Topic 1
The question for topic one was “What do you think personalized medicine is? Do you think pharmacists should be doing personalized medicine?”
Personalized medicine means to me, in a broad sense, that patients receive optimal medication therapy based on their own personal situations. So this is a move away from “trial and error medicine” with first, second etc line therapies that get adjusted and changed based on a patient’s bad experiences (side effects, lack of compliance, whatever the issue may be) or lack of drug effect. Use of personalized medicine looks at a patient as a whole, incorporating a patient’s previous medications, current medications, other disease states, and finally their genetic profile into the decision making on what the best, safest and most effective drug therapy is for the individual.
Optimally, in a perfect world, I absolutely think pharmacists should be doing personalized medicine. We are the “drug experts”, and should thus be using current and previous knowledge and skills to the best of our abilities to make interdisciplinary decisions WITH the patient on the best therapy to fit them. However, with the status quo in pharmacy, personalized medicine is a difficult entity to get the ball rolling on. To start with, there are a lot of unknowns surrounding genetics still. The sequencing of the human genome was only done recently, and although there has been promise in certain drugs and their dosing, such as codeine, warfarin and anti-cancer drugs, there might still be more to learn about these genetic polymorphisms and their consequences. Secondly, your average pharmacist does not have extensive knowledge of genetics. Although there is a course on pharmacogenomics here at UBC, there is bound to be additional information needed for pharmacists to assist in making the optimal choices for patient care, and pharmacists who graduated pre-human genome sequences likely did not get exposure to this kind of education. At the current moment, I don’t know of any additional training available for pharmacists to, for example, do a residency or clinical rotation in pharmacogenomic research. And finally, pharmacists are in a difficult situation with respect to pay scale and business models. At the current moment, most pharmacists (at least those outside of the hospital setting, as they are paid by government funds) are paid a salary by private sector corporations which own the pharmacies. These corporations are, as any other business, looking to make money. Money in a pharmacy comes from scripts filled, dispensing fees, and kickbacks from pharmaceutical (generic drug) companies. Without adequate financial support for expansion into additional fields such as pharmacogenomics, it will be difficult to get the ball rolling on this one as nobody wants to work for free and corporations, unless they see the value of this kind of service, are unlikely to pay the extra wages for specialized pharmacists if they are not bringing in money for the services. In a hospital setting, I think this kind of personalized medicine service has more promise. Warfarin therapy, in the small sliver of practice I have seen, is very labour intensive with frequent lab tests, frequent changes in dose, and can be dangerous to the patient resulting in ineffective therapy or dangerous bleeding consequences. If something such as this was introduced prior to a patient beginning warfarin therapy, I wonder if it would save on pharmacist and physician time and take some of the “guesswork” out of warfarin dosing.
Well that’s my thoughts on personalized medicine…anyone else want to weigh in?
Melissa Twaites