Personalized Medicine, Pharmacogenomics, and the Pharmacist
As we move away from the paternalistic ethos of medicine, we approach a unique way of incorporating patient-centered care: personalized medicine. Whereas the current approach of health care is largely based on trial and error of therapy and monitoring for the patient’s response, personalized medicine makes health care a truly individual experience by tailoring it the patient’s genetic makeup. The goal of personalized medicine is to optimize and deliver the best possible outcomes for each person by integrating advanced knowledge of disease at a molecular level with the individual’s unique genetic and environmental factors. As we gain deeper insights and understanding of current and new disease states, it is important that there are specialized treatments at our arsenal to properly provide patient-centered care.
One of the interesting developments in personalized medicine is pharmacogenomics. The mapping of the human genome just over a decade ago has breathed new life into the area of therapeutics, giving rise to the new and exciting field of pharmacogenomics. This new area of research can potentially give us new insights into what drugs do to our bodies as well as how our bodies respond at the molecular level. Pharmacogenomics integrates genomics with existing knowledge in pharmacokinetics and pharmacodynamics, and seeks to develop personalized treatment based on the patient’s unique genome. This entails collecting information on the patient’s genome, and looking for unique genetic traits and deviations in particular genes. These genes typically code for enzymes and proteins crucial in the mechanism of action of the drug, and thus greatly affect the metabolism of the medication, and its effect on the individual as a whole. Contrary to the belief of some people, various individuals do not metabolize drugs in the same way. Some may have an allele resulting in a lower than normal level of metabolism of a drug, while others may have a genotype resulting in a completely non-functional enzyme. This can seriously affect the way a patient responds to a medication, and the dose required to achieve a desired effect. If we can tailor the dose and regimen of the drug according to the patient’s genetics, we can help to deliver the more effective drug therapy, and avoid unwanted adverse effects.
As we make the momentous shift toward an exciting new era of pharmacogenomic research, it is important to always relate it back to the concept of personalized medicine. Pharmacogenomics has already made an impact on cancer research and treatment. For example, an individual can be tested to see what levels of certain proteins they have in their body. If they then have a high level of a certain growth factor protein (breast cancer) which can be the cause of a tumour, treatment can be individualized based on the levels of this growth factor. Treatment in the future will also aim to just target this molecular pathway to minimize or even eliminate side effects which are quite undesirable in cancer treatment. This is just one example of how having the ability to tailor one’s medication regimen to his / her genetic map opens the gate to a much broader spectrum of medication options for an individual, especially those suffering from complex conditions and chronic illness. The conventional therapy we are currently accustomed to, while effective, may carry more cost over benefit with consideration of their side effects, complexity and rigid regimen. The knowledge that we will be able to introduce medications with minimized adverse reactions reassures the success rate of a medication therapy. Physicians will be able to take a closer look at the patient’s physiological and genetic profile and determine the best fit for their patient. Bacterial resistance may no longer be an area of concern, and hospitalized cases of serious drug reactions will no longer be a fear at the back of our minds. With personalized medicine, we are able to carry out a “best-fit” strategy as opposed to a “trial-and-error” system, elevating patient adherence and healthcare credibility. This is an exciting area in medicine as well as pharmacy. Imagine a day where we no longer see shelves of “top 40 drugs” on the pharmacy counters, instead having specially-formulated medications tailored to each patient. Not only will the most effective assessment be made for our patients, we, as pharmacists, will be able to exercise our knowledge and training to its fullest potential.
Another interesting aspect of personalized medicine is finding new and innovative ways to deliver treatment to patients in ways that maximize adherence. Medicine can be individualized through diversifying routes of deliveries in order to suit the individual differences and needs, and minimize side effects. For instance, it is a common practice to give oral antidepressants, gabapentin, and other oral medications for relieving pain. However, if formulated properly, the drugs can be incorporated into topical, transdermal creams to specifically target the site of pain through skin instead of systemic oral medications, thus reducing systemic side effects. The topical application not only decreases the side effects but may also increases compliance and convenience for patients. Another type of personalized medication includes using a patient’s own body fluids and parts to treat the patient’s condition. Autologous eye drop for treating dry eye is a good example which is effective and safe for the patient since it is a sterile ophthalmic solution extracted from a patient’s own blood serum. There are only four pharmacists in Canada who make the personalized drop for patients, which brings us to think how much more pharmacists can do for patients and expand the scope of practice.
Personalized medicine holds great promise for the future. If this process is made more cost effective/more readily available, this could reduce the amount of adverse drug reactions and related hospitalizations. This is advantageous to the patient, healthcare professionals and the taxpayers who help support the medical system. It will also allow us to provide more effective care for patients. If medical professionals know in advance how well a drug will work in a patient, they can help ensure that the patient in question receives optimal care at the lowest cost possible. If this up-and-coming idea of personalized medicine were to become more widespread, perhaps pharmacists would have the chance to establish their role in clinical decision-making. Pharmacists are in the ideal position to incorporate genetic testing into the role of drugs in therapy. We are the drug experts; furthermore, we are also very knowledgeable about the body’s various responses to these compounds. Pharmacists have the education required to interpret genetic tests and recommend appropriate drug therapy accordingly. The growth of personalized medicine would see the pharmacist being able to function within his/her full scope of practice and the patients receiving better health care.
Despite all the benefits patients may receive from “personalized medicine,” it may take a while before this idea can be fully implemented into the current health care system. As our profession embraces this new idea, many challenges await us. Money, time, patient’s acceptance, and the collaboration of different health care professionals are all potential barriers that we have to overcome in order to achieve this goal. We, as pharmacists, have a big role in introducing this new concept to patients, and explaining the purpose and benefits of doing so. Having the patients understand and acknowledge our care for them, will motivate us and the whole health care team to strive for this rather new but exciting and rewarding idea.
Stephanie Ho, Lingsa Jia, Caitlin Lang, Sarah Lee, Greg Ouellette, Megan Tromposch, Ken Wong, Tian Zhang
Great article.
I’m a pharmacist who currently works in the field of pharmacogenomics interpreting test results and providing clinical interpretation and education to physicians requesting pharmacogenomic tests. I also agree that it is time that pharmacists step up and function at full scope rather than being a poor functioning pharmacist and not making maximum use of their therapeutics knowledge. It will be a surprise to each pharmacist to find out how much they really know.
Good luck
Sam Mostafa
6 Feb 12 at 5:12 am edit_comment_link(__('Edit', 'sandbox'), ' ', ''); ?>
Thanks for the write-ups. Kindly keep me abreast of developments in the field of pharmacwwogenomics.
Idris Oyemitan
12 Sep 13 at 7:05 am edit_comment_link(__('Edit', 'sandbox'), ' ', ''); ?>