The Different Faces of Pharmacology

Special Feature from Avante HealthmanyFaces(1500)

A Peek into the World of Ethnopharmacology

Ethnopharmacology is the study of the effects of ethnicity and culture on medication and treatment of disease. Although it has been around since the 1960’s, it has not been widely applied until the past twenty years when it was first noticed that there were differences between the effectiveness of certain medications in certain groups.

It is well-established that not all medications work on every patient. It has also been well-established how most members of a family will respond in a similar manner to the same medication. These observations support the hypothesis that perhaps medication metabolism has a genetic basis. However, in the “everyone-is-the-same-beneath-the-skin” framework in the 1960’s and 1970’s, the thought that different ethnic and/or cultural groups could share a medication metabolism was heresy.

One prominent researcher, Michael Smith, M.D., believed that most differences in medication effects could be explained by the diet that accompanied the medication. His hypothesis, demonstrated to be partially accurate, was that since both food and medication passed through the stomach, groups that had a high-corn diet might absorb medications differently than groups that consumed high protein diets. He later studied the impact of traditional herbal medications on the toxicity of physician-prescribed medications. This further supported the notion that genetics was only part of the situation, as well as diet and perhaps other factors.

At the same time, Keh Ming Lin, M.D. and others were looking at the effect that liver pathways had on medications in different cultural groups. This had been prompted by the observation that certain ethnicities had higher rates of hospitalization and less robust medication responses in schizophrenia. Very close scrutiny revealed that there were at least three primary pathways responsible for nearly all metabolic breakdown of medication. Of these three, one pathway was not as functional in Asians, another was not as functional in African-Americans, and the third was less functional in Asians and Latinos.

Certain medications work better in certain ethnicities, and there are lists that pharmacists can check to enhance the chances of medication response. Physicians who perform complete and thorough histories of their patients will also be able to provide guidance based on their experience and training. Finally, there are companies such as Genesight and Millenium that can perform a laboratory analysis that provides the physician with a list of medications that will be more easily metabolized by an individual. Although these tests can be expensive, they can provide much needed information to prevent adverse outcomes in care.

If you have any questions, comments, remarks, or concerns regarding any aspect of your psychiatric care, feel free to contact Avante Health at

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