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Lisa S. Parker and Valerie B. Satkoske
Lisa S. Parker and Valerie B. Satkoske, Ethical Dimensions of Disparities in Depression Research and Treatment in the Pharmacogenomic Era , 40 Journal of Law, Medicine & Ethics 886 (Winter 2012)(88 Footnotes Omitted)
Personalized medicine with its promise of developing interventions tailored to an individual's health need and genetically, related response to treatment might seem a promising antidote to the documented underutilization of standard depression treatments by African Americans. In addition, understanding depression not merely in biochemical terms but also in genetic terms might seem to counter cultural beliefs and stigma that attach to depression when conceived as a mood or behavioral problem under an individual's control. After all, if there is one thing for which a person is not responsible and cannot be blamed, it is her genes. Nevertheless, for multiple reasons, a personalized medical approach to depression treatment, and its attendant conceptualization of depression and treatment response as genetically influenced, present the risk of exacerbating well-documented disparities in access to, and utilization of, treatment for depression among African-American and Caucasian elderly adults. At the same time, if treatment response is indeed influenced by genetic variation, then the development of effective treatments for depressed minority elders will be all the more important and yet may be impeded by the disparately lower participation rates of racial minority members in research on depression and its treatment. A self-perpetuating and expanding cycle of disparity in effective depression treatment may result.
This paper begins by examining the multidimensional factors associated with disparities in effective treatment of depression among African-American and Caucasian elderly adults. It focuses on the cultural constructs, socioeconomic factors, multiple levels of racism, and stigma attending both mental health issues and older age, and argues that the intersection of these factors may help to explain disparities in the treatment of the depressed elderly. Then, the paper examines the relevance of these factors for ensuring that pharmacogenomic research enrolls and holds the potential to benefit African Americans, as well as Whites. It argues for the scientific and ethical importance of pursuing various paths to address multiple levels and sources of stigma and mistrust if pharmacogenomics is to help, rather than exacerbate, disparities in depression treatment. In its final section, seven recommendations are offered to increase the likelihood that developments in pharmacogenomics will reduce disparities in depression treatment.