featured an aerial photograph of Chicago, in which
the positive correlation between amount of trees on a given block, and household income, was outlined with startling precision.)
These are complex issues requiring complex solutions. If government leaders with both the inspiration and power to enact change
are few and far between, and the prevailing ethos among the moneyed classes is one of "personal responsibility"—as opposed
to civic duty—then what else can be done?
Pharmacogenomic research and new drug development, that's what. But first, you'll need to be screened, to determine what sort
of human being you are, genetically speaking. "How much 'Asian' do you have in you?" asked Charmaine Royal, PhD, associate
research professor at the Duke Institute for Genome Sciences & Policy, imitating the awkward conversation a doctor might need
to have with a patient, after it was discovered that carbamazepine (Carbatrol, Equetro, Tegretol) can cause "serious and sometimes
fatal dermatologic reactions" in patients with the HLA-B*1502 allele, which, it turns out, is found "almost exclusively in
patients with ancestry across broad areas of Asia," according to FDA's black box warning.
If a strong correlation can be shown between the presence of a genetic marker and drug toxicity, it follows that new drugs
targeting ethnic populations with high incidences of a given disease can be developed to focus on genetic markers and drug
efficacy, right? Not exactly. That premise assumes that ethnic groups, or different "races," are to some important degree
homogeneous, genetically. The truth is a bit muddier. The IL28B gene, for example, has been shown to predict hepatitis C treatment-induced
viral clearance, but it's not exclusive to a particular "race"—it occurs to a varying degree in all "races." The word race is deserving of quotation marks because it's a somewhat arbitrary designation; racial and ethnic categories have changed
every 10 years on the US Census.