Genes, Culture, and Medicines: Bridging Gaps in Treatment for Hispanic Americans

WASHINGTON, D.C., March 8, 2004 – Hispanics are less likely to receive or use medications for asthma, cardiovascular disease, HIV/AIDS, mental illness, and pain, according to a new study. These disparities in pharmaceutical treatment are substantial and often persist even after adjustment for differences in income, age, insurance coverage, and coexisting medical conditions.

The study, Genes, Culture, and Medicines: Bridging Gaps in Treatment for Hispanic Americans, was co-authored by Dr. Carolina Reyes, Adolph P. Falcón, Texas State Senator Leticia Van de Putte, and Dr. Richard A. Levy. It encourages physicians to tailor prescribing for Hispanics based on age, coexisting conditions, responsiveness to medications, and cultural perceptions of disease and treatment.

According to Senator Van De Putte, study co-author and practicing pharmacist, “This study brings together for the first time emerging research demonstrating that genetic and environmental factors have a significant impact on the effectiveness of medicines for Hispanic patients. Eventually advances in genetics will allow us to tailor pharmaceutical therapy to individual needs.”

The study shows that differences among racial and ethnic groups in how medicines are metabolized have been observed, and may be due to variation in genes regulating drug metabolism, environmental factors, or their interaction. These differences can result in higher or lower levels of drugs in the bloodstream. Based on preliminary evidence, the study pointed to several classes of medicines that particularly warrant extra attention:

• Some Hispanic groups may require lower doses of antidepressants and some antipsychotic medications and may be more prone to increased side effects at normal doses of these medicines. In one study, the average therapeutic dose for Hispanics was half the dose commonly given to Caucasians or African Americans.
• Mexican Americans metabolize drugs regulated by the CYP2D6 gene faster than whites, impacting 30 percent of therapeutically important medications, including many cardiovascular drugs.

The study found that language barriers and differences in cultural values can have an impact on the quality of care delivered and can negatively influence medication compliance, self-management of chronic disease, and overall health outcomes for many Hispanic patients.

“Patients and physicians need to be on the lookout for unexpected responses to medications,” said Dr. Carolina Reyes, Assistant Clinical Professor at the UCLA School of Medicine and the study’s lead author. “Physicians must help their patients identify what to look for in determining whether a prescribed medicine might be too weak or too strong of a dose and health providers must be aware of environmental factors such as a patient’s diet and environmental pollutants in the community. Good communication and awareness between patients and their doctors will ensure the best access and care for Hispanic populations.”

The authors make several recommendations:

• Improve access to pharmaceutical therapy. Health care financing and reimbursement practices should be broad and flexible enough to enable rational choices of drugs, dosages, and formulations for Hispanic patients based on their genetic, medical, and cultural needs. Choice of the best pharmaceutical therapy should be between patient and provider.
• Prescribe based on individual needs. Hispanic populations require prescribing that considers the many biological, environmental, and cultural factors that can influence drug effectiveness and patient adherence to treatment regimens.
• Treat coexisting conditions. Pharmaceutical treatment must take into account coexisting conditions common in this population, including depression paired with asthma, diabetes or cardiovascular disease, and diabetes paired with depression.
• Meet quality standards of cultural proficiency and communication. Communication barriers and cultural differences between health care providers and Hispanic patients can reduce treatment adherence and compromise overall disease management. Implementation of existing federal and professional standards for cultural and linguistic proficiency is a priority.

About the National Alliance for Hispanic Health
The mission of the Alliance is to improve the health and well-being of Hispanics. The Alliance is the nation’s oldest and largest network of Hispanic health and human services providers. Alliance members deliver quality services to over 100 million persons every year. As the nation's action forum for Hispanic health and well-being, the programs of the Alliance strive to:

• Inform and mobilize consumers;
  
• Support providers in the delivery of quality care;
  
• Promote appropriate use of technology;
  
• Improve the science base for accurate decision making; and
  
• Promote philanthropy.

The Alliance provides key leadership and advocacy to ensure accountability in these priority areas with the result of improving health for all throughout the Americas. The constituents of the Alliance are its members, Hispanic consumers, and the greater society that benefits from the health and well-being of all its people.

About the National Pharmaceutical Council
Since 1953, NPC has sponsored and conducted scientific, evidence-based analyses of the appropriate use of pharmaceuticals and the clinical and economic value of pharmaceutical innovations. NPC provides educational resources to a variety of health care stakeholders, including patients, clinicians, payers, and policy-makers. More than 20 research-based pharmaceutical companies are members of NPC.

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Related:

• Download the report http://www.hispanichealth.org/pdf/hispanic_report04.pdf
• Selected Facts and Findings
• June 15, 2005 News Brief: FDA Review of BiDil Shows Genes Matter