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How many drugs have race-specific instructions?

#1
Lately I've been trying to get a sense of how many drugs there are that are packaged with instructions to consider race when determining the correct dosage. I'm not asking about cases where doctors do this without talking about it, but cases where the drug itself includes instructions to do this. The only example of it that I'm aware of offhand is Crestor/rosuvastatin, which includes these instructions: "People of Asian descent may absorb rosuvastatin at a higher rate than other people. Make sure your doctor knows if you are Asian. You may need a lower than normal starting dose."

I've heard several references to there being numerous drugs that include these sorts of instructions, but no other specific names/quotes. How many other specific examples of this are the people here aware of?
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#2
I was hoping somebody here would know the answer to this. I guess no one does?

If someone could compile an extensive list of drugs whose packaging includes instructions to take race into account when determining dosage, I think it would be an effective refutation of the claim that race should no longer be used in medicine. One example of that argument is this paper in Nature, which states:

Quote:There is broad consensus across the social and biological sciences that groups of humans typically referred to as races are not very different from one another. Two individuals from the same race could have more genetic variation between them than individuals from different races. Race is therefore not a particularly useful category to use when searching for the genetics of biological traits or even medical vulnerabilities, despite widespread assumptions.

When a doctor is prescribing a drug whose packaging includes instructions to take account of the patient's race, if he were to ignore these instructions and prescribes a harmful overdose, he would presumably be sued for malpractice. It would be useful to have a complete list of drugs for which that's the case.
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#3
Using race will most likely be made irrelevant in medicine(if it already isn't), because you can diagnose people based on specific individual traits instead, which is far more accurate and becoming easier as technology advances.

Thats probably why you are having a hard time finding them and also why people don't care that much.
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#4
In cases where quick treatment is needed with unknown ID, one will have to rely on group/race information. However, for cases with more decision time, one can use individualized information. The world is moving towards everybody having had pre-scanned their genomes, so the group averages will be less useful (as the Zoidberg said above).

Perhaps you could write to some pharmacist professors, they should know.
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#5
(2014-Nov-24, 10:23:14)Zoidberg Wrote: Using race will most likely be made irrelevant in medicine(if it already isn't), because you can diagnose people based on specific individual traits instead, which is far more accurate and becoming easier as technology advances.

Thats probably why you are having a hard time finding them and also why people don't care that much.


For medical research a more important concern is population stratification in clinical trials. Unless the specific genetic pathways are know -- which they aren't in most cases -- one can only try to take into account population structure. In the near to medium term there will not be individualized drug development, the costs being prohibitive. Thus race, understood properly as genomic affinity, will continue to be used as a control. As such, you will continue to get results such as:

Quote:Heart attack drug less effective for Maori and Pacific Islanders

"The non-response rate for Maori and Pacific Island patients was very high with 57% not demonstrating an adequate response.

“This is an important finding as Maori and Pacific Island patients have a high rate of cardiovascular disease and poor outcomes following heart attacks. This finding could partially explain these poor outcomes,” says Dr Harding, who is also an adjunct professor at Victoria University. Additional aspects of the study also found that the drug dose and the presence of diabetes affected the patients’ response to the drug.

There are quite a few papers which explicate the logic e.g.,

"Pharmacogenetics: Implications of race and ethnicity on defining genetic profiles for personalized medicine

