If genetic differences between racial demographics are so small why does testing for clinical drugs need so many representative samples?

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Seems like a contradiction to me. If we are saying the majority of humans are incredibly genetically similar except for some genes that code for pigmentation but also there are reduced clinical efficacy for drugs based on certain races. I can understand outliers like sickle cell anemia but this diversity of sampling is required for every drug.

When they do clinical testing, pharma companies try to pull from different racial groups to ensure their drug works across demographics. If we were that genetically similar then wouldn’t pulling from one group primarily do the job?

Please don’t make this a white supermacist thing. I don’t believe in that stuff. Legitimately just curious.

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Anonymous 0 Comments

It’s not really a contradiction — when the “incredibly genetically similar” argument is used in an anti-racist context it basically just means that no race is inherently more-or-less-human than the other. The human race as a whole is still significantly more genetically distinct from our closest (ape) relative, than we are from each other. It doesn’t tell you anything about what happens when you pop an extra-strength Tylenol — to that end me & my dad are super close genetically but probably still don’t experience the same effect, down to differences like body mass, age etc.

There can be a vast difference between a person’s genotype (fancy word for “what do the genes say”) and their phenotype (what we actually see manifested in real life). This is mostly to do with dominant vs recessive genes — a recessive gene doesn’t express itself in the phenotype unless you receive a copy of it from both your parents (otherwise a dominant gene will override a recessive one).

Bit of a side note, but this is also why inbreeding is generally considered harmful, as it increases the likelihood of the child inheriting the same recessive gene from both parents. Recessive genes aren’t necessarily *bad*, but they could be — and you might not even know you’re carrying a harmful recessive gene if it’s never manifested in your family before (until someone was unfortunate enough to get a double serving). See wikipedia’s [introduction to genetics](https://en.wikipedia.org/wiki/Introduction_to_genetics) for a further (roughly ELI5’d) explanation.

Humans have tens or hundreds of thousands of genes (the exact numbers are still [hotly debated](https://bmcbiol.biomedcentral.com/articles/10.1186/s12915-018-0564-x)), and even one gene being missing or present can lead to a vastly different outcome. You mentioned sickle cell anemia, someone else mentioned lactose intolerance — these are all good examples. Now imagine that we don’t fully understand how all the genes work, **and** we’ve created a fresh new substance that humans have never ingested before. You’re going to want some heavy duty testing until you’re reasonably confident that your product is safe for everyone, if the expression of even a single gene could spell disaster.

Like someone else said, racial group based testing is likely more of a shorthand for “this person is coming a previously geographically isolated community (i.e. a different continent), so they’re likely to have *relevant* genetic variety compared to other groups”.

(disclaimer: I’m not a geneticist or anything, but I really liked this topic back in high school biology)

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