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Comment by mcguire | Hacker News Reader

"Not only do minorities get asthma at a higher rate, but [UCSF] pulmonologist Dr. Esteban Burchard ... has found that ethnicity is the most important factor in determining if a patient will respond to asthma therapy. Unfortunately, for the most most commonly prescribed asthma medication, Albuterol, 67 percent of Puerto Ricans and 47 percent of African-Americans show no improvement when taking it, yet Albuterol works therapeutically for the vast majority of Caucasian patients."

I did not know that. It's horrifying.

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It sounds horrifying, but actually is kind of meaningless as written.

Imagine two worlds:

World #1 (the horrible world): medical research neglects black people. They only bothered to develop an asthma treatment that works on white people.

World #2 (the reasonable world): medical research is careful to make sure they cover all groups. They developed several asthma drugs. None works well across all ethnic groups, but there is a good one available for each ethnic group.

In both of these worlds the most commonly prescribed asthma drug will be one that works on the vast majority of white people and does not work well on black people.

What they need to include to make the point they are trying to make is how the less commonly prescribed asthma drugs do on different ethnic groups.

Your assumption in #2 is incorrect. What actually happens often is the doctor doesn't know what to prescribe the patient and the patients quality of life suffers. As well as stated in my article, one of those alternative treatments "For another type of asthma treatment, long-acting bronchodilators, blacks are 4 times more likely than whites to die or experience serious complications when using them."

And that's not the only one.

https://www.medicine.wisc.edu/asthmanet/bard

Advances in personalized medicine can't come soon enough.

Cytochrome P450 is a family of closely related enzymes that are involved in drug metabolism. There are certain isoforms that have variants with wildly different activity in certain populations. In drug discovery we screen for their involvement and do not like to develop compounds that are metabolized by one of these isoforms because the variation in pharmacokinetics would be too huge. This is kind of the opposite of personalized medicine, making response uniform across the population.

This article gives an overview: https://www.aafp.org/afp/2007/0801/p391.html

> This is kind of the opposite of personalized medicine, making response uniform across the population.

Which is a far more pratical approach.

Does anyone know why this is? Seems very weird.

We don’t because no one has run a clinical trial to find out why :(

Would a clinical trial tell why? Or only who it works for and who it doesn't?

Well you’d have to do basic research, come up with a hypothesis, then run a clinical trial to test that hypothesis. And hopefully find useful information although clinical trials do fail.

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