Personalized medicine, a field that tailors health care to individuals based on factors such as genetics, lifestyle, diet, disease presentation, and living environment, has shown great promise in improving patient outcomes. However, experts warn that inequities in access and diversity in research may limit the benefits of personalized medicine, potentially exacerbating existing health disparities.
One example of these inequities can be seen in the case of BRCA1/2 genetic screening for breast cancer risk. Despite the overall decline in breast cancer mortality rates since the introduction of personalized medicine, Black women continue to die from breast cancer at a disproportionately higher rate than non-Hispanic White women. Research shows that Black women are offered and receive BRCA1/2 screening less often than White women, highlighting the disparities in access to personalized medicine.
Rick Kittles, PhD, senior vice president for research at Morehouse School of Medicine, emphasizes that personalized medicine products are not equitably benefiting all communities. People who are Black, Hispanic or Latino, American Indian or Alaska Native, those with low incomes, the uninsured or underinsured, and those living in rural areas face multiple barriers to accessing personalized medicine. These barriers include a lack of diverse genetics in research, high costs of genetic testing and technology, and limited awareness and education among health care providers outside of urban medical centers.
To address these issues, several academic medical centers are implementing strategies to expand personalized medicine research and engage diverse communities. Morehouse School of Medicine, along with three other HBCU medical schools – Howard University College of Medicine, Charles Drew University College of Medicine, and Meharry Medical College – have received grants from the Chan Zuckerberg Initiative (CZI) to advance medical research focusing on the inclusion of historically excluded and underserved groups.
Researchers at these institutions, such as Melissa B. Davis, PhD, at Morehouse, are working to identify genetic variations associated with diseases in people of African descent, which have been largely overlooked in genome-wide association studies. Kittles emphasizes that the lack of funding and research capacity at HBCU medical schools has hampered progress in reducing health disparities, as these institutions often have more trust and access to marginalized communities than other medical centers.
In addition to the efforts at HBCU medical schools, the National Institutes of Health (NIH) All of Us research program aims to build one of the largest and most diverse health databases in the world. The program studies patients' social determinants of health, which include factors such as environment, socioeconomic status, access to healthy food, and access to health care. The NIH has partnered with various organizations to expand their reach into historically underrepresented communities, enrolling a diverse cohort of participants.
Despite these initiatives, Kittles stresses that all academic medical centers have a responsibility to resolve inequities in their own communities to truly advance accessibility to personalized medicine. This involves a commitment beyond superficial gestures and requires bringing individuals into institutions that represent the communities they aim to benefit.
As personalized medicine continues to advance, it is crucial to address the inequities in access and diversity in research to ensure that its benefits are equitably distributed across all communities. By prioritizing the inclusion of marginalized groups and investing in research capacity at institutions that serve these communities, we can work towards a future where personalized medicine truly lives up to its promise of improving health outcomes for all.
