School faculty members argue for the responsible use of genetic ancestry in health care

As society continues to grapple with issues of race, racism, and systemic injustice, health care and medicine remain at a crossroads, forced to balance an understanding of the role of ancestry in health outcomes with the need to shed racially biased practices.

UCSF School of Pharmacy faculty members Esteban Burchard, MD, MPH, and Akinyemi Oni-Orisan, PharmD, PhD, recently contributed respectively to papers published in the New England Journal of Medicine suggesting paths for reconciling these issues while continuing to provide the highest standards of patient care.

Burchard is a faculty member in the Department of Bioengineering and Therapeutic Sciences, a joint department in the UCSF Schools of Pharmacy and Medicine. Oni-Orisan is a faculty member in the School’s Department of Clinical Pharmacy.

The first paper, titled “Race and Genetic Ancestry in Medicine — A Time for Reckoning with Racism,” was published on January 6. The second paper, titled “Embracing Genetic Diversity to Improve Black Health,” was published on February 10.

Both papers differentiate between race, which is a social construct, and genetic ancestry, a correlate of race that also reflects people’s populations of origin. Genetic ancestry, the authors write, is an important determinant of patients’ health care needs and responses to different therapies.

“There are ways to use genetics for improved health outcomes in an anti-racist manner —we all have different genetic backgrounds and this diversity contributes to differences in disease susceptibly and treatment outcomes,” said Oni-Orisan. “We must use genetics to make sure that all patients can benefit from advances in biomedicine.”

Steve Babuljak

Esteban Burchard, MD, MPH

In response to heightened awareness of the negative impact of race on health care access, some in health care have argued for the outright removal of race-based considerations from medical decisions. But the authors of both papers argue that such a move would actually exacerbate, rather than ameliorate, inequities in health care.

Until it is possible to efficiently and affordably account for the genetic ancestry of individual patients, to match them with the proper therapies without introducing bias, race should only be factored into medical decisions in cases where it improves outcomes and promotes health equity, the authors say. At the same time, the health care fields must continue to address institutional racism and racial bias through policy changes and ongoing anti-racist training in the workplace.

More

Embracing Genetic Diversity to Improve Black Health (New England Journal of Medicine)

Race and Genetic Ancestry in Medicine — A Time for Reckoning with Racism (New England Journal of Medicine)