Patrick D. Hahn questions the value of large-scale genetics studies involving African Americans in Baltimore and elsewhere (“Does Baltimore really need personalized medicine?” Oct. 21). He is certainly correct that some of the most important determinants of mental illness reflect environmental stressors — poverty, inadequate social support, exposure to trauma — that continue to plague Baltimore and other cities.
As a psychiatrist and neuroscientist (and one born and raised in Baltimore), I agree that investigators in the field of mental health research must pay more attention to these factors and other social determinants of health. We must also be sensitive to previous abuses of African Americans and other minorities in the conduct of medical research and must work to earn back their trust.
I strongly disagree, though, with Mr. Hahn’s notion that studies of genomic underpinnings of psychiatric disease in African Americans will yield little of value to our patients. Genetics is by far the strongest predictor of serious mental illness — accounting for upwards of 80 to 90% of one’s risk — and any serious effort to understand the biology of these illnesses must take this into account. But nearly our entire framework for understanding genetic risk for disease has relied on studies of individuals of European origin and these findings do not readily translate to those of other racial and ethnic backgrounds.
A better understanding of what causes mental illness can benefit all of us, but it will take studies of diverse populations including those who have been underserved and underrepresented, to reach this goal.
Joshua Roffman, MD, MMSc, Charlestown, Mass.
The writer is an associate professor of psychiatry at Harvard Medical School.