Latinos suffer from wide ranging health disparities in comparison to non-Hispanic whites. They
are twice as likely, for example, as non-Hispanics of the same age, to have diabetes and to develop complications from diabetes such as heart disease, high blood pressure, blindness, kidney disease, amputations and nerve damage. While we know these disparities are caused by a combination of environmental and genetic factors, we don't know to what degree each are involved for many conditions disproportionately affecting Latinos. That's where modern genomics comes into play.
With the Human Genome Project complete for over a decade, the benefits of genomic data
are now trickling into the business and practice of medicine. The passage of the Genetic Information Non-Discrimination Act in 2008 and the Affordable Care Act in 2010 have set the rules of the road, and made the critical investments necessary to lay the ground work for new advances in American genomics research. In the coming years, as the price of whole-genome scans come down and the medical community enters a new era of personalized medicine, we will have a new set of tools with which to study the origin of diseases affecting specific populations.
Genetics can reveal useful information about an individual's health status, but they can also reveal unexpected information about group identity. The Latino community is both genetically and culturally diverse; and as gene-based medicine advances, Latinos will need to make sure that new medical technologies serve that diversity.
I believe that to capture the necessary genetic diversity to study the drivers of health disparities, America's research agenda must include a broad swath of the Latino population. The National Institutes of Health (NIH) has so far committed $61 million to observe more than 16,000 Latinos over six years through the Hispanic Community Health Study, the nation's largest longitudinal study of Latinos. Yet there is still so much more to be gained by incorporating the study of Latino populations into other research projects. But the research process does not end with research funding decisions. Clinical and biomedical research practices must also be more responsive to patients, who should be empowered to tell researchers and doctors what kinds of questions they want research to answer.
Every step of the biomedical research process -- from genetic testing to clinical trials -- can be
made more inclusive, addressing the broad range of genetic and economic diversity in the U.S. The Latino community will need to work together with research institutions and private companies to overcome the barriers that exist with regards to inclusive biomedical research. These barriers range from economic inequalities and provider biases to lack of awareness, distrust, or cultural and linguistic differences.
Doctors can play a major role in making Latino patients more fully aware of clinical trials or genetic studies by communicating the possible risks and benefits. Doctors should also inform patients of the privacy protections afforded by laws like the Genetic Information Nondiscrimination Act and the Health Insurance Portability and Accountability Act in order to build trust and allay fears of discrimination in employment or insurance. This kind of communication will become a necessity in the future as medical research and clinical care become ever more closely intertwined.
The Department of Health and Human Services has already laid out recommendations for more
inclusive research practices in a 2009 report. It recommends the building of a more diverse scientific and health care workforce; outreach to trusted community members who can promote the benefits of research; and the building of cultural awareness surrounding diet, work-life balance and access to resources. The report also elaborated on a research model known as "community-based participatory research," which would involve the Latino community in the design and conduct of the research, creating a sense of community "ownership" over the results and a greater adherence to the outcomes.
These practices have the potential to create actionable, results-oriented research processes that incorporate the histories, lifestyles and values of Latino patients. The last thing we want is for the research establishment to become overly reliant on a single indicator, measurement or classification that does not account for the needs of individuals in the Latino community and other communities. Only by making sure that every community's voice is heard, can we be sure that personalized genetic medicine will truly be personalized.
Michael Rugnetta is a former research assistant at the Center for American Progress and author of the new report, "Addressing Race and Genetics: Health Disparities in the Era of Personalized Medicine" .