How Your Patients Benefit from 23andMe and Similar Pharmacogenetic Tools
September is Healthy Aging Month! Because so much of our health is tied to our genetic makeup, we wrote this post about the importance of knowing and taking detailed family health histories. Read on, and share your favorite checklists, surveys, or tools for gathering this information.
Your ethnicity and ancestry can reveal a lot about your health-related risks.
The concepts of ethnicity and ancestry may overlap, but for the purpose of this blog, ancestry refers to where your family is from (which offers insight into your genetics), and ethnicity refers to your cultures, customs, and lifestyle choices.
Your ancestry matters because of many diseases’ prevalence among people of certain backgrounds. Some of these include the rates of occurrence of Tay Sach’s in Jewish populations, cystic fibrosis in Caucasians, and sickle cell anemia in African Americans. These histories are often discussed only with fertility physicians assessing the risk of passing these genes onto offspring, but they deserve attention in other areas of medicine too.
For example, adults in the United States are more likely to die from heart disease than any other cause, but certain minority groups face even greater risk. Heightened risk may appear among certain ancestral groups but may also arise from high blood pressure, diabetes, and obesity – which may be linked to one’s lifestyle choices – further compounding the complexity of these analyses.
About half of African American adults have some form of cardiovascular disease, compared with about one-third of Caucasian American adults. (Read more here.) Some researchers attribute this to the biological adaptations of ancestors in equatorial Africa who developed a genetic predisposition to salt-sensitivity, which causes the body to retain more sodium. Salt sensitivity allows the body to conserve water, which can be beneficial in a hot, dry climate, but outside of that climate, it just increases blood volume and consequently raises blood pressure. This has meaning for those treating those Africans’ descendants, several generations later, who suffer from hypertension.
Other studies show that Hispanic and Latino populations suffer from higher rates of obesity, diabetes, and other cardiovascular risk factors as compared with Caucasians, but they also appear to have lower rates of heart disease than their Caucasian counterparts — which is counterintuitive. This “Hispanic Paradox” is not yet well understood.
Your ancestry might also determine how you respond to certain medications, so it provides important context for physicians prescribing drugs. Companies like YouScript and, most recently, 23andMe, market their genetic tests as tools for prescribers to learn more about their patients’ ancestry. This rapidly-developing field of pharmacogenetics promises to bring ancestry front-and-center in our efforts to make healthcare more personalized, to reduce trial-and-error, and to continue to reduce spending.
Patients’ ethnicities are an entirely different, yet equally important, source of information. One’s culture may determine whether or not they smoke, or what type of diet they prefer. Further, a patient with an ancestral/genetic predisposition to a disease may reduce their risk by tweaking their lifestyle choices – which sometimes collide with their cultural or ethnic practices.
Ultimately, both providers and patients will benefit from having honest conversations about the role that a patient’s ethnic and ancestral backgrounds might affect their health and treatment.
Curious about how to integrate pharmacogenetic tools into your practice, what privacy requirements apply, and how you can share that data? Reach out with questions.
about the author
Erin K. Jackson is Jackson LLP’s Managing Partner. She is responsible for all aspects of firm management, is a sought-after speaker for healthcare conferences, and is a published author. She is specifically focused upon the intersection of the patient experience in healthcare with the legal and ethical responsibilities of providers.
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How your ancestry and ethnicity affect your health, Health Essentials (Mar 10, 2014).
(2) Race and ethnicity: Clues to your heart disease risk? Harvard Medical School (July 17, 2015).
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