Why Your Medication Might Not Work the Way It Used To

A note from Dr. Jen: Tiffany Whitlow has made it her mission to fix a blind spot in medicine by making sure underrepresented communities are included in the clinical research that shapes their care. After speaking with her and learning about Acclinate, the company she co-founded, I thought she had a story to tell that is both thought-provoking and important. I’m grateful she agreed to share it with you here in Today’s Ajenda.

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If a medication you’ve taken for years doesn’t seem to work like it used to, it’s very possible that it’s not just your imagination. And after 60, when you’re likely managing more than one prescription at a time, that’s not something you should just shrug off.

The “standard treatment” doesn’t mean the same thing for everyone

Drugs get labeled “standard of care” based on research that is usually done on a narrow range of patient demographics. Clinical trials have historically underrepresented both women and racial minorities, especially postmenopausal women. Then, everyone downstream—including you, your doctor or healthcare provider, and your pharmacist—inherits that gap without a warning label attached. Doing everything right, showing up to your appointments, and following instructions exactly doesn’t protect you from missing pieces of data in the research itself. And medicine still hasn’t fully caught up or made up for all these years of “narrow” patient population research.

When my son was diagnosed with asthma, the first thing doctors prescribed was albuterol, the go-to rescue inhaler for nearly every asthma patient in America. So when it didn’t work the way it was supposed to, I assumed we were doing something wrong. Wrong technique, wrong timing, wrong dose. It never occurred to me that the medication itself might not be right for him.

It took a lot of digging (the kind of digging you only do when your child is struggling and the standard answer isn’t fixing it) before I discovered that certain genetic differences (that are more common in Black patients) can often lead to a weaker response to albuterol. Through my own research, I learned that the “standard treatment” describes what’s most common in the population that was tested, but that this may not be the population that is actually being treated. In other words, there can be a mismatch between patient and treatment.

What I couldn’t see coming (and why you might not either)

I’m biracial, and I was adopted, which means I don’t have a mother or grandmother I can call and ask, “Did this ever happen to you?” There was no family health history to check my son’s reaction against and no pattern to recognize a step ahead of time. Whatever I was going to learn about how our bodies respond to medication, I was going to learn it in real time, usually after something had already gone wrong first.

But you don’t need a complicated family history to be affected by this. If you’re part of a group that medicine wasn’t originally built around—which is a much bigger group than most people assume—it could happen to you too.

How to discuss this with your doctor

This isn’t to say you should distrust your medications. But if you’re not experiencing the intended effects of a drug, it’s worth bringing up with your doctor. Here are a few talking points to use at your next appointment:

• Say it plainly: “My medication isn’t performing the way it’s supposed to.”

• Ask this key question: “Was this medication tested on people my age, my sex, and my background?”

• If the problem has persisted long-term, ask: “Is genetic testing for medication response available?”

And if you know your family health history, use it. Ask relatives what worked and what didn’t for them. If you don’t have that history, like me, treat your own response over time as your baseline instead and keep track of it. I didn’t get to inherit a warning about any of this.

I had to learn it firsthand by watching my son struggle to breathe with the “right” medication in his hand. I’d rather you get the shortcut I didn’t.

Tiffany Whitlow is the Co-founder and Chief Development Officer of Acclinate, a digital health company dedicated to advancing health equity by ensuring communities of color are actively represented in clinical trials and genomic research. She spearheaded the creation of NOWINCLUDED, an award-winning community platform that empowers underrepresented groups to take control of their health journeys.

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