Making History Today: Loren Saulsberry, PhD

Innovation in medical technologies is vital for maximizing human health and life. But it is just as important that the leading-edge care brought about by those innovations is accessible to all, especially historically underserved groups.

Loren Saulsberry, PhD, Assistant Professor of Health Policy and Health Services Research at the University of Chicago, studies how advances in pharmacogenomics and genomic medicine are put into practice and the potential impact on health disparities.

“There is enormous potential for genomics to improve the precision of drug treatment for traditionally underrepresented and medically underserved patient populations,” Saulsberry said.

Through her work, Saulsberry strives to improve access to genomic medicine for patients in diverse communities like Chicago’s South Side. Chronic diseases like cancer, diabetes, hypertension and cardiovascular disease disproportionately affect Black and brown patients. But these conditions can be treated more effectively by tailoring treatments to patients’ genetic profiles.

Genomic medicine uses information about each person’s unique DNA sequence to inform how they are treated for diseases and medical issues. Within genomic medicine, pharmacogenomics uses the features of a person’s genetic sequence to predict how they might respond to specific drugs. For example, you might have one set of genetic markers and be more likely to respond well to a drug, while your friend with a different set of genetic markers might be more likely to experience adverse side effects. Advancements in pharmacogenomics are making it possible to treat patients in ways that are more precise and tailored to them, leading to better health outcomes.

However, medical advancements in genomic medicine and beyond are often not available to all patients equitably. And, unfortunately, unequal distribution of medical advancements can make existing health disparities worse. “A question that I hope to address in the future is how pharmacogenomics implementation into clinical practice has reduced, exacerbated, or newly created health disparities,” Saulsberry said.

Saulsberry, who brings a wealth of experience and knowledge to her research on health equity at UChicago, has taken key lessons from her early life and career. Growing up in a diverse community, Saulsberry became interested in health disparities when she saw how people of different backgrounds had very different experiences with the healthcare system.

Early in her career, she worked on preclinical trials for cancer pharmaceuticals at Harvard-affiliated Brigham’s and Woman’s Hospital, where she learned the critical role a variety of healthcare stakeholders play in determining patients’ access to scientific discoveries. Research she conducted with the Kaiser Family Foundation focused on the challenges faced by patients covered by the Medicare and Medicaid public insurance programs.

“These experiences enabled my further defining critical intersections between genomics, health disparities, and public health, which have directed my research career,” she said.

When deciding where to start her own research program, Saulsberry chose UChicago because it is a leader in translational genomics and home to a National Cancer Center-designated Comprehensive Cancer Center. The diverse community of the Chicago South Side was also a draw, as it resembled the community she grew up in and wants to serve through her work.

Through her research, Saulsberry hopes to highlight the untapped potential of pharmacogenomics and genomic medicine for treating historically underserved populations. “Medications with clinically relevant and evidence-based pharmacogenomic information to guide prescribing decisions include those that serve as the foundation of drug treatment and disease management for the chronic conditions that disproportionately affect minority communities,” she said. “Consequently, pharmacogenomics could have significant implications for the quality of care delivered to these patients.”

One of her recent studies suggests that disparities might be addressed simply by communicating more effectively with patients. In the study, Saulsberry and her collaborators compared the experiences with pharmacogenomics of patients self-describing as white to those self-describing as Black. They found that Black patients were less likely to initiate conversations about personalized care guided by pharmacogenomics with their health care providers (4% vs. 15% of white patients) and less likely to discuss pharmacogenomics with their providers overall (49% vs. 59% of white patients.) “Notably, not a single Black respondent with lower education attainment (high school or less/some college) reported initiating a discussion about personalized medicine with their provider,” the authors wrote in the study, published in 2021 in NPJ Genomic Medicine.

These results suggested that additional implementation strategies, supports, and/or tools to enhance patient-provider communication may be needed to more equitably deliver pharmacogenomically informed care to patients from diverse backgrounds.

In another recent study, Saulsberry and co-authors saw results suggesting that for African American patients, pharmacogenomic information was available for drugs prescribed during hospitalizations, and could be used to guide medication treatment for each patient while receiving care in the hospital and at the time of discharge. The study also indicated that when patients were prescribed new medications that were suboptimal given their genetic profiles, they could be susceptible to longer hospital stays.

The researchers used information collected from a multisite pharmacogenomic implementation program at UChicago, the University of Illinois Chicago and Northwestern University. The results suggest that there are opportunities to improve the care delivered to African American patients during their hospital stays by using their genetic profiles to inform drug prescribing at the point of care.

“An opportunity exists, particularly within the inpatient care setting, to facilitate provider access to pharmacogenomic information, which may avoid potential adverse drug responses and optimize medication treatment for patients at risk for experiencing health disparities,” Saulsberry said. By leveraging pharmacogenomic information, healthcare providers can help to provide better care to populations that are already vulnerable.

Long term, Saulsberry also wants to address how pharmacogenomic care across clinical settings is influenced by health policies such as those that set the rules for reimbursement and insurance benefits. For genomic medicine and pharmacogenomics to be accessible and affordable for all patients who would benefit, the healthcare system will need to provide insurance coverage and suitable reimbursement models for genetic testing in clinical care.

“Ultimately, I hope my research career in genomic medicine will inform the design and adaptation of pharmacogenomics implementation within our healthcare system so that it is truly patient centered and equitably serves the nation’s diverse patient populations,” Saulsberry said.