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Genomics Clinical trials frequently underrepresent Black, Latinx, and Indigenous people, and largely involve individuals of European descent. Safety and efficacy testing are thus not performed in a varied group of people that reflects the population in which the drugs will be used. In a Perspective, Bumpus discusses the implications of this lack of diversity in clinical trials, particularly in terms of pharmacogenomics, whereby genetic variation can modulate drug metabolism and, in turn, toxicity and efficacy. This variation can be associated with distinct ancestries, so a lack of diversity in clinical trials can exacerbate health inequities. Finding ways to ensure diversity in clinical trials is therefore essential to improving drug development for everyone. Science , this issue p. [570][1] [1]: /lookup/doi/10.1126/science.abe2565