Chapter 6: Yes, We’re Alike, But the Differences Matter

INTRODUCTION

American psychiatrist Abraham Maslow (1908–1970) proposed a hierarchy of needs theory that describes humans as having five basic categories of needs that progress from lower needs to higher needs, as follows:

• Physiological (lowest)

• Safety and security

• Love and belonging

• Self-esteem

• Self-actualization (highest)

Maslow’s theory identifies the common, and some might say the universal, needs of mankind. Since Maslow’s work in the 1950s, the science community has discovered that humans are 99% or 99.9% (depending on the source) genetically alike, which might explain our similar drives and needs. That remaining 1% or 0.1%, however, results in critical differences that impact biological and psychological differences among and between groups.

1% OR 0.1%: SMALL DIFFERENCE, HUGE IMPACT

Healthcare providers have known for a long time that some genetic diseases are more prevalent in certain groups than in others (for instance, cystic fibrosis, Marfan syndrome, sickle-cell anemia, Tay-Sachs, and thalassemia). In 2003, scientists identified the 20,000 to 25,000 genes in human DNA as an outcome from the Human Genome Project (1990–2003; http://genomics.energy.gov/). This accomplishment provides opportunities for scientific discoveries and the potential for enhanced deliveries in healthcare.

Ethnopharmacology

Unfortunately, many healthcare providers are unaware of the importance a 1% or 0.1% difference can make in healthcare practice. Documented differences in drug responses among different ethnic groups (and different genetic patterns) have launched a growing specialty called ethnopharmacology, where the influence of ethnicity and culture is studied in relationship to the following:

• Pharmacokinetics: How the body absorbs, distributes, metabolizes, and excretes drugs (what the body does to the drug)

• Pharmacodynamics: Biochemical/physiological effects of drugs on the body (what the drug does to the body)

• Drug adherence: Degree to which a patient follows medical advice regarding drugs (dosage, duration, and so on)

• Education needs: Dealing with fear, ignorance, myth/superstition regarding drug use/effectiveness

Healthcare providers are encouraged to carefully monitor this emerging field of ethnopharmacology as they seek to improve their level of care for patients from diverse populations. Unfortunately, research in this area is limited and has primarily focused on psychotropic and antihypertensive agents. The following articles, though older, are good primers on ethnopharmacology:

• Ethnopharmacology: The Effect on Patients, Health Care Professionals, and Systems (Warren, 2008)

• Ethnopharmacology: Understanding How Ethnicity Can Affect Drug Response Is Essential to Providing Culturally Competent Care (Munoz & Hilgenberg, 2005)

• Ethnopharmacology (Tripolo, 2005)

• Ethnopharmacology: What Nurses Need to Know (Wessling, 2007)

If you would like to explore this area in greater depth, these are great articles to get you started.

Pharmacogenetics

Though different from ethnopharmacology, as we talk about likenesses and differences, I think it is critical to mention pharmacogenetics, “the study of genetic differences in the alleles associated with individual variability in drug response” (Prows & ...