Knowing Your Family Health History, Part 3

This is part 3 of a three-part series on the importance of understanding your family history of disease. Please see Part 1 and Part 2 for more information on why your family health history is so important.

Race-based drugs are on the horizon. With the pending approval of BiDil, a heart failure drug designed specifically for African-Americans, many people are keeping a watchful eye to see if it will prove to be both medically and commercially successful. Using race as a substitute for detailed information on a person’s genetic profile may be effective but it is not problem-free.

When used in combination with information on a person’s family history of disease, a person’s ethnic or racial origin may signal the need to more closely examine inherited predispositions for diseases such as sickle cell disease. The ethnicity and country of origin of both the patient and his/her relatives are equally important. Qureshi and Kai wrote in American Family Physician,

For example, the label “Latino” embraces many countries and cultures: in genetic terms, a Latino of Spanish-Caribbean origin may be at greater risk of SCT because of some African ancestry than a Latino of Mexican origin.

Here are a few things for physicians (and patients) to keep in mind when they’re from different ethnic cultures:

• Take care when translation and interpretation of complex medical information are necessary.
• Counseling about inherited risk may affect a relative acting as the interpreter.
• Ethnic diversity in support and information networks, such as family involvement in a patient’s decision to have a genetic test, also may pose ethical dilemmas that are incongruous with traditional approaches to confidentiality.
• In all cases, caution is required to avoid stereotyping.
• Respond to each patient and their family individually, recognizing that community and sociocultural norms may not hold for them, and indeed may evolve over time.

Even when DNA technology becomes affordable and commonplace, we will still need to rely on family history and race data to signal when a person might be at increased susceptibility to certain diseases. In the midst of the genomic revolution, this old adage still holds true: knowledge is power.