Pharmacogenetics, race, and ethnicity: Social identities and individualized medical care

Social categories such as race and ethnicity have long been used in interpr eting patient symptoms, diagnosing disease, and predicting therapeutic resp onse. DNA-based diagnostic tests and pharmacogenetic screens could make the se uses of social categories largely irrelevant by allowing clinicians to b ase diagnosis and treatment decisions on the unique genetic features of ind ividual patients. Despite this attractive vision of individualized care. ho wever, social categories are likely to continue playing a significant role in the coming era of genetic medicine. Current uses of social categories in pharmacogenetic research, for example, illustrate how drug development and marketing will perpetuate the use of social categories such as race and et hnicity. Those uses may unintentionally blunt the precision of genetic tech nologies and pose new threats to socially identifiable populations. These i mplications suggest the need for greater caution in using social categories as indicators for specific tests or therapies and for federal legislation to protect against discriminatory uses of individuals' genetic information. In addition, more precise social classifications than those presently in u se may allow us to realize the full potential of DNA-based technologies, th us minimizing social disparities in health care. Those more precise social classifications should reflect extended patient pedigrees and not the self- reported claims of racial and/or ethnic affiliation.