Several prescription medications bear FDA-approved, race-specific labels that suggest certain racial or ethnic groups should receive lower doses or may be at greater risk of side effects. And guidelines to physicians, which are endorsed by professional societies, sometimes recommend prescribing certain drugs differently based on race or ethnicity.
Race-based labels exist for drugs to treat heart disease, various cancers, epilepsy, tuberculosis and other diseases. Prevalent implicit bias in health care can create racial differences in rates of prescriptions to treat pain or substance use disorders.
Connecting the dots between the fine print on a pill bottle and patients’ experiences can lead journalists to rich narratives. When writing these stories, journalists should understand — and aim to explain the differences between genetic ancestry, which can affect drug responses, and the social categories of race and ethnicity.
Why this matters
Medications are not one-size-fits-all. Common genetic variants can impact drug efficacy. Genetic makeup can determine the odds of experiencing side effects or whether someone might need a lower or higher dose of a medication.
When studies are conducted only in specific racial or ethnic groups, it may appear as if the social category is linked to the drug response. However, the underlying genetic variants may be prevalent across many other social groups. Prescribing drugs differently based on race or ethnicity can cause or heighten health inequities.
“There’s more genetic variability within a race group than between race groups,” said Jasmine Luzum, PharmD, Ph.D., a researcher who studies how genetic variation affects drug responses at the University of Michigan. “It’s really problematic trying to make recommendations for certain race categories.”
Race-based recommendations for medicines crop up in three key spots: on drug labels under the “Warnings,” “Dosage,” or “Use in Specific Populations” topics; in guidelines issued by clinical societies on treating various conditions; and in algorithms to help doctors calculate dosages.
Explain the race/genetics overlap
Large genomic datasets over-represent people of European ancestry. As a result, less is known about genetic variants prevalent in other parts of the world. This can make race seem important when it is not.
For example, when researchers compared a race-based algorithm for prescribing the blood thinner warfarin to one that also included genetic variants, the race-based algorithm performed better. Although this might suggest a race-based algorithm is essential, that’s not the complete picture. “The full range of genetic factors affecting warfarin-dosing requirements in persons of African ancestry is unknown,” according to a 2021 commentary. “Further studies in large populations of African descent are necessary to help address this racial disparity.”
Journalists can explore these gaps in biomedical research to report on their fallout on health care. A 2024 study, for example, found historic disparities in the use of warfarin or other drugs to treat heart conditions in Medicare beneficiaries.
In several instances, the FDA recommends genetic testing before using a drug — but only for specific racial or ethnic groups. This may be because the genetic variants were only studied in particular groups. For example, the FDA recommends screening for one gene variant in people of Asian descent before using the epilepsy drug carbamazepine. However, a 2019 study found that screening a broader population for that variant identified twice as many people at risk for a severe drug reaction than screening Asian people alone.
Journalists can address questions around why genetic testing recommendations are restricted to certain racial or ethnic groups. What rules are established around insurance coverage for these tests, and what systems support — or discourage — clinicians from thinking beyond race and ethnicity when prescribing?
Spotlight social forces
Stark racial disparities in pain management are well-documented, with white patients receiving opioids at higher rates than Black patients. Similar biases extend to other conditions, including under-studied issues such as endometriosis. Not only is endometriosis diagnosed differently in Black and Hispanic people, but pain management practices also differ.
Reporters should investigate guidelines for physicians on the diagnosis and treatment of chronic pain conditions and explore how hospitals or local clinics are trying to address implicit bias in treatment decisions.
Find mainstream narratives
Race and ethnicity-based guidance around medications hurts everyone. Guidance to avoid using first-line treatments in certain populations can be harmful because they are typically the safest and most effective drugs based on available evidence. On the flip side, recommending genetic tests for side effects only for Asian, Black, or other ethnic groups can harm anyone not belonging to these groups.
Luzum points to hypertension treatment guidelines, which recommend that angiotensin inhibitors “should not be first-line treatment specifically in Black Americans,” she said. But hypertension is more common among Black people, she added, and they have “worse outcomes compared to other race groups. Essentially, what that guideline is doing is eliminating two of the most commonly prescribed drug classes as first-line agents in people who are Black.”
Noticing who is included in a guideline or recommendation and amplifying the voices of those excluded can lead to compelling health equity stories.
Resources
- Medications with race- and ethnicity-based initiation and monitoring guidelines, a list of drugs with race and ethnicity-based guidelines
- VA patients of color less likely to be prescribed blood thinners for a common cardiac issue, study shows
- Ethnicity and Prescribing Psychiatric Medications
