Personalized Medicine and The Pharmacist

On Jan 31, 2012, the federal government pledged a sum of $67.5 million for furthering research into the field of personalized medicine.

Proponents of personalized medicine say it is likely to change the way drugs are developed, how medicines are prescribed and generally how illnesses are managed. They say it will shift the focus in health care from reaction to prevention, improve health outcomes, make drugs safer and mean fewer adverse drug reactions, and reduce costs to health-care systems.

From the CBC article ‘Personalized medicine’ gets $67.5M research boost

So, what is personalized medicine and how significant is it to have garnered such a considerable sum from the reserves of our government?

What is Personalized Medicine?

Personalized medicine involves individualizing a patients’ drug therapy based on the patient’s genome and their therapeutic needs. This idea explores new avenues of pharmaceutical care as it involves tailoring the right medication, dose, and regimen, for the patient, as per the more traditional roles of pharmacy and medical practice with a genetic twist:  Not every drug may be suitable for a patient because not every patient has the right genes involved in metabolizing the drug. For patients who have a variant gene for the metabolism of specific drugs, they could metabolize the drug too slowly and thus  be at a higher risk for drug toxicity, or they could metabolize a drug too quickly and not be able to achieve therapeutic effects in the body. Because of the complexity and variation in the human genome, it is hard to determine a drug therapy that is suitable for every individual. Personalized medicine would therefore be very beneficial to patients as it can ensure safe and effective drug therapy, and in turn improve patient compliance.
So how does personalized medicine compare to the more traditional form of medication management?  The conventional form of medication management in most clinical settings involves the following steps:

1. Look for an appropriate drug with minimal side effects and drug interactions
2. Deliver drug and wait
3. Observe for efficacy and side effects of the drug as they appear
4. Conduct lab tests and measure/interpret drug concentration and other relevant parameters
5. Individualize therapy based on the info gathered.

With the above steps, finding the appropriate medication is little more than trial and error. With personalized medicine, clinicians can start to individualize therapy even before the administration of the first drug.  Each individual responds differently to a drug since no one has the same number of metabolizing enzymes, drug targets or drug transporters in their body. By analyzing the genome of patients, these unique constituents will come to light. Clinicians can then respond accordingly by either altering concentration of the drug or choosing a different one altogether.

Should Pharmacists be Involved?

Pharmacists definitely have a role  in personalizing medicine for patients as part of their expanding scope of practice. Because pharmacists are drug experts, they are ideal candidates in optimizing patient health through personalizing medication for patients. However, the path to implementing personalized medicine is lengthy and requires a lot of work. Pharmacists would first need to be trained and educated on how to interpret results of genomic tests and utilize the results to determine a drug therapy that would best fit the patient. Pharmacists will then need to keep up with the rapidly evolving research behind personalized medicine. Moreover, in order for personalized medicine to be a role of the pharmacist, pharmacists need also be involved in the promotion of personalized medicine so that it becomes a necessary component in their practice.

It is also important to note the role that the patient plays in his or her own health care. The patient is the one who makes the final decision regarding their health at the end of the day. Before including personalized medicine as a part of the pharmacist’s scope of practice, we must be confident that we as pharmacists will be able to educate patients about the significance of their genes in relation to the success of their drug therapy. Education is key in making sure that patients have all the information they need in order to make an informed decision.

What Should They Be Doing?

With a lack in formalized education in pharmacogenetics, it is not surprising that the majority of respondents reported their understanding of pharmacogenetics as fair or poor (83%). Only 17% of respondents rated their understanding of pharmacogenetics as excellent, very good or good. Those participants who rated their knowledge as either excellent or very good were associated with the highest mean scores on knowledge assessment, which helps validate this perception as being accurate. One encouraging statistic was that those with less than 10 years of practice experience demonstrated the highest scores on pharmacogenetic knowledge assessment, which may represent the increased focus of pharmacogenetics in the pharmacy curricula across the nation, as well as the increased amount of information on pharmacogenetics over the past decade. Of note, this group of practitioners with less than 10 years of experience also had the highest level of interest in further pharmacogenetics education.
-From the article Knowledge of Pharmacists Regarding Pharmacogenetic Testing

Pharmacists hold a critical position in the success of genome-based medication therapy.  In many institutions, the role of pharmacists in the implementation of personalized medication program has already been confirmed. Pharmacists in these institutions are specially trained in pharmacogenomics and they utilize their expertise to make appropriate decisions in optimizing patients’ drug therapies.These pharmacists obtain and interpret genomic test results for certain medications, such as those for cancer, prior to administering the medication. The test results tell the pharmacist whether the patient has variant alleles that put them at a higher risk for severe toxicities. Armed with this information, both patient and pharmacist can work together to make the right decisions about the patient’s treatment. Thus, not only does pharmacist involvement in personalized medicine help ensure the safety of the population, it also has the potential to save costs. Although at its infancy, pharmacogenomic concepts have already been successfully applied in some hospitals to date, and in the future, personalized medicine will ideally be able to extend past hospital care and into the community.

Arthur L, Sarah L, Nicole T, Alana W, May W, Christopher Y, Mohan Z,