Pharmacogenetics is being used to develop personalized therapies specific to subjects from different ethnic or racial groups. To date, pharmacogenetic studies have been primarily performed in trial cohorts consisting of non-Hispanic white subjects of European descent. A “bottleneck” or collapse of genetic diversity associated with the first human colonization of Europe during the Upper Paleolithic period, followed by the recent mixing of African, European, and Native American ancestries, has resulted in different ethnic groups with varying degrees of genetic diversity. Differences in genetic ancestry might introduce genetic variation, which has the potential to alter the therapeutic efficacy of commonly used asthma therapies, such as β2-adrenergic receptor agonists (β-agonists). Pharmacogenetic studies of admixed ethnic groups have been limited to small candidate gene association studies, of which the best example is the gene coding for the receptor target of β-agonist therapy, the β2-adrenergic receptor (ADRB2). Large consortium-based sequencing studies are using next-generation whole-genome sequencing to provide a diverse genome map of different admixed populations, which can be used for future pharmacogenetic studies. These studies will include candidate gene studies, genome-wide association studies, and whole-genome admixture-based approaches that account for ancestral genetic structure, complex haplotypes, gene-gene interactions, and rare variants to detect and replicate novel pharmacogenetic loci"


I imagine that there's a load of research on ancestry differences in drug efficacy just as there was in the case of SES and race. But no one has organized it. Let's make this a running thread where we post findings.
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#6
By the way, Nature Genetics devoted an issue to this topic back in 2004.

Instead of collecting a list of medicines with race interactions you can also collect a list of papers that found race x disease associations. You can just repeat this exercise using diseases as outcomes.
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#7
Edits made.

Quote:There is broad consensus across the social and biological sciences that groups of humans typically referred to as races are not very different from one another. Two individuals from the same race could have more genetic variation between them than individuals from different races. Race is therefore not a particularly useful category to use when searching for the genetics of biological traits or even medical vulnerabilities, despite widespread assumptions.

I am so sick of the lies and distortions. For example, we are told, on the one hand, that there are extensive outcome differences between socially defined races (e.g., Sussman's claim). On the other, we are told that there are trivial genetic differences. It is then argued that the "massive" between social race differences must be due to discrimination. But the numbers are roughly commensurate! Below, for example, shows inequality decomposed within and between socially defined races in Latin America. The variance between for a typical country is about 8%. In the US, the "massive" income and educational gaps between Blacks and Whites also come out to around 8% too (as compared to the 1 SD IQ gap, which comes out to about 20% of the total Black+White variance). An evil Lewontin would simply argue that these social outcome differences really don't exist because they are "so minute". There just aren't any people that intellectually dishonest.

The same goes with the medical genetic disparity arguments. It's claimed that biological race doesn't matter. When you point out that there are clear specific medically relevant genetic differences it's claimed that overall genetic differences are small so genes couldn't explain many medically relevant outcome differences. When its pointed out that the magnitude of the medically relevant differences is roughly commensurate with the overall genetic ones, it's said that "so that proves it, race isn't an important determinant". When one notes that others consider such magnitudes of difference to be rather important when interpreted as due to environment/discrimination, the conversation is abruptly cut short. Not long after one sees the same researcher arguing that (a) medically relevant outcome differences must be due to discrimination since (b) overall genetic differences are too small © and that biological research on race must be stopped because (d) this type of thinking encourages racial discrimination.

Madness.


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#8
Can you explain the table in more details? I don't quite understand what the data represent.
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#9
Basically depends how quick they find the pathway/trait for the said disease and on how much of the statistical differences are caused by environment instead of the genes. Like eating habits and epigenetics.

Still it will be interesting to know how many can be found.

So far 2.
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#10
(2014-Nov-25, 01:54:58)Chuck Wrote: Edits made.

Quote:There is broad consensus across the social and biological sciences that groups of humans typically referred to as races are not very different from one another. Two individuals from the same race could have more genetic variation between them than individuals from different races. Race is therefore not a particularly useful category to use when searching for the genetics of biological traits or even medical vulnerabilities, despite widespread assumptions.

Madness.


Whats the actual genetic difference between races? Its a frequency difference in some percentage out of the 0.1%. I got 0.014% from Wade, someone else said it was 0.008%(critic of Wade). What is it?

Whatever it is you still need to subtract any genes that don't do anything and different genes that do the same thing... then environment.

Does anyone have a reasonable estimate of how much of a genetic difference there could be considering everything?
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