Personalized Medicine and The Pharmacist

I see personalized medicine as a natural extension of the application of basic science to medicine. I don’t believe it’s a new phenomenon, but just the latest iteration in targeting the basis of disease. A hundred years ago and before, the practice of pharmacy included many “cure-alls”.  These remedies purported to help with hair loss to gout and everything in between and thus were not even personalized to the disease state of the patient, let alone standardized or adjusted for dose and regimen or even ingredients. As science progressed and the underlying causes of some of these diseases became better understood, the “cure-alls” were replaced by drugs targeting the causes (or at least specific symptoms) of diseases. Pharmacokinetics could be viewed as another form of personalized medicine that allows for dose adjustment of a drug for physiological factors in a given patient with a given disease. The newest pharmacogenetics tests that have been trialed for metabolic and other enzyme variants are essentially extensions and refinements of pharmacokinetics that aim to adjust drug dose (or guide alternative drug choice) based on the genetic factors that underlie some of those physiologic factors that were the basis for pharmacokinetic monitoring in the first place. Other physiological factors, such as renal failure, are often environmental rather than genetic but there are already tests available to distinguish these. For this reason, I see pharmacogenetic testing by pharmacists for the purposes of determining metabolic enzyme profiles (really, an extension of PK monitoring) as a very logical extension of the trend of refining drug therapy that has been going on for hundreds of years as our knowledge of the basis of disease and drug response to disease increases. It has the potential to minimize patient suffering and maximize therapeutic efficacy with little additional cost as genotyping becomes ever faster and cheaper. With the support of genetic counsellors, already in place, this may be extended even further in scope and in predictive value into the development of future disease states (although this raises other ethical issues). Identifying susceptibilities of infectious organisms or diseases such as cancer through genetic testing is also a very exciting area. (Written by Robyn)