This paper states that New Zealand Māori have some of the highest rates of Group A streptococcal infection (GAS) in the world. Since GAS elevates titres of anti-streptokinase (SK) neutralising antibodies, GAS may induce resistance to SK. The study measured anti-SK titres in 180 patients presenting with symptoms consistent with an acute coronary syndrome to three New Zealand rural hospitals, selected because they provide care for patients from communities with different socioeconomic and ethnic mixes (Māori proportions were between 6% and 67%). Compared with the community with the lowest proportion of Māori, patients in the community with the highest proportion of Māori had mean anti-SK titres that were 2.8 times higher (p=0.05) and they were 2.5 times more likely to have a high anti-SK titre (33% vs 13% p=0.035).
There appears to be an increasing focus in research and clinical fields on the role of ethnicity in pharmaceutical treatment. My concern is that such ‘literature’ may influence clinical decisions to the detriment of Māori health outcomes (for example, SK is not offered to Māori presenting with ST elevation MI because they MAY have higher anti-SK titre). As the researchers suggest, the point is that evidence based best practice should be made available to all citizens. Therefore, firstly we should strive to treat GAS asap and reduce the incidence of SK resistance. And if SK is not clinically appropriate, alternatives (such as PCI or CABG) must be offered to ensure best and equitable outcomes.
Independent commentary by Dr. Matire Hardwood
Dr Matire Harwood (Ngapuhi) has worked in Hauora Māori, primary health and rehabilitation settings as clinician and researcher since graduating from Auckland Medical School in 1994. She also holds positions on a number of boards, committees and advisory groups including the Health Research Council. Matire lives in Auckland with her whānau including partner Haunui and two young children Te Rangiura and Waimarie.
Research Review publications are intended for New Zealand health professionals.
Disclaimer: This publication is not intended as a replacement for regular medical education but to assist in the process. The reviews are a summarised interpretation of the published study and reflect the opinion of the writer rather than those of the research group or scientific journal. It is suggested readers review the full trial data before forming a final conclusion on its merits.
