Chris Lancelot on…prescribing for differences

In these days of racial and sexual equality it has become almost anathema to talk about differences — yet the more we understand human beings, the more diverse we appear to be.

We know different racial groups have different susceptibilities to certain diseases — CJD, thalassaemia, TB, and so on. Our brains work in subtly different ways too, with male-type brains devoting the right side to spatial perception and female-type brains using both sides for language.

Nor are we psychologically the same: Myers-Briggs analysis demonstrates clear differences in the way individuals think, decide and act.

It is gradually becoming clear there are many other ways  the human race can be subdivided. One of the most potent, presenting huge opportunities for the future, is our reaction to medications — an emerging discipline now known as pharmacogenomics.

We all know of patients who have strange sensitivities, or those in whom certain medications never seem to work. This is often genetically determined. For example, codeine is a pro-drug, changed by an enzyme into morphine; those without the enzyme derive no benefit from taking codeine.

DNA profiling increasingly allows us to understand these individual responses; in the US this is now performed on those about to undergo anti-neoplastic treatment.

As we bring age and racial type into deciding which antihypertensive to use, so in the future we are likely to use DNA profiling to establish a much broader range of parameters. Rather than always using drug X for vomiting, or drug Y for first-line treatment of diabetes, I suspect eventually we will select most medication according to each patient’s genetic profile. Gone will be the blunderbuss ‘one size fits all’ approach of present-day pharmacology, to be replaced by much more subtle protocols.

So, contrary to the politically correct view of the world, we are not all the same, but the exact opposite – all individuals – with attributes such as ‘diabetic’, ‘Afro-Caribbean’, ‘hypertensive’, or ‘introvert’ being nothing more than highly simplistic groupings. Yet paradoxically this demonstrates a new uniformity about humankind, which is that we are indeed all different – even twins (who have different fingerprints).

Isn’t medicine fascinating?  

Dr Lancelot is a GP from Lancashire. Email him at

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