Precision medicine could provide another tool for addressing widespread health disparities that occur along racial lines. Genetic, environmental, and behavioral data will improve researchers’ and physicians’ understanding of how much each factor contributes to health outcomes. This information is vital not only for prescribing drugs, but for tailoring therapy to fit the needs of individual patients. If racial medicine can roughly predict that black patients are more likely to suffer heart disease and respond to certain medicines, precision medicine gives physicians the dexterity to identify a patient’s individual risk and prescribe a therapy––including but not limited to drugs––that uniquely fits that person.
The question is not whether precision medicine will supplant self-identified race as factor in physician decisions, but when. President Obama’s Precision Medicine Initiative pours hundreds of millions of dollars into “the intersection of human biology, behavior, genetics, environment, data science, and computation.” It establishes a cohort of 1 million participants whose data will form the backbone of precision-medicine databases, and is committed to ensuring diverse representation. Bonham sees these and other developments as a paradigm shift in health care.
“I actually think that we are in the midst of a revolution that’s occurring,” Bonham said. “The new drugs that are coming out and that are being approved as precision medicine drugs by the FDA, that number is growing fast. And I see the next 10 years as really shifting how we use race in drug treatment.”
Precision medicine may prove instrumental in creating a post-racial medical future, but there are real obstacles. The research team identified costs, data quality and representativeness, and physician readiness as the main barriers. If those factors are not addressed, precision medicine might reinforce the current state of racial segregation in health care.
“One of those challenges is making sure that there’s diverse ancestral populations and social and cultural backgrounds participating in the research so that we have as much information available to help identify how specific drugs and specific information can be useful for different groups,” Bonham said. If underrepresented and marginalized populations do not participate in the research and database-building, knowledge of medical best practices will remain skewed towards white patients and the therapies that work best for them.
Access issues could persist and deepen racial divides in medicine even if the data pool for precision medicine is broad and diverse. Bonham’s previous research indicates a serious lack of familiarity and comfort among physicians about genetics. This could wall patients off from access to effective therapies. Even though precision medicine is becoming more and more accessible, it requires money, time, equipment, and expertise. As is usually the case in America’s health-care system, these resources are scarce among providers who care for people of color